Despite objections from the Commonwealth Healthcare Corp., the Fitial administration said recommendations made by HealthTech Management Services, Inc. cannot be ignored.
“The administration commissioned this [HealthTech] assessment to find ways to further improve the healthcare system in the Commonwealth. Therefore, it would not be prudent to outright ignore recommendations that we invested the grant funds in,” said press secretary Angel Demapan.
He revealed the turnaround management team recommended by HealthTech is intended “to stabilize the delivery and efficiency of healthcare.”
Privatization of the Commonwealth Health Center, he said, is an entirely separate issue that would require more review and detailed planning.
“Right now, it's too soon to speculate [on privatization of the CHC],” he told Saipan Tribune, adding that the administration is analyzing all the recommendations to determine its next steps.
Demapan admits that funding is a major issue at this point, which is why Gov. Benigno R. Fitial is exploring the possibility of obtaining federal assistance for this undertaking.
It was earlier said that bringing in a team of experts to head the turnaround effort for the hospital will cost some $2 million.
Sources earlier told the corporation's position against HealthTech's recommendations, and CEO Juan N. Babauta confirmed this in a nine-page letter to Office of Insular Affairs Assistant Secretary Tony Babauta, who was recently on-island.
In his letter, CEO Babauta trumpeted the progress made by the corporation, claiming that it has already made the “turnaround” at the hospital and addressing many of the critical problems identified by the HealthTech analysis.
Babauta said he welcomes HealthTech's assessment and does not dispute many of its findings but he does not agree that a new management team should be brought in for six months.
“The CHCC accepts many of the findings of HealthTech. In fact, the CHCC pointed out many of the problems and understand in depth their consequences because we have to deal with the problems on a day-to-day basis. Further, the CHCC believes that it will take longer than a six-month period of time that resources should be targeted to specific problems and benchmarks for success, and that there should be a long-term commitment to improving the capacity of the CHCC team at all levels,” CEO Babauta told OIA's Babauta on his Oct. 29 letter, adding that “the CHCC is concerned that not addressing the approach of hiring a management team could lead to a slippery slope to privatization, which would be ill-advised for the CNMI.”
Evidence of turnaround
According to the corporation, it has been meeting its payroll for the past four pay periods and is resolving issues with many vendors.
He said the corporation has been reinstated as a provider of Medicare and was able to hire billers and coders for the implementation of its revenue cycle management. The HealthTech assessment found backlogged clinic bills from November 2011 but the corporation claims it is now only from April 2012-representing five-month worth of productivity in the cycle.
Because of this, Medicare issues have been resolved, although the CHCC is not fully caught up to its goal of having all bills generated within 30 days, according to CEO Babauta.
A major reason for the turnaround, he said, has been the development and application of CPE [certified public expenditure] methodology for calculating Medicaid patients.
Because of the newly established “recruitment and retention committee,” the coporation is now very close to signing a contract for a pediatrician, he said. Additionally, the corporation also hired for one year another pediatrician and an internal medicine doctor who will start next month.
Babauta reported that the establishment of the new Virtual JDE system last September also enables CHCC to implement a new Chart of Accounts and modifications to the general ledger to enable improved accounting. Also cited are strides made in the electronic health record project and information technology system.
The corporation also disagreed with the recommendation to separate public health functions from CHC, citing lack of justification in the analysis.
“While HealthTech stated that public health function should be separated, there was no justification for the recommendation and we strongly disagree. The integration of the clinical and public health programs is providing synergy to focus on healthcare system improvements and outcomes,” said Babauta, adding that the merging of hospital and public health quality management will provide opportunity for gathering complete and meaningful data.
The corporation described as “unreasonable” HealthTech's projected $17 million loss for the hospital considering the infusion of Medicaid and Medicare funding through the CPE methodology.
The analysis, the corporation added, also failed to acknowledge that a factor of overtime in nursing was the loss of nursing personnel due to uncertainties in the CNMI. At present, the corporation is paying back wages after the federal government found labor violations concerning nonpayment of overtime.