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Financial Strain at Juan F Louis Hospital as Medicaid Reimbursements Lag

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The Juan F. Louis Hospital is grappling with financial strain, exacerbated by delays in receiving approximately $7 million in Medicaid reimbursements. Despite these setbacks, hospital staff continues to deliver care with unwavering dedication.

Chris Lewis, the Senior Vice President of Finance at the hospital, disclosed to legislators that full Medicaid payments have been absent since November. The hospital has engaged in discussions with the Medicaid Advantage Plus (MAP) office to identify and resolve the underlying issues. A technical glitch involving MAP and Gainwell, a Medicaid management system provider, has been pinpointed as the probable cause. A resolution is anticipated by mid-April.

Senator Ray Fonseca, chair of the committee, expressed concern that the shortfall in Medicaid funding could be contributing to the hospital’s growing pile of unpaid bills. Lewis confirmed the financial strain, stating that the lack of funds has necessitated delaying payments to many vendors. However, efforts are underway to mitigate the situation by pursuing other owed payments. The outstanding $7 million encompasses pending Medicaid reimbursements for both inpatient and outpatient services.

The financial predicament of the hospital has alarmed legislators. Senator Diane Capehart emphasized the urgency of the situation, insisting on aggressive measures to secure the owed funds, highlighting the significant impact on the hospital’s financial health.

Despite small payments being received, they fall short of addressing the hospital’s financial challenges. Lewis noted an increase in collections from commercial payers, yet the absence of consistent Medicaid payments, typically amounting to $1.2 to $1.5 million monthly, remains a critical issue.

CEO Dough Koch conveyed to lawmakers the hospital’s proactive stance, including holding an emergency meeting to confront the funding shortfall head-on. Koch emphasized the hospital’s commitment to collaboration and seeking solutions to ensure its operational and financial stability.

Senator Fonseca, acknowledging the hospital’s efforts, shared his deep concerns about the potential worsening of its financial situation, which could jeopardize the hospital’s ability to meet payroll and provide staff benefits. He pointed to a previous $2 million support to the Eastern Medical Center as a cautionary example of the risks of financial decline.

Koch acknowledged the challenging financial circumstances, mentioning that some vendors have extended grace periods for payments due to the hospital’s cash flow problems. He assured that every possible measure is being taken to navigate these difficulties.

Fonseca concluded with a commitment to engage further with the Office of Management and Budget and the Medicaid director, underlining the critical importance of securing the $7 million in outstanding Medicaid payments to stabilize the hospital’s finances.

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Governor Bryan Pushes for Urgent Legislation to Address Medicaid Fund Shortfall

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Governor Albert Bryan announced on Monday that the territory has exhausted its funds for the local Medicaid match, prompting Government House to submit draft legislation to the Senate seeking an additional $3 million for this purpose.

Despite the fiscal shortfall, Governor Bryan views the situation as a sign of increased healthcare access. “We’re having so many people access care,” he stated, highlighting that during the pandemic, nearly 40,000 individuals utilized Medicaid for services including braces, dental care, and various medical appointments. Furthermore, eased referral requirements have facilitated access to specialty care. “Before, you had to go to East End or Frederiksted Health Center for a referral; now, a regular doctor can refer you,” Bryan explained.

These expanded services and simplified processes have rapidly depleted the Medicaid matching funds. However, Governor Bryan does not foresee this as a recurring issue, predicting stabilization next year. He noted that the V.I. Department of Human Services has already reduced some services, which has led to a decrease in Medicaid enrollment.

The proposed $3 million allocation remains critical for Virgin Islanders. Governor Bryan emphasized its importance, pointing to the recent U.S. Department of Defense Innovative Readiness Training (IRT) Program health fair, where medics served over 2,500 people seeking no-cost healthcare services. Although 6,000 people applied, many were turned away due to limited resources. The governor stressed that healthcare costs for uninsured residents ultimately fall on the territory, whether through Medicaid or hospital services.

