A doctor and military veteran who’s practiced medicine on Guam for decades said the Guam Memorial Hospital’s finances would be improved by using the procurement process to bid out service contracts for doctors who aren’t on staff.
Dr. Jerone Landström, an orthopedic hand surgeon with his private clinic Pacific Hand Surgery, said GMH administrators, for years, have created policy “that gives them the perceived authority to not follow GovGuam law.”
“They believe that they do not need to go through the GovGuam procurement process for physicians’ service contracts, including allied health,” he said, which has allowed them to create “ludicrous” contracts that benefit the doctors but leave the hospital short.
Doctors are essentially being paid twice
GMH, for decades, has had a financial shortfall because it is required to care for all patients regardless of their ability to pay.
This is exacerbated by the contracting practice that started more than 16 years ago, he said. GMH administrators started the practice of contracting on-call doctors outside of the procurement process, which would help ensure more standard fees and parameters for payments are included in the final contract.
GMH has physicians on staff. However, GMH officials have said a shortage of doctors required them to contract local physicians working in private practice to place them on call.
Landström said these doctors get paid for being on call regardless of whether they are actually called in or not. However, a number of those contracts also allow doctors to collect the fees for their services – on top of what they’re paid for being on call.
Policy takes money away from nurses, infrastructure
“Now when you pay a physician to be on call in the states, they get X dollars a day, but the hospital owns everything” that the patient pays, Landström said. It’s different at GMH.
“A patient comes in, a doctor is already getting paid $2,000 to be available, he does the surgery, he bills out for it and gets paid more and then collects the money for being on call, and then the hospital can bill out for the facility fee but they’re not billing out for the physician’s services,” he said. “And that’s where the hospital is getting killed.”
“And that takes money from this pot and puts it all here so we can’t pay our nurses more. … If you pay more they’ll stay on Guam … at the hospital and allow you to put money to the facilities as well,” Landström said.
Completely ignoring GovGuam procurement law
He reiterated that the contracts that allow this freedom haven’t been through the proper procurement process.
“Previous gubernatorial administrations had a laissez-faire attitude of financial management at GMHA, allowing their appointed political physician and non-physician proxies [to] 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,” Landström wrote in a letter to The Guam Daily Post. “This system of granting hideously lucrative physician service contracts and physician administrative positions to political cronies and friends doesn’t add value to GMH.”
Landström: Current hospital leaders are cleaning house
Landström, who has been critical of GMH’s financial practices for years, lauds the current GMH administration for trying to correct these previous practices.
“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 GMH 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,” Landström said.
He said what needs to be done is a review of all contracts with physicians.
Use RFPs, eliminate double payments
Additionally, GMH needs to put every new contract for a physician or an allied health service through a request for proposal, which is one method the government uses to procure services. This can help ensure lower costs for contracts and make clear that the hospital will only pay for the surgeon to be on call. Fees collected for any patient care would all go to the hospital.
By following the RFP process, the hospital can say, "If we’re paying for you to come in, then we own everything you do ... so we can recoup the cost of services and paying the doctor."