SDA working to address physician shortage
Guam - In an effort to address the ongoing shortage of physicians on island, the Seventh Day Adventist Clinic is moving forward with hiring over a dozen more physicians in the next two years. But just as it plans to expand, it continues to face challenges in actually getting payments for its services.
SDA Clinic chief executive officer Ted Lewis says not only is there not enough physicians at SDA, but everywhere else on island. "For instance, the number of orthopedists and cardiologists are pathetically low and we have no pulmonologist for 160,000. To me, this is unacceptable," he said.
And in just the last week, the SDA management team and board approved a plan to possibly help with the situation. "So we've launched an aggressive campaign to hire 20 additional physicians in the next two years," he added.
Lewis says SDA currently has 14 full-time physicians and is developing relationships with medical schools stateside to recruit physicians to come to Guam - some of whom in just the last few weeks signed a contract with SDA. "So the process of getting physicians, it takes time but we're building the momentum," he said.
But as it works to recruit and bring in more doctors, Lewis says he's been challenged with getting some of his physician's credentialed, particularly with TakeCare Insurance. 'And the term 'credential' means they will recognize the physician and will pay their members if they see them for a visit, so if a physician comes in, in an area where they have what they think is an adequate amount of medical staff in their FHP clinic, the practice has been they won't credential them with us," he said. "So maybe a year or so, it wasn't a problem but now there are more and more doctors they don't recognize and pay for."
As a result, the SDA Clinic has since given notice to TakeCare Insurance that it will be terminating their current contract because it has refused to reimburse the clinic for services of certain physicians. Lewis says he's heard of other clinics experiencing the same problem.
Guam Medical Association president Dr. Thomas Shieh meanwhile says while he's unaware of the details regarding SDA's decision or its business plan in expanding, he says the matter is of grave concern. "The Guam Medical Association we're very concerned regarding credentialing of physicians and providers especially insurance companies," he explained.
Shieh adds with over 220 providers from nurses to doctors in the GMA, he says it's important for all insurance companies to not only credential a provider but to make payments in time. "For an insurance company to not credential a provider for whatsoever reason they have, I don't think that's too friendly. The island is small, you want to be able to work together and you want to ensure that a patient has a choice of doctors," he said.
In addition to this concern, Shieh adds GMA has also raised issue with the lateness of payment for claims from insurance companies and is working to improve the Prompt Payment Act of Guam.
In the meantime, SDA currently estimates 150,000 encounters a year in which TakeCare accounts for 9% of its total customer base. He says the notice to terminate the TakeCare contract allows for a 90-day clause that ensures TakeCare customers are still taken care of. And after repeated calls and email messages, TakeCare management had told KUAM they have no comment at this time.
We should note this isn't the first time TakeCare's practices have been scrutinized. Last year the Guam Memorial Hospital terminated its direct payer agreement with the insurance provider after concerns were raised about its pattern of coverage denial, however after further negotiations with the hospital the termination was rescinded. Also last year, while other insurance companies were issuing rebates as part of Obamacare. TakeCare's subscribers weren't paid a penny instead stockholders were able to split $15 million, this despite 2011 audited financial statements indicating unpaid claims for the year increasing to $11 million and total liabilities increasing to $19.7 million.