emiller@westhawaiitoday.com
BY ERIN MILLER | WEST HAWAII TODAY
Reimbursement for services — particularly from Medicare and Medicaid — will continue to be a top issue for Kona Community Hospital and West Hawaii physicians, a Big Island senator said Monday.
Sen. Josh Green, D-Kona, Kohala, tied the closure of Hawaii Medical Center’s two Oahu locations to low reimbursements, and noted the similarities between HMC’s situation and West Hawaii’s medical care situation.
“If you want to know why HMC closed, it’s because Medicare and Medicaid simply do not pay enough,” he told the Kona Hospital Auxiliary members during a meeting Monday afternoon. Whether hospitals are able to stay open is a “coin toss if there’s not other forms of support.”
Green said the possibility exists that reimbursements will be cut by 28 percent. That would be a huge blow to hospitals with tight financial margins like Kona Community Hospital, he added.
Already, because Hawaii is grouped with Guam and not with West Coast states like California and Oregon, Hawaii is underpaid by about $150 million in Medicare and Medicaid reimbursements, Green claimed.
That is “the single-most appropriate battle our senior guys in (Washington) D.C. should take on,” he added. “Those monies mean we would never worry about repair and maintenance.”
Insurance providers, including Hawaii’s largest, Hawaii Medical Service Association, should also increase their reimbursements, he said.
Maintenance will be a continuing concern for the aging hospital, Green said after the meeting. Those repairs, and not a lack of hospital beds, will likely be the practical concerns that propel West Hawaii toward a new hospital, he said.
Green is introducing legislation this session, requested by Regional Board of Directors Chairman Dr. Alistair Bairos, for a $150,000 planning appropriation for a new hospital in North Kona.
Bairos agreed that West Hawaii has sufficient hospital beds for patients. Projections when the hospital was built in the early 1970s estimated the hospital would need 100 or more patient beds by 2000, Bairos said. Because technology has increased the number of procedures that can be done on an outpatient basis, the need for beds hasn’t grown as quickly as West Hawaii’s population, he said.
Green said he expects to see a four- to six-year planning stage, then about 10 years to fund and build a new hospital. Part of that planning and building stage will be used to change which services are offered in Kealakekua and by North Hawaii Community Hospital, both of which would be affected by a new North Kona hospital.
Another potential “game changer” for health care in the next year is the need to push for more personal responsibility, Green said. He noted 1 percent of the country’s population account for 21 percent of the country’s health care spending, and 20 percent of the population account for 80 percent of health spending.
Green also noted the doubling health care spending nationally, from $1.5 trillion in 2001 to $3 trillion last year.
That increase is “completely impossible to sustain,” Green said.
He reiterated his desire to see more programs that forgive student loans for doctors and nurse practitioners who move to rural areas like the Big Island. Green’s participation in one such program brought him to Ka’u and South Kona after he completed medical school.
emiller@westhawaiitoday.com