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TESTIMONY TO THE COMMITTEE ON HEALTH, HOSPITALS, AND HUMAN SERVICES The Honorable Senator Ray Fonseca Chair of the Committee TESTIMONY BY: Darlene A. Baptiste, MA Ed., RTT, EMT, CPM CHIEF EXECUTIVE OFFICER THE GOVERNOR JUAN F. LUIS HOSPITAL AND MEDICAL CENTER February 25, 2025 Good morning, Honorable Senator Ray Fonseca, Chair of the Committee on Health, Hospitals & 1 Human Services, esteemed Senators of the 36th Legislature of the U.S. Virgin Islands, and members 2 of the listening and viewing audience. 3 I am Darlene A. Carty Baptiste, Chief Executive Officer of the Governor Juan F. Luis Hospital and 4 Medical Center (JFL). Before we delve into today’s testimony, I would like to take a moment to 5 introduce myself formally. I come with over 25 years of experience in health, business, and education 6 and have led projects across administration, budgeting, education, outreach, and case management. I 7 have served in many jurisdictions, including Florida, the British Virgin Islands, Anguilla, and the U.S. 8 Virgin Islands. In my previous roles, I’ve served as the Director of Practice Operations for the 9 Advanced Radiation Therapy Department at the Orlando Health Cancer Institute, Group Facility 10 Administrator for DaVita Kidney Care (Central Florida), Chief Executive Officer for the B.V.I. Health 11 Services Authority, Executive Director for Acute Alternative Medical Group, Chief Executive Officer 12 for the Health Authority of Anguilla, and USVI Health Commissioner. 13 My vision for JFL is to foster a dynamic environment where we not only navigate uncertainty but 14 thrive in it. By cultivating robust internal and external collaborations, alongside a strategic 15 organizational framework, JLF will remain competitive and resilient, ready to seize opportunities as 16 they arise. I also want to express my sincere gratitude to the Governing Board of Directors for their 17 trust and confidence in my leadership. 18 Joining me today to assist with this testimony are Interim Senior Vice President of Finance, Rosalie 19 Javois; Chief Nursing Officer, Darice Plaskett; Chief Human Resources Officer, Patricia Canegata; 20 Chief Legal Counsel, B. Patricia Welcome; and Chief of Staff, James Rollins. 21 Thank you for the opportunity to testify on JFL’s strategic initiatives, including efforts to address 22 staffing shortages, reduce emergency room (ER) wait times, resolve the ongoing patient disposition 23 crisis, and provide an update on accounts payable. I look forward to today’s discussion. 24 Addressing Staffing Shortages 25 The impact of staffing shortages on the healthcare industry has been the subject of much speculation. 26 The shrinking populace and limited pool have contributed to the inadequate availability of a trained 27 health-specific workforce. At JFL, addressing this shortage is a top priority, particularly in three critical 28 areas: nursing, allied health, and medical (physician) staff. Today, I will focus on these high-priority 29 workforce challenges and our efforts to strengthen recruitment and retention. 30 Nursing - We have made remarkable strides in stabilizing our nursing workforce, with a total of 22 31 full-time registered nurses hired in FY '24 and FY ‘25 to date. This underscores our commitment to 32 excellence and efforts to reduce our reliance on travel nurses. Currently, we do not have any travel 33 nurses. The successful completion of negotiations for the Collective Bargaining Agreements (CBAs) 34 with the Virgin Islands Licensed Practical Nurses Association (VILPN), the Virgin Islands Nurses 35 Association (VISNA), and the Registered Nurse Leadership Union (RNLU) has significantly enhanced 36 our ability to recruit and retain nurses. We are proud to offer competitive benefits and incentives that 37 ensure our nursing salaries are on par with market compensation. 38 We continue to focus on stabilizing our nursing staffing levels, particularly in critical and specialized 39 areas such as the Emergency Department, Intensive Care, and Neonatology. These areas demand 40 highly specialized nursing training and experience to provide optimal care for critically ill patients. 41 To address this need, we continue to build on our collaboration with the University of the Virgin 42 Islands (UVI) School of Nursing through our Graduate Nurse-Residency (GNR) Program. We have 43 successfully onboarded 34 local nurses through the GNR program to date. The GNR program 44 provides new graduates and inexperienced nurses with structured training and mentorship allowing 45 the opportunity to gain experience in different nursing specialties. By investing in mentorship, 46 continuing education, and staff development, we can strengthen our nursing workforce for the long 47 term. 48 Allied Health - Allied health professionals provide specialized skills and services for comprehensive 49 patient care. These professionals including surgical technicians, CT/X-ray technologists, ultrasound 50 technologists, echocardiography technologists, and dietitians play an essential role in ensuring that 51 diagnostic and surgical procedures run efficiently. With a deficit in allied health professionals, as 52 observed nationally, JFL has supplemented the need for allied health professionals with agency staff. 