The effort to secure adequate Medicaid funding is ongoing. In 2019, Congresswoman Stacey Plaskett successfully obtained an additional $252 million for the territory in a fiscal year 2020 spending bill, raising the federal match from 55% to 83%. This increased match rate, initially set to expire in 2021, has been made permanent, ensuring the territory receives the highest possible Medicaid match in the U.S.

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Measles Outbreaks Prompt Vaccination Drive in U.S. Virgin Islands

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As measles outbreaks rise across the United States and the Caribbean, U.S. Virgin Islands Health Commissioner Justa Encarnacion is urging parents to prioritize their children’s vaccination schedules.

Commissioner Encarnacion voiced her concerns this week about the alarmingly low vaccination rates among children in the territory, emphasizing the imminent threat of measles. “We are very concerned about the low childhood vaccine rate in the Territory, especially with measles threatening the US,” she said. Currently, only 60 percent of USVI children are vaccinated, a situation worsened by an increasing number of parents seeking vaccination exemptions.

The urgency is underscored by the latest data from the Centers for Disease Control, which reports weekly on measles outbreaks. As of June 6, 2024, there have been 151 measles cases across 22 jurisdictions, including Arizona, California, Florida, and New York, with over half resulting in hospitalizations.

The infectiousness of measles is a significant concern for the V.I. Department of Health. “While 151 may seem like a low number, it is alarming because one person can infect nine to ten others,” Encarnacion explained. She also highlighted the risk of the disease spreading to the USVI and neighboring regions, noting that the Turks and Caicos Islands reported their first measles cases since 1991 this past May.

In response, the Department of Health launched the “Be Wise, Immunize” campaign earlier this year. This initiative aims to educate parents about the vital importance of vaccinations, stressing that immunization is the best defense against diseases like measles both in childhood and later in life.

The primary defense against measles is the measles, mumps, and rubella (MMR) vaccine, which provides long-lasting protection against all strains of the virus. Measles can lead to severe health complications, particularly in children under five, including pneumonia and encephalitis.

Measles is highly contagious, spreading through the air via coughs or sneezes from infected individuals. It remains active in the air or on surfaces for up to two hours. Symptoms typically appear seven to 14 days after exposure and include high fever, cough, runny nose, red watery eyes, and a characteristic rash.

Although declared eliminated in the United States in 2000, measles continues to persist globally and is often brought into the U.S. by unvaccinated travelers.

The VI Department of Health is urging parents to ensure their children are vaccinated and provides resources for scheduling immunization appointments at www.doh.vi.gov/immunization.

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Douglas Koch to Lead Kearney Regional Medical Center in Nebraska

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Just a day after announcing his resignation from the Juan F. Luis Hospital (JFL) on St. Croix, CEO Douglas Koch has been named the new CEO of Kearney Regional Medical Center in Nebraska. He will assume his new role on August 5, according to a report from KSNB Local 4.

In his resignation letter, Mr. Koch cited a desire to return to the Midwest to be closer to his family. His departure has been a significant loss for local health officials, with JFL Board Chair Chris Finch expressing disappointment. Mr. Finch, who also chairs the Territorial Hospital Board of Directors, highlighted Mr. Koch’s exemplary service, noting that he had recently received an excellent personnel evaluation from board members.

Koch’s new role in Nebraska is eagerly anticipated by his future colleagues. John Woodrich, Executive Vice President and Chief Operating Officer of Bryan Health, which owns Kearney Regional, praised Koch’s midwestern roots, education, and extensive operational experience as ideal for the position. “Doug’s commitment to community health and his leadership skills will be a tremendous asset to Kearney Regional Medical Center,” said Woodrich.

Before his tenure in the U.S. Virgin Islands, Koch held leadership positions in South Dakota, Wisconsin, and Illinois. At Kearney Regional, he will oversee the expansion of inpatient facilities and the construction of a cancer center, similar to his work with JFL’s transition to a temporary modular structure. Woodrich emphasized Koch’s ability to help communities thrive, stating, “He will be an outstanding leader for Kearney Regional Medical Center.”

As Mr. Koch prepares to embark on his new journey, JFL officials now face the task of finding a new CEO to lead the hospital forward.

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