Guamanians are looking at a whooping 12% to 2,449% rate increase for certain procedures and services at Guam Memorial Hospital Authority.
GMHA, the island’s one and only civilian government hospital, in its Board Resolution on September 24, approved and adopted 14 new fees for Labor and Delivery, Pharmacy, and Operating Room. In another resolution though, GMHA wants to increase the rates of some 402 items in order “to meet its financial obligations, operating expenses, and capital improvement needs.” The proposed rate increase would be from a low of 12% to as high as 2,449%. This rate increase exceeds the allowable 5% annual increase provided for under Public Law 22-66.
On August 21, GMHA conducted a Public Hearing on the 14 new fees. This was attended to by stakeholders to include representatives from health insurance companies. No attendees signed up for testimony, however.
On that same public hearing, the hospital’s Board of Trustees provided the participants another list (402 items) of rate increase.
Frank Campillo of Selectcare stated during the hearing that the “huge rate increase would only affect the third party payers and not the non-payers that are the majority of the population.” He added that the “impact would damage the system with less insured population and consequently increase the hospital’s receivable.”
On his August 26 letter to GMHA’s CFO, Anthony Mendiola (VP of Staywell Insurance) states that “implementing the proposed 2015 Medicare APC fees at GMHA would lead to an average increase of 277%,” further adding that “Increases in individual procedure code pricing ranged from 12% to 2,449%.” He said that such increase would have a staggering financial impact. “For instance, the simple blood typing procedure that costs $9.79 would be billed at $76.07.” Mendiola cited more examples such as code 31500 for insertion of emergency airway for which the current rate is $5.09, will be increased to $129.72 which is a 2,449% increase.
“As we all know, the changes will significantly impact the private payers and the consumers as well. Earlier this year, the hospital already implemented an adjustment in its fees. A gradual, rather than a sudden steep adjustment, is the approach that the community can work with.
“On the other hand, we question the appropriateness of applying the 2015 Medicare APC rates on Guam at this time. APCs or ‘Ambulatory Payment Classifications’ are the government’s method of paying facilities for outpatient services for the Medicare program. This component of the Outpatient prospective Payment System (OPPS) for hospital outpatient services is analogous to the Medicare prospective payment system for hospital inpatients known as ‘Diagnostic Related Groups’ or DRGs. From our recollection, this system – including its required coding systems, rules and processes – has never been used at GMHA. Medicare itself may not use such a scheme with GMHA at this time,” Mendiola explained in his letter.
In the August 21 GMHA public hearing, Benita Manglona (GMHA CFO) emphasized that the cost of delivering healthcare has significantly increased over the years while GMHA rates have not kept pace of the increases. She said that the hospital “has not adjusted its rates since early 1990s” and that “current fees are not sufficient to cover operating costs,” citing from the 2014 Office of the Inspector General report.
On October 12, GMHA submitted the proposed rate increase (and the new fees) for Legislative action. Senator Dennis Rodriguez, Jr. being the chairman for the Committee on Health, Economic Development, Homeland Security, and Senior Citizens filed Bill No. 189-33 (COR) for such purpose. Rodriguez announced that a public hearing will be conducted on October 22 at 5:30 pm in the Public Hearing Room of I Liheslatura.
The hospital’s rate adjustments can be downloaded at the hospital’s website, www.gmha.org./The Junction News Team
