The recent application for an ambulatory service center on St. Thomas has caused quite a stir. The physicians claim that the center will add to the betterment of healthcare in the V.I. Roy Lester Schneider Hospital officials claim that a center of this sort will drain existing revenues from the government-owned hospital. A St. Thomas hospital official has claimed that 30% of hospital revenues are generated by these same day surgeries. The Commissioner of Health has 60 days to determine if a certificate of need will be issued for the center.
This is where the rubber meets the road. Is there a need?
It is no secret that the islands' airports are populated by insured patients seeking flights to Puerto Rico and the states in search of medical attention. If this is the client base that the center is attempting to capture, then the physicians should be encouraged. This will keep the insurance revenues recycling into the local economy and in turn generate must needed tax revenues for the government. A qualified, representative survey outlining the anticipated revenue capture would be the best evidence for a certificate of need to be granted.
I am a bit concerned relative to reaction of RLS officials. How will a new ambulatory center immediately impact the hospitals revenues? The hospital patients would be attended to by the same physicians that would be servicing the center. Why would the hospital not be able to provide the same level of care, or better than that is provided by a private center? It is a bewilderment that RLS officials believe that the new center will be the first choice for on-island, same day procedures.
The only cause for the immediate reaction of revenue loss would be due to physician referrals to the new center, as opposed to the hospital. This act of "self-dealing" can be countermanded by adjustment to the individual physician's six-figure, government-paid salary, their license to practice and their hospital privileges. This seems to be an easy solution.
The other item adding to the debate is that of the certificate of need being determined by the Commissioner of Health. This is probably a grandfathered procedure carried over from the time when hospitals and health were operated as one unit. The hospitals have since been separated and are governed by a territorial board and individual island boards, in a semi-autonomous fashion. The Commissioner of Health has continued to maintain authority over the territorial Health Department. An independent commission with participating members that do not have a vested interest in the outcome should be charged with determining the need for the ambulatory center and future proposed enterprises of this nature.
The outcome of the process will involve an interesting debate that will impact the future of V.I. healthcare for many years to come.
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