June 24, 2009 — If expanded Medicaid payments for the Virgin Islands and other insular areas that are in the draft health reform bill unveiled last week in the U.S. House of Representatives make it through Congress, the territory's hospitals will stand to benefit, Carmelo Rivera, chair of Juan. F. Luis Hospital's governing board said Wednesday.
It was a routine meeting of the St. Croix District Governing Board of Director’s of the Virgin Islands Government Hospital and Health Facilities Corporation, the full name of the board which oversees the hospital, with reports from the board's committees on such topics as progress on establishing policy and procedures for intravenous sedation of conscious patients and progress in hiring doctors for some highly specialized positions. No crises or imminent deadlines were on the workaday agenda and no major initiatives were begun or completed.
"I've been watching President Obama and I hope we see comprehensive health care reform," Rivera said. "And I hope we are not forgotten here in the territory. To be on the table to receive more Medicaid dollars, that is going to be of tremendous benefit to us if it actually happens. We can use every penny possible from the federal government."
Both Luis Hospital and the Schneider Regional Medical Center pay dearly for their large number of uninsured patients every year. In 2007 Luis Hospital had to absorb $39 million in uncompensated care, $12 million specifically because of Medicaid, (See "Hospitals Bleeding Red Ink Because of Uncompensated Care, Contract Nurses, Officials Say.") an amount that went up just slightly in 2008. (See "Luis Hospital Taking Multiple Financial Hits, CEO Tells Senators.")
The bill in the House of Representatives right now leaves in place a discriminatory cap on Medicaid in the territories, but it provides $10.35 billion in extra funding over nine years, split between the five territories based on population.
(See "Bill Before Congress Would Boost Medicaid in Territory.")
In other business, Dr. Kendall Griffith, director of Juan Luis' V.I. Cardiac Center, told the governing board Juan F. Luis Hospital is working to improve outcomes on St. Croix by identifying illness earlier and using technology to make emergency care faster and more efficient, especially with severe kidney disease.
"Many first come in to the hospital with end stage renal disease," Griffith said. "The best scenario is to be able to identify those patients early on and see they are quickly referred to a nephrologist (kidney doctor). That way the nephrologist may, one) delay end-stage and, second) if end-stage is at hand, prepare the patient for the inevitable dialysis."
Once a patient is expected to need dialysis in the near future, Griffin suggested the hospital should quickly perform minor surgery to create a fistula — a vein strengthened to make it more tolerant of repeated puncturing by a catheter — so the fistula is in place and fully healed before the patient is in dire need of dialysis.
"That should thereby reduce the catheterization rate and … have a beneficial impact on kidney patients in the territory," he said.
To speed up the hospital's response times for some emergency surgeries, Griffith is talking with Emergency Medical Services personnel to arrange for them to transmit electrocardiogram (EKG) data from the ambulance to the hospital while en route.
"They have the equipment, but must take care of a few things first," he said. "They will be able to transmit to the hospital, but also to our cell-phones."
If he receives a graphic image of the data on his phone while out driving or on the golf course, he gets a chance to begin preparing right away, he said.
"I see it before I get in and we activate the team right away, so we shorten that time between first notice and beginning surgery," he said.
The hospital has already implemented a simpler time saving mechanism, having a single short phone code that pages every single person on the cardiac response team in one go.
"Press 9999 and everyone comes in," he said. "Those are a few examples. We are trying to find every little way to reduce that time."
Present at the meeting were board members Rivera, Valdemar Hill Jr., Kye Walker, Joyce Heyliger, Wallace Phaire (by phone) Chief Operating Officer Darice Plaskett, acting Medical Director Robert Centeno, Chief Financial Officer Rosalie Javois, Nursing Administrator Wendy O'Brien and Gregory Calliste, the hospital's chief executive officer. Board members Imelda Dizon and Dr. Michele Berkley were absent.
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