DeJongh's legacy: JFL shuttered

Here is an excellent commentary about JFL by Frank Schneiger.

http://stcroixsource.com/content/commentary/op-ed/2014/09/23/source-manager-s-journal-disaster

B&J, comprehensive thoughts. Mostly correct. What did you do to improve it while you were there?

And for those who insist that that a private company should take it over. Ha. Which business could last by giving services to people who cannot pay as JFL are mandated by law? Not even WAPA is required to provide electricity to persons who cannot pay. No one will run this thing unless the entire territory and all the guests and illegals have health insurance. Right now we are at 40%.
The government doesn't just "subsidize" JFL. They reimburse them for uncompensated care.
And it was published that Griffith got a private company to do the billing after he finally got approval from the Territorial Board 6 months after he requested it. So in addition to internal failings and challenges, they have to contend with external struggles like an uncooperative governor and a logistics nightmare, with a population that is largely unwilling and unable to pay for excellent care. A lose lose situation.

The GVI can hand out vouchers to those that can demonstrate being in need and that can't pay. The hospital doesn't even try to collect what its owed, especially if its friends and family who havereceived free care. As long as the hospital is part of the GVI, it will always be a money loser. Privatize and stop the bleeding.

There is a difference between indigent care and subsidizing those that could pay.

Privatize - new rules.

A hospital in Miami pre ACA offered a subsidized care plan as a substitute for insurance. You paid a reasonable fee monthly but could only use that hospital's docs and facilities. For locals who couldn't afford or qualify for health insurance (pre ACA that was many people), this was a really good deal. I think it was Jackson Memorial.

With a captured market like St. Croix, something like this executed wisely could work. Not by VI Government or JFL status quo though - not capable.

I find it paradoxical that what was done with Obamacare in the USVI directly opposes the actual use of the money through Medicare/Medicaid going to the hospitals.

It's like watching a dog chase its tail.

I should add to this. I am going to point a nurse who administered my last shot, that I happened to talk about the VI, to this thread, specifically B&J's insightful post.

She specifically asked about moving there, because she had heard of open nursing slots. I told her that there was a price for living in Paradise, and some people can and are willing to pay it. I told her that a lot of things were generally not that different from the states as far as things such as racism (I see it the other way around here, mostly white toward black) and that crime was high. I told her about how things could be on a never-ending "tomorrow".

i told her that if I had to pick one word to describe the islands, I would pick "enchanting". I told her she would never forget living there, good and bad.

At the end, I encouraged her to go. After reading B&J's post, I will now tell her to not even think about it.

Here is an excellent commentary about JFL by Frank Schneiger.

http://stcroixsource.com/content/commentary/op-ed/2014/09/23/source-manager-s-journal-disaster

This is probably the most accurate take on the situation I've read to date. Thanks for sharing. I believe we likely have the exact same issues with our education system here too!

Here is an excellent commentary about JFL by Frank Schneiger.

http://stcroixsource.com/content/commentary/op-ed/2014/09/23/source-manager-s-journal-disaster

Excellent, excellent article. Should be mandatory reading for every VI resident or prospective resident.

Griffith’s stated intention to appeal the decertification indicates a lack of understanding so fundamental that it is shocking. There is no appeal of decertification. There is only application for recertification, based on correcting the many deficiencies cited by CMS.

Virgin Islanders have an unfortunate habit of thinking that they can jerk around regulators forever, not realizing that there is always a last straw. That’s what happened here. With respect to the numerous wrong statements that have been made, they all fit into the category of “TL squared” (too little, too late).

And -

The jobs program makes connections and politics the primary drivers in a setting where they should have no place. It’s hard enough to find good people for many jobs in a hospital. It becomes far more difficult when there is widespread favoritism, a lack of accountability for performance for “protected” people, an inability to fire poor performers and the biggest killer of motivation and quality, a sense of “relative deprivation.” Why should I kill myself when he doesn’t do anything, and we are getting the same pay?

