‘Touchback exacerbates CHCC workforce shortage’

As with many other entities in the CNMI, the workforce shortage at the Commonwealth Healthcare Corp. is expected to be further exacerbated by the “touchback” rule, according to CHCC chief executive officer Esther Muña on Wednesday.

Speaking before the Senate Fiscal Affairs Committee’s Fiscal Year 2024 budget hearing for CHCC, Muña discussed workforce and financing for health in the CNMI, which she cited as their top priorities as the committee considers the budget for the hospital and health system.

In response to committee chair Sen. Donald M. Manglona’s (Ind-Rota) questions on challenges with the touchback provision, Muña said they have personnel in the laboratory , as well as radiology and in nursing that have “touch back.”

Touchback refers to the requirement for foreign workers to leave the CNMI before their work visas could be renewed for a third consecutive time. That departure requirement also means they will have to stay away until a new permit is approved, which could take months.

Muña disclosed there are a couple of employees that are leaving in September 2023 and some in December 2023, May 2024, December 2024, and all the way to December 2025. She said the total number of employees affected in 2023 is 12; in 2024, it’s 22; and in 2025, it’s 25.

Even for the Northern Marianas College nursing graduates, there is always a push for them to pass their National Council Licensure Examination as soon as possible. “So we do have the graduate nursing program that exists. [But] without the NCLEX, they [only] have one year to work for CHCC,” Muña said.

She said they actually provide a bonus for those who take the graduate nursing program. Muña said they encourage them to work at least for the graduate nurse program and also provide them assistance for studying and administrative leave, and even pay for their tests if they request as well.

Esther Muña and Donald M. Manglona

“We’re trying as much as we can to try to have them work especially to fill the gaps of the touchback,” she said.

The CEO said they did hire less than a handful as some of them are pursuing their NCLEX.

In fact, one of the staff that works for CHCC as a graduate nurse actually recently passed the NCLEX and is going to be promoted to a registered nurse, Muña said.

She said the Commonwealth Health Center, which is the CNMI’s only hospital, is not immune to the crisis of staff burnout and staff shortages.

Muña said CHCC healthcare workers at were working 2.5 times longer during the COVID-19 pandemic response to meet the demands of the community, at a wage that was 3.5 times lower than their counterparts among travel nurses.

“It was, therefore, necessary to make an unprecedented investment in our workforce as recruitment and retention continue to concern us to this day,” Muña said.

She said adequate patient care staffing is required to comply with the Centers for Medicare and Medicaid Services’ conditions of participation, which hospitals like CHC must obtain to get paid by Medicare and Medicaid.

As a reminder, Muna said, CHCC continuously provides services to the uninsured and deals with several financial gaps as a safety net healthcare provider.

She said the Legislature has the power to help them with these gaps by providing CHCC with funding for the CNMI government’s responsibility to match the cost of providing care for Medicaid patients, and funding for the medical referral program.

“We are aggressively working with patient assistance programs to provide access to critical medications for our patients treated at the hospital and beyond,” Muña said.

The CEO said creating a hospital foundation, which is in development, will have a board’s governance soon.

However, it is not enough, Muña said, and they need the CNMI government’s funding support.

She said receiving cost reimbursement from Medicare and Medicaid is never adequate for any healthcare provider, and is certainly inadequate for the largest provider in the CNMI.

The CEO said that, with cutbacks and funding shortfalls in the Medicaid program, CHCC is experiencing nonpayment and underpayment for the cost of services provided to Medicaid patients in fiscal year 2023.

That is a $12-million shortfall before the end of fiscal year 2023, she said, and that it is why CHCC cannot take the additional financial burden of the cost of the Health Network Program, the government’s medical referral program.

Muña said there are many more priorities that are considered in the fiscal year 2024 budget, and these are from behavioral and mental health issues that are plaguing the community, to lead poisoning, and the lack of policies that encourage healthy behaviors and lifestyles.

“We understand the financial situation of the CNMI government. But please help us ensure that every resident in the CNMI has equitable access to healthcare and in an environment that helps them achieve that,” Muna told the committee.

CHCC chief financial officer Perlita Santos said they are requesting $9.6 million for the Health Network Program operations excluding payroll; $1.5 million for subsidy for operation; $4.5 million for capital expenditure; and for the government to fund a local match for Medicaid of $7.1 million.

“The total ask for CHCC then is $13 million and for HNP, $9.6 million,” Santos said.

Gov. Arnold I. Palacios had proposed a $1 budget for CHCC subsidy and HNP.

Muña said their budget proposal builds on the organization’s success over the last 13 years since CHCC became a semi-autonomous agency with the intent to align with what the Legislature and Gov. Arnold I. Palacios want for the health of CNMI residents.

“This budget provides a strong and resilient health system that will serve our people—an available workforce, affordable treatments and services, and access to healthcare needs for all,” Muña said.