While Juan F. Luis Hospital’s resources continue to be stretched thin by tens of millions of dollars in uncompensated care and other financial strains, it is moving forward with telemedicine, expanded kidney care and other improvements to care, hospital officials said in budget hearings Thursday.
"The percentage of uninsured and underinsured patients has increased from 38 percent to 40 percent," said Juan Luis’ acting Chief Executive Officer Darice Plaskett. "This … has resulted in approximately $42 million in uncompensated care for fiscal year 2008, which translates to 59 percent of our gross charges."
While the government of the Virgin Islands directly subsidizes the hospital, partly offsetting the unfunded care, Gov. John deJongh Jr.’s recommended appropriation of $25.9 million is far short of the $42 million in lost revenue to the hospital, she said. The hospital has a legal mandate to treat all patients without regard for ability to pay, so it has limited ability to force payment. Also, care for Medicare and Medicaid patients is reimbursed at a lower rate in the Virgin Islands than in the states, covering only about 50 percent of the real cost of care, Plaskett said.
Because nurses’ union contract for salaries is uncompetitive, the hospital, like every clinic and hospital in the Virgin Islands, is forced to fill the shortage with contract, traveling nurses at a much greater expense, she said. Travel Registered Nurses cost about $115,000 per year, with 40 percent of that going not to the nurse but to the contracting company. But a nurse who is a full-time regular employee of the hospital makes on average about $55,000, Plaskett said.
Senate President Louis Hill asked if the traveling nurses who are already working at the hospital might sign up permanently if they were offered the same pay they are already receiving, saving the hospital 40 percent of the cost.
"I do believe we can, because for many reasons they have already chosen to come to St. Croix," said Chief Nurse Officer Wendy O’Brien-O’Reilly. "They have come and made this their home and are always willing to stay with the support of salaries and of the nursing team we have."
Carmelo Rivera, chairman of the hospital’s board of directors, agreed paying equivalent salaries would attract permanent nurses and save money, but doing so would violate labor contracts, raising questions from Hill.
"I don’t think there is one nurse who is part of a collective bargaining agreement who would not agree to a substantial increase in salary, so why can’t we use the collective bargaining process to design a solution?" Hill asked.
Rivera said all nurses in the territory are in the same union, so Juan Luis could not pay its nurses more than nurses at any other facility without violating the contract.
DeJongh’s 2010 budget recommends $25.9 million for the hospital. This represents a three-percent reduction from last year’s level. Plaskett requested an additional $4 million to help with utility bills and $1.4 million to help with other expenses, for a total budget request of $31.3 million.
No votes were taken at the budget oversight hearing. Present were Hill, Sens. Wayne James, Nereida "Nellie" O’Reilly, Terrence "Positive" Nelson, Patrick Sprauve, Carlton "Ital" Dowe, Usie Richards and Sammuel Sanes.