1. Ending Health Disparities: Health, Environmental, and Social Justice in the Caribbean and Beyond Panel discussion on Health and Social Justice from the Hospital Perspective Christine deJongh-Lewis, MPH, DHA Candidate Associate Administrator of Operations Schneider Regional Medical Center cdlewis@srmedicalcenter.org

2. Schneider Regional Medical Center Safety net provider St. Thomas – St. John District Territorial Health System Three facilities: ◦ Roy Lester Schneider Hospital ◦ Charlotte Kimelman Cancer Institute ◦ Myrah Keating Smith Community Health Center

3. Focus of Care Mission – To provide comprehensive, quality healthcare to the residents and visitors of the VI in order to improve health and wellness. Vision – To be the health care provider of choice to the residents of the VI and the Caribbean.

4. SOCIAL JUSTICE HEALTH DISPARITIES

5. Social Justice, Health Disparities & SRMC We care for all, regardless of ability to pay ◦ Critically ill patients ◦ Chronically ill patients ◦ Maternal / child health care patients We train care providers ◦ Nursing students ◦ Clinical & experiential learning ◦ Brain drain considerations

6. Self Pay Patient Service Volume Self Pay Patient Status2009201020112012Totals Clinical Patients3014121874 Emergency Room Patients604962586522621925048 Inpatients16001422137613385736 Observation Patients257252229190928 Recurring Patients4003904123751577 Referred Patients1581149211448515068 Surgical Day Care Patients190157141122610 Totals1010799859836911339041

7. Self Pay Reimbursement Reimbursement2009201020112012Totals Clinical Patients $ 2,940.37 $ 6,935.13 $ 4,135.80 $ 10,966.34 $ 24,977.64 Emergency Room Patients $ 2,564,688.55 $ 4,042,705.45 $ 4,863,361.99 $ 5,450,456.78 $ 16,921,212.77 Inpatients $ 7,958,008.68 $ 7,234,502.66 $ 7,727,408.02 $ 9,277,448.36 $ 32,197,367.72 Observation Patients $ 99,776.37 $ 192,086.83 $ 241,901.28 $ 304,177.47 $ 837,941.95 Recurring Patients $ 793,007.53 $ 626,529.93 $ 1,145,233.22 $ 1,336,920.28 $ 3,901,690.96 Referred Patients $ 212,067.61 $ 270,938.12 $ 278,669.41 $ 218,151.13 $ 979,826.27 Surgical Day Care Patients $ 576,893.80 $ 816,768.96 $ 625,071.44 $ 530,529.89 $ 2,549,264.09 Totals $ 12,207,382.91 $ 13,190,467.08 $ 14,885,781.16 $ 17,128,650.25 $ 57,412,281.40

8. Self Pay Charges Charges2009201020112012Totals Clinical Patients $ 4,753.05 $ 10,388.35 $ 4,406.45 $ 12,413.00 $ 31,960.85 Emergency Room Patients $ 4,346,834.65 $ 4,789,383.02 $ 5,640,090.99 $ 6,182,960.43 $ 20,959,269.09 Inpatients $ 14,621,241.51 $ 14,341,815.99 $ 14,620,372.94 $ 16,665,993.40 $ 60,249,423.84 Observation Patients $ 184,323.66 $ 260,359.79 $ 285,977.66 $ 346,762.15 $ 1,077,423.26 Recurring Patients $ 1,682,749.39 $ 848,135.19 $ 1,539,448.91 $ 1,605,487.01 $ 5,675,820.50 Referred Patients $ 366,601.07 $ 374,159.24 $ 356,078.02 $ 260,983.09 $ 1,357,821.42 Surgical Day Care Patients $ 1,021,314.66 $ 970,454.54 $ 923,343.34 $ 877,551.02 $ 3,792,663.56 Totals $ 22,227,817.99 $ 21,594,696.12 $ 23,369,718.31 $ 25,952,150.10 $ 93,144,382.52

9. Issues Impacting Social Justice in VI Healthcare Budget reductions Reimbursement reductions Increased fixed costs Increased staffing costs ◦ Impact in scope of services ◦ Impact to care and treatment ◦ Social inequity in healthcare

10. Stakeholder Support ◦ Organizational opportunities exist ◦ Financial support required ◦ Collaboration required ◦ Innovative solutions required

11. Commitment to Equity Board Leadership Front line staff ◦ Committed to the continued provision of care and treatment to all ◦ Committed to improvement

12. Panel Discussion