The Tribune

By MORGAN ADDERLEY

Tribune Staff Reporter

madderley@tribunemedia.net

PRINCESS Margaret Hospital is owed over $700m in unpaid bills accumulated over the last 30 years, Health Minister Dr Duane Sands said yesterday.

Speaking during his budget communication in the House of Assembly, Dr Sands also said that 86 percent of patients who use the Public Hospitals Authority do not pay for services.

To offset this, Dr Sands said last September, 20 PHA employees began a training course to become certified medical coders. These participants will “populate a centralised billing and collections facility to collect the legally gazetted fees”, Dr Sands said.

These remarks came weeks after the health minster in an interview forecast “increased collection of gazetted fees” to meet healthcare demands - though he insisted no one is going to be denied care in health facilities.

The Minnis administration has earmarked $301,973,034.00 to the public health sector with $223,455,825 designated for the PHA and $58,517,209 allocated to the Ministry of Health and Department of Public Health, according to Dr Sands.

“With respect to revenue generation and collection over the 2018/2019 period, the PHA’s projected collection of $13.9 million is in line with the previous year’s collections with a variance of about $1.3 million below target,” the health minister said.

“Eighty-six percent of patients that access PHA do not pay for services. Of those that have been billed... From 1988 to 2018, over 30 years, Bahamians have racked up unpaid bills at PMH of $782,596,050.27.”

Dr Sands added that the 2019/2020 budget will result in challenges in two areas of priority needs.

“Firstly, just over five million is required annually to cover the costs of staff that were required to operate the Princess Margaret Hospital’s Critical Care Block which remains unfunded dating back to its inception.

“Secondly, approximately $10.3 million is required in excess of the annual allocations to facilitate the additional amount required for drugs, medical and surgical supplies.

“In keeping with recent years, the projected expenditure for drugs and medical and surgical supplies amounts to over $31.4 million dollars, while the budget allocation was $21 million dollars, representing a shortfall of $10.4 million.

“Mr Speaker, I think you will agree that we must find a way to cover this shortfall for the good of the country and all its citizens.”

Dr Sands said a year ago, 40 PHA employees participated in a 10-week introductory coding training programme. Of that group, in September 2018 the top 20 began the advanced one-year training course to become certified medical coders.

“These initiatives are geared towards increasing the number of medical coders in the public hospital system and are all critical steps towards improving the availability of the vital data required within our health system for growth, strengthening and reform,” he said.

“These individuals will populate a centralised billing and collections facility to collect the legally gazetted fees. Some, but not all these fees will be adjusted to reflect current day costs. We have not yet completed the recruitment exercise for leadership in this area. We have not yet agreed the final fee schedule. We do not yet have the private bed inventory to ramp up the adjustment of charges to insured patients carrying insurances paid for by the people of The Bahamas.

“But we shall begin applying the existing (historic) fee schedule effective immediately. If we have persons who can pay ...pay just the minimums that they are mandated to pay... we can dramatically improve the services in our health system.

“Yes, we will have to adjust the fee schedule to be more reflective of the costs. But we are not yet able to effectively bill and collect. We expect to achieve this during this year.”

Dr Sands said overall, included in PHA’s short, medium, and long-term goals are initiatives to augment revenue collections, streamline operations, and reduce waste.

In this vein, one of PHA’s major objectives over the next five years is to transition to a “cost recovery model” where its dependency on the Public Treasury is “appropriately reduced”.

“In the interim, significant revenue augmentation initiatives such as, but not limited to, real time billing, revenue leakage reduction, centralised collections management, and strengthening of insurance claims processing, are being undertaken,” Dr Sands said.

“Simultaneously, the PHA is pursuing significant cost reduction measures including outsourcing of appropriate services, consolidation and renegotiation of contracts, improved inventory management, continued transition to solar energy, telecommunications audit, optimisation of staff scheduling, consolidation of group purchasing and other opportunities for maximisation of economies of scale.

Dr Sands also said of the financial issues that result in shortfalls in the annual budget -including the last fiscal year- is the expenditure on overtime, “which typically exceeds the approved allocation, with nursing coverage continuing to be the biggest challenge due primarily to the shortages of specialised nurses in the hospitals”.

He also cited contracts for medical services and laboratory supplies as other challenging budget items.