Marianas Variety

Wednesday, November 26, 2014-3:09:10P.M.

Last updateWed, 26 Nov 2014 12am

Headlines:

Cuts for medical referral program

APRIL ushers in significant and costly medical referral program changes to patients and their families.

Medical Referral Services manager Ronald D. Sablan announced the changes at Wednesday’s Commonwealth Cancer Association survivor meeting at the Fiesta Resort.

“Due to the economic situation, we were forced to adjust payments to referral patients and medical escorts,” he said.

Beginning April 1 the subsistence allowance, or SA, of $20 per day will be cancelled.

For those already receiving SA payments, April 16 will be the last effective day.

Airline tickets, though, will be the biggest hit for patients and medical escorts.

Patients with an annual salary of $50,000 and above will now shoulder the total cost of their airfare.

For those making between $25,000 and $49,999, the referral program will pay only 50 percent of the ticket price.

Clients making under $25,000 are not affected and will continue to be subsidized at 100 percent.

Family/medical escorts will be reimbursed for 50 percent of air travel costs.

The bright spot for patients was the program’s decision to continue paying for hotel accommodation at the current level.

Seismic shift

Since Sablan assumed management of the program in 2007, it has undergone seismic shifts in various areas.

“Governor Fitial asked me to make this program more accessible to more citizens, and we have,” said Sablan.

He explained that seven of the eight staff members were replaced because of attitudes that did not reflect a “clients-first” work ethic.

“I couldn’t accept staff that thought they were always right and ignored the needs of the patients and families,” explained Sablan regarding the staff replacements.

During his stewardship, clients being served have surged.

In 2007, the program handled just 200 people.

But in 2011, over 1,200 patients and their families were assisted.

Part of the caseload increase was the introduction of government austerity that forced many civil servants to drop their private insurance.

Sablan noted that the continuation of austerity measures in FY 2012 prompted another wave of government employees to cancel health insurance and was creating an ever increasing group of working but uninsured patients.

Another drastic shift was the in medical illness mix of patients.

Prior to 2007, the majority of off-island medical referrals were for cardiac and liver ailments.

Since 2008, the bulk of patients were oncology — cancer — which pushed cardiology into second place.

Variety asked Sablan if he had any ideas about what fueled the change so quickly.

He offered no concrete theory, but an audience member theorized that perhaps increased “awareness” had prompted the community to visit the doctor sooner when pain and ill-health set-in.

Sablan agreed and also offered a thought on possible higher levels of environmental contamination than historically thought for the rapid rise in cancer rates.

While the exact cause(s) of increased rates may not be known as of yet, the effects can be calculated.

According to the executive branch’s 2011 fiscal report, the medical referral program overspent by $2.36 million.

Mechanics & challenges

A panel of eight physicians — two private and six CHC practitioners — comprise the medical referral committee that meets weekly.

Sablan and two other program staff members sit-in on the meetings to provide logistical advice.

Any island doctor can refer a case to the medical panel — about 25 per week — and once a patient is approved (95 percent are) the referral program assigns a case-worker to handle appointments, travel arrangements, medical records etc.

The workload for the caseworkers is heavy — especially due to austerity Fridays — with each of the seven NMI staff handling a minimum of 25 cases simultaneously.

Adding to the caseload are problems securing off-island medical appointments and airline tickets due to the NMI’s bad reputation regarding paying its bills to third-party providers.

The program is no longer able to block hotel rooms in Guam and Medical providers in Hawaii treat Medicaid cases as hot potatoes and pass them around in the hopes they land elsewhere.

In an effort to seek alternatives to places such as Hawaii and Guam, the program now refers a growing number of patients to the Philippines for what Sablan described as “excellent and professional care.”

While there was some resistance to what some residents perceived as “third-world care,” Sablan explained the hesitation has faded as patients experience first-hand the caring and competent service at various Philippine medical facilities.

Treatment options are also sought in places such as Korea and Japan, but again higher costs are an obstacle.

Above and beyond funding and staffing workload challenges, Sablan outlined other roadblocks the referral service encounters.

Many cases have arisen where indigent patients do not have a passport, which delays the process for weeks.

Although the Philippine government and the U.S. state department in times past allowed referral patients entry into the PI without a passport, that practice has now stopped.

Only pediatric patients are now allowed entry into the PI without a passport, for humanitarian reasons.

Dedicated staff

Sablan credits NMI local and referral program staff in Hawaii, Manila and Guam for their dedication to patients who require a high-level of attention and sensitivity during their time of greatest vulnerability.

“This program’s staff is hard-working…they work nights and weekends without pay and without complaint,” stated Sablan.