By IVA MAURIN
GUALO RAI, Saipan — Modernization is in the works for CNMI’s only hospital, the Commonwealth Healthcare Corp., with CARES Act money to upgrade its most crucial facilities — in particular, its emergency and operating rooms.
Esther L. Muna, CEO told the Journal funding received from the CARES Act of about $1 million — awarded to the Northern Mariana Islands and transferred to CHCC, is now being used to renovate its Emergency Department, and to modernize its operating rooms with adequate isolation rooms.
The money was also used to expand and upgrade CHCC’s laboratory to add the different platforms the hospital has for COVID-19 testing, which included Biofire, additional GeneXpert, Solgent (Korea), and Abbot ID Now testing.
“The hospital itself is over 30 years old. It needs modernization. We’ve added the Oncology Center, we’re looking at clinical trials, we’re looking at all kinds of assistance that we can do. One of the ways to address access and prevention is to modernize this facility.”
In addition to the renovations, Muna said there is an over-all plan to build a modern CHC, which would be implemented in phases.
Phase one would include the building of the Outpatient-centered clinics, with modernized equipment and the MRI facility; phase two would move the ER and the ancillary services; and then phase three would take all the emptied rooms to be expanded as a ward hospital — with more beds. The hospital only has the 76 beds it was built with in 1986, when the NMI population was at less than 20,000.
As CHC now serves almost 50,000 people, and especially with COVID-19, the hospital operates at a loss for the patients it receives.
It runs on an $80 million to $90 million budget. While the NMI government still owes CHC $12 million in appropriations from fiscal 2018 and fiscal 2019 — money which could go towards expansion — Muna said CHC “can’t ask” right now, as they understand the cash flow situation of the government.
Due to COVID, CHC was able to receive $2 million as part of the public health emergency, allowing for the accelerated payment of Medicare. In addition, the approval of the Medicaid Presumptive Eligibility, also due to the pandemic, is also beneficial. Not only does that allow more individuals to be covered by Medicaid, it will also play a big part in recouping the hospital’s expenses.
“We do have a large amount of people here in the poverty line,” Muna said. “I know that people are suffering. If they’re not accessing care, we’re going to have increase in hospitalizations. We want people to access care as much as possible — early. When Presumptive Eligibility was allowed during the pandemic, it was a no brainer.”
Muna said with Presumptive Eligibility, people were able to come to the hospital and get serviced, and that they were able to test for COVID. The program was successful to the point that people were enrolling. The hospital saw an increase of 700 outpatient visits in March, compared to the same time last year.
People who have been sick and have not accessed care, now do, Muna said. While it is CHC’s hope that this continues, it would not, hence, the discussion towards having a universal health insurance.
“We do have people that may [have] work, but still can’t afford the insurance, and we’re seeing a lot of that. This Presumptive Eligibility provides that [access but] we need to find a solution to universal health care once the Presumptive Eligibility ends.”
Having universal health insurance, Muna added, is not only good for the relationship with the provider [CHCC or other service providers] and the patient, but would also benefit providers because they will get paid.
For the hospital that means renovating, building, and modernizing hospital facilities.
The Oncology Center at CHC was renovated, though from a donation of about $1 million –also used to hire personnel.
There is an ongoing benefit to upgrading facilities such as the Oncology Center, Muna said.
“When we did that, we saved the government [expenses on] medical referral.”
Plus, she said, “A lot of people [who are sick and in need of treatment] can’t afford to leave the island, not because they cannot afford to leave the island — it’s because this is their home and they want to be with their family. That’s our culture.”
With the Oncology Center on island, people no longer need to be displaced to be able to access constant treatment, and instead, can return from the mainland. Muna said that option doubled the number of patients CHC now sees.
Muna said CHC aims to transform healthcare delivery further in the NMI, for integration of public health and its facilities.
“We’re designing healthcare for the long haul. … That’s always been our mission and I know that it’s also the government’s mission. I hope that with funding that’s coming to the CNMI, that we take a look at that and [see] how can we make it just better for everyone.”
She said she hopes the collaboration during the pandemic will translate to
other health issues, such as the non-communicable diseases or chronic diseases in the NMI
“What we saw with COVID is that people don’t really want to leave, they don’t want to go elsewhere for their healthcare. So, let’s invest in health care here. We have great people, great minds here in this organization that want to see that,” she said. “Let’s build a strong health system so that we can have a resilient and strong community.” mbj