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  • By Mar-Vic Cagurangan

How will you fix the Guam Memorial Hospital?

The Guam Memorial Hospital is the staple of news, with the same running stories that get recycled under different administrations for more than a decade. The public hospital has a revolving door for administrators, who are confronted by the same bundles of seemingly unsolvable problems including poor billing and collection systems, questionable expenditures, outdated fees and low cash inflow, operational and financial mismanagement, overcrowding and bed shortage, low medical supply, insurance disputes, unpaid debts to vendors, unremitted retirement contributions, and so on and so forth.

Every now and then, new laws are passed, new taxes are levied and new debts are incurred but GMH only proves to be bottomless pit, operating on a $30-million operational deficit every year. How will the new administration break the back of the beast?

For the second in our series of Q&A with gubernatorial candidates, we asked these obviously generic questions: How do you intend to fix the Guam Memorial Hospital? Is privatization a viable option?

Following are their responses:

Ray Tenorio (R)

Running mate: Tony Ada

The Guam Memorial Hospital has been underfunded by as much as $30 million a year for over 40 years. Its legal mandate to care for every patient, regardless of their ability to pay, created a public hospital that was consistently inadequately financed by our islands’ policy-making arm. It is the funding shortage that has been the source of the hospital challenge, which has hurt operations and quality of care for our people.

Governor Eddie Calvo, Speaker BJ Cruz, Senators Joe San Agustin and Tommy Morrison along with scores of workers behind the scenes helped champion what is today, the first major step in sustaining the hospital. Governor Calvo signed a bill into law after four decades of financial deficits that promise to improve healthcare. The law funds GMH with a dedicated revenue source every year starting October 2018. GMH Doctors, nurses, technicians and expertly capable employees will now have the funding and resources they need to keep the hospital running and improve healthcare.

With funding now in place, which was the main source of problems at GMH, management and leadership now have the privilege and opportunity to focus on improving healthcare delivery, finding operating efficiencies, and modernizing GMH equipment and facilities. I will be working with the Governor Calvo’s health czars Dr. Mike Cruz and Dr. Larry Lizama, as well as GMH stakeholders to identify long term goals and create a path to minimize the need for people to leave Guam for healthcare. We must also look at Guam’s entire healthcare system to find areas where stakeholders can create sustainability and synergies that complement each other to the benefit of the entire community.

(On GMH privatization) We must always look to find ways in improving operations and patient care at GMH. Outsourcing, where it complements the work of the existing employees and makes sense, is always something that management should look into if it improves the quality of care.

Carl Gutierrez (D)

Running mate: Fred Bordallo

If elected, the Gutierrez-Bordallo team will take over the hospital. Autonomous agencies are fine when they work, but drastic situations call for executive action and the concerns at GMH have been too long and too numerous to ignore anymore. The buck stops with the governor. We will cut back on non-core public expenses temporarily and follow the legislative budgeting process to fully fund the hospital.

No business is going to survive a $30 million annual deficit, yet that’s what we expect of GMH? The Gutierrez-Bordallo team understands the need to eliminate the politically appointed board of trustees, take charge of the executive power over health vested in the chief executive by the Organic Act, and start subsidizing the shortfall with compact-impact dollars and other funds that the GB administration will identify and reprogram.

We bring to bear the compact reimbursement by getting our region’s chief executives to press the federal government by activating the Council of Micronesian Chief Executives. This is a board of directors, originally created by Governor Gutierrez, to create a forum of communication and activism within the Micronesian region. This council will work together to develop plans for regional health insurance, among other timely and relevant issues. Additionally, our team will do everything to ensure hospital vendors are paid on time.

We will work with the U.S. Department of Health and Human Services to assign certified public health service doctors and nurses to augment GMH services. By shoring up the public health clinics in the northern, central, and highly neglected southern villages, we provide adequate general and trauma care in reasonable proximity to those in need rather than overburdening the emergency room of GMH, especially when time and distance are critical to saving life and/or limb.

Gutierrez-Bordallo opposes all tax increases claiming to help fund GMH. GovGuam has fallen into the bad habit of attempting to tax its way out of problems, then misspending new revenues and starving the same public programs that the increases were intended to help.

(On GMH privatization) Gutierrez-Bordallo clearly sees that privatization can only be an option when unnecessary expenses are cut and a plan is in place to fully cover the cost of indigent patient care. As the federal government continues to mandate that no patient may be turned away, while simultaneously failing to meet its Compact Impact obligations to the Government of Guam, a viable insurance program covering unpaid hospital expenses of poor local families and dependent migrants is the only way GMH could ever privatize. We believe responsibility for GMH should rest with the governor.

Dennis Rodriguez (D)

Running mate: Dave Cruz

Historically, government has stove piped its approach with little or no long-term solutions. How many times has a governor had to take direct control of the hospital? Really? Is that the solution? And what happened after that?

It is time to look at the entire system. As chairman of the health committee I have started this process and you can see the beginnings of these plans illustrated in the GMH Task Force Report and the Healthcare Para Todu Health plan. If elected governor we will move forward with evolving and implementing these plans.

