Revenue: The NMI is broke!

CHC is now on life support, financially. “There’s no money anywhere that could be earmarked to support operations under a new management or health corporation,” a source said. “The intent to leave it under new management team was fine until it was left on its own with $5 million in initial funds to commence operation.” CHC used to receive about $27 million in annual budget until last fiscal year when it was severed from the regular NMI budget.

The new CEO ponders where to begin with zero funding. He could grab his briefcase and leave without ever coming back, cut hospital operations by half that includes firing over 100 ancillary and professional staff deemed excess baggage, slash boilerplate expenses that have been entrenched in the system for the last 30 years. The latter doesn’t add value to improving healthcare delivery but benefits solely the recipients.

Doctors who aren’t regular surgeons at CHC performed some 33 percent of total surgeries in 2011. CHC general surgeons performed about 48.56 percent of surgeries the same year. OB/GYN surgeons performed some 18.21 percent of total surgeries. Statistics compiled on the performance of two surgeons hired by CHC show they’ve underperformed against the national norm of eight surgeries per day. “And they’re complaining of being overworked and are pushing for a third surgeon,” the source related.

With underperformance, these doctors won’t have it easy. “Any other private hospital in the U.S. mainland and these guys would have been booted out for underperforming.”

Interesting too how free use of CHC by private physicians (from eight clinics) was permitted with nothing accruing (revenue-wise) to the local hospital. For instance, let’s say that you’re pregnant and you agreed that Dr. X from a private clinic handles your pregnancy through delivery. When that day arrives, your doctor provides care for the delivery of your baby. He charges you fees for such service, all of which goes to his account, none for CHC, though he used the facility, nurse’s assistance, medicine, and supplies for this purpose. It’s called freebies to which funds went in only one direction or the doctor’s bank account.

There are local doctors who were retained for lack of doctors for a hefty fee. They come in and mingle with patients, look at their time then quietly leave for their own clinics. It’s almost a bonus for mingling (without much medical work done) to the tune of over $100K per year. This entrenched practice too must stop forthwith. It doesn’t add value to the quality of healthcare other than drain the hospital of direly needed funds. It’s the equivalent of a nice bonus no one in planet Marianas receives!

Then there’s the discovery of CHC doctors moonlighting in private clinics. This must be probed for it may run contrary to the Physicians Inducement Kickback Regulation (PEKR) prohibiting doctors from moonlighting. I mean, it’s either CHC or the private clinic; you can’t have it both ways. Your contract, paid for by local funds, simply requires your service at CHC, not moonlighting in private clinics. This scheme must be investigated and prosecuted to end it with finality. “These are highly paid doctors who are receiving housing and repatriation benefits, a practice entrenched in the system that must change,” the source said. It’s nothing short of greed that must cease forthwith!

Do I sense that these guys have no sense of their obligations here? I’d like to meet them if only to explore if they’ve invested in expensive yachts or other leisurely boats for pleasure. I’m not going to deny you your day in the sun, but where underperformance is at issue, perhaps some sense of commitment may be in order where you take your clientele and financial condition of the CNMI to heart. You’re not exempted from fulfilling medical fiduciary responsibilities and it’s good to forward your name to the American Medical Association for censure in the event you’ve violated PEKR.

I’ve also discovered that tiny glass containers where nurses or doctors draw liquid medicine (used by private clinics) are incinerated at CHC, packed, crated and shipped off island—all at the hospital’s expense. It may not be much, but one shipment after another for an entire year could add up to a sizeable bundle for use at the local hospital. This freebie too must end forthwith. The constellation of entrenched wasteful and costly spending must cease to exist and efforts focused on funneling as much money to the coffers of the local hospital to pay for its operations.

It’s unfortunate too that there are dialysis patients who receive thrice a week treatment to cleanse their blood from toxins. The only problem is they have no health insurance or out of pocket income. To dialyze a patient costs about $6,000 per month. It pans out to $72,000 per patient per year. Now, let’s say the dialysis center has 20 patients drawing freebies from dialysis. The annual freebie is about $1.44 million per year. So what’s at issue? Does CHC continue shouldering free provision of a costly service?

To make matters worse, it is rumored that CHC can’t refuse healthcare service per federal law. We’d like to know where’s that federal law and what it specifically says on providing freebies. If one exists, did that law point to some agency in the federal government legally assigned to pay for free healthcare around the country and territories? It’s costing taxpayers here over a million dollars a year. This too must be addressed realistically. You may get free breakfast but never free lunch!

The only alternative left on the table is for the corporation to use its assets to borrow the initial funds it needs to get its feet wet. MPLT would be a good venue for this purpose or CDA. The former must not fear loaning in that its coverage is the health and wellbeing of the entire CNMI. The sad fact is: This government is literally broke in every corner. Even if reduction-in-force is implemented cutting the bloated payroll by half, it won’t collect sufficient funds to scaffold one of three essential departments of the CNMI. CHC is one of three essential departments!

No matter how you splice it, the financial debacle of CHC doesn’t absolve the local government from meeting its obligation regardless that CHC is now on its own. It should have stayed the course for at least five years until the health corporation is steady and sturdy in its financial posture.