Finances and plans for improvements dominated the agenda of the Juan F. Luis Hospital board Wednesday night, with board members voting to increase rates to keep up with inflation.
Dr. Kendall Griffith, chief executive officer, said the hospital has received no correspondence from the Legislature about a funding date, nor have they received any portion of the $10.3 million requested to implement the System Improvement Agreement the hospital entered into to keep its Medicare and Medicaid revenues.
“It’s imperative for the hospital. Dr. Griffith needs the funding requested. It is imperative. If he doesn’t have the funding he requested, we won’t be successful,” said board member Philip Arcidi, chairman of the hospital’s finance committee.
According to JFL’s October financial report, revenue decreased to $3.8 million, and accounts receivable increased nine percent, Arcidi said.
On the other hand, expenses decreased 11 percent for October, he continued. Salary and benefits were up 31 percent but contract service for traveling nurses and medical supplies were down.
Michael Younger, interim chief financial officer, said the hospital collected less money in October but has been bringing in around $4 million a month. At the same time, they are saving on expenses by correcting deficiencies and optimizing systems, he said.
After a short discussion, the board voted to increase rates 3.5 percent – the rate of inflation in the territory, according to Arcidi. Board members asked about various discounts and payment plans that will stay in place. The increase does not include Medicare and Medicaid patients.
“We want to assist everybody who comes to the hospital,” Arcidi said.
To increase revenue, Arcidi said the finance committee is compiling numbers for CMS in hopes they will increase reimbursements by $8 million year. CMS is using a 1996 rate for services and the board hopes to convince them to use 2012 rates.
“We need Medicare to pay their fair share here,” Arcidi said. “We’re losing 25 cents on each dollar.”
After getting an update on the Systems Improvement Agreement signed by the U.S. Center for Medicare and Medicaid Services – known as CMS – on Nov. 19, extending the hospital’s certification for participating in the federal health program, the board discussed improvements at the hospital, including hiring administrators.
CMS notified JFL in September of its intent to decertify the hospital – jeopardizing an important funding source. The federal agency cited a number of “deficiencies” including harm to patients, poorly maintained medical records and lack of governance.
After meeting with CMS in October, JFL was able to squeeze out an extension, with Nov. 20 as the deadline for having an approved Systems Improvement Agreement. Since the SIA was accepted, the hospital now has nine months to implement the plan and pass CMS inspection.
Griffith said he expects JFL to be inspected by CMS between July and September, 2015. In the meantime, a third party consultant, Greeley, has been selected to help JFL regain compliance. Griffith said a final agreement to contract Greeley is being written.
The Ropes and Gray legal firm, hired to help craft the SIA, will continue “very minimal” assistance with communications between the federal agency and the hospital after Greeley arrives on-site, according to Griffith.
It was not clear if the $1.6 million JFL wants to set aside will be adequate to pay both entities.
Attending the meeting was Dr. Ken Okolo, the final candidate for the chief operating officer position at JFL. He commented that he would support Griffith and help turn JFL into a “premier institution.” Griffith asked him what he thought after hearing the hospital’s October Quality Assurance Performance Improvement.
“I don’t feel happy about it at all, especially the emergency department. When the volume (of patients) goes down, why does the wait time go up?” he commented.
Hazel Thomas, JFL regulatory chief, presented the QAPI report and said there was “a lot of opportunity for improvement in the ER,” as well as in other areas. Infection control, patient flow, door-to-door time, use of restraints and medication errors need work, she said. On the plus side, the so-called fall rate improved in October.
Justa Encarnacion, chief nursing officer, said a new supervisor has been hired for the emergency room and a director is in place, so changes should be visible in “a couple of months.” Fast tracking patients through the ER will be accomplished when patients can be moved from triage to a treatment room instead of sending them back to the waiting room.
A surveyor has also been hired, according to Encarnacion, who regularly visits each department and suggests improvements and changes. Several unit secretaries were hired and more are needed as well as a medical assistant. Medical surgery nurses are badly needed, she added.
According to Griffith, other staff additions include a chief financial officer, legal counsel and a strategic planner, who have been chosen. Asked what the priority positions are, he said the hospital needs surgery, internal medicine and critical care physicians.
Dr. Mavis Mathew, chief medical officer, added that specialists in pediatrics and obstetrics and gynecology are also being sought.
“By January, we will have a very strong team. We will prove it to ourselves and we will prove it to CMS,” Griffith said.
