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Schneider Hospital Seeking Financial Health

Schneider Regional Medical Center CEO Tina Comissiong said the hospital was working to address more than $24 million in uncompensated care provided in 2023. (Photo by Bernard Matthew, Sr., Eustace Brown and Barry Leerdam, Legislature of the Virgin Islands)

The health of Virgin Islanders depends in part on the financial health of its hospitals, officials said at a meeting of the Budget, Appropriations, and Finance Committee Wednesday.

Leaders of Schneider Regional Medical Center, in particular, said they were “doubled down” on efforts to collect revenues by investing in training its personnel.

CEO Tina Comissiong said the institution was dedicating new resources to bill collection and bolstering its existing efforts.

“We have implemented an online bill payment option and are now sending bill notifications and reminders via text messages,” Comissiong told senators. “We have to collect more and cut our expenses.”

The hospital is also expanding services, adding a psychiatrist, interventional cardiologist, dermatologist and gastroenterologist this year.

“We must optimize patient volumes, improve the payor mix, and introduce new, profitable service lines to generate new revenue for SRMC,” she said. “We have invested in expanding service options that our community has a demonstrated need for.”

For 2024, the hospital will only be able to generate $72.3 million of its planned $105.7 million operating budget. She said the St. Thomas hospital is working to reduce the remaining $33 million by increasing revenue collection.

Comissiong estimated the Schneider Regional Medical Center would lose more than $24 million in “uncompensated care” — services provided for which payment will never be collected despite the hospital’s best efforts.

More than $5 million of that uncompensated amount comes from 10 long-term boarders parked at the hospital. These are people who cannot be safely discharged due to their frailty but also have no means of paying for their services. The hospital is not designed to provide this long-term care, she said, so these patients take up beds meant for acutely ill people, who are then pushed back to the emergency room.

“Our unsafe discharges/boarders continue to be a drain on our resources costing the hospital millions of dollars per year. Moreover, these patients occupy rooms on the inpatient units that are needed for the acutely ill which contributes to extended stays in the ER for acute patients due to the inability to move admitted patients to an open bed on the inpatient units,” Comissiong said. “Because the agencies charged with caring for these individuals cannot place these patients, this body might consider re-appropriating the funding that is given to these other agencies for long-term care to the hospital as compensation for the care we already provide.”

The emergency room itself is a major source of uncompensated care, she said. With relatively few people visiting the emergency room having health insurance, collecting can be near impossible.

“We are required to provide services to anyone who walks through our doors,” she said. “Self-pay accounts are a challenge to collect on.”

In 2022, the hospital was only able to collect on seven percent of the more than $17.3 million owed by people without insurance. So far in 2023, the self-pay patients have racked up more than $14.7 Million in charges, of which just more than $556,000, or four percent, has been collected, Comissiong said.

In February, the hospital collected more than $500,000 from patient billing compared to less than $300,000 in February 2022, Comissiong said. Timely billing and other efforts to be paid for care provided have helped the medical center increase collections every month since.

Part of cutting expenses is getting away from temporary labor and hiring full-time employees, she said.

“In fiscal year 2022, the organization spent over $11.4 Million in staffing agency costs for critical positions such as registered nurses, midwives, locums, and Allied Health Professionals,” Comissiong said. The trend continued in 2023, with contracted labor rising to $12.5 million.

Counterintuitively, the new contract giving nurses long-awaited raises actually brought costs down by eliminating outside labor. Comissiong predicted contract labor in 2024 to cost $9.2 million.

“We will continue to aggressively recruit permanent nursing, allied health, and medical staff members. We are hiring,” she said.

Addressing budget shortfalls goes beyond what can happen within the walls of the hospital, Comissiong told the legislators. Removing federal caps on Medicare and Medicaid in the territory, expanding private insurance, and timely payment of inter-government debts would help.

“The budget we presented today is conservative. Schneider Regional Medical Center will continue to be aggressive with our billing and collections. We are committed to expanding service lines and improving our financial position,” she said. “But, this body and the government must work adequately fund the hospital system so we can deliver the health care our community needs and deserves. We are an aged population. We are underinsured and uninsured. The hospital must receive more meaningful financial support to continue to provide high-quality care to the territory.”

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