Over 700 patients referred in 2013; govt expense at $5.2M

Despite tight controls in the government’s medical referral program, there seems to be an increasing number of patients being referred off-island for medical treatment, with more than 700 served last year.

Ronald D. Sablan, director for medical referral services, disclosed to Saipan Tribune yesterday that a total of 732 off-island referrals were recorded in 2013, nearly a hundred patients more than the 645 recorded in 2012.

The medical referral program, which is under the Governor’s Office, has been one of the government’s largest expenditures over the years. In 2013, Sablan bared that the administration spent $5.274 million on these referral expenses, not including the program‘s personnel and operational expenditures.

Records obtained by Saipan Tribune show that of the 732 referrals last year, the bulk was sent to neighboring Guam hospitals, totaling 442. Patients referred to Philippine hospitals came next with 211, which Sablan said is where most of the funding went last year.

“This is a concern because at times, due to a patient’s medical condition, we are forced to send the patient to the Philippines at 100-percent expense versus nothing if a patient’s Medicaid coverage would be accepted in a U.S. certified medical institution,” Sablan said.

For hospitals in Hawaii, the CNMI referred 62 patients while referrals to the U.S. mainland totaled 17.

Saipan Tribune learned that the medical referral program gets a budget of $2 million to $3 million a year—much lower than what it always proposes, resulting in a significant shortfall.

When asked how the program copes with its budgetary constraints, Sablan said the reprogramming authority of the governor is a big help.

“The governor’s office reprograms funds to cover the shortfall. Our expenditures for prior fiscal years are right around our budget submissions. Unfortunately, the actual budget passed by the Legislature has always been underfunded,” he said.

According to Sablan, one important factor that contributed to the increase in medical referrals last year is the lack of medical maintenance among many patients. When they come in and seek help, many are in worse stages of their illnesses or diseases.

“[The] impact of members dropping their health insurance benefit [is the] higher number of referral submissions and at worse stages due to lack of medical maintenance. Fortunately, [the Commonwealth Healthcare Corp.] medical staff are now proactive and new recruits are experienced and well-rounded, allowing some cases that are normally sent off-island to be treated locally,” said Sablan.

The program’s biggest challenge right now is its inadequate funding to run its operation. Sablan said the lack of funds hampers their ability to do utilization review and hire more people, affecting processing time, the frequent complaints of patients, the delivery of service in designated off-island field offices, and the challenge of where to send patients because most providers in Guam and Hawaii will not accept Medicaid coverage due to the unpaid obligations of the CNMI government.