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In my initial op-ed, we began with the discussion of LBJ’s foray into the world of electronic medical records (EMR) as an example of American Samoa’s struggles managing the public funding for the business of healthcare.

It was the early 2000s when this Federal EMR push really started happening, and my clear recollection is that LBJ never came anywhere close to maximizing the full potential of that system.

I also know for a fact that the hospital continued to seriously struggle with funding for even the most basic of its needs, like personnel, the stocking of essential services and supplies, the formulary (inventory of all available medications at the pharmacy), and the off-island referral program — just to name a few.

Of course these issues continued to run pretty much throughout the whole organization at different times and to somewhat different degrees, but they were undeniable. The number of stories in this paper alone on these perennial shortcomings for LBJ over the last 15-20 years is truly massive.

 Then about a decade went by, and the LBJ Board found out that its version of that EMR system was not compliant with the latest Federal mandates (these are called "Meaningful Use" criteria). As such, LBJ had to implement a pretty substantial (and not to mention, expensive!) "upgrade" to be able to continue receiving most of the federal funds, which are available for healthcare.

 This transition was preliminarily being setup around 2011-2013 I believe, but then it finally got installed in 2015. Again, there was essentially free money to be had from the Feds for taking on this upgrade, and it bought LBJ all kinds of new and badly needed IT equipment at the time, like hardware and wireless capability, plus other improvements as well.

But it also came with serious requirements for rates of usage by our practitioners, with periodic reviews for making sure that enough patients’ EMR charts had specific boxes checked and multiple data fields populated. I mean, these are absolutely mandatory and heavily data-driven sorts of measures to be held accountable to! And LBJ’s performance with the upgraded EMR system over time would tell whether or not that startup money would have to be paid back.

 Again, although I haven't seen first-hand what has been happening down there for about the last 18 months or so, my clear memory is that LBJ was essentially always behind schedule, borderline acceptable in its performance data (at best), and clearly hovering just about constantly "at risk" for the loss of these kinds of funds as well.

Now I ask you, does "at risk" sound familiar to anyone in the Territory?

Which brings me back to Medicare/Medicaid ("CMS,” i.e. The Centers for Medicare and Medicaid Services); what an impending disaster the precariousness and possible complete loss of all of that funding remains for LBJ and American Samoa?!

 Now under the applicable U.S. and Territorial Regulations (with current Federal Medical Licensing and National Provider Registration Numbers and such), I was one of a fairly small number of physicians at LBJ whose work there was essentially at all times fully billable. I mean not only billable to Medicare and Medicaid of course, but also to Tricare, Champus, and well, pretty much any of the major nationwide health insurance plans, which are out there.

 But not once, and I mean, not even ONCE in all of my years working at LBJ did I ever get so much as an inquiry from one of those organizations about anything that I did or did not do, or any document or order or prescription that I signed. There would have been thousands of documents with my name on them over all of those years. And like everyone else, I am certainly not perfect.

So it is reasonable to assume that there should have been at least a few questions here and there about possibly some of the claims being made for my services, right? Unless of course, those claims were just not being submitted… Well, the most likely conclusion that I can make from all of this is that LBJ and/or ASG simply were not properly writing up and submitting anywhere near all of their eligible claims for services rendered.

These kinds of questions finally must be asked of the Territorial leaders: Is American Samoa claiming all that is due to its people from Medicare and Medicaid?  We’ll discuss this, and more, in my next installment.