WAIMEA — Dr. Peter In has been a psychiatrist in the same Waimea office complex since 1978. Although he has attempted to retire over the past five years, with more than 1,100 patients and not enough doctors to go around, the demand has been too great.
But next month, Waimea Community Counseling Clinic, where he works, may be forced to close.
“We began losing money two years ago,” Dr. In said. “I’ve been trying to keep it going and get support from other organizations here, but what I’ve realized is that this clinic needs to be a nonprofit because basically that is what it is.”
He is known around town as the community psychiatrist, working with both children and adult patients.
“We’ve always had very few psychiatrists here,” Dr. In said.
In 2015 he retired. At that time, a new psychiatrist, Dr. Wayne Nickens, replaced him on the WCCC team.
“We thought he was the answer, but it wasn’t a good fit,” he said. “There’s basically a dearth of doctors nationwide, so it’s been really difficult to recruit. The Beacon study, done by a national organization, did a survey of health needs on this island. They identified between 12-19 psychiatrists that this island needs additionally.”
So, last April Dr. In came back to work three days a week, but the clinic started losing money.
“We have always been open to anyone who wants help, but our patient population has traditionally been 40 to 50 percent Medicare or Medicaid, many of which have a high rate of no-show or cancellations,” he said.
Despite the time spent processing Medicare reimbursement claims paperwork, many of the claims were rejected or needed to be resubmitted.
“Our assistant was spending 80 percent of her time with 20 percent of the patient population,” Dr. In said.
Another problem were changes in the health care system.
“I think Obamacare was a step in the right direction, but between that and the insurance companies using new coding systems and requiring us to go to the electronic medical records system this was a real challenge,” he said. “Plus, around that time, HMSA announced they would do a 20 percent reduction in fee schedule for behavioral health. I had to negotiate with them just to keep our old fee schedule. They agreed to do that for our psychologists and mental health counselors, but the compromise was that for psychiatry they would keep to their new fee schedule that was a reduction of 20 percent. Can you imagine what businesses would go under with a 20 percent reduction?”
Dr. In has kept his practice going the last two years hoping to find more nurse practitioners and a full-time psychiatrist to replace him. WCCC currently has two psychologists — one full-time and the other part-time — and two mental health counselors, one who works four days a week and the other one day a week.
“It’s a matter of timing,” he said. “I’ve had lots of inquiries from potential doctors to join our practice, but without a nonprofit status we can’t keep our doors open. It’s a complicated matter to change a practice over to nonprofit. I was trying to affiliate with an existing nonprofit, but for one reason or another they have all fallen through. This past year my life has been one thing after another, and it’s come to the point where I’ve been putting my life savings into trying to keep this company going while I find somebody else to affiliate with.”
Dr. In has approached a number of organizations such as Lokahi, North Hawaii Community Hospital and Hamakua-Kohala Health to discuss a possible partnership or affiliation, but to no avail.
“We were turned down by The Queens Health Systems. We had approached them and negotiated all year but they looked at our books and said ‘we just can’t take you over,’ even though the mission of the hospital is to support the location providers,” he said.
Kipuka o ke Ola — the Native Hawaiian behavioral clinic that expanded into a new facility in Uilani Plaza recently — is willing to take referrals from WCCC.
“I’ve spoken to Dr. Chun recently and they are willing to see our patients, but they already have a two to three month waiting list, so it’s going to be difficult to accommodate our patients,” Dr. In said.
One of the biggest problems that behavioral staff address with patients on Hawaii Island is substance abuse.
“What we need is not just an outpatient substance abuse clinic, but a residential program that’s affiliated with the hospital to detox people. We really don’t have a true detox and rehab facility on this island. There are only two in the state, on Maui and Oahu, and it takes months to get into them,” he said.
As a psychiatrist, Dr. In said the issues he addresses most often are depression, anxiety, adjustment disorders and neurological problems. A major cause is family pressure.
“I see family disintegration as one of the key roots of the mental problems our residents face today,” he said. “We’re raising a generation of children who are growing up in dysfunctional households, and it becomes a vicious cycle. We need more psychiatrists.”
To meet this need, Dr. In said the only way WCCC could continue would be if they joined efforts with another organization.
“The easiest way to go would to be affiliated with a nonprofit,” he said. “My dream would be for us to have a true, integrated mental behavioral health program between substance abuse and all the other areas of behavioral health, as an umbrella under a nonprofit organization funded by the state, county and federal government.”
In the meantime, Dr. In is trying to think realistically if a solution isn’t found in the next month.
“Miracles can happen, but I think we need to plan. Our patients need to start looking for new providers now. We’re also hoping the counselors here are able to find another organization to work for, or start their own practice,” he said. “Reflecting back on my work, I would say one of the values of behavioral health is giving people hope. The sadness for me is if patients don’t have anyone to turn to that can help them. That’s what this clinic has always been about.”
Info: Call Waimea Community Counseling Clinic at 885-7444