When you look at the GMH from a system perspective you understand that to improve cash flow you need to ensure our people have insurance. Our first step in our Healthcare Para Todu Health Plan is to expand Medicaid eligibility, but ultimately, we believe all people on Guam should have health insurance. Simultaneously we need to work the specific “issues of today” that impede GMH.

We need a realistic priority list of issues based on sound management principles. I will destroy the stove pipe structures that exist in our healthcare system. It is imperative that Public Health, DISID, GBHWC and GMH coordinate efforts in so many areas since each of these organizations impact the operation of the others. It is ridiculous that automated systems are purchased that cannot talk between and among these government health entities. It is ridiculous that these entities do not coordinate care from the patient’s viewpoint. I will leverage federal grant money to improve our data and analytics.

(On GMH privatization) It is and has been our stated position to pursue public private partnerships as part of a system of care approach to healthcare. We believe in using this PPP approach with Medicaid and MIP as illustrated in the HealthCare Para Todu Health Plan.

I believe we need to aggressively pursue a PPP with the hospital. This should in no way be interpreted as “we are selling GMH.” In April 2016, we passed Public Law 33-143 directing GEDA to develop and publish a “request for information” relative to how an interested operator/partner would transition into a public-private partnership of the operation of GMH. If elected, I will push for viable ways to partner with expert organizations in the health care field.

Lou Leon Guerrero(D)

Running mate: Joshua Tenorio Team

To fix the Guam Memorial Hospital and regain accreditation, we first need authority that works. I know this intimately because as a hospital trustee I worked with doctors, nurses, maintenance staff and many others to secure accreditation in 2010 after decades without it.

I saw the contributions and sacrifices, unity and teamwork directed toward that one goal. By working together we achieved what few people thought was possible, and we can do it again.

We must collect every dollar lost at GMH because of bad billings and capture every federal dollar available to reimburse the cost of healthcare on Guam. To achieve these goals will require that we overhaul GMH’s financial management system, end politically driven management, adopt 21st century technological solutions, and consider alternative ways to make good on outstanding receivables.

Additionally, Guam Regional Medical City will be a partner not a competitor. This is the first step in a truly collaborative effort to maximize our limited healthcare resources and provide the best possible care for our entire population.

Moreover, we have to recognize that many of our healthcare costs are a result of high rates of preventable diseases. Cancer, high blood pressure, diabetes, and other lifestyle diseases are too prevalent in our community. I believe education and wellness initiatives are a cost-effective means of prevention and they will be an integral part of our treatment and care initiatives.

We must break-down the walls that separate insurers, providers, doctors, nurses, patients, and community leaders. We must also bring in those whose voices may not have been heard in the past. That is why on Day 1, I will convene a meeting of health community leaders to determine how best to improve our health care system.

(On GMH privatization) I certainly believe that all options should be on the table to fix the problems at GMH. However, those options, including privatization, should not hold us back from moving ahead with the solutions that are already within reach. Restoring accreditation to GMH must be the first priority. We know that it is certainly achievable because in 2010 we did just that. With determined leadership, I am confident we can secure accreditation again.

Frank Aguon

Running mate: Alicia Limtiaco (D)

To fix GMH, we must admit that GMH is a symptom, not the problem. There are three problems that must be solved: 1) our public health system is broken; 2), seven out of ten people don’t have adequate healthcare coverage; and 3), GMH is a political football.

First, we fix our healthcare system so the focus is on making people healthy, which is more cost effective than treating them in the emergency room. Second, we will work to improve the levels of healthcare coverage by setting for ourselves a goal that a primary care physician visit will be a person’s first choice, not an emergency room visit because they had no choice. Lastly, we will get rid of the political football by placing qualified healthcare facility professionals in charge to manage and support the medical professionals and staff, not political appointees.

Placing healthcare at the top of my agenda makes it possible for us as an island to restore trust in the operation of this vital part of the public health care system giving our people a reason to believe that in their time of need, they will have the best care available to them.”

(On GMH privatization) We can no longer continue business as usual operations at GMH. Instead, we must explore options similar to public-private partnerships that would leverage the capacities and resources of GMH, without compromising the years of government service and experience of the medical professionals and support staff at the hospital.

I am no expert in running a healthcare facility, but experts do exist; and we need these experts running the operations of GMH. One example of a successful public-private partnership on island is the rehabilitation and improvements to the Harmon Industrial Parkway. Through Public Law 33-191, a measure I had authored, the Harmon Industrial Parkway will finally be built through government leadership and business partnerships. This same model may be used to build the GMH maternity ward.

The success of any public-private-partnership is also determined by the involvement of all parties and the firm oversight of our government. Furthermore, establishing public-private partnerships should not be limited to GMH alone, but must also include our public health centers throughout the island. Supporting our public health centers would provide access to primary care, which in turn would reduce the uninsured from seeking emergency care for primary care services.”

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