Director says solution is adequate funding with no political interference
The director of the Medical Referring Services himself believes that transferring the program back to the Commonwealth Healthcare Corp. is not the answer to the ills plaguing the program. Rather, priority and adequate funding with no political interference is the solution, according to Ronald D. Sablan.
In his testimony Friday before the House Committee on Health and Welfare, Sablan said the program’s size and expenditures are based on the number and category of patients approved for off-island referral whose treatment can’t be done locally. Therefore, he said, reducing the number of off-island referrals means supporting the advancement of CHCC’s operation, especially on human resources, equipment and facilities to meet today’s health care challenges.
The committee hearing continues the series of meetings that committee chair Rep. Christina E. Sablan (D-Saipan) has held on Rota, Tinian, and Saipan to review the program and examine how the program may be reformed to improve services, streamline costs, and enhance accountability.
In his testimony last Friday, Ronald Sablan said the Medical Referral Services has a long history as the top political subject every election year, yet its personnel and operation requirements were never fully supported or funded appropriately to meet its mandated responsibilities.
“Medical referral must be depoliticized and adequately budgeted to run smoothly and consistently following its owned rules and regulations focusing on patients care,” he said.
He pointed out that it’s very frustrating and an insult to them whenever news articles or personal interviews emphasize the deficit status of MRP, when in actuality it was never funded in the first place.
For the program to run smoothly with consistent policy, Ronald Sablan said, means it has to be allowed to hire its own personnel, be adequately funded, and be officially organized as an independent program similar to the New Medicaid model or as an autonomous agency. He said full-time employee funding requirement must be addressed and memorandum of understanding from mayors’ offices and other political hires must stop.
At times, he said, the Guam or Hawaii officer-in-charge would not follow protocols or submit required reports to the CNMI central office because they only answer to the one who hired them. This, Ronald Sablan said, is creating a dysfunctional operation affecting their level of service.
He said due to the sensitivity and confidential nature of their operation and to be compliant with Health Insurance Portability and Accountability Act requirements, MRP recruitment must be scrutinized based on operation requirement and applicants’ qualification, attitude, a people-to-people personality, ability to deal with difficult and stressful environment, and the willingness to multitask.
“In all fairness, civil service pay scale must be followed depending of qualification or morale becomes a problem,” he said.
On the misconception issue, Ronald Sablan said off-island referrals are reviewed and approved by the Medical Referral Committee—not the Medical Referral Office management. He said the committee is composed of six voting members who are all physicians licensed by the CNMI Professional Licensing Board and approved by CHCC’s chief executive officer. Committee members meet every Wednesday to review every referral request submitted for the week and those incomplete from prior meetings.
With respect to its budget, Ronald Sablan said MRP has always been underfunded to the tune of 50% or as low as 13% in the last 10 years. He said the funding level obviously is inappropriate and the program runs under underfunded liability when expenditures are realistically within a margin of error of requested budget submission, depending on number of patients.
On personnel housing, Ronald Sablan said employees in past administrations accepted their employment without the housing benefit. Currently, only Honolulu personnel are receiving housing allowance and Guam employees are complaining of the unfairness. “It’s either we provide to all or eliminate entirely,” the director said.
He said MRP must focus on direct patient care. Sablan said the program will provide airfare, hotel accommodations, ground transportation, and subsistence allowance only during out-patient status.
He said the program provides hotel accommodations for the duration of treatment if a family escort is approved.
He said MRS should only be the prayer of last resort for all medical treatment.
Sablan said patient will be seen only at approved facilities unless referred by the approved facility for specific treatment.
With respect to escorts, the director said there should be no family or friend escort unless approved by the committee for patients with debilitating medical condition and require one.
He said MRS will not be responsible for any medical cost of escorts except for real emergencies.
Ronald Sablan said a high percentage of complaints registered from medical facilities, transportation, and hotel providers are because of escorts.
On insurance, the director said most private Guam-based insurance carriers except for Aetna only covers treatment done in the Philippines.
He said MRS will not cover maintenance cost (hotel, ground transportation and sub-allowance) beyond 45 days unless satisfactory and up to date medical reports are submitted for review and approval by the committee.
Ronald Sablan said MRS will not pay for any benefits when the treatment for a condition is available in Guam.
With respect to enhance accountability, the director said they have updated software and computer systems specifically program to their operation requirement allowing linkage to their satellite offices and providers.
He said they have also enhanced working relationship communication with providers, provided professional advancement training to all staff, and assistance for legal and finance and accounting issues.