The governing board of the Gov. Juan F. Luis Hospital on Wednesday was given an update on finances and progress towards reaching compliance with the Centers for Medicare and Medicaid Services during a critical audit expected in August.
“Substantial progress has been made in addressing the previous CMS citations,” Dr. Kendall Griffith, chief executive officer, said in his report read by Chief Operating Officer Ken Okolo at the board meeting. “The hospital is on track with improvement initiatives and continues to monitor these areas for sustained compliance.”
CMS threatened to withdraw reimbursing the hospital for Medicare and Medicaid insured patients after finding a long list of discrepancies at the medical center last year. JFL was given nine months to take corrective action to avoid losing millions of dollars.
The purpose of the hospital’s CMS approved systems improvement agreement is to address root causes of the medical center’s quality, safety and compliance “challenges,” according to Griffith. Okolo and Griffith are chiefly responsible for monitoring the improvement agreement’s progress.
Griffith outlined three areas that have received administrative attention: oversight, process and documentation design, and events management. Oversight improvement involves developing and implementing processes for electronic agenda planning and management, electronic presentation management and assignment follow-up using tracking lists.
Three hospital administrators comprise the process and documentation design team and will ensure JFL policies and processes are managed and organized from inception to implementation and finally audited for sustainability, according to Griffith. They will work to simplify clinical process and documentation and arrange staff education.
Another committee will manage review and revision of hospital policies such as bedside education. Clinical policies with impact on patient care have already been revised to meet regulatory compliance, Griffith reported.
The third project is managing adverse events. Griffith said the executive team meets daily to address adverse events and situations as well as take action to control the root cause of such issues.
The hospital also is addressing infrastructure deficiencies. An operating room suite and the labor and delivery unit are being renovated and plans are under way for revamping the inpatient behavioral unit.
CMS also cited the chronic understaffing at the hospital. Griffith reported that 55 new employees have been hired for nursing, clinical support, security, administration and environmental areas. Additional staff should be on board in the next two months, he said.
The board approved the appointment of three physicians and two registered nurses. However, the resignation of two physicians was also announced.
Dr. Ramesh Lakhram, president of the medical staff, said an anesthesiologist is needed as soon as possible to replace the one who is leaving.
Philip Arcidi, board treasurer, and Tim Lessing, chief financial officer, told the board $4.8 million in net patient revenue was an increase of $3.5 million over May 2014. Year to date is almost 21 percent higher at $35.3 million.
On the other hand, the loss for May, after expenses, was $1.1 million and $5.6 million year to date. The loss was $4.4 million for 2014 – a difference of 26 percent. The Senate has provided $2.3 million of $7 million requested by the hospital to meet CMS requirements. Operating expenses are 160 percent of earnings this year compared to 175 percent last year, he said.
Lessing added that June books were closed out and $4.4 million was collected for “another stellar month.”
JFL is making its current contributions to the Government Employees Retirement System, Arcidi said, but owes for previous years. He said the finance department is working on the 2016 budget to be presented to the Legislature in August. First it will be reviewed and approved by the board, he added.
Other reports included news that a recent power outage was handled by the one working generator and parts for the other back up have been received. (During an islandwide outage in April, the hospital lost power for several hours when neither generator worked properly.)
The air conditioning has been “fixed temporarily” after failing two weeks ago leaving the emergency room and finance office, among other areas, without cooling air. The problem occurred because the system is old, Okolo said.
Board members present Wednesday were Arcidi (by telephone), Dr. Anthony Ricketts, chairman, Joyce Heyliger, Troy de Chabert Schuster and Kimberly Jones. Griffith was absent.
One area of CMS concern was governance and the lack of a board quorum. Currently there are five members of the nine-member board. Jones said Gov. Kenneth Mapp has submitted names to the 31st Legislature of possible members but Ricketts said no word has been received on nominees.