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Featured FAN: Karen Bowling

Educate, then Communicate: A Conversation with WVU Medicine’s Karen Bowling 

Each quarter, we feature a Federal Action Network (FAN) member leading the charge on Capitol Hill to protect essential hospitals. This quarter, we spoke with Karen Bowling, MSN, president and CEO of Summersville Regional Medical Center and Braxton County Community Hospital and vice president of care delivery and transformation, WVU Medicine. A longtime advocate for the 340B Drug Pricing Program, Bowling finds that persistence is key when educating political leaders about essential hospital issues.

Recent actions undertaken by drug manufacturers have threatened the 340B Drug Pricing Program. Can you talk a little bit about what the 340B program means to the communities and patients WVU serves?

WVU Medicine really focuses a lot of attention on what we can do to be the leader in health care across West Virginia. We serve a large number of patients throughout the state, many of which are in very rural communities, very isolated counties. We use our 340B savings to ensure that we can continue to use and expand our offerings in those counties. We have a large number of Medicare and Medicaid patients, and, in those communities, the cost of care for those patients is significant. We use our 340B savings to ensure that we can maintain and continue to provide services in those communities that otherwise would not receive services.

For example, the hospital that I run, Summersville Regional Medical Center, was at the verge of bankruptcy, and that’s really due to the fact that it’s a critical access hospital and the fact that it serves a large number of people that are either Medicare or Medicaid recipients. WVU Medicine came in, and we were able to pull that hospital into the system. By doing so, really, we were able to save health care in this community.

Without 340B and the savings our systems receive, we would not be able to do many things that we do to make sure we have access to care for people across the state of West Virginia. We use savings for things like our Bonnie’s Bus, which is a mobile mammography unit that goes throughout the state of West Virginia and provide services to individuals who otherwise would not be able to access mammography, which we know is an important screening for women for breast cancer. We have a lot of diabetic programs. These programs are provided free of charge to individuals who can hopefully improve their health and wellbeing.

340B is critical to our system and our ability to continue to serve the people across the state of West Virginia, especially those in the more rural outlying areas. We also provide access to specialty services in our outlying communities through telemedicine. The technology that provides telemedicine in the community is very expensive. We’ve invested in that because we want to make sure that, as an example, a patient that needs a nephrologist, if there’s not one available in their community, that they can get access to a nephrologist and do it through a telemedicine hub. Many of our people here in the state of West Virginia have transportation issues. Some of our seniors really have difficulty, if they can’t drive themselves, to find people to drive them all the way up, say, a two- or three-hour drive. What we’ve seen is that, if we’re able to provide that specialty care through telemedicine, these are individuals are able to make their appointments instead of missing appointments because they don’t have transportation. Therefore, it increases the ability to, again, improve their overall health.

You are a leader among essential hospital advocates for the 340B program. What have you found to be your most successful messages when advocating for 340B with members of Congress and their staff?

I think the most successful messages are those where you provide them with facts and information. I think there’s a lot of misconception out there among some of our [members of Congress] about what 340B is and why we use it. There’s a lot of misconception out there — when the pharmaceutical companies talk about it, they basically are able to paint a different picture than what we know to be factual; [the truth] is that 340B is a very, very small part of what pharmaceutical companies get nationwide in terms of their profits. I think just dispelling the myths and making sure that all of our congressional leaders are educated about what 340B savings really are and what we do, and the fact that we already do provide transparency. It’s clear exactly which drugs and what the discounts are. The importance of that to each hospital community is what I think is most effective.

When I go advocate, I talk about as much specificity as possible. I talk about what it means to WVU Medicine, or what it might mean to Summersville or Braxton if we lose 340B savings, and how that could impact the care provided in their local community. I think that resonates with our representatives or our senators when they’re able to understand exactly what it means to each community.

I will tell you, in West Virginia, it’s especially important, because over the last two years, we’ve had several hospitals close. There is definitely a challenge in terms of access to care. I think that our congressmen and senators know that. When you talk about it in terms of, if the critical access hospital in this very small, rural county didn’t have 340B savings, this hospital couldn’t survive. There’s no way they could provide these services with the amount of charity care that’s already being provided. This charity care wouldn’t exist. How can we improve our overall health of West Virginia if we don’t have access to care? We need that 340B savings to be able to help us.

