April 11, 2002 – The chief executive officer of the only nursing home in the Virgin Islands receiving Medicare and Medicaid payments says the St. Thomas facility will keep its doors open in spite of recent cuts in the federal reimbursements. What's more, it has plans to begin home-care services on St. Croix.
Reductions in payments to doctors and other health-care professionals from the two federal insurance programs are forcing providers across the nation to go out of business or turn away poor and elderly patients, Delegate Donna Christian Christensen said in a release this week. But Linda Pulley, CEO of Sea View Nursing and Rehabilitation Facility on St. Thomas, said the lower payments that have been given the Virgin Islands all along has left her facility better able to withstand hard times.
"I'm not saying we haven't felt it. It's always been tight. It occurs with us every day. It's been an uphill battle," Pulley said.
Nationwide, providers found their reimbursements cut by 5.4 percent in January, Christensen said. "This and other cutbacks in reimbursement to home care agencies and skilled nursing facilities has forced the closure of our only home care service and has severely threatened the nursing home," the delegate said in the Wednesday release from her Washington office.
Christensen issued the release on the day when she tried to question the chief administrator of the Centers for Medicare and Medicaid Services at a congressional hearing before the House Small Business Committee. The administrator, Thomas Scully, was expected to testify about the cuts and hear "complaints of health care providers affected by major cuts in reimbursements, over-regulation and too much paper work." But Scully "would not speak to the health professionals present" and abruptly left the hearing, she said.
Christensen, a physician, helps to shape national health care policies affecting people of color as head of the Congressional Black Caucus Health Braintrust. She said she was "surprised" by Scully's actions. "Our committee had held these hearings in an attempt to resolve the issues at CMMS, not to attack it," she said. "It was not helpful that the new administrator would walk away instead of trying to come up with a solution."
She said her greatest disappointment was losing the opportunity to ask the administrator why a plan to change the carrier system for the Virgin Islands was suddenly abandoned. The carrier is the agency that advises and helps doctors and other providers fulfill their paperwork requirements. It also informs those filing for reimbursements about the deadlines they have in which to submit claims.
Even those providers who do not accept Medicare have to complete paperwork when they see a patient covered by the program, so the patient can receive direct reimbursement after paying for health care, Christensen said.
"It's been frustrating," she said. "They [CMMS officials] were supposed to fix the carrier system, and that's the one I wanted to ask the administrator about … Right now, you have to deal with Puerto Rico. We have had a lot of complaints, and a lot of the providers want to change the carrier."
She noted that Scully was scheduled to attend the Black Caucus Health Braintrust's spring hearing on medical reimbursement disparities on Friday, where some of the same issues were to be raised.
The Medicare and Medicaid programs of supplemental health insurance provided by the federal government have been around for more than 30 years, helping the poor and elderly meet their medical needs. Doctors and other providers have long complained that federal reimbursements — the amount of money they get back for treating these patients — have been inadequate. (For background on the disparity between Medicaid reimbursements to the territory and to the states, see "U.S., V.I. Medicaid inequities described".)
Because the Virgin Islands has never qualified for 100 percent reimbursement, Pulley said, Sea View set a cap on admittance for Medicaid patients. Medicare patients, on the other hand are admitted with no limit, leaving administrators to struggle through a morass of reporting requirements. "The burden goes on directors of the department," Pulley said.
In spite of such difficulties, Pulley said, Sea View is getting ready to launch a new home care service on St. Croix, where the previous service cited by Christensen failed. "We were getting a lot of requests to expand our services," she said.
Christensen's release said that she had told the House committee about "several doctors who are in jeopardy or have closed their businesses because of years of unsolved issues with the health-financing agency." Shawn-Michael Malone, who manages the delegate's St. Thomas office, said Friday that he knew of no physicians on island who had closed their doors because of such problems, but he said he was aware of several who were greatly concerned.
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