"To pro idc quality patient can: in a The Hospita l belie ..: in the following core \::tlucs: sati: environment."

i. uality scrvi1:c and standards compliance:

Strategic Goala ii. pen anJ consistent 1:ommunication

hctwcen clinical and nun-clinical :tatl: the Boan.I of Trustees.. and the public as a\\ hole: and.

'ommis. ion

II IA ii i. l· i cal responsihilit, and accountabi lit al all lcvds.

Brief History

Guam 1 kmorial 1 lospital (GM H). the only puhlic hospital on uum. ' w huih at Oka Point in I 956. rcpn: ·cnting o major change in the hi. tory of th..: local go emmcnt's role in the deli cry ot medical can: to Lhc community. thee tablishmcm ofG 111 as a line agency of the (j vcmmcnt of Guam' "xecuti c Rmnch in 1964 s..:paratcd the adm ini ·tration of ho ·pi ta! ·ervict: from the community hcalU1 services prov i led by the Department f Puhlic 1 lcalth and Wei fan!. Then. in 1977. the uarn Mem ria l H spital uthorit ( 1 A) ' us cn:ated as a public corporation and

•MMfllll has heen operating us a governmental. non-profit in titution erving the p.: pie of Guam under the go cmancc fa nine-member Board of Trustees.

In 1974. the local and f..:dcral government' · plans to n:pluce the rapidly deteriorating Guam lemnrial Mo pita! 1: cilily began to develop. The U.S. Department or the Interior purchased and

t.ran ICrred Lh1.: m:arb, Medical 'enler of the Marianas to the Go cmment of 1uum. to serve as 1hc new Guam Mem rial 11 > pital. The lcdieal enter of th.: larianas foci liry was initially constructed h_ the Catholic Diocese lo serve as a private maternal-child health facility. Financial diflicuhics. however. prompted th.: Dioc.: ·c to consider the sale uf the fo il it. t 1m·et the gO\'cmmcnt's ncec.J to rcplm:e its o ld faci lity at ka Point.

uam Memorial Hospital Authority rccei ed full accrwitation b the Joint ion, a non-pro li t rganization that accredits h1:>-pital · ''orld' idc.

PalentMx Method d Raintusementto GMiA Peroer rtage

Ma:fically lrcligent Daly per ciem fun:led 100"Ai by tte Govenmant c1 15%

A'ogaTI

Mrlcaid Ceily per dem Wiic:h is ID°k fun:led bj the GovelTment

19% of Gan am Sl°/o bj the FeOOal Goverrrrent

Ma:ficae Ceily per dem fLrldaj 100'Ai by the Federal Govemrrent 20%

Self Pay - lns..red 1 OO'k from the Patiert andkJr Qacrla 16% aroU'lirssed

AJI other Based on allol.ed c:aveed be1efits of tte rmclical teath :!)% ~fa1

I'-.)

,, Performance Assessment Page 2

Huge ccomplishment in 2010 lfwe ere to ummari ze both the goa l and chnlknge · ' e faced in 20 10, it w uld be all fi u. ed in ou r journc towards aecreditati n. nee the lleci i n was made to pur ue accred itation. which was cry talliLed by lur oard of

I Tru tees ' hairper n, Ir. Daniel L. Webb in 2008. it was clearly undi:r ·toad b tho ·e in ol ed that it would not I

nly Iran ·late into an increase in H ·pil..11 co ts. but al an intcn ifica1i n of time. cffi rt, and hard work b all r our employees. he Joint om mi ion (J ')Accreditation mean that the le el o f medical care pro ided b the fa ili ty ha been a ·c cd to be of quality ' taudard and that the accredited organizati n ha demonstrated c mpliance to the most stringent ·tandards of performance.

MAP: Medical Assistance Plan. MED.Medicaid. MIP: Medically Indigent Program. As of September 30, 2010. 55.067 patient accounts were referred to an external contracted colleclion agency with an aggregate unpaid amount of over $99 million. Life of these accounts stem back at least five fiscal yea~.

