by Andrew Walden
This week’s closure of Hawaii Medical Center hospitals in Ewa and Liliha—with the loss of 1,000 jobs--will be the first of many unless the Abercrombie administration abandons its suicidal policy of dismantling the Hawaii Prepaid Health Care Act.
Low Medicaid and Medicare reimbursements are at the center of HMC’s financial collapse. The Star-Advertiser June 22 reported:
(HMC) had been hoping to increase referrals for higher-priced procedures and increase the number of patients with commercial health insurance to offset the large population covered by Medicare and Medicaid, whose reimbursement rates are significantly lower. But the plan failed to generate the revenue needed….
Despite efforts to become financially viable, HMC said it was unable to overcome obstacles that affected financial performance such as static patient census, federal regulatory requirements and reductions in reimbursements….
Hawaii physicians and hospitals have been pushing to reform the Medicaid and Medicare payment formulas. In spite of Dan Inouye’s seniority, Abercrombie and Hawaii’s other Congressional representatives did nothing for decades. This summer the Hawaii Healthcare Association joined forces in the Value Coalition with healthcare providers from six other state receiving the lowest Medicaid reimbursements. Pacific Business News August 5, 2011 reports on a Value Coalition study which discovered that “Miami’s (Florida) average Medicaid reimbursement per beneficiary is almost $17,000. By comparison, Honolulu’s average reimbursement is $6,500.”
Yet, the Obamacare expansion of Medicaid eligibility to 133% of the poverty line is set to displace the private insurance mandated by Prepaid thus flooding all of Hawaii hospitals with even more red ink. As a candidate, Abercrombie called for the replacement of Prepaid with Obamacare. In office, the Abercrombie administration is pushing pre-Obamacare reforms through even as Congress gradually defunds its mandates, the Supreme Court is considers its constitutionality, and Republican House and Senate majorities likely to be elected in 2012 are set to repeal it.
To see why HMC was first, on need only look at the map. HMC West was the hospital nearest to the impoverished Waianae Coast. HMC’s balance sheets were loaded down with underpaid Medicaid and Medicare work. The HMC West emergency room is already closed and the results are plain to see. The Star-Advertiser reported December 17:
EMS received more than 40 calls for emergencies from the Leeward Coast from midnight to noon today, the city said. The additional units, the city said, “have ensured an adequate emergency medical response.”
EMS ambulance units from Leeward and Central Oahu had been using Wahiawa General Hospital and Pali Momi Medical Center in Aiea since Friday afternoon. However, those hospitals have maximized their capacity and are now on ambulance reroute or divert status.
EMS ambulances on the Leeward Coast are utilizing Kaiser Medical Center, Tripler Army Medical Center and the downtown hospitals until the others are no longer on divert status.
This means that Wahiawa, Pali Momi, and the others are immediately feeling the pressure that comes from getting paid less than costs. Patients are feeling the pain as well. It is 31 miles from the Makaha Valley to Wahiawa General. It is 26 miles to Pali Momi. Both trips pass right by the closing HMC West facility.
Hawaii has been suffering from Hospital bankruptcy for years. HHSC is maintained on life support by legislative appropriations only because it employs 4,200 HGEA and UPW members. Efforts by HHSC management to privatize their hospitals have been beaten back because such privatization is contingent on decertifying the HGEA and UPW. Hawaii’s community clinics are sustained by a unique policy which allows them to pad their patient rolls with thousands of ghost patients.
Emergency service is not the only loss. HMC East in Liliha was the State’s only organ transplant center. Currently 420 Hawaii patients are waiting for donor organs. For successful surgery, they must report to HMC East within five hours of a call. Queens hospital is considering establishment of a transplant center, but the earliest that could come about would be February and Queens officials estimate an additional six months to fully ramp up the program. Meanwhile, transplant patients only option is to move near a transplant hospital on the mainland and wait months or even years for an organ to become available.
What is the Abercrombie administration doing? Nothing. KITV reports:
“Immediately the state has got to get involved, I think Abercrombie should take note of this right now. I mean for other emergencies they know how to take care of it why don’t they take care of this one,” said Bill.
Governor Neil Abercrombie said plans to care for long-term and short-term healthcare needs are ongoing but there is no immediate solution to the closure of two Oahu hospitals.
“I don’t want to put anything out there that would create a false impression we are working on it,” said Abercrombie.
Ongoing plans to care for long-term and short-term healthcare needs? That is double-speak which means Abercrombie is doubling down on the policies which destroyed HMC in the first place. Abercrombie last May told an audience of Health Care providers:
Yes, there’s a cost factor. I’ve just come from a meeting with the financial side of construction and dealing with the question of healthcare, dealing with the question of whether we can continue to have a dichotomy between employers and employees. That, what was a progressive system of dealing with healthcare for many years—the Prepaid Employer Healthcare Plans that we had going back into the 1970s, are even relevant let alone applicable in today’s situation. And the same thing has to do with whether its Medquest, whether its Medicaid, whether its Medicare, whether its Medicare Part B payments coming out of your Social Security Payment. We have to deal with the realities of a population post 65 that is growing in numbers—in absolute numbers in terms of the population demographics and in terms of life expectancy as well. What kind of consequences does that have? What does it mean in terms of long term care? Are we extending life or are we prolonging death? Who is going to be eligible and under what circumstances—for Medicaid? And how are we to conduct the business of providing services. These are real questions that I know we are going to have to come to grips with.
Because of its Catholic roots, HMC was a powerful pro-life voice in Hawaii’s medical community. In stark contrast, Abercrombie’s “Health Care Coordinator” Beth Giesting told the Star-Advertiser December 9:
So we have a system that rewards lots of procedures, lots of high-tech services. It really rewards growing the extent of the system, but it doesn't reward trying to improve the health of populations, trying to manage care in a more effective way. It doesn't reward primary care and the basic services that everybody needs….
I think it can be. It is going to be tough, and part of reason it's going to be tough is that we have population issues that, basically, we need people to take more responsibility for their health….
So right now we have an organization in Hawaii called the Hawaii Health Information Exchange, which is setting up the rules and policies for information exchange between providers, so those things can actually happen....
With the closure of HMC East, the expensive “high-tech service” known as organ transplant is pau. Your grandmother should have taken better care of herself. Got a problem with that? Tough.