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Pacific Islands Development Program, East-West Center

With Support From Center for Pacific Islands Studies, University of Hawai‘i

NMI Healthcare Corporation’s Federal Review Continues
Medicaid certification maintained as final decision forthcoming

By Tammy Doty

SAIPAN, CNMI (Marianas Variety, Dec. 5, 2012) – The Commonwealth Healthcare Corp. in the Northern Mariana Islands seems to have dodged a bullet by maintaining its federal certification.

In a conference call yesterday with the U.S. Centers for Medicare and Medicaid Services, or CMS, the NMI’s lone hospital was granted a reprieve from the Dec. 3 cut-off date of Medicare and Medicaid payments amounting to over $10 million yearly.

During the discussion federal officials acknowledged the receipt of CHC’s plans for corrections that address the three immediate jeopardy, or IJ, citations meted out by CMS in October.

The corporation had until November 19 to submit plans for corrections of the IJ citations which they did successfully.

In parallel — and as mandated by federal law — CMS published last week a community advisory in this newspaper that stated as of Dec. 3 the NMI would no longer be eligible for CMS federal Medicaid and Medicare reimbursements.

CHC’s chief financial and administration officer Esther Muna confirmed yesterday that a final CMS decision is in the works.

"CMS certification is still in place while the review is ongoing," stated Muna.

With so much riding for the community on the outcome, a CMS decision is hoped for in the very near term.

In the meantime, CHC moves forward to address the remaining 200+ pages of the CMS September survey report, which took up a large part of the board of advisers meeting last Friday.

Board meeting issues

The newly appointed director of medical affairs, or DMA, Dr. Sherleen M. Osman, a nephrologist and hemodialysis center director introduced herself by describing her "no nonsense" working style.

"My focus will be the same as when I arrived here…the quarrelling will stop and we will sit down and look at policies and procedures to ensure this place runs as it should run," stated Osman.

The new DMA went on to describe her view of the current state of the hospital as not about personalities but competence.

"Our problem is not that we are bad… the problem seems to be that people in key positions don’t quite understand how a hospital should run," Osman explained, "We don’t know how to answer Medicaid’s questions and that seems to be a major problem… we need to work together to correct this."

Additionally, Osman advocated a "slow, steady work-process to permanently fix problems" as opposed to short-term ‘Band-Aid’ patches. I tend to be no nonsense and I hope that works for the board," she said.

Osman is the first woman to occupy the DMA position and steps in on the heels of a tumultuous year in which three physicians — Drs. Deary, Richards and Lamar — assumed the responsibilities only to step down under contentious circumstances.

CEO’s annual review

As has happened in recent meetings, the adoption of the agenda turned into a major point of contention among board members.

Staff-elected representative Raho objected to the chair’s ruling for an agenda vote and for almost 30 minutes a round-robin ensued of points of order, motions and debate over rules that threatened to derail the meeting before it even began.

Raho requested that several items be added to the agenda but Torres ruled several times that the items were "moot."

Torres kept insisting that chief executive officer Juan N. Babauta’s annual performance review — as mandated each October by the public law forming the corporation — was unnecessary, as was discussion of the CHC strategic plan, the board’s position on the recently proposed "fat tax" legislation and an update of the 13 violations identified in the CMS report.

"For the credibility of the CEO and this board it is important to undertake our mandatory responsibility — per P.L. 16-51 and our by-laws — and add the CEO’s evaluation onto this agenda," Raho reiterated several times.

Torres replied that the board’s unanimous approval of the CEO’s contract in October was a de facto evaluation and "complied with the board’s mandated duties" because the board members did not agree to an extended meeting to address all agenda items.

His attempt to sideline Raho’s agenda items met with little success.

Vice chairman Pete Dela Cruz informed Torres that standard policy for all boards is to carry over unfinished agenda items from one meeting to the next.

Dela Cruz suggested the review be completed in written form at a later date because if the CEO’s review is considered moot then "we wouldn’t be complying with the law."

The vice chairman went on to say that the review was needed to see "what the problems are and what needs to be done."

He also reasoned that a public CEO review would be a "field day" for the media.

After members Anthony Aguon, the CEO himself and Dr. Osman agreed with Dela Cruz the chairman finally relented, tabled the motions and added the CEO’s review to the "old business" items of the agenda.

The motion was carried and the CEO’s evaluation is scheduled for January, although it is not known if the review will be made public or only provided to the governor.

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