The op-ed piece by Mr. Schneiger is excellent, and I rarely agree with his work. I wholeheartedly endorse his statement: "At the heart of the problem is the central reality of public service as a jobs program." This is not just a problem at JFL, but throughout many government departments. Labor and unions protect the incompetent at the expense of the good people of the VI. A recent example was the teacher's union refusing to go back to school early because it cut into their vacation time. The kids here could use year-around school, but that will never happen. I know of employees who have no apparent purpose except getting a check every two weeks. I also know of very good, hard-working government employees who get the short end of the stick because of the hangers-on...

noOne, her commentary was terrible. but (dreaming here) maybe good nurses can make a difference

The GVI can hand out vouchers to those that can demonstrate being in need and that can't pay. The hospital doesn't even try to collect what its owed, especially if its friends and family who havereceived free care. As long as the hospital is part of the GVI, it will always be a money loser. Privatize and stop the bleeding.

Give out vouchers? Only Chucky and her children and a few government officials would have vouchers.

Give out vouchers? Only Chucky and her children and a few government officials would have vouchers.

Is there no comment or opinion remotely leaning to the positive that you won't arbitrarily and summarily dismiss?

Give out vouchers? Only Chucky and her children and a few government officials would have vouchers.

Is there no comment or opinion remotely leaning to the positive that you won't arbitrarily and summarily dismiss?

Positive ones I welcome a lot, specially right now. Impractical,ones not. No civilized country uses vouchers for healthcare. They use insurance or Medical assistance cards. That way eligibility can be verified.

And call the dept of Health every day for the next two weeks. 3407731311. If they answer to phone, and that is a big "if" ask for Elizabeth Hansen Wattley. Her brother gets his check and reports to work? Never? That is wht I don't trust a "voucher system". The place has ingrained corruption. From the criminal senator who was pardoned by a dishonest governor.mdont forget the court whose decisions are fixed.

Don't forget that this whole thing was started by a senator who shot his son in the back killing him and looted during hurricane Hugo when he was a police chief...

http://www.reverbnation.com/elizabethwatleyakasocadiva

Same Elizabeth?

Here is an excellent commentary about JFL by Frank Schneiger.

http://stcroixsource.com/content/commentary/op-ed/2014/09/23/source-manager-s-journal-disaster

Excellent, excellent article. Should be mandatory reading for every VI resident or prospective resident.

Griffith’s stated intention to appeal the decertification indicates a lack of understanding so fundamental that it is shocking. There is no appeal of decertification. There is only application for recertification, based on correcting the many deficiencies cited by CMS.

Virgin Islanders have an unfortunate habit of thinking that they can jerk around regulators forever, not realizing that there is always a last straw. That’s what happened here. With respect to the numerous wrong statements that have been made, they all fit into the category of “TL squared” (too little, too late).

This man does not know what he is talking about. CMS has explicit rules for appeal decertification as well as the other option for applying for decertification.
Appealing a ruling has to be dine within 15 days. Now one can argue that it was not a good move to appeal or that there are no valid grounds for appeal. But to say that you cannot appeal is false. Period.

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/pdf/CFR-2011-title42-vol5-sec486-314.pdf

 

That citation was for OPO's? Organ procurement organizations

Thanks for the clarification MJ. Good information as always.

the link is kind of misleading as it only applies to OPO's. In my understanding JFL can only apply for 'reconsideration' and that process will take up to 60 days (for further CMS review) all which time the facility will not be accredited.
After the review CMS will issue a reversal or a denial. If denied then JFL would have 60 more days to request a hearing. etc. etc.

All of this info can be found with a bit of digging on the CMS site.

Here's a blue print for what may be transpiring to stop decertification.

CMS' Systems Improvement Agreement: A Last Chance Alternative to Medicare Termination?