53 To address this, we entered the negotiation phase with Seafarer’s International Union (SIU) in June 54 2024 to explore sustainable solutions. As this issue remains our priority, we are expected to reconvene 55 negotiations in 2025. Completing these negotiations will empower us to develop competitive 56 recruitment and retention strategies, significantly reduce employee turnover rates, and position JFL as 57 a competitive employer for allied health professionals. 58 Medical (Physician) Staff - JFL continues to navigate the ongoing physician shortage, with 33 active 59 physicians on staff while some critical specialty positions remain unfilled. To help bridge this gap, JFL 60 supplements the deficit with locum coverage, ensuring continued access to care. By February 21, 2025, 61 we have expended $520,726.03 in locums, with an outstanding balance of $827,097.10 owed to 62 individual locums, not including miscellaneous and staffing agency costs. 63 Our first strategic goal to improve physician recruitment and retention is set to take shape as we work 64 to refine the physician compensation model. We look forward to collaborating with our sister hospital 65 on this important initiative. 66 The recent approval of our National Health Service Corps (NHSC) site application is an asset in our 67 recruitment strategy. It empowers us to effectively attract and retain healthcare professionals through 68 NHSC programs that offer valuable loan repayment, scholarship opportunities, and other attractive 69 benefits. This makes JFL a preferred choice for providers ready to serve in designated shortage areas 70 and we will be prepared to adapt to any changes in the national trajectory. 71 Lastly, we will devise a marketing strategy designed to attract medical talent inclusive of digital 72 campaigns through social media and direct engagement. We remain committed to implementing 73 strategic initiatives to stabilize and strengthen our workforce, ensuring high-quality care for our 74 community. 75 Reducing Emergency Department Wait Times 76 The Emergency Department (ED) wait times remain a major priority of focus, as this directly impacts 77 the quality and efficiency of the ED services and community satisfaction. Recognizing that emergency 78 room delays stem from multiple factors, we employed a multidisciplinary approach to tackle these 79 issues. 80 To drive significant improvements, we re-established the Emergency Department Improvement Team 81 (EDIT) Committee in May 2024, focusing on enhancing ED throughput—the time patients spend 82 from arrival to departure in the ED. This committee meets monthly and includes key departments: 83 Nursing, Medical Staff, Quality, Radiology, Laboratory, Executive Leadership, Patient Access, Patient 84 Experience, Case Management, and Housekeeping. 85 The EDIT Committee evaluates and tracks essential data, including turnaround times (TAT) for ED 86 visits, diagnostic testing, & imaging, left without being seen (LWBS) rates, and discharges against 87 medical advice (AMA). The EDIT also focuses on refining patient triage processes, optimizing staffing 88 levels, and streamlining discharge procedures to create a more responsive and efficient emergency care 89 system. 90 We recognize several challenges affecting patient throughput that we are actively addressing, including 91 financial and supply constraints, staffing shortages in the Emergency Department, Laboratory, and 92 Radiology, limited bed availability, the "boarder" crisis with 50% of Medical/Surgical beds occupied 93 by a boarder, and the increased patient influx stemming from Medicaid coverage loss. Through our 94 efforts with the EDIT Committee, we are committed to finding effective solutions and improving our 95 overall operational capacity. 96 In addition to internal process improvements, public education plays a vital role in reducing 97 unnecessary emergency room visits. Many individuals seek emergency care for non-life-threatening 98 conditions that could be better managed at urgent care facilities or primary care clinics. Our strategy 99 involves heightening community outreach efforts to educate the public on when to visit the emergency 100 room versus when to seek alternative care and the process of how patients are seen based on acuity 101 levels. This initiative aims to reduce overcrowding in the ED and ensure that those with the most 102 urgent medical needs receive timely attention. 103 Finally, we recognize that patient experience and communication are integral to improving emergency 104 care. To enhance satisfaction and transparency, our strategy involves more patient experience 105 touchpoints throughout the ED. These touchpoints include improved signage and regular status 106 updates from staff. By addressing these key areas, we are committed to reducing ER wait times and 107 improving patient throughput. 