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Changes Needed to Overcome Nursing Shortage, Schneider CEO Tells Senators

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Feb. 29, 2008 — Schneider Regional Medical Center is short of nurses and bleeding tens of millions of dollars a year from unpaid care and extremely low federal Medicaid and Medicare reimbursements, but is accredited and providing high-quality care with what it has, CEO Amos W. Carty Jr. told senators Friday.
Schneider Regional includes Roy Lester Schneider Hospital, the Charlotte Kimelman Cancer Center and the Myrah Keating Smith Community Health Center.
Carty cited a familiar litany of worrisome statistics during the oversight hearing of the Health, Hospitals and Human Services Committee, interspersed with accounts of what he and the medical center are doing to address them and suggestions for what the Legislature might be able to do.
"The nursing shortage limits the number of patients we can serve and the number of services we can offer," Carty said. "Our vacancy rate over the last two years has averaged 40 percent, as compared to the national rate of 13 percent."
By hiring many temporary, traveling nurses on contract with an agency, Schneider Regional has cut the vacancy rate enough to meet national standards and the needs of the center, but at a much higher expense than permanent nurses.
"We are spending $6.4 million a year for agency nurses," he said.
A recent recruitment effort showed that a lack of sufficient financial incentives is the principle obstacle to hiring enough permanent nurses, he said.
"While we have recently implemented a new collective bargaining agreement with the Virgin Islands State Nurses Association, our salaries remain significantly lower than the mainland," he said.
The nurse shortage is a national, even worldwide problem, not just a local one, which means the territory must compete for nurses in a very tight market.
To work around this fundamental issue of cash, Schneider Regional is experimenting with options like flexible scheduling, allowing nurses to work 12-hour days for a shorter work week, and have hired a person whose primary role is to help with a smooth transition into working and living in the territory, he said. To help hire enough traveling nurses, Carty wants the Legislature to pass a bill letting them receive the same health and other benefits as permanent nurses.
"We have to have a mechanism to get nurses," he said. "We look at it as a temporary measure while we get permanent nurses, but at the same time, we have to attract both temporary and permanent nurses."
Ultimately, Carty believes, expanded and improved training to produce nurses locally is the lynchpin to this problem, and Schneider Regional's Educational Institute is offering courses to help nurses progress upward in their careers.
As a safety-net hospital and medical center, Schneider doesn't turn anyone away, and last year the hospital provided $49 million in care that was not paid for, Carty said. For comparison, the total, gross revenues of the hospital are between $45 million and $50 million. It is uncompensated care because of low incomes and high numbers of uninsured patients. Also, Medicare and Medicaid funding is far lower here than on the mainland.
"In the 50 states and the District of Columbia, Medicaid alone provides about 40 percent of the funding for safety-net hospitals," he said. "Medicaid provides Schneider Regional with just 4.3 percent of its total funding in fiscal year 2007. … The cap amounts to $60 in federal funding for each of our 15,000 Virgin Islanders eligible for Medicaid. In the states, Medicaid spending averages $565 per person. "
On top of that shortfall, $7 million in Medicaid funding has not been released to Schneider Regional by the territorial Medicaid office, he said.
"If you are a Medicare enrollee in the Virgin Islands, you can expect to receive a yearly per-capita benefit of $2,800," he said." If you are a Medicare beneficiary in the states, you receive $6,800. … If the U.S. Virgin Islands were a state, instead of $37 million, our Medicare funding would be more than $100 million dollars. Because Puerto Rico lobbied successfully … it receives Medicare funds."
It was not all doom and gloom, Carty emphasized, pointing out the hospital-accrediting body — the Joint Commission for the Accreditation of Healthcare Organizations — gave Schneider Regional good marks, comparing its quality of care to that of mainland hospitals in markets of similar population.
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