HSA deficit, collections need to be addressed
Acknowledging that the Health Services Authority has many issues to deal with, some more pressing than others, new CEO Craig Brown is nevertheless optimistic for the future of the HSA.
Top of his list of things to do is to deal with financial issues. Plagued by a $7 million deficit, a lack of financial records, and problems with both individual collections and insurance payments, the HSA needs to get a chief financial officer in place.
‘One of the major issues is the finances. Until we can get the finances in order that will always be the major issue.
‘I’m not a CFO and frankly I think it is more important to have a CFO first before a CEO. That’s my number one slot that has to be filled. I’m hoping to be able to have a shortlist of candidates within 30 days. We need to have somebody here sooner than later. Once somebody is in place, I can concentrate on other issues,’ Mr. Brown said.
He would also like to get the hospital up to speed on using the Cerner system. Cerner is a healthcare information technology system that covers everything from prescriptions to billing.
‘We are well-managed, but our financial systems aren’t in place. I don’t think our hardware is robust enough to fully utilise the Cerner system. I’m not sure all of our staff is fully versed in the system,’ Mr. Brown said.
Mr. Brown and other HSA staff will be travelling to the Kansas City, Missouri, headquarters of Cerner next month to become better acquainted with the system.
‘We want to understand how to make it work fully for us,’ he said.
He admitted that not all the bill-payment problems can be blamed on others.
‘Part of it is our problem. The system hasn’t always captured what our needs are or supplied the information insurance companies require to pay the bills,’ he said.
The HSA may still have to call on the government for help at some point, Mr. Brown explained.
‘Down the road, unless we find some relief with finances, after we’ve done our due diligence in collections, if there are still shortfalls we will have to go back to the government.
‘If fees for service and collections improve and we are not self-sufficient, the government will need to fund us differently or change the scope of the program, such as limiting service.
‘But if the volume doesn’t cover the ongoing cost of the service and if it is clearly a service we have to operate – such as the ambulance service – the funds will have to come from somewhere else,’ he said.
The new CEO will also be looking to involve the community in fundraising for the hospital to help finance such things as major equipment purchases.
‘I hope to be able to have a hospital foundation set up within six months,’ Mr. Brown said.
He has set up foundations at two other hospitals. One of the first priorities for the foundation would be to raise enough money to buy a 16-slice CT scanner to replace the single-slice unit now being used.
The new scanner, which he believes should be the minimum requirement for the hospital, would cost about US$1 million to US$1.5 million, he explained.
‘That’s something I think a foundation would get everyone in the community contributing towards. And then we have to thank them.
‘I would put up a big donor board downstairs and put their names up and recognise them so when people walk into the hospital they can see who is helping to make this hospital bigger and better.
‘I know there are organisations right now that would like to contribute. The foundation would look at what areas of health care would contribute to the islands,’ he said.
Mr. Brown also cited recommendations from the Mercer report, in which a consulting company evaluated the organisational structure of the HSA.
‘I’ve been trying to assess what makes sense on a senior corporate level. Where can we make changes that have the least impact on people? The last thing I want to do is put people out of work.
‘Within 30 days, I need to get to the board (of directors of the HSA) to say this is the kind of structure that I think we need in place to allow us to move forward,’ he said.
As for staff in general, he believes that poor morale is not an issue.
‘I have trouble with people telling me the morale is terrible here. I see a lot of very committed, positive people. It’s a myth we have bad morale. We have pockets of problems. But, overall, I think it’s wrong to paint a picture of morale problems here,’ he said.
He also addressed salary increases for staff.
‘We have to get our financial house in order first. But, the staff needs to be treated fairly and equitably. If we are falling behind compared to other organisations we need to do something.
‘The staff has been short-changed in some areas. The board has made a commitment to carve out some funds to make adjustments,’ Mr. Brown said.
He spoke of the need for a review to determine where the shortfalls are and added that recruitment would be difficult if the hospital is behind in areas such as pay.
Quality of care
‘Our first goal is quality of care. We have to be focused on the patient but to do that we have to have good staff who enjoy their jobs.
‘There are lots of issues here but I really believe people want to make a difference. There’s a saying I’ve always loved – The race for excellence has no finish line. We can always do better,’ he said.
The hospital is not unique in facing difficulties, he added.
‘Any organisation has issues and problems. I think being the hospital we are usually more front-page news than other organisations.
‘What usually sells newspapers is more problems than positive things. We need to do a better job of publicising some of the great things we do here,’ he said.
Mr. Brown cautioned, however, that his arrival should not be considered the solution to all of the HSA’s problems.
‘A lot of expectations have been built up around the CEO and I’m not sure that’s fair. I don’t perform miracles,’ he said.
He is determined to do his part, however.
‘This is one of the most dangerous jobs in the organisation; there have been four CEOs in four years. Hopefully, I’m going to break that trend.
‘I’m very proactive. I look to the future and how we can deal with issues. I’m not one to dwell on the past,’ Mr. Brown said.