Hemodialysis machine is costing Schneider Hospital millions, CEO says

ST. THOMAS - Schneider Hospital officials gave senators an update on the hemodialysis unit Thursday, saying the St. Thomas hospital is in full compliance with federal regulations; however, the unit is operating at a severe loss and does not have the money to meet some upcoming federal deadlines.

Interim Chief Executive Officer Angela Rennalls-Atkinson told senators the program cannot support itself. The hemodialysis unit brings in net revenues of about $2 million a year, but expenses exceed $5 million.

By Jan. 1, 2014, all dialysis facilities will be required to have an electronic medical record system. The unit currently uses paper charts. Rennalls-Atkinson said the hospital does not have the resources to make the transition unless it gets a large infusion of cash.

It would cost approximately $121,935, according to Rennalls-Atkinson. That includes the cost of the electronic records system, wiring, laptops, and other necessary equipment.

Once the system is up and running, it will cost about $26,664 to operate annually, she said.

The facility also is required to provide all end stage renal disease-related oral medications to its dialysis patients - for onsite and offsite treatment - by 2014.

Rennalls-Atkinson said the hospital currently administers medications during onsite treatment only. She said the hospital is looking at ways to meet the deadline.

Gala Bryan, administrator of the hemodialysis unit, said the high costs of water and electricity are a major factor in the unit's operating deficit.

She said it costs about $65 for water per treatment and about $12 in electricity per treatment - not including the Levelized Energy Adjustment Clause, which goes to the V.I. Water and Power Authority to pay for the cost of fuel.

"In the States, it would be pennies," Rennalls-Atkinson said.

An analysis determined that each treatment costs the hospital about $348, according to Rennalls-Atkinson. After some cost-saving measures were implemented, the hospital lowered the cost to about $286, she said.

On average, the hospital is reimbursed only about $140 per treatment, leaving a $146 deficit per treatment, Rennalls-Atkinson said.

The unit currently is at capacity and cannot accept any new patients.

Last year, the hospital added two more dialysis stations, bringing the total number available to 18. Services are provided six days a week. Sixteen stations can accommodate three shifts per day, the two new stations can do only two shifts per day.

In 2012, the unit had 99 patients and performed 14,848 treatments. Currently, the unit serves 101 patients.

Rennalls-Atkinson said the hospital gets calls all the time from visitors looking to use the unit on a temporary basis and from people off-island who want to receive dialysis on a permanent basis, but Schneider has to turn them away.

A waiting list has been created with 15 people requesting permanent transfers to St. Thomas and 51 requesting temporary space in the unit, according to Rennalls-Atkinson.

Rennalls-Atkinson said the hemodialysis unit was surveyed by Centers for Medicare and Medicaid Services, the federal regulatory agency, in 2009. Multiple deficiencies were found, and the hospital responded with a corrective action plan.

CMS returned in June 2010 and still found problems, which resulted in a settlement agreement signed in September of that year.

In March 2011, CMS auditors cleared the hospital of all condition-level deficiencies.

Rennalls-Atkinson said CMS made a follow-up visit in June 2011 and found only three minor problems, all of which were corrected within 30 days.

The hospital has maintained its compliance with CMS regulations and currently is awaiting an updated settlement agreement, she said.

- Contact reporter Aldeth Lewin at 714-9111 or email alewin@dailynews.vi.

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