OPINION: We Must Open Up Virgin Islands Market To More Doctors If We Want To Improve Care, Lower Costs
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By FREDERICK HANDLEMAN
SPECIAL TO THE VIRGIN ISLANDS FREE PRESS
Health Care in the Virgin Islands is on life support and in critical condition. There is an urgent need for major changes to the antiquated, protectionist, draconian laws and regulations relating to the provision of health services in the Virgin Islands. If we are concerned with the quality of life in the territory immediate action must be taken. Quality of life affects all aspects of our society and community. It directly impacts the residents, visitors, and economic development.
The events of September 2017 have shown us that our healthcare infrastructure is not sufficient to provide the needed services to the population. There is a need for more than one hardened healthcare facility on each island and the private healthcare infrastructure must be expanded. The time for politics is over.
Areas which must be addressed are: certificate of needs requirements, licensing of medical professionals, telemedicine, and gross receipt taxes on medical procedures and facilities.
Our hospitals are suffering from decaying infrastructure, and aged facilities. The use of Certificate of Needs as a means of protecting our hospitals and existing medical facilities is limiting technological advancement and growth in the availability of health care and must be eliminated. With a greater selection of health care choices, the quality of health care in the territory will improve. In 2004, the Federal Trade Commission and the Department of Justice came to the conclusion that CON laws have neither reduced the cost of nor increased access to health care. They suggested that in some states CON laws have contributed to higher health care costs by reducing supply and stifling competition. CON laws result in actively blocking citizens’ access to health care choices and to the modernization of health care facilities; they also bog down health care providers in stacks of regulation and paperwork. The Federal Trade Commission and the Department of Justice claim that CON programs actually contribute to rising prices by impeding competitive markets. Most other opponents of CON laws similarly suggest that CON regulations suppress competition by restricting new construction, inflate prices, and are largely political. As noted above regarding CON regulations and crumbling medical infrastructure, many healthcare professionals are forced to recommend their patients leave the territory to receive their healthcare needs. Even many of our elected officials and high ranking members of the Executive Branch leave the territory for their annual physicals. This is lost revenue to the Territory.
Telemedicine has the potential to improve access to care and ease the physician shortage. However, physician licensing and other regulations, and other obstacles have hindered telemedicine’s expansion. Our health care workforce is stretched to its limits. Many of the current primary care physicians are nearing retirement and the numbers to replace them are insufficient. Telehealth—a tool that uses technology to provide health care and other health services remotely—is seen by many as one solution to help improve access to care. Telehealth can leverage the existing health care workforce by expanding the reach of providers and making services more convenient. With technology’s ability to span borders, some states are looking at ways to streamline the licensing process so providers can practice more easily across state lines.
The Virgin Islands must be willing to attract qualified medical professionals and make them feel wanted and a member of our community. By removing the choke-point of antiquated licensing laws and regulations there will actually be a greater availability of healthcare options in the territory. This will take a re-thinking of reciprocity for medical licenses and a cultural acceptance. We have seen many medical professionals try to integrate into the Virgin Islands community and fulfill their Hippocratic Oath by providing up-to-date medical care to all. Sadly, many have been made to feel so uncomfortable here
by both excessive regulations and paperwork to obtain licensing, or actual threats that they have had to return to the United States. Many of our health care professionals are seriously re-considering the acceptance of Medicare and Medicaid due to the Virgin Islands only receiving a small percentage of reimbursements given to the States from CMS and the imposition of gross receipt taxes which makes such procedures a money losing proposition. By exempting gross receipt taxes there will be a greater incentive for medical services to expand.
It is a sad state of affairs when a community must send its loved ones and elderly away from their home and comfort to receive medical attention which could easily be provided here at home. With the updating of our healthcare laws and regulations we have the opportunity to allow our people to receive the care they deserve and need here in the territory.
–Frederick Handleman is a former V.I. Assistant Attorney General and a 25-year resident of the islands