WMC's legal argument over 'community provider' status may not work

2011-08-14T01:30:00Z 2011-09-16T19:45:07Z WMC's legal argument over 'community provider' status may not work


Star-Tribune staff writer

Casper Star-Tribune Online

The nonprofit Wyoming Medical Center Inc.’s hoped-for legal out that could save $7.8 million in Medicare reimbursements may not pan out, according to the intermediary company between the hospital and federal government.

The state’s largest hospital probably will lose its “sole community provider” status because the new Mountain View Regional Hospital garnered more than 8 percent of area inpatient volume in 2010, thus crossing a threshold for disqualification, WMC officials said earlier this week.

Wyoming Medical Center will legally fight the loss of this status — and the hefty reimbursement for the sometimes money-losing services it offers to the community — on the grounds the requirement in question was put into effect in 2002, 10 years after WMC received “sole community provider” status from Medicare.

The requirements in 1992 included the provision that another hospital in the area would need to provide services like those of the “sole community provider” hospital. Mountain View doesn’t offer services such as trauma care, WMC President Vickie Diamond said.

That defense may not fly, said a manager at the Fargo, N.D.-based Noridian Administrative Services LLC, which handles the Medicare Part A claims filed by hospitals in 10 states, including Wyoming Medical Center.

“There’s only one regulation that applies to the whole country,” Paul Orth said.

While the federal Centers for Medicare & Medicaid Services has revised its regulations over the years, Noridian and other intermediary Medicare administrators regard them as a single uniform policy, Orth said. “We’re going to go by that.”

Thursday, Diamond disagreed.

Congress asked Medicare years ago to consider multiple factors when conferring “sole community provider status,” she said.

The 8 percent threshold applies to hospitals seeking the status, not to those that already have it, Diamond said. “We’re working with our congressional delegation on this.”

The hospital and its attorneys planned to submit their response Friday, hospital spokeswoman Mary Lynne Shickich said.

Meanwhile, Natrona County continues to

monitor the situation, county Commissioner Bill McDowell said. “Right now, there isn’t any light at the end of the tunnel.”

The county owns the hospital assets, most of which are in the 1200 block of East Second Street, which in turn are leased by Wyoming Medical Center. In exchange for using the buildings and equipment, the lease requires WMC to provide indigent and prisoner care. The lease is overseen by a five-member board of trustees called the Natrona County Memorial Hospital.

McDowell, a former WMC board member, is the county commission’s liaison with the Memorial Hospital board.

The probable loss of “sole community provider” status is happening at the same time as the federal government is taking a hard look at spending, including Medicare. If a 12-member congressional panel cannot agree on a budget plan by Thanksgiving, certain severe across-the-board spending cuts would go into effect automatically.

In that light, Washington, D.C., won’t be caring much about a community hospital in Wyoming, McDowell said.

“In this political environment, if the Medicare default comes into place, I don’t believe [WMC] will have any help,” he said.

Reach Tom Morton at 307-266-0592, or at tom.morton@trib.com. You can read his blog at trib.com and follow him on Twitter @GTMorton.

Copyright 2015 Casper Star-Tribune Online. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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