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Faipule calls for delay in LBJ fee reduction plan

Rep. Larry Sanitoa has called on the LBJ Medical Center board to “hold off” on implementing the $5 reduction in hospital fees until a complete study has been conducted and a report submitted to the Fono on the impact such a decrease will have on hospital revenue.


However, board chairman Mase Akapo has insisted the hospital is conducting this necessary analysis and is looking at implementing the fee reduction next month after the matter has been presented to the governor.


Mase along with LBJ chief executive officer Joseph Davis-Fleming and EMS boss Galumalemana Popo Avegalio appeared last Friday before the House Public Health Committee to discuss a handful of hospital issues raised by lawmakers.


One of those issues involved a follow up on the LBJ board’s plan to reduce by $5 the hospital fees. Committee chairman Rep. Maugaoali’i Tusipa Anoai asked for a status report on this matter, and when it will be implemented.


Mase said that board discussions have been held and reports from various departments, including the CEO’s office, have been received for review. However, because there was no quorum last month due to some board members being off-island, the board plans to meet this week for another around of discussions on this important issue — which is one of the governor’s mandates, he noted. 


According to the chairman, the board was looking at implementing the reduction on the first of April, this year. However, he said that before implementation it will be presented to the governor for his review.


The board is now hoping the reduction will take effect no later than Flag Day this year, the board chair noted.


Sanitoa says he has concerns about implementing a fee reduction without a thorough review or study being conducted — by either a task force or an independent group — on the impact the reduction will have on LBJ operations, not only for the immediate moment, but long term.


He recalled that about two years ago, when there was a move by the previous hospital administration to raise hospital fees, there was a lot of community opposition and big debates in the Fono over the matter.


In the end, he said,  the fee was increased only up to $20 per visit — which is affordable to local residents — instead of $50 per visit. He said there were also minor hikes on other LBJ services.


“I’m extremely concerned that we [are] sort of rushing to decrease these fees without having a decent study on how much that is going to impact our operations at this particular point, or six months from now. Because I don’t want us to come back here again, in six months [from now] ...and say ‘guess what, we made a mistake, we need to put that $5 back’,” Sanitoa said.


Mase responded that the board has looked at all areas of the hospital which collect revenue, and how that revenue has been expended.


Additionally, he said, the board has looked at revenue collection from previous years, current rates, and how much will be collected in the future when the rates are decreased by $5,  adding that the board has conducted a through review of the issues raised by Sanitoa and there have been reports and input from all departments.


Mase also shared that the hospital is benefiting from a provision of the federal Affordable Care Act (ACA), or Obamacare, dealing with Medicaid and requests for federal funding will be made on other provisions of ACA. He said the only concern at the start is to ensure there are sufficient local matching-funds for federal grants — but that has already been reviewed, and the board is satisfied with moving forward with the reduction.


Sanitoa was dissatisfied with Mase’s reply and pointed out that “for the most part, we rely on studies and reports to give us some indication" on what kind of impact any changes will have on operations and funding; and also noted there is already in existence with the LBJ fee structure, a sliding scale in the system, to help low income patients.


But “in the absence of any solid report that tells us that this is the right thing for us to do, I think we should hold off until we have a complete study” on the impact of such a reduction in LBJ operations now and into the future, he said, adding that such a report should provide how much money the hospital stands to lose under the reduced fee proposal.


In response, Mase said that on a daily basis, many residents have called upon the hospital to reduce hospital rates, and noted that since the rates were last increased, they have seen a 50% decrease in the number of people coming to the hospital and the board believes if fees are reduced, more people will visit the hospital.


Mase insisted that the board has conducted a full impact review before making any proposed fee reduction, and the board and management’s move was meant to help the community.


Regarding Mase’s claim that there is a drop in the number of people visiting the hospital, Sanitoa said, “With all due respect… we have really been pushing for primary care” services at Health Department clinics for the public.


So if there is a decrease in patient numbers at LBJ, there is an increase in patient numbers for DoH clinics, which the public have been encouraged to use, due to — among other things — convenience, Sanitoa responded.


(Samoa News notes the governor in his State of the Territory Address this year noted, aside from his reaffirmation of his mandate to establish “a one fee structure for all residents of American Samoa regardless of immigration status” — he wanted to have LBJ “dedicate its energies to chronic care services” and for clinics, such as dental, primary, EMS, to be moved over to the DoH. It should also be pointed out that DoH fees are $10 per visit.)


Maugaoali’i agreed with Sanitoa on the need for a study and asked that Mase provide an impact report on finances of the hospital.


Responding to questions from Rep. Taotasi Archie Soliai, the CEO said the sliding scale program is still in place and “applies across the board” regardless if it’s for in-patient or out patient services. He also said LBJ is looking at services across-the-board, and how it will be financially impacted by the $5 reduction.


“We... have already started that financial impact analysis not only about the $5 but we are also looking at a $10 reduction scenario,” Davis-Fleming explained. “As part of that formula, we’re trying to figure out what’s going to replace it.


“Because not only are we looking at short term impact, we’re looking at the long term leading into the budget planning for FY 2015. We’re looking at a long term sustainable plan,” he said.