Maintaining the Accreditation GMHA i the only omponent of the overnment of Guam in which servic · cannot be withheld due to the financial ability of lhe patient The negative impact of this mandate i clearly illustrated in the toll wing page. The mandate i hampering the g al toe ablish greater self reliance. dditi nally, the ho pital did realize an

, increa e in operati nal exp n e due L J ccreditation pur uit becau e the ccreditation require a certain l number f clinical tatlS to be maintained. o maintain the ccreditation, the G 1HA executes monthly and

quarterly e alualion of performan e indicators lhat are geared toward determining compliance with JC ilandards becau e f periodic J ' ia on- ite i it to ex. min \ hether the facility i maintaining adh rence to the tandar' of care.

The H pital continues to dep nd hea ily on the government of Guam for payments of medical er ice to llP and Medical i tance Program clients. Furtherrn re, the Hospital saw an increase 17% in ninsured elf-Pay

1 Patienr who were d f de lared to be unemployed at 76% between F 2009 and FY - 0 I 0. he Hospital. as a part f ext nding it effort t collect on all outstanding a counts, ha made it a andard operating procedure t

..i:_:~~- unpaid accounts to ex~mal __ tracted collecti n agencies_

I

Gold Medal I · JC Accreditation is equivalent to a I gold medal of 1

1 hospitals across the USA . ____ J

page were included ba ed on the Management Discussion and Analysis ( ID& ) in Fiscal ear _OIO mplete rfbrm~r:ice measur ment infonnati~ -~-be f!:>ur:id on Website:

I The Cost of Servicing the Citizens Page 3

1°/o

1%

87%

8%

I a Net Patient Servioe ~"~ (Net) • Cafeteria~ ~;::J IO Qher AJvenues o l..hcollectible Amounts

llbn-Q:>e~~ AJvenues a ~ Gr'ants and Contrib"!ons

,-- --- --·-

=fl I Dilemma I ! tn · _o I 0. G IH A' t t< I revenues

decrens d by 16.7 million or I % compared j to FY _009. 1\ uch the Hospital continue j

I to depend hcavil on the go crnmcnt of Guam ti r paym1:nts of medical crvices to IP and I

I' lcdical A i lance Program clien t . The

I lo pital, a a part f c tending it fli n to ; collect on all outstanding account ·. has mad

it a srandard op rating procedure t refer I unpaid a c unts t 'xh:rnal ontra ted ollecrion agencie .

REVENUES FY2007 FY2008 FY2009 FY2010 CHANGE% Net Patient Service Revenue (Net) $7 4, 785, 155 $88,745,514 $92,560,551 $83,481 , 135 -9 .8% Cafeteria Food Sales 481 ,676 581,065 655,976 642,581 -2 .0% I I Other Revenues 266,898 119,828 323, 154 502,652 55 .5%

1 Uncollectible Amounts (782,371) (267,893) 0 0 0.0% Non-Operating Revenues 7,356,034 8,410,141 15,850,579 7,235,032 -54.4% Capital Grants and

· Contributions 1,002,1 35 1,920,307 2, 130,307 2,944,847 38.2% Total Revenues $83, 109,527 $99,508,962 $111 ,520,567 $94,806,247 -15.0%

48%

I a f\lirs ing l • A"ofessional Support

o Admnistrative Support 1

o F1Scal Services

• Depreciation I a AdrTinistration

1

• Retiree Healthcare

D Medk:al Staff

• Non-Operating Expenses

' operating e pen es hav grown faster than its revenues. GMH ha been operating at a loss. Its biggest e pen e is personnel co . G IHA continue to operate al a lo and uffer negative ca h flows; its revenues continue to be in ufficient to pay current expenses and payments to vend r . Becau e of the e cash flow challenges. GMHA is unable to take ad antage of di C_<?unts offered by uppliers.

n independent aud it report of G1 IH 's tinan ial sratements prepared by Deloitte & Touche LLP c ncluded that the ·tatement wa prepared in accordance with genera lly accepted accounting principles in the . Guam OP released the audit repon on Ja~uary ~2. 20 I 0.