How have you been able to maintain congressional staff’s focus on 340B in the midst of a global pandemic?

I think my success is related to my relationship with the offices. I think that I can talk about a number of things with the offices. When I have those conversations, if it’s about COVID-19, I’m still able to pivot to 340B and continue to maintain my audience. I think you do that by making sure that the information that you provide to the offices is accurate and factual and up to date, and you let them know that things are changing. I think you also emphasize that COVID-19 is a pandemic that has been very scary for hospitals, and it continues to go on, and we continue to be very worried about it. But we also cannot be single focused in the health care industry, that there are multiple things that can impact us.

Quite frankly, I think you talk about 340B along the same lines that you talk about COVID-19, in terms of saying it’s a double whammy for us. If you start taking away 340B savings, we’re already strapped in terms of cost, and things that are happening to us from the COVID-19 work. How do you expect us to survive? I think you have to have that ability to connect those dots and talk about things in a more holistic manner. What is impacting health care? It can be more than COVID-19. It could be the fact that if Medicaid expansion goes away and the Supreme Court strikes it down, what’s going to happen to our country?

You can’t lose sight of the big picture and other things that are going on in health care for one thing, but, at the same time, you want to make sure that you’re keeping COVID-19 front and center because that’s the immediate crisis, but 340B plays in. That’s how I frame my conversations, and that’s how I talk about it when I talk about this with the offices and try to get them to advocate on our behalf.

I think we’ve been pretty successful in keeping our folks up to date and striking a balance to ensure that they’re advocating on our behalf, and I think a lot of it is about education and communication. That’s what I always say is the key to advocacy. You’ve got to educate and you’ve got to communicate. They’re not going to always agree with you, but you’ve got to keep going back at them with the education and the communication. You never give up, you just keep talking to them. Sometimes they disagree with you, sometimes you’re not happy with their response, but don’t give up on them. Sometimes there’s another way that convinces them. To be smart about it, you need to engage others in advocacy efforts, especially when you think those others could be influential based on their location or some connection that they may have to one of the offices.

What advice do you have for other essential hospital leaders who want to lean further into advocacy?

One piece of advice is to educate yourself. Know your subject matter. When you’re advocating, someone’s going to ask you a question; if you haven’t looked at the material or you don’t understand it, and you haven’t first gotten to a point where you’re comfortable talking about it, you’ll be at a disadvantage. But if you educate yourself, whether that’s reading about it or talking to others about it, or, if you have questions, getting those answers before you go in to be an advocate, that’s going to help you be a really good advocate.

The second thing I think you have to do is understand or learn about the personalities of the people in the offices that you’re working with. Be sensitive to their time, because they are very busy people. You may only have 10 minutes to get to the high points of what you want to advocate about. You really want to make sure that you go in there armed with the ability to get those five or 10 points within the x number of minutes allotted to you. I would say also that you have to have a lot of patience. You’re going to be on their time, not yours, so you just work within their time, whatever those parameters are, and be patient, and if at first you don’t succeed, try, try again. You know, you’ve got to keep making your point, don’t give up.

If I could impart any wisdom, it’s educate yourself and them, and communicate. Make sure there’s that free flow of communication between their offices and you. They need to see you as a resource. Even if, at the end of the day, they don’t vote exactly like you wanted to, don’t give up. There are always ways to make changes in your messaging to hopefully get through for the next time. And they’re your friends, that’s the other thing I tell people. They get elected to serve their state and their country, and they’ll make decisions based on the information they receive. They’re out there to try to do the right thing, and we just have to see that. It’s not an easy job; it’s pretty challenging, and they have a lot of people coming at them from a lot of different directions, but I always try to give people the benefit of the doubt, and I always try to see their perspective. That helps me with my messaging at the time I’m talking to them and then later on if I need to regroup.


Karen Bowling, MSN

President and CEO, Summersville Regional Medical Center and Braxton County Community Hospital
Vice President of Care Delivery and Transformation, WVU Medicine

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