Nov. 16, 2004 The Roy L. Schneider Hospital is now facing off-island competition as well as potential competition on the island.
Puerto Rico's Pavia Hospital is courting the St. Thomas market, and it has set up shop in the Grand Galleria Building in Charlotte Amalie across from Emancipation Garden. It is celebrating the grand opening of its St. Thomas office Thursday, hosting a Chamber of Commerce Business After Hours from 4 to 7 p.m.
Meantime, Health Commissioner Darlene Carty has not issued a decision on whether a local ambulatory surgical center will receive the Certificate of Need it requires to pursue such a facility on St. Thomas. (See "Ambulatory Surgical Center Passes First Hurdle"). Carty said Monday that she would announce a decision "in a week to a week and a half."
Rodney Miller, RLS chief executive officer, said Monday he is not surprised at Pavia's interest. "Every hospital in Puerto Rico would love to be in this market," he said. "The V.I. government's patients are considered 'the crown jewels' from a health insurance standpoint. The Cigna insurance they carry pays significantly better than any Puerto Rico government insuree. Sometimes they are getting twice as much."
He continued, "Our government health plan is among the best in the country. That's why Puerto Rico is interested, as well as the groups who are proposing the ambulatory surgical center. We get the majority of that business. It's a plus for us that we support our operations, even when we have to subsidize so much of our indigent care."
The Pavia Hospital is banking on offering services RLS does not provide, Miller said. "For instance, we don't have a burn unit or a pulmonologist. It wouldn't make sense," Miller said. "We have always supported going off-island [for those cases]."
Dr. Jim Smith, Pavia Hospital Caribbean operations director, said Monday, "About 17 percent of our business comes from the [Virgin] islands. We have a base of roughly 800,000 people. A territory with a population base of 50,000 can't support the variety of services we offer."
Pavia is a series of five hospitals, four in San Juan and one in Mayaguez. He said San Jorge, the children's hospital, has 200 beds; another facility, which specializes in neurosurgery and heart and lung problems in Santurce, has 170 beds. "All in all," Smith said, "we have 500 beds." By contrast, RLS has 169 beds.
"We have 500 doctors, in comparison to RLS's probably 30," Smith said. "We have doctors who are dedicated to pediatrics. We do bone marrow transplants at the children's hospital."
"We want to make sure that the business that goes off-island doesn't go to Miami. We're half as expensive," Smith said.
"Miami, for instance," Smith said, "would charge $1,300 for an MRI. We charge $700, and, no matter what the insurance covers, that is what we would charge. We are very competitive in Puerto Rico."
Smith said RLS does not have a cardiac surgeon. And he candidly said Pavia wants that business.
Miller took strong objection to Smith's remark. "That is almost appalling," Miller said. "We have Dr. Roy Flood, who is one of the top inventral cardiologists in the country. If you have a heart attack, that is who you want to be treating you. I'll bet there is not another cardiologist in the Caribbean of his expertise and training," he said.
"And that is a slap in the face for the folks from St. Croix, too," he said in reference to the Juan F. Luis Hospital Cardiac Center.
Flood joined the RLS staff in August. He came from the Washington Hospital Center, ranked as one of the nation's top heart-care centers by U.S. News & World Report this year.
Miller allowed that RLS doesn't have all the specialties the Puerto Rico hospital can offer. He named pulmonary and endocrinology specialties, and said, "We are short in pediatric heart and neurosurgery."
"If you have a heart attack or a stroke, you are going to have to go off island," Miller said. "If you have acute pancreatitis, you're going to be leaving the island."
However, Miller said, "We are doing very well with what we have. Most of everyday health care needs, we are offering here on island. More and more people are having work done here. We have better trained neurosurgeons than at some of the best institutions Drs. David Weisher and James Nelson."
Smith said Pavia has negotiated with American Airlines and certain hotels in San Juan for reasonable rates. He said AA gives hospital patients a $75 round-trip fare, and hotels vary, but some can be had for as little as $67 per night. "The arrangements have to be made through the hospital," he said.
Miller said, "One piece of the puzzle is that some of the business goes to Puerto Rico because of the insurance agreements folks have negotiated with insurance providers in Puerto Rico. A number of private patients find it's much cheaper to go to Puerto Rico. So Pavia, in essence, is competing with other PR hospitals." Miller noted however, "We must be doing something right, because we are beginning to get into business that would normally go off-island."
Smith couldn't say offhand how much the Puerto Rican government insurance pays, as opposed to what the territory's pays. Asked if other Puerto Rico hospitals might be soliciting St. Thomas' business, Smith said he has heard "rumors" that might be true. "I can't substantiate them," he said. "I really don't think it's a case of businesses coming to the islands to snatch away business," he said, "We're more concerned about not having Miami as a destination."
Smith said he understood Miller's point of view. "He is under pressure from different sides. He doesn't want to lose any business, but the fact is that a good portion [of V. I. residents] has been coming to Puerto Rico for years."
Asked how Pavia deals with indigent patients, which RLS is required to do, Smith said, "Puerto Rico has relaxed laws about indigent care. The government has a trauma center, and they are required to take everybody. But if it's a burn victim, or things the trauma center cannot do, we would take them." He said the hospital had "just started" a foundation for indigent care for children. "Patients from the islands would call the foundation and describe the problem. They can apply for grants."
Smith said Pavia has no plans to solicit business from other Caribbean islands.
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