Governor: NMI Healthcare In Need Of ‘Complete Overhaul’

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Assessment calls for service improvement, ‘turnaround’ team

By Moneth Deposa

SAIPAN, CNMI (Saipan Tribune, Oct. 17, 2012) – A comprehensive assessment on the status of the Commonwealth Health Center (CHC) has confirmed that the Commonwealth of the Northern Mariana Islands’ (CNMI) healthcare system is extremely inefficient and needs a complete overhaul in how it operates.

"The study indicates that the current structure of healthcare in the Commonwealth presents immediate threats to public safety, is extremely inefficient, and requires a complete change in method of operation. Due to the seriousness of these issues, we need to quickly develop a new model in which quality of essential health care is improved and delivered in an efficient manner," said Gov. Benigno R. Fitial yesterday.

The study was conducted by HealthTech, which was commissioned by the Office of the Governor using a grant from the Office of Insular Affairs to do a top-to-bottom assessment of the public hospital. The objective was to determine the true condition of CHC and how it could improve its services. The analysis examined 42 different areas of hospital operations.

Among the recommendations that need to be accomplished within 30 days are the issuance of a proposal to hire a "turnaround management team" to quickly stabilize hospital operations and begin implementing the recommendations.

This turnaround management team will push for the temporary hiring of a team of experienced professionals for just six months to provide services as chief executive officer, chief nursing officer, chief financial officer, and business office manager.

Currently, the corporation's management team is mostly made up of department heads formed early this year and directly reporting to CEO Juan N. Babauta.

Calls made to Babauta yesterday yielded no response.

Corporation board chair Joaquin Torres told Saipan Tribune that he needs to first read and review the report.

This early, however, Torres is concerned about where to get the money to hire a professional management team for the hospital. He said he needs to see the rationale behind each recommendation.

HealthTech also recommended other actions to be taken within 30 days.

This includes implementing a plan of correction based on U.S. Department of Health and Human Services inspection; hiring a utilization review nurse; meeting and building consensus with employees and physicians regarding problems and suggested improvements; collecting unpaid Medicaid claims; improving collection from insurance carriers; developing a staffing and productivity improvement program; resolving billing backlogs; requesting for emergency funding to ensure enough resources; meeting with vendors to resolve delinquent accounts and continue critical supplies; immediately collecting patient information data; reconciling cash; developing balance sheets; preparing financial statements; and identifying critical supplies.

HealthTech also recommends expanding some services such as imaging, gastrointestinal procedures, laboratory, physical therapy services, oncology, and urology to reduce reliance on off-island services and increase revenue, among others.

The report provides a summary of recommendations for each department, ranging from minor improvements such as daily posting of expenses and revenues to outsourcing of accounts receivable services.

Some of these specific recommendations include eliminating or combining staff in six areas; using government procurement agencies to reduce costs; reducing overtime; increasing the number of dialysis technicians; separating public health functions from hospital services; and reducing medical referrals by expanding on-island services.

'We need to work together'

Fitial pledged yesterday to quickly resolve the crisis at the hospital and emphasized the need for all stakeholders to work together.

Fitial and Lt. Gov. Eloy S. Inos shared the report during a leadership meeting attended only by a handful of lawmakers.

The governor expressed disappointment at the absence of several lawmakers at the meeting.

"It's truly disturbing that these lawmakers continue to put politics before the interests of the people of the Commonwealth. They know that we have so much issues that warrant not just our attention, but our collaboration as elected leaders. Their absence and refusal to work together is truly an embarrassment and an insult to our people," said Fitial.

Fitial also wrote the Legislature yesterday, citing the critical need to resolve the crisis at the hospital.

"This review indicates that there are significant shortcomings in our healthcare system, and that immediate changes are required in order to meet the needs of our community. The report indicates that the problems are widespread throughout all sectors of our healthcare system. These problems are longstanding and are not reflective of the inadequacies of the current management team, but rather the ineffectiveness of the model we have been using for delivery of healthcare," he said.

In the coming weeks, the Fitial administration will be meeting with legislative leaders and the community to identify the most effective way to improve medical services and how to immediately implement the changes recommended.

Inos said the report indicates inadequacies in the current business model and the need for change.

"We need to provide quality care to the people of the Commonwealth, but it must be done in a manner that recognizes our financial limitations. However, recent problems with the healthcare system indicate that we need to move forward quickly on this issue. Because of the high cost of medical services, this will require the development of a creative approach and cooperation of all sectors of the community. The business model that seems to be most appropriate for our needs seems to be a combination of private and public partnership that can lower costs while still providing quality medical care," he said.

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