Despite assurance from local health officials that all requirements set by the U.S. Centers for Medicare and Medicaid will be completed and submitted on the deadline, they admitted that the Commonwealth Health Center's certification with the federal organization continues to hang in the balance.
This was hospital services director Karen Buettner confirmed with health corporation board members during its meeting Friday, disclosing that CHC has until today, Dec. 3 at 2pm, to fulfill all the “evidence” asked by the CMMS or else its certification will be revoked which will result in losing millions of federal monies for the public hospital.
It was in September when CMMS issued immediate jeopardy statuses on the CHC due to serious deficiencies discovered in its operation. Of these three IJs, only one was “abated” pertaining to the lack of defibrillators in key units of the hospital. For the two remaining immediate jeopardies, CMMS had given the corporation until Nov. 19 to submit evidence which Buettner claimed was met on time.
Buettner admitted that CMMS, besides the remaining IJs, has also provided CHC additional citations as indicated in its 217-page survey report released to the corporation. “Evidence” for these additional citations as well as for additional documentations asked for the remaining IJs are all due today at 2pm, Saipan time.
“Our deadline is on Monday (today), but our plan is to finish everything by end of the day. We will also have teleconference with CMMS tomorrow morning (Saturday) so they have the opportunity to let us know if they think we still have outstanding (requirements). They've been very helpful to us,” Buettner reported to the board last Friday.
According to Commonwealth Health Corp. COO Esther Muna, the “additional evidence” asked by CMMS for the remaining IJs pertain to the signed contracts with specific vendors such as for diagnostic lab services, shipping and tracking numbers for procured equipment such as dishwasher and CT scan, and others.
Muna assured the board that all needed contracts have been finalized and signed last Friday with the Office of the Attorney General and ready for submission to CMMS.
“Everything though is still hanging in the balance for our certification. Monday...our deadline, is the day they will let us know whether we lost our certification or not,” said Buettner, adding that since Day 1 of the CMMS survey, the corporation has been doing its best to rectify all problems as indicated in its action plans and has been in constant communication with the CMMS.
“This is the define moment for us to move forward,” added Buettner.
Corporation CEO Juan N. Babauta, for his part, said that the dishwasher has already been procured and is being readied for shipment by the vendor. Contracts with specific vendors that relate to the immediate jeopardies, he said, have also been resurrected. He said many services had stopped in the past due to nonpayment to vendors. CHCC, he said, has even made an advanced payment to one specific vendor as guarantee for uninterrupted service to the CHC.
Muna reported to the board that one of the major sources of funding that helped CHCC address the citations from CMMS, is the reimbursement received by CHC from Medicaid. Last October, she disclosed, CHCC received $6 million in Medicaid reimbursement alone. Coupled with improved billing and collection unit, health officials are optimistic that revenues of the hospital will grow.
Medicare provides CHC reimbursements for services from $8 million to $10 million annually.
Lack of skilled leadership
Besides funding issues, Buettner disclosed to the board that problems of the hospital are also attributed to the lack of “skilled leadership.”
She revealed that of the existing 26 managers, 22 are replacements that needed to be trained. But due to lack of funding for training, CHC is operating without the proper training activities that will help the managers better perform their tasks. This is why CHCC, she said, has been requesting assistance to Office of Insular Affairs.
Also a result of having no funding to hire additional personnel or replacements, CHC has been incurring huge overtime cost-a problem that can only be remedied if proper staffing is met.
In hiring the needed specialists and medical professionals, Buettner is convinced that the unattractive salary offer to qualified candidates hampers this objective. She described the current compensation offer as the rate set some 10 years ago.