CHC decertification could cost millions of dollars

If decertified by the Centers for Medicare and Medicaid Services, the Commonwealth Health Center stands to lose millions of dollars it acutely needs to run the islands’ sole public hospital, according to Commonwealth Healthcare Corp. chief executive officer Esther Muña.

CMS recently decertified the only public hospital in the U.S Virgin Islands, Gov. Juan F. Luis Hospital and Medicare Center. If you think CMS won’t decertify a lone hospital, JFL is just one example.

“If the hospital gets decertified, CMS will no longer be a funding source for the hospital and we will not get reimbursed for providing services to clients,” Muña told Saipan Tribune.

It doesn’t mean, though, that the hospital would have to close but CHC would have to rely solely on local government funding.

CMS isn’t just a funding source. Muña said it also acts as a regulatory agency, ensuring that standards of care are met. CHC must comply with CMS conditions in ensuring that quality care is provided to clients.

“Since CHC was threatened with termination, we made a commitment to raise the bar and do our very best to meet those standards. It is definitely not easy when funding—other than funding from CMS—is an issue,” she said.

CMS reimburses CHC for providing services to their clients and don’t reimburse for self-pay and for those that can’t afford to pay.

“Yet we are in a business that must still treat the patients even if they are unable to pay. So if CHC gets decertified, it would even be more difficult to meet those standards and there is a high risk that the quality of care will go down. It would certainly be unfair to our island community since they deserve better,” Muña said.

A three-person survey team visited on Sept. 8 after CHCC received approval of its corrective action plans in late August. They looked at medical records, medical staff files, and several areas of the hospital that included the pharmacy, laboratory, and operating room. The team left on Sept. 12.

Muña said they are committed to addressing all the problems and meeting the standards of care set by CMS.

“[Based on] the verbal comments received by our staff during the latest survey, we know they see the tremendous progress we’ve made so far and that is definitely encouraging,” Muña said.

She noted that the hospital management and staff are much better off than back in 2011 when the survey showed numerous problems that threatened patient care.

Muña assured that they are not in a similar situation as JFL in the U.S. Virgin Islands because CHC is determined not to let it.

“When CMS tells us what we are doing wrong, leadership has a responsibility to make sure to correct that and ensure it doesn’t happen again,” she said.

Two major improvements so far at CHC are effective quality and performance improvement and an effective infection control program.

CHC is still awaiting the CMS decision on its recertification.

“I want to assure the CNMI community that we will do our very best to avoid getting decertified. This is our only hospital and we need to support it. We should support it. Even if we’re not your primary provider, we are the only emergency room and inpatient provider in the CNMI. We all need CHC to be the best it can be because we deserve the best,” Muña said.