By NEIL HARTNELL
Tribune Business Editor
The “crashed” healthcare data contract was critical to cutting Princess Margaret Hospital’s $88m income deficit, which exists despite patient days being five times’ higher than in other Caribbean nations.
Documents obtained by Tribune Business reveal that the $18m deal awarded to Allscripts, and its partner Infor Lawson, by the former Christie administration was vital to the introduction of “real time billing and revenue leakage reduction” at The Bahamas’ major public hospital.
This, in turn, would have narrowed the $88m gap that exists between the $5.678m in revenues collected by Princess Margaret Hospital (PMH) for treating patients and its annual $93.747m operating expenses, which are detailed in a position paper presented to the Public Hospitals Authority’s (PHA) Board of Directors.
The paper, which was updated on April 27 this year, reveals that PMH’s income pales alongside the annual nine-figure revenues collected by the health authorities in Bermuda and the Cayman Islands.
This is despite New Providence’s Bahamian population being almost four and fives times’ that of Bermuda and Cayman, with patient days at PMH more than 100,000 higher than those recorded by the latter territory’s health authorities.
The report to the PHA Board discloses that Bermuda and Cayman’s health authorities generated $326.419m and $104.351m in annual revenues, respectively, from population bases of just 64,268 and 54,878. Patient days for both stood at 97,419 for Bermuda, and just 23,702 for the Cayman Islands, with the former turning an operating profit on the healthcare it provided.
Yet PMH, which dwarfed both territories with 124,828 patient days from a 248,948 Bahamian population, collected just under $6m in revenues. This was despite the report revealing that annual fees billed to patients were projected at $83.7m for the financial year ending June 30, 2018, highlighting the “urgent need” to plug the income gaps and focus on collections.
In particular, it revealed that there were “high instances” of persons receiving treatments and care before they were even registered in PMH’s computer systems. This, the report added, “results in lost revenues or, at best, a very delayed bill once such a situation is discovered. This scenario would be eliminated by a fully integrated health information system”.
Such a system is exactly what Allscripts/Infor Lawson were contracted to provide in August 2016, but Dr Duane Sands, minister of health, revealed to Tribune Business earlier this week that the deal had “not just stalled, it’s crashed”, and described it as “a bust” that had wasted millions of Bahamian taxpayer dollars while delivering zero value for patients.
An April 18, 2018, letter from Catherine Weech, the PHA’s managing director, to Marlon Johnson, the Ministry of Finance’s acting financial secretary, placed the integrated healthcare management system (iHMS) as the top item among the revenue-enhancing initiatives being eyed to help close the state-owned enterprise’s (SOE) $28m annual deficit.
“We project incremental revenue collection increases in the short-term, and material increases in the long-term, due to several initiatives including real-time billing and revenue leakage reduction with the implementation of the iHMS system,” Mrs Weech wrote.
That never happened, and the PHA Board position paper confirms that in the absence of such a system all patient bills - apart from those relating to pharmaceutical and laboratory services - have to be generated manually as opposed to taking just one day.
“[The] absence of a fully integrated health information system (iHIMS) means that currently the only systems that are interfaced are inpatient drugs and laboratories,” the position paper said. “All other charges must be manually posted, which also include those in the radiology department....
“Notwithstanding the PHA’s structural deficits, infrastructure challenges and the archaic state of its 33 year old mission critical informational systems - Keane Insight Patient Information, Centricity Pharmacy and Infor Masterpiece General Financials & Materials Management - each requiring replacement, upgrading or complete overhaul, there is an urgent need to focus on the PMH’s inability to currently issue integrated patient bills; obtain electronic reimbursements for individuals with private health insurance or Government-run health plans; bill for radiology services or charge the credits cards of the 11,000-plus tourists who require EMS, clinical, emergency or air ambulance services.”
The desperate financial situation is further underscored by the fact that the PMH data does not include the 51,170 expatriates or 29,157 immigrants that it says reside in The Bahamas, meaning that the lost revenue opportunities are greater than the document allows for given that these persons will also undoubtedly use the public healthcare system.
The PHA is the largest government-subsidised state-owned enterprise (SOE) in The Bahamas, consuming more than 50 percent of such allocations in the 2019-2020 Budget with its $223.5m, which means that doing a better job on cost recovery will alleviate some of the pressure on hard-pressed taxpayers.
It would also give the Authority much-needed income to reinvest in the quality of its facilities and infrastructure, not to mention the care provided, thereby ensuring better treatment outcomes for Bahamians and residents.
Allscripts did not respond to Tribune Business phone calls, voice messages and e-mails seeking comment yesterday. However, Dr Sands suggested that the cause of the contract’s failure may lie with too many members of the Christie administration taking responsibility for the minister of health portfolio.
Asked to respond to comments by Opposition health spokesman, Dr Michael Darville, that the then-government “makes no apologies” for awarding the contract to Allscripts, Dr Sands said: “I think you understand now how this problem may have occurred.
“Because I don’t believe the minister for Grand Bahama [Dr Darville] was ever the substantive minister of health. Nor was the minister of national security [the late Dr Bernard Nottage], nor was the Prime Minister, nor were a number of other people that carried the health portfolio in the previous administration. The diffusion of attention probably led in part or in whole to this mess.”
Dr Sands was alluding to the impression that his predecessor as minister of health, Dr Perry Gomez, was often sidelined by other members of the former Christie administration, as appeared to be the case when the Prime Minister’s Office and Dr Darville took control of the National Health Insurance (NHI) scheme’s roll-out.
The current minister, meanwhile, yesterday affirmed to the media outside the weekly Cabinet meeting that around $7m-$8m had been paid to Allscripts/Infor Lawson and their third party vendors to-date without a single benefit accruing to the Bahamian people.
“It is a matter of looking at a contract that was executed on behalf of the PHA that cost the Bahamian public many millions of dollars for which there is very little to show,” Dr Sands said. “We would have spent, I’m advised, $7m, perhaps even $8m and there is not a single line of code that has been downloaded on a PHA computer.
“We don’t have an electronic medical record, and it is quite disconcerting that many years after signing this contract that there is very little to show and we basically have to start over.” He added that the Bahamian public healthcare system had been placed “behind the eight-ball and we have to catch up” as a result of Allscripts’ failure to perform.
“We have been negotiating, in the interests of the PHA and also the people of The Bahamas,” Dr Sands said. “I’m sure taxpayers will expect if millions of dollars of their money are being spent that they’ll get something for it. Having sacrificed these funds they will expect advantages and improvements in the healthcare system. That has not happened.”
He added that Santa Rose Consulting was helping the PHA to move forward. He added that the Authority had also obtained support from the World Health Organisation (WHO) and its regional affiliate, and agreed to be a “pilot” for a project designed to help small countries “catapult themselves into the realm of electronic medical records”.
Dr Sands said such a system would enable a patient’s medical history to follow them wherever they accessed care in the public system, thus improving the quality of services and treatments they receive.