Future Challenges and Economic Outlook Page 4

!\ hat will Fi al conomic Outlook

car 20 11 be like fl r the Ho pital? ne thing will be pr minent in the minds of all Ho ·pita! emplo ees - the commitment to en urc out-patient receive quality medical are in a safe en ir nm nl. De pit the financial hal leng in FY -0 I 0, our mployees ntinue to come in to work everyday because of our patients. ur empt ee are dedicated to nsuring I patient car ' ill never be ompr mi ed. The H pital has ' rked too hard and long to re-attain accreditation from the Joint Comm is ·ion. but mo ing

1 fon· ard our challenge ' ill continu to mo lly exi in FY 2011 thus make our journey interesting.

Through the forethought and planning between the Hospi tal ' new Board of ! Tru tees. the enato f the 31 t ' uam Legi. lature. and the dministrnti n,

Military Buildup The econ rnic bo m of the projected military buildup on uam may not be full possibly until 20 1-t 'ntil then, th Ho pita! is beginning talk with organizations n the impact of the influ o f 11-w rkers. um:ntly ponsoring 1,; mpanies do not ha c t retain medical h a lth insurance for their H-~

workers. \i ith the Ho ·pital's mandate to accept all

1 patients ' ho pre ent them el es a medical condition at the H ·pital. the expected fourteen thousand H-2

1 w rke o er the ne, t c uple of years ' ill mo t

certainly re ult in the increase of uncompensated care to the Ho pital .

the negative impact f P.L. 29-132 may he le s ned in the next ear. 1 1

In line with the military bui ldup and the e. peeled Mu h like Fi cal Year _o I 0. o erall Go cmment of Guam ollections will increa e in the civi lian population, the H pital is likely be luggish and thi ill likely be reflected in delayed oil ction/ working on derennining the feasibility of retro-fitting

, r imbursement t the Hospital for adjudicated llP and M P account and/or I ' its xisting stru ture or building an entirely new other appropriated funding source . Ho pita I. ompletion of the feasibility tudy i one f

luggish ollection from the government of Guam. in rease in unemployed/ I uninsured elf-Pay Patients, and increase in patient/ operational needs hou ld be warni ng indication to our c mmunity. elected Legislators and lected ! fficials, tH ne ds to be provided additional fund in order to meet its

l organic mandate of provided care to all ~ ho present them el es regardless of j ~eirab~tytopal. __ _ ·-- _____ l

The World and Guam ationall , according to nited tate Bureau of Labor tat1 sllc report dated:

December 22, 0 I 0 it is anticipated that the age group of 55 and older will ! encompass a larger portion of the population between the years - 008 and 20 18, in other words, the baby boomers are Ii ing longer. If they are living longer,

1 we will have to contend ' ith the health needs of these aging baby boomers. oupled with the projected nursing shortag in th nited tares and the heal th

conditions associated \ ith an aging population one can easi ly perceive how it wil l impact Guam - increase challenges in re ruiting and maintaining qualified r licen cd/ registered clinical staff - from nurses. phy icians. phannacists, respirat ry technicians. physician assistants, phlebotomi t • and on and on. The federa l go ernment predict that. by 10 I 0 .. retirement will contribute to a

~·hortage of appro ·imately 24,000 doctors and nearly one million nur ·es - a

riou clinical personnel deficit that will ha e a direct impact on Guam's

i~ity to recruitment_efforts. --·

I the tep necessary t allow acces by the Ho pita! to federal funding from the nited tales Department of

I griculture. he Ho pita! currently has a ailable I 58 I acute bed . For the ize of Guam. ' e are planning to j add ne hundred additional adult acute bed bringing I the total to two hundred and fifty pri ate acute beds.

Report We want to hear from y u. Do you like this report? Do you believe it should include any oth r infom1ation? Plea e let us kn w by conta ting sistant

hief inancial Officer. Mr. Jun In fante atjun.infante@gmha.org or call 671-647-2256 or 2190.

References uam Memorial Hospital uthority. Fiscal Year2010 Financial talements,