Roanoke Times looks at Appalachian Virginia's difficulties with federal health reform

The federal health reform law continues to put pressure on rural health care systems. We reported on doctors in rural Vermont who are already at capacity and unable to accommodate new patients. The same problem is occurring in rural Virginia, especially in its Appalachian region, and may increase if tehe state expends the Medicaid program.

As more patients become insured through the law, more people are seeking doctors, but there aren't enough doctors to treat the new patients. In Virginia "there’s a projected shortage of about 600 patient care physicians—a gap that is expected to grow to more than 2,500 full-time equivalent positions by 2030, according a 2010 forecast by the Lewin Group for the Virginia Department of Health Professions," Laurence Hammack reports for The Roanoke Times. 

Places like Highland County (Wikipedia map) have been especially hit hard, Hammack writes. The county of 2,200 people doesn't have a hospital or pharmacy and has been without a practicing physician since last December. The county does have a medical center that has 10,000 patient visits a year; nurse practitioners handle most of them. "In fact, the most frequent call to the Highland County Volunteer Rescue Squad is made from the medical center, where the most seriously ill or injured patients must be transported by ambulance or helicopter more than 50 miles to hospitals in Augusta, Bath and Rockingham counties, according to squad captain Chris Vernovai."

At least Highland County has a facility. In Lee County, at Virginia's western tip, the only hospital closed Oct. 1, Hammack notes. "Wellmont Health System, which ran the hospital, said the closure was partly the result of cuts in Medicare reimbursements under the Affordable Care Act." Beth O’Connor, executive director of the Virginia Rural Health Association, said "the hospital is the first in Virginia to close as a result of Medicare payment reductions, according to O’Connor."

Some local doctors aren't buying that the hospital closed because of the reform law, Hammack reports. Dr. Art Van Zee "said Wellmont’s blaming of the Affordable Care Act is 'an invented, if not spun, reason for the closure.' Van Zee said Wellmont shuttered the hospital with the expectation that patients would go to other hospitals it runs in neighboring counties, protecting its bottom line—if not the residents of Lee County." Van Zee told Hammack, “Many lives are at risk, and some lives without question are going to be lost.” (Read more)