The horizon continues to look brighter for the Williamsburg Regional Hospital as it follows its path to better serve the citizens. Simple, yet critical changes such as system upgrades, as well as the welcoming of new physicians will support the ever expanding list of services. However, one problem continues to plague the Critical Access facility.

Cost report figures totaling $725,212 for the first half of 2011 and owed to the Centers for Medicaid and Medicare Services (CMS) are on the front burner. The figure, which is interim, is also being questioned. As a Critical Access Hospital (CAH), Williamsburg Regional receives cost-based reimbursement from Medicare. However, the program can backfire depending on many factors that include, of all things, being efficient. “It actually penalizes you for being efficient,” said Hospital CEO Sharon Poston. “The more efficient you are, the more you hold down expenses and increase your revenue - the more money you end up having to pay back.” For example, in 2011, hospital revenues went up 37 percent while expenses went up 8.8 percent.

“If that continues then we will owe every year,” said Kline adding they have applied for a repayment plan. “There’s nothing we can do about it.” Kline also recommended hiring a company to review the cost reports. “After four years of this nonsense we need to engage a different firm, a new set of eyes, and let them see if the last four cost reports were correct.” Kline said the audit would be set on a contingency basis.

In 2004, the hospital converted from Acute Care to its current status. Whether or not former administrators could have determined payments and set aside monies is not up for debate. “I’m not faulting the administrators. They used what they had to pay what they could pay,” said Poston in reference to paying the bills. “If they had no other cash to pay it, then they used what they had. If you’re in those same shoes, then you’d probably have to do that.” CMS will not close their books until it has reviewed cost reports dating back to 2006 according to Poston.

Kline suggested moving away from its current status. “We’ve got to decide whether we’re prepared to move away from Critical Access, prepare for additional surgery, move to a greater then 4.0 patient length of stay and stop this retrospective settlement.”

There were five Critical Access hospitals in the state. Of those, one has closed and another is having difficulty. He asked the board to at least consider his recommendation. “Congress passed this law to provide these Critical Access hospitals with this haven of cost basis but it’s not working for us.” Poston clarified Kline’s recommendation saying, “We would stay not-for-profit, just not Critical Access.”