Marianas Variety

Tuesday, November 25, 2014-11:29:23P.M.

Last updateWed, 26 Nov 2014 12am

Headlines:

CHC’s tailspin continues

ANOTHER department head physician of the Commonwealth Healthcare Corp.  resigned yesterday as acting Gov. Eloy S. Inos was meeting with CHC’s chief executive officer and managers to identify stop-gap solutions to the worsening crisis at the CNMI’s only hospital.

The resigning physician, who declined to be identified, said due to CHC’s condition, “parents should be very, very afraid!”

Counting the resignation of last week, yesterday and one to three more expected in the coming days, CHC will have a total doctor roster of below 10 — a critically low number for a population of 50,000.

As one physician commented late in the afternoon after news of Inos’ meeting circulated through the hospital, “They’re all in denial and don’t want to acknowledge that it’s the point of no return.”

More unsettling news

As if the steady stream of resignation letters were not enough, the supplies situation brought only more dire news.

CHC yesterday had only one central intravenous line available in the hospital and even that  carried an expiration date of one year ago.

Additionally, the supply of spinal tray kits ran out and all women in need of a Caesarean section will now be subjected to general anesthesia, a much riskier option for both mother and fetus.

That is, if the operating room is even open, as basic surgical supplies are in short supply as well.

Clinics yesterday were technically “open” but as one doctor described it, open was in name only.

“You can check the Medicare/Medicaid certification box and say the clinics were operating but for all intents and purposes they are not…we don’t have the staff or the supplies and patients can’t get their medications filled…so what is the point, really?”

Inos’ reaction

After an almost three-hour meeting with CHC officials, Inos and Babauta agreed to an extensive question and answer discussion with Variety.

Asked point-blank if he still had confidence in Babauta’s leadership, Inos unequivocally responded “Yes, we do.”

When pushed to acknowledge the complete lack of confidence in Babauta by the medical staff and community-at-large, Inos responded with a lengthy explanation of the condition that created the CHC crises.

“It’s true that steps should have been taken earlier to avert the problem, but lack of funds has been a primary cause of the situation…we’re going to address that issue in the next 48-hours.”

According to the acting governor, he will meet with the Marianas Public Land Trust today in an effort to induce the board to release the $7 million line of credit for CHC approved by the legislature and signed off by Gov. Benigno Fitial in June.

“We intend to immediately draw down $2 million for CHC so payroll can be met on Friday and supplies can be purchased,” stated Inos.

Queried as to his general message to a worried public, the acting governor responded: “We’re going to turn this around, definitely.”

What’s next?

Ask the doctors what they think is in CHC’s future and the comments range from bad to worse.

“Too little, too late.”

“The lights are on and the doors are open but CHC is a mirage…gutted, devoid of hope and a demoralized staff.”

Variety posed the same questions to Inos and Babauta and the answers could not have been more different.

“We’re working with the Centers for Medicare and Medicaid Services in an effort to get them to certify the MPLT  $7 million line of credit as certified public expenditures, or CPE, [that is, local match money] that would allow us to draw down significantly more federal dollars,” explained Babauta on the issue of possible solutions.

Apparently, CMS Region IX officials have, in theory, been receptive to the idea, but the first step is for MPLT to release the funds that have proved elusive in the past two months.

Under a CPE option, CHC would provide a cost-report to CMS detailing a total figure for treating patients and then CMS would “reimburse” the corporation up-front for the year.

At year’s end, actual costs would be reconciled with the up-front CMS payments and any overage would be returned to the federal government.

If it happened that CHC under-estimated the yearly amount then CMS would make up the difference with a final payment.

Also noted by Inos and Babauta was a long overdue update of the computer-based “charge-master” billing software to reflect increased pricing for services.

Asked if CMS officials had approved increased costs, Babauta responded that federal approval was not necessary.

Inos expressed confidence that the charge-master could be updated in the coming week, which would increase collections from insurance payers, CMS and self-paying patients.

Lastly, the acting governor and CEO cited the impending on-site assessment by Health Tech, the consulting company awarded the $170,000 CHC request for proposal in July.

Health Tech is scheduled to be on island in early September for an extensive physical and organizational review of CHC and will prepare a detailed report of recommendations.

“We’re confident that the consultant will identify areas of improvement in CHC, specifically in the area of revenue management,” stated Inos.

In the meantime, Inos noted the importance of the MPLT funds to bridge the gap between now and implementation of Health Tech’s recommendations.

“The MPLT money is not a solution in and of itself but it will ensure that CHC continues to operate and that payroll is met and needed supplies are available,” he said.

Variety also spoke yesterday by telephone to CHC board of advisors president, Jack Torres, currently on the mainland for medical testing.

Asked if he and the board still had confidence in Babauta’s leadership, he too, responded “Yes, we still do.”

Torres acknowledged the critical importance of retaining staff and was disheartened to hear of the ongoing medical staff resignations.

“If we lose the doctors, it’s possible we will not be able to recruit replacements…we must treat them with the utmost professionalism and respect,” he said.

Medical staff could not agree more with his comment but take issue with what they describe as “empty reassurances.”

“We’ve heard this all before…for the last 10 months we’ve been told ‘Trust us, we appreciate your dedication the problem will get solved’…and here we are staring into the abyss,” said a very weary and distrustful physician.