The Organic Act of Guam mandates that GMHA will care for all patients regardless of ability to pay. This is an example of Guam's compassion and social generosity, but it has been a fiscal strain on GMHA operations and taxpayers for decades. The fiscal strain on GMHA was partially reduced by passage of Bill 248-34 into law. It increased taxes on the people of Guam to subsidize GMHA for expenditures mandated by the Organic Act of Guam. Yet, this added taxpayer support doesn’t assure GMHA fiscal viability, since the law doesn’t address deficiencies of GMHA fiscal management. GMHA's new administration took over in January of this year and is in the process of improving fiscal management. This requires that all physicians employed by GMHA have their contracts or arrangements reviewed to determine if a given physician service mandated or not mandated by Medicare is appropriate for care. This review also requires an assessment if a given physician service is value added to GMHA and critical to patient care. For the past 16 years, this administrative assessment hasn’t been done. Previous gubernatorial administrations had a laissez-faire attitude of financial management at GMHA, allowing their appointed political physician and nonphysician proxies grant service contracts to their physician friends based on chenchule' political favoritism that previously ignored, and continues to ignore and bypass, Government of Guam procurement law.

This system of granting hideously lucrative physician service contracts and physician administrative positions to political cronies and friends doesn’t add value to GMHA. This activity has been hidden from the public for decades and apparently has been also hidden from scrutiny by the Association of Government Accountants that recently awarded GMHA the "Bronze" medal in the interagency contest the "Best Citizen Centric Report.” The increase in taxes upon passage of Bill 248-34 has resulted in millions of dollars going to GMHA physicians through uncompetitive procurement, manipulation of physician on-call schedules so that some physicians can achieve overtime pay on top of ridiculously high salaries that are atypical for a community of our size. This administration is in the process of achieving fiscal responsibility and stability. This activity has resulted in unfair criticism by a GMHA emergency room physician who financially benefited by the old entrenched system of no fiscal oversight. This is now being upended by the leadership of Lillian Perez-Posadas, CEO, RN, MN., Dr. Annie Bordallo and the hospital board of trustees, so that GMHA can pay our hospital nurses more to attract and retain staff and to maintain hospital logistics to assure the best quality of care to the community. There are many community hospital models in the States that have maintained quality of care and reduced costs by doing the things that our current hospital administration is in the process of implementing, and this extends well beyond the GMHA emergency department. For example, our sister hospital GRMC and hospitals in Oregon have reduced costs by millions of dollars in their anesthesia departments by using certified registered nurse anesthetists as extenders of care of physician anesthesiologists. This has reduced costs to hospitals by reducing the number of physician anesthesiologists whose salaries are double to quadruple that of a CRNA, while maintaining the quality of care. Is this the case for GMHA? No, it is not, because like the GMHA emergency department, the GMHA physician anesthesia department functioned autonomously from the GMHA administration, without any fiscal oversight. That is changing now, and instead of criticizing the current GMHA administration, they should be applauded in this effort to stabilize GMHA financially.

Dr. Jerone T. Landström lives in Tamuning.

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