ViewPoint; Guam Hospital Development Forum

It. Is a new medical center possible can Guam have a state of the art hospital in the next few years. The Guam hospital development forum tonight on viewpoint hope. Thank you. For that concern. On a previous edition of

viewpoint we took a look at a hospital in his capacity as a public safety net institution. We saw that many of the problems at GMH are shared by many such facilities across the country. We also found out that while we can learn from that situation the hospital must be prepared to meet the needs of the population for short and long term. Is the government in a position to do what is necessary to me is a renovated or revamped. Or do we need a nuance. If we need a new one and how will it be financed. Recently a community group was formed to address these questions. The group by attorney and is comprised of a number of professionals concerned with the future of care on this is their mission statement. The hospital development forum is a private sector driven effort whose primary purpose is to creation of a

written concept paper or model to support the financing and development of a medical center that is either privately or one created under a public private partnership structure. Tonight on viewpoint we welcome guests from the development today. There are members of all areas related to a hospital facility and discuss the project. Thanks for joining us. Introduce yourself. Good evening my name is Kira money I'm the medical director of half the specialist group and I'm a surgeon and even Jack you my name is peach grower and I'm the founder of the gram hospital development forum and I also chair the finance and Investor Relations Committee for the forum.

An engineer with an Associates and I'm heading up the location and physical facilities committee for the forum. Good evening Jackie. My name is Ruth. I'm a nurse. I'm a businesswoman. I own health services of the Pacific homecare and hospice and I am the chair of the recruitment and retention Committee for the forum. Thank you very much for being here. Or just go ahead with our questions. The underlying assumption of the hospital or development form seems to be that we need a private sector effort to replace or complementary image. Does the form intentionally not include government participation. And what is the planned relationship between the new hospital and Memorial Hospital. Yeah I think I'd like to first clarify that from the outset the forum has never had any purpose that would be involved with the placement of the ground hospital. In fact from the very beginning our purpose has been to coexist with the

hospital. In fact the motivation behind this effort came because of a terrific group of people that work at that hospital. Nothing that we do is going to detract from the positive work that happens at the hospital by committed doctors nurses technicians. There are however certain weaknesses that happen at the hospitals that we address in some very open dialogue which we feel thats going to lead to a business plan that does not look at. Basically you know trying to get rid of grammer hospital but instead creating a synergy with a new privately owned hospital which were discussed later about the nonprofit status and why we chose that and how that hospital can work together with GM made sure that it better serves our community. What anyone else. I think one area where government Portis participation may actually be desired is in locating the facility and I think weve had some discussions about the potential for

using public land as an option in siting the facility if the conditions work out favorably for both parties. Jackie just wanted to add something. To go with what Peter was saying is this new hospital development is to complement each with services that GMH does not provide right now. And so that's important to stress. And that's. OK. OK. Now the forum is organized into committees as I understand it covering financing ownership insurance the physical plant and staffing. These are certainly important areas of consideration but there is no medical or patient care committee. How are these issues included in the project. Jackie Unfortunately the way building a hospital works is much the same way as building a house works. You don't move in and then start putting the bricks around you. And what we're building up now is

we're building the walls and doing the plumbing in. And at this stage actually we're at the architects office trying to decide how many rooms we need and how many bathrooms. So the patient care and the medical part is actually the easy part. You know that's what we went to school for. And that part is easy to put together. The hard part is actually the business side and the organizational and the financial and the physical side effect putting it together so. Those things there's lots of very good models in fact any hospital or zation this looking after patients you can pretty much take out a boilerplate plan of action that they have and there are systems in place that we're going to follow like the Jayco and Medicare that give us guidelines how to do it so that part is the part that comes after we decide on what what the facility's going to be what services it's going to definitely provide and how many beds it's going to have and so on

keeping on to that issue of the physical plant the requirements of the physical plant and the location are key considerations. What kind of a facility will this be and where might it be built. Based on our preliminary estimates the medical center will be about one hundred bed facility with surgical suites and sent of care units laboratory and other bed related functions. It also includes die not diagnostic and treatment functions as well as outpatient related functions and administrative and service functions. Based on what we've come up with so far we're looking at about a two hundred and forty thousand square foot facility with 80000 square foot footprint. When you include the parking requirements that for the building in the parking area that will cover about five point five acres. And we anticipate the remaining 4.5 acres would be needed in order to expand into a medical office building and perhaps add additional rooms at a later time. So we're looking at about a 10 acre

site. We were trying to find locations that have adequate infrastructure that will meet the zoning requirements. All of those types of criteria are being factored in and we're currently looking at sites and we need to mooning or Pago. And in the teens an area as well. Okay. Now. Jack if I could just add one more point as a follow up to what Dr. Ramani was saying earlier with respect to the committee composition. Everything that is done in committees does have a direct impact of patient care. OK I want to just give you an example for instance you may not think this right away but for instance the financial viability of this new entity directly impacts patient care the ability of the hospital to be financially buyable to buy new equipment. So on and so on. The design of the hospital for instance there was literature that was passed out at one of our meeting for instance is how do you designed the rooms in configuration to where the nurses station are can they see the patients private rooms for instance.

