The loss of 50% of its bed capacity, an increase in off-island transfers and the pandemic has made a substantial dent in Luis Hospital’s revenues — potentially 25% in the current fiscal year — staff reported at Tuesday’s governing board meeting.
With a large share of Medicaid-funded patients, Medicaid rates and the timeliness of reimbursements continue to be a major challenge, said Dynma Williams, the hospital’s interim CEO, and the executive team is working with the Human Services Department to improve both.
By keeping a tight rein on the purse strings, hospital expenses came in 9 percent below projections, Williams said, and the hospital is trying to pay as many past due bills while remaining solvent. At February’s end, the hospital owed $35.2 million.
March brought a surge of COVID patients to the hospital and the installation of four additional ventilators.
Eight COVID patients were admitted, the highest since the pandemic started, and 17 staff members got vaccinated, or 30 percent.
Working with the Health Department, the hospital introduced Monoclonal Antibody treatments for COVID-19-positive patients with mild to moderate symptoms to reduce the progression of the disease and the likelihood that individuals will have to be admitted to intensive care. And the staff is now testing for more variants and for influenza as part of its COVID-19 response. Previously, health care workers knew that variant cases could be present in the territory, but could not test for them.
A surge of gun violence in the St. Croix community made Luis Hospital ground zero for treating the victims. The hospital remained in lockdown for the first two weeks of March because of the security risk, staff said.
Buildings in progress
The hospital’s temporary quarters, JFL North, are gathering momentum with the critical pieces of infrastructure — oxygen, water, firelines, internet connectivity and backup generator — coming together. Bids are in for construction management and a selection will be made soon, staff said.
The transition team is mapping how the hospital’s processes will work in the much smaller temporary space, from patient billing to supply chain management.
Side by side with the temporary facility, Flad & Associates was retained and is at work on a new build design, and $1.4 million has been earmarked by the V.I. government to help procure property. A closing can be expected soon, officials said.
Staffing continues to challenge Luis Hospital, with registered nurse shortages in the clinical and allied health areas of special concern. At the same time, with revenues flagging, more staff are needed to expand the clinical lines of service — joint programs and hoped-for interventional cardiology and behavioral health services.
This doesn’t even address the transitional need for licensed healthcare professionals when the hospital goes from 46 to 105 inpatient beds, board members said.
Overtime costs have been high because of under-staffing, and this has taken its toll in exhaustion and morale. Overtime cost the hospital $3 million in FY2020 and $1 million in FY 2021, the board reported.
Because most of the hospital’s specialty trained and licensed staff are not local, the hospital bears a high cost for temporary workers; and, too, a high cost to recruit and keep critical personnel permanently on-island, the board said.
The operations staff has engaged the Labor Department to create onsite apprentice programs at the hospital for technical programs such as electrical, plumbing and carpentry work.
Outpatient dialysis services will soon transition to Caribbean Kidney Center, giving patients a more comfortable venue for treatments, officials said.
And Dr. Ramesh Lakhram announced the hospital has recruited a permanent surgeon with vascular as well as general surgery experience, who will improve care on-site and reduce trips abroad.