Behind the drama of last Thursday’s public hospital legislative oversight hearing were two critical admissions by Lillian Perez-Posadas and her longtime chief financial officer at Guam Memorial Hospital, Yuka Hechanova.
The first, as Ms. Hechanova lamented, is that GMH can never get on track with its litany of financial problems because one insurance company “is really giving us a hard time. They don’t pay us.”
The second, Ms. Posadas pointed out, is that GMH never will be financially solvent if the Centers for Medicare and Medicaid Services continues to reimburse the hospital at rates far below the actual costs of hospital services to Medicare and Medicaid patients.
“Medicare pays us on a per diem rate,” Ms. Posadas exclaimed to Speaker Therese Terlaje, almost indignantly. “So if my hospital bill is $10,000 per day, Medicare will only pay GMH $1,500. So that’s the problem. Although we can be very aggressive with our collections, the pay, the reimbursement is not 100 percent.”
That rate is based on something GMH refers colloquially to as TEFRA. It is an acronym for Tax Equity and Fiscal Responsibility Act. It’s a federal statute. For GMH, it is the magic tool it constantly seeks to “rebase,” or change, the federal reimbursement rate, so that GMH gets more money from the federal government for all the Medicare and Medicaid patients it treats. This accounts for somewhere around 60 percent of all its patients.
“We plan to hire, um, hopefully we have an RFP out by the end of the year to get a consultant so that we can work on the rebasing of, um, for Medicare,” Ms. Hechanova told Ms. Terlaje. “That’s the only way we’re going to get the per diem rate up. That’s the only way. Right now, we’re capped.”
The irony about what they said is thicker than the quartet of Mariah Carey’s background singers at her Unplugged concert. The irony of Ms. Hechanova’s exhaustion and near desperation in that oversight hearing, and Ms. Posadas’ walk out amid senatorial demand for accountability from her is rich beyond the money vault at the Bank of Guam. And it has everything to do with the fact that Ms. Posadas replaced Benita Manglona with Ms. Hechanova nearly five years ago.
Because while Ms. Hechanova said that the only way GMH can rebase TEFRA is to spend more taxpayer money on a consultant to even start the process, Ms. Manglona remains the only person in the history of GMH to have ever accomplished the feat.
Yes, as Kandit has previously reported, Ms. Manglona – the hospital CFO before Ms. Hechanova – set out in 2016 on what many, including Eddie Calvo, believed to be mission impossible. At the turn of Mr. Calvo’s administration into Lou Leon Guerrero’s hands, the federal government informed Ms. Manglona that her efforts had worked. And, within Ms. Leon Guerrero’s first term in office, TEFRA was rebased for the first time at GMH.
Ms. Leon Guerrero and Ms. Posadas took full credit for the accomplishment Ms. Manglona made for the people of Guam. And then they replaced Ms. Manglona with Ms. Hechanova after the problem of an insurance company failing to remit payments to GMH led to a net payroll situation.
GMH has not been able to rebase TEFRA since.
Ms. Hechanova requires a consultant to begin the process.
The hospital is falling apart.
Ms. Posadas walked out of a hearing in resignation because she no longer wanted to hear about the failures at GMH.
And, to add color to the irony, Ms. Hechanova and Ms. Posadas at least twice this year presided over net payroll.
I cannot think of anything more ironic, except of course if GMH asked Ms. Manglona to make an offer on the RFP.
