St. Thomas–St. John Hospital District Board members learned Wednesday evening during its monthly meeting that relocating its hemodialysis unit off-site won’t solve the unit’s financial woes. The board considered this and other issues facing Schneider Regional Medical Center at its monthly meeting.
The 15-chair hemodialysis unit is losing 40 percent of what it brings in every month, approximately $1 million per year, according to financial reports; and the board had directed staff to explore the advantages of moving the unit off-site to see if any savings could be realized.
The answer was a resounding no.
Moving the unit, which is the only one available to patients on St. Thomas and St. John, will increase costs rather than reduce them, according to Harold Wallace, SRMC’s vice president of ambulatory care, who prepared the report.
The unit costs SRMC in the neighborhood of $200,000 per month, but the hospital only recoups about $120,000 per month. Serving a population that depends largely on Medicare and Medicaid to cover its medical expenses, the unit is able to recoup only around 20 cents on the dollar for Medicare patients and around 22 cents for Medicaid patients.
Medicare and Medicaid recipients make up 81 percent of the unit’s patient mix, and less than 12 percent of patients carry private insurance.
If the center were serving privately insured patients, it could be profitable, according to Stephen Brady, SRMC’s interim finance director, who assisted in the report’s preparation.
In addition, need for dialysis is forecast to expand by 10 percent a year, Brady said. The unit’s 15 chairs are almost completely scheduled, serving around 70 local patients, according to Blondell Williams, SRMC’s director of nursing. She noted that vacationing dialysis patients may also schedule treatments.
Dialysis patients come three days per week, with a day in between. The hospital offers treatments Monday through Saturday, in three shifts according to a report by SRMC Chief Executive Officer Alice Taylor.
Taylor’s report forecasts reaching capacity within three years.
To mitigate the shortfall, Taylor’s report to the board recommended establishing a regional group purchasing with hospitals on St. Croix and Tortola, reevaluating current vendor agreements, reviewing staffing patterns and researching outsourcing options.
Taylor’s report also addressed the issue of boarder patients. These patients are not necessarily in need of hospital care, but without a rehabilitation or nursing home to go to, remain at the hospital.
Reimbursement is often a problem for these patients, with Medicare and Medicaid stay limits preventing funding from these sources.
In order to provide long-term stay services, the hospital would have to alter its current operation.
“I’d have to do some research to see what we can do under our license,” Taylor said in response to questions about altering the facility mission to accommodate rehabilitation or nursing home patients.
The board also learned that the hospital’s operating revenue for the period ending April 30 was $5.5 million, and expenses at $8.9 million.
Last month, SRMC experienced the highest reimbursement level last month of $6.7 million, before it plummeted to $3.4 million for the period ending April 30.
SRMC Interim Chief Financial Officer Eugene Welsh attributed the rise and subsequent fall to an accounting scramble to settle claims before the acquisition of Blue Cross Blue Shield by Triple S, and noted a variance of $650,000 in payments for services rendered by visiting medical professionals.
The hospital still paid more than $500,000 in salaries and wages and $3.6 million for goods and services.
One of the largest issues in funding that the hospital faces is a disparity with the mainland in reimbursement from Medicare and Medicaid. SRMC has joined with Gov. Juan F. Luis Hospital’s board to coordinate efforts for Medicare and Medicaid appeals under the auspices of the territorial hospital board. Addressing the continued funding shortages, SRMC’s board approved an increase in the mandate of a committee to set up and authorize a fundraising entity. The committee will develop a vision, fundraising targets, bylaws, as well as strategies to serve the funding needs of SRMC.
Staffing also remains a difficulty for the hospital, which depends on the services of visiting nurses and fill-in nurses to meet care needs.
With nursing vacancies in several departments, recruitment is proving a challenge. A recent breakfast for UVI graduating nurses was poorly attended.
Board chairman Cornel Williams questioned what the hospital is doing to follow up with students from local high schools to come back and work at the medical center.
“We should have some kind of program,” Cornel Williams said. “We have to be extremely proactive.”
Williams encouraged staff to maintain contact with these local students throughout their college careers to increase chances of employing them within SRMC.
Board member Aldria Wade was not present for the meeting.