You know I think a decision has been made that every room should be a private room because studies have indicated that patients heal better when they're in the privacy of their own room so with respect to every single one of our committees there is a direct correlation and discussion with respect to patient care. OK. Very interesting. I understand that a business plan is in the process of being written before the completion of the plan. Will the public input and decisions that are already included. First of all I want to say that we have operated this forum every single one of our meetings has been very transparent. We have notified every member of the media to get our message out to the community. Every single one of our meetings has been in some form of publication radio broadcast or television broadcast. We've had guests or members of the public that have been to the meetings. I constantly

receive e-mails almost on a daily basis from people giving their thoughts and I basically forward those emails to the person that we have selected to draft a business plan with with respect to the other part of of of your question. The part about Enter Jack and Jackie Pete. We've also I mean we are we are a cross-section of the public as well. I mean we're not if it wasn't by accident that you know we got chosen we're not all doctors or lawyers or engineers. It's just that you know obviously people with certain expertise but also people with interest are involved. The other thing is that from day one Mrs. Crowe's being very active and and all of us actually that's been part of our mission to recruit the interest of the public and to educate and you know that's part of the reason why we're here today is is to educate the public with regards to what we're doing and

we're we're open to any and all suggestions that might come in and they will be considered. It's just you know you cannot have a plebiscite for for something like this and really need somebody to take the reins and start driving this horse. And what Jackie is is included in that plan. I was trying to finish up later for I got my thought is is that we have already made a determination that number one. It is in the best interest of the people of Guam that this hospital be privately owned. We took that to the next level. Since there's different types of private ownership and we took that to the next level when it was unanimous among all 23 members that it should be nonprofit. So those two elements in itself which are which are major decisions as far as the next step in financing and everything else are going to be incorporated in the plan. That's. The mandate of every public safety net hospital is to treat everyone who needs help regardless of their ability to pay. Guam's

on usually a large number of indigent patients is the root of many problems. Will the new medical center be under such a mandate. And if so how will it pay for these patients. Jackie I think the critical critical issue is the fact that we're going to be non for profit and as such that will give us certain advantages in terms of how we can take care of our patients and what our costs will be. So obviously at the end of the road the insured patient is paying for the uninsured patient to be looked after. But that's you know it's a way of taxation and so a way of averaging out society. The other thing is that although we don't at this point we don't have a mandate. We will accept everyone because this is not a government hospital this is a service to the community. But it's not a gun. It's not going to be a government hospital so it doesn't have a mandate for

that. The fact that we're going to have services to complement GMH means that you know if God forbid I or you need the services that are only provided at that hospital you're going to have access to it no matter what your situation. And the only way we can do that is to really work together with GMH And what we're going to see down the road is a transfer of patients going back and forth you know as the need arises to work together on this process. Dr. Ramani brings up a good point about. Cooperation and working together with different elements of the community. As another example of that which also relates to the civil facilities question we've been exploring the possibility of forming a relationship with the University of Guam they're interested in providing a site for the new medical center and it in fact does meet the site's criteria and a lot of the other criteria are favorably

addressed by that facility. The other component to that which makes it mutually beneficial is that the university can provide or it opens up for them opportunities for funding as a land grant institution which the medical center would not otherwise be able to avail itself of. Very good. Now I wanted to ask you something as well. A medical center with expanded services requires even more staff including specialists and maids. Finding and keeping staff is a major issue. How does the form propose to recruit and retain specialized staff. That was something that we discussed in our subcommittee. The recruitment retention committee we looked at. Recruiting. And staffing facility any health care facility in the United States right now is a challenge. Then we looked and we looked at well what are the problems that are currently that currently. Why Memorial

Hospital encounters. And we looked at it that way and we looked at how do we address and what do we put into this new. Hospital. And there are three areas or actually I'm going to break it down into recruitment and then I'm going to break it out into retention. In the recruitment process the key is hiring immediately the speed in the hiring process and that process right now. We can't really look at how is hiring done in the government sector because of all the process that it takes through government sector and private sector it's going to be quicker. The other thing that we needed to. We know it's not going to be a problem is using technology when you're going to hire. And there is a lot of people that go off island and get their degrees and want to come back and practice here on Guam. And we've got to be able to process them as quick as possible so the technology use is important. And the. Third area and we broke it out