Written by Victoria May Fennel, MSN, RN-BC, CPHQ, Director of Accreditation and Clinical Compliance for Compass Clinical Consulting | September 18, 2012

In the past, when CMS conducted a survey and unfavorable findings led to a determination of immediate jeopardy, healthcare organizations had very little choice (prepare an acceptable corrective action plan or risk Medicare decertification) and very little time (23 days) to correct the deficiencies. For some healthcare organizations, failure to provide an acceptable corrective action plan following multiple citations of immediate jeopardy or repeated surveys with immediate jeopardy findings resulted in Medicare terminating the hospital's contract.

link below.

http://www.beckershospitalreview.com/quality/cms-systems-improvement-agreement-a-last-chance-alternative-to-immediate-jeopardy.html

the link is kind of misleading as it only applies to OPO's. In my understanding JFL can only apply for 'reconsideration' and that process will take up to 60 days (for further CMS review) all which time the facility will not be accredited.
After the review CMS will issue a reversal or a denial. If denied then JFL would have 60 more days to request a hearing. etc. etc.

All of this info can be found with a bit of digging on the CMS site.

JFL wrote that the hospital has 15 days to appeal.
It is called due process.

in looking at newspaper reports from around the US detailing similar threat of decertification, 99 percent keep CMS accreditation. But all of the issues cited have to be corrected and those corrections have to continue. JFL/VIG and CMS will sign a legal agreement detailing the correction process and ongoing plan. JFL/VIG will have to pay for all of this process.

My guess is JFL/VIG sat on this report for longer than they have said before having to come forward with the findings.

How convenient and timely... The senate confirmed the two nominees to the hospital board... That is their idea of "fast tracking"...

http://virginislandsdailynews.com/news/senate-confirms-2-nominees-restoring-quorum-to-luis-board-1.1760444

P.S. Wow, and it them more than 30 years to finally make the Christiansted by-pass a reality... Not bad, it took them months and an impending de-certification to approve the nominees...

in looking at newspaper reports from around the US detailing similar threat of decertification, 99 percent keep CMS accreditation. But all of the issues cited have to be corrected and those corrections have to continue. JFL/VIG and CMS will sign a legal agreement detailing the correction process and ongoing plan. JFL/VIG will have to pay for all of this process.

My guess is JFL/VIG sat on this report for longer than they have said before having to come forward with the findings.

The hospital was notified on a Friday, eight days ago. How long are you guessing they sat on it?

JFL/VIG and CMS will sign a legal agreement detailing the correction process and ongoing plan. JFL/VIG will have to pay for all of this process.

This occurred well over a year ago and as of this article almost a year ago JFL was still coming up short on inspections as well as it's payment for the process.

Luis Hospital in danger of losing Medicare, Medicaid certification
BY JOY BLACKBURN (DAILY NEWS STAFF)
Published: November 8, 2013

JFL received notification on Wed., Sept 16 and publicly announced the decertification notice on Sept 18. The only notice CMS makes to the community is through a classified ad in a local newspaper.

The CMS notification on Sept 16 is a 23 day notice - citing "immediate jeopardy" to patients. This is different than previous 90 day notices called "condition" notices.

The survey in August 2014 most likely was triggered by a patient/family complaint that was made directly to CMS about quality of care at JFL. Alternatively, a newspaper article could have triggered the CMS survey. This is good to note for any who have been or may be harmed at JFL in the future - CMS will respond to complaints if JFL doesn't.

There was no requirement for JFL to share the CMS report with the community - though it ultimately would be available through a freedom of information request to the feds. The one thing JFL/GVI leaders haven't done is apologize to the community for any mistakes and assure all effort will be made to improve the quality of care for residents. Blaming CMS was not a well thought out or insightful strategy.

If JFL succeeds in answering the most critical part of the "immediate jeopardy" notice from CMS - that related to patient care - the notice will convert to a 90 day "condition" notice retroactive to Sept 16. If CMS decertification does occur - this document will be signed by the US Secretary of HHS.

Despite protests from JFL/GVI leaders, right now JFL is the sickest hospital in the US.