108 Boarder/Disposition Patients Crisis Overview 109 Currently, JFL houses 8 disposition patients and pays for three disposition patients housed at Casa de 110 Salud, Puerto Rico at an average of $5,100.00 monthly each as of March 2020. These patients no 111 longer require acute hospital care but cannot be discharged due to a lack of available placements and 112 guardianship issues. Their prolonged stay in the hospital significantly contributes to bed shortages, 113 impacting our ER wait times and our ability to admit new patients in need of critical care. Disposition 114 patients incur a significant cost to our hospital. Note that the daily room rate in the Medical-Surgical 115 Unit is $1,758.48 - this equates to $52,754.40 per month per disposition patient, which does not 116 include medication, supplies, staffing, and other overhead costs and increases uncompensated care. 117 The lack of community resources such as skilled nursing homes, rehabilitation centers, or long-term 118 care facilities, which would be suitable for many of our boarders to care for their specific needs, 119 including recreation and socialization, is a significant challenge. 120 To facilitate timely placements, we continue to collaborate closely with the Department of Health 121 (DOH) and the Department of Human Services (DHS) through regularly scheduled meetings to 122 provide status updates and discuss the plan for the disposition patients at JFL. These partnerships are 123 essential in identifying suitable facilities, securing necessary resources, and streamlining the transition 124 process for patients who require specialized care beyond our hospital setting. 125 Despite these challenges, we have made progress. This calendar year, two patients have been 126 successfully placed at Herbert Grigg Home for the Aged, with one additional placement currently 127 pending. This demonstrates the effectiveness of our ongoing efforts to find appropriate solutions for 128 patients who are no longer in need of hospitalization. However, the demand for placements continues 129 to outpace availability, requiring continued advocacy and system-wide improvements. 130 We are seeing an increase in patients, particularly seniors and those with behavioral health needs, 131 remaining in the hospital without a clear care plan. Limited resources and caregiver challenges can 132 make it difficult for families to coordinate long-term support, leading to extended hospital stays. This 133 places added pressure on both families and the healthcare system. To better support these patients, 134 we must strengthen policies, enhance coordination, and expand community-based resources. 135 Finally, public education on this matter is crucial. Many people are unaware of how “boarders” affect 136 not only individual patients but also the broader healthcare system. By raising awareness, we can 137 encourage families, caregivers, and policymakers to support sustainable solutions that prevent 138 unnecessary hospital stays and ensure that all patients receive proper care in the right environment. 139 Through continued collaboration, advocacy, and education, we remain committed to addressing these 140 challenges and improving patient disposition processes for the benefit of both our hospital and the 141 community. 142 Accounts Payable Overview 143 Throughout the testimony, we highlighted several key areas that directly impact JFL’s financial 144 stability, including uncompensated care. Notably, accounts payable have significantly decreased from 145 $54 million to $19.9 million over the past six years. However, there has been a recent upward trend, 146 with payables increasing between fiscal year (FY) 2023 and the present. As of the close of FY 2024, 147 accounts payable stood at $17.8 million, which has since carried over into FY 2025, rising by an 148 additional $2.2 million to a total of $19.9 million as of February 2025. 149 We acknowledge the need for further process enhancements to our revenue cycle processes to support 150 vendor commitments for supplies, medications, and other services. This is a high priority focus for 151 our hospital. To address this, JFL and SRMC collaborated on a joint RFP for contracted services to 152 address the opportunities for improvements to optimize billing and coding, charge capture, and 153 ultimately collections. 154 We are also working on immediate steps to address cash flow challenges at our hospital. These include: 155 - Increase real-time collection for all medical services 156 - Itemized review of denied and rejected claims 157 - Right size JFL through workforce productivity and evaluation 158 - Increase automation supplies management and inventory control 159 - Conducting a workflow analysis for business administration and operations 160 - Strengthening internal controls and monitoring of claims processing 161 - Revisiting internal access to the clearinghouse 162 Conclusion 163 Despite evolving healthcare challenges, JFL remains steadfast in its mission to drive improvement 164 with compassion and respect while implementing strategic solutions to address staffing shortages, ER 165 wait times, patient disposition challenges, and financial sustainability. We extend our deepest gratitude 166 to our dedicated staff, whose unwavering commitment ensures the best possible care for our patients. 167 We also thank our Board of Directors for their leadership, the Governor and the Executive Branch, 168 for their ongoing collaboration, and this legislative body for its continued support. We stand ready to 169 answer any questions. 170