in many areas is. That we really need to begin recruitment. If it's for ancillary health care radiology dietary lab tech nursing you know that kind of support we should begin that right now here in our high schools. The University of partnering with the University of Wyoming we've already had several meetings with them. You know that you know what there is that me and they're going to build that up and then we need to work with residency programs in their second and third and fourth year and start recruiting. Then the other thing we looked at is there's no reason why we can't meet the national average in salaries. That's not a problem. And the other thing that we were looking at lots of states are looking at is called multi state licensing which would make it easier for people to come out here Enric. Work retention. Work environment. Work environments going to be key accreditation any standard of care. And we thought the salary living on an island that's a U.S. island no

freeways you know that's going to be writing and retention factor. And we also talked about when you want to recruit and bring somebody out is to take care of their spouse or their family and making sure that they've got work. So when we identify all these areas we find we realize it's not going to be a problem to attract. People to come and work in this facility. It's really good to hear because often times we hear of how difficult it is to bring people into the medical community and keep them here. You know what we often hear. Actually the reverse. But I guess this is part of the solution. This facility and the services that to be able to bring can add to that point. Jackie I think a lot of people in Guam are not aware that the United States Department of Public Health is designated as a physician shortage area. There are some benefits that come along to that that I think that one needs to take more advantage of.

There are literally thousands of doctors throughout the United States that are still in the process of paying back federal loans for any particular area such as one that has a physician. Shortage designation area. There are certain requirements where they can come to Guam as a means to pay off the loans that they owe to the federal government. In fact that that's going to be one of the topics that we'll be discussing with some federal officials in a conference in Honolulu. And the last point is while we were looking at also you know who are the best people. You know we're not just looking at anybody to come into our community but. But but what group actually would help the people of one of them is the faith based nonprofit hospitals. And a lot of times those particular organizations tend to have a pool of physicians a pool of professionals that you know in a minute's notice just because of the so called Mission aspect of their care. If that's say it whether it's the Episcopalians or whether

it's the Catholics or whether it's it's any other religious groups the Adventists if they should determine Yeah we want to make this investment to Guam. It will be much easier for a group like them to transfer physicians and other professionals to Guam to help with this effort. Very interesting. Thank you also part of affiliations that we are working at is with Norman. Entities So you know association with the University of Hawaii or University of California association with a center of excellence like Cleveland Clinic Mayo Clinic or you know and if we can build those up there and we can have a residency program that would come to Guam as well where people are training in this environment. It's very hard to bring somebody who's never been to one. I think that's that's a reality. It doesn't matter what the job is whether you're in TV business or you're a doctor. It's as if you've never lived on an island. It's

difficult to get that in your mindset. But I think once we have that here and they come out here for they know it's a time limited thing they learn to love it and you know hopefully will keep some of them as well. In the interest of time are we now coming to the close of our program is what I'd like to do. I'll ask my last question but I would like all of your input. And so we'll start with you Dr. Ramani. He has been meeting now for a few months and has made significant progress in that short time. What is the timeline for the forums work and what vision do you have of course. The timeline the immediate timeline is by the beginning of this year so January. Hopefully we're going to have a solid business plan together and that's being worked on. And once the business plan is out it will go out and we'll hopefully get the appropriate investors. My vision of this is that in

about six months to less than a year we'll begin construction and in about two years from now we'll have a fully operational fully serviced hospital. Basically my answer would be consistent with what Dr. Ramani had said. I'm very pleased that currently the business plan is being drafted every single member of this forum based on the information that they bring unique tour to our community is going to be involved in that process. The first draft will come back to us. We're going to have editorial meetings where we're wearing gauged in some of the modifications to that plan. And again those timelines I think that Dr. Ramani have talked about are very realistic in what we're shooting for. I'd like to say that I couldn't agree with all the timelines that. Sad but being. Being the engineer I think the what's the business plan is done

and we have investors ready to go. You know the location finalizing the location getting the design in place getting all the necessary government permits and approvals that might be required depending on where the site is located. Those things take time so I don't think you know will be breaking ground within six months. Hopefully will be. Between 6 to 9 months completing the design part of it and just getting into the permitting part of it and then constructing shortly thereafter so. Otherwise I think the time frames are correct I think. The good thing about this group is that everyone seems to be very committed to moving this forward and everybody that I've spoken to on the form believes that this is a very realistic process. Obviously we don't want to be involved in spending a lot of time on something that we don't think will work. It's our dream. All of our dreams to to see this happen and we feel very confident that it will. So the timelines that we've spoken about and obviously we need to. Be aggressive but I think it's

very very doable. OK. Let's go south. And we will be done the farm will be done by the end of this year beginning of next. But I think that. My role as a forum member would be to continue to provide professional support and guidance through this whole process. And when the hospitals built this private nonprofit hospital in two years I hope to be a patient. And client access in health care. OK. All right. Thank you very much. They vary greatly. As our island community continues to grow healthcare will become an even more important issue for all of us. We thank our panel from the Guam hospital development forum for joining us tonight to tell us about this fascinating project as their plans progress. And we will visit with them again for an update. That's our show this evening. Thanks for watching and join us next time. Funny you point. Just so. Oh yes.