After going over staffing and policies Wednesday, the Territorial Hospital Board exhausted a discussion of a major vendor contract that could mean financial relief for Gov. Juan F. Luis Hospital but at a steep cost.
The board encountered a major hump with JFL Hospital’s proposed “revenue cycle optimization project,” which would utilize Advisory Board, the same company used by Schneider Regional Medical Center to streamline its revenue cycle.
“We are giving an outside entity the opportunity to help us increase our revenue stream,” explained JFL Chief Executive Officer Kendall Griffith. “In the meantime, the ones we have there right now would be shadowing those people. They would be doing it, but our people would be learning onsite.”
The St. Croix hospital could get up to $6 million in returns, or an additional $62,000 in monthly invoices, if Advisory Board successfully sorts out its revenue cycle, which it most likely will, said Schneider CEO Bernard Wheatley.
The board balked at the contract cost, however: $250,000 in initial payments for the first four months and $1.27 million in total for a full year of service.
Concern rose when Fred Vitello, Schneider’s chief financial officer, mentioned that Advisory Board’s services to Schneider, with similar scope and anticipated returns, were capped at $300,000 for eight months. The JFL contract with Advisory Board seemed exorbitant in comparison.
Board Chairwoman Lynn Millin-Maduro said she was concerned that the hospital might have difficulty paying Advisory Board, considering its already “huge outstanding balance to external consultants,” but JFL officials say that the scope of the services are somewhat different.
Anthony Ricketts, acting chairman of the St. Croix district board, pointed out that JFL Hospital’s situation might differ from Schneider’s in degree.
“For practical purposes, our starting line might be further behind than your starting line, so to get to the same place that you need to get to, we need a little bit more,” Ricketts explained. “I’m not saying that’s the case, and I’m also not saying that the numbers that they are giving us are the right numbers, but I’m open to discussion as to the specifics of this whole contract.”
Millin-Maduro, however, stated outright that she does not think the board should approve a one-year agreement with Advisory Board, suggesting that JFL pursue the four-month contract, then consider the one-year option based on results seen in the first four months.
“You can’t ask somebody to come in and commit resources and bring their folks in for a four-month, $250,000 project,” protested Nellon Bowry, CFO at the St. Croix hospital.
Vitello suggested having an offline discussion with JFL officials regarding the contract, an earlier suggestion by the board that the hospitals failed to do, but Griffith expressed concern.
“I understand we need to have an offline discussion but I don’t want us to leave today without a signed contract,” said Griffith.
However, almost four hours into the meeting, the board lost its quorum with only six members remaining, and no official decision could be made.
Patient Responsibility
With revenue cycles a focus of improvement efforts for both Schneider and JFL hospitals, the discussion turned to patient responsibility when it comes to paying owed amounts to the hospitals.
One major trend among patients, according to Williams, is nondisclosure of insurance information in hopes of avoiding either copays or insurance deductibles. Ricketts added that it might also be due to the erroneous assumption on the part of patients that if they do not reveal their insurance information and just sign a payment plan agreement, they would not necessarily have to pay, at the expense of a negative blow to their credit histories.
“There is definitely learned behavior and people keep learning how to beat the system,” said Ricketts.
Wheatley added that government employees add to this burden, with some $2 million in outstanding balances to Schneider belonging to government employees who have been billed but have not paid.
Millin-Maduro suggested that the hospitals use their legal muscle, making use of the courts’ small claims process and knowledge of such employees’ workplaces to collect the owed amounts.
“Eventually what you want to do is change behavior,” said Williams. “Change that behavior and send a message that, first, it’s not right, and secondly, you’re not getting away with it.”
‘Disruptive Medical Staff’
Earlier in the meeting, all board members present, except Finance Commissioner Angel Dawson, who abstained, approved an array of policies and procedures for different departments at JFL, but not without comment from Wilbur Callender, who questioned the need for a policy dealing with disruptive staff members.
“In the physician arena, there will always be disagreements among physicians,” said Callender, himself a physician, “but it just seems as though you must have a pervasive problem at an institution for disruptive physicians to have such a policy.”
But according to Ricketts, the policy for disruptive physicians has always been in place. Out of the 60 physicians at Schneider, Ricketts said, there may have been one or two who needed addressing in the areas of anger manager and conflict resolution.
“Collectively you’ll realize there just needs to be some guidelines for physicians who need guidance on how to conduct themselves,” said Ricketts.
The board scheduled to meet in about two weeks’ time, but a brief special meeting might be held to consider the Advisory Board matter before the next board meeting.
Present in the St. Thomas board room were Millin-Maduro, members Miles Stair, Joyce Heyliger, Callender, Debra Gottlieb, Williams and Ricketts, while Dawson attended via telephone. Members Maria Tankenson-Hodge and Greta Hart-Hyndman were absent.
In other action, the board:
– approved JFL’s Revised Medical Staff Policy, PICC Line Assessment and Documentation Policy, Anesthesiology Department Procedure Manual, Revised Laboratory Policy, Emergency Department Policy and Procedure Manual, Ambulatory Care/Fast Track Policies and Procedures, and Health Information Management Services Policy. All members present voted yes, except for Dawson, who abstained.
– and approved initial appointments to JFL medical staff for Dr. Lorenz Spengler and Dr. Learie Lindsay.
