By Stephen B. Kemble, M.D.
Honolulu Star-Advertiser, Feb. 20, 2017
Hawaii’s once-exemplary health care system is now starting to fall apart due to policies pushed by Medicare, HMSA, the Ige administration and a few key legislators, including the chairwomen of the Senate and House health committees.
The Legislature passed a bill in 2009 to create the Hawaii Health Authority (HHA), intended to plan for a universal health care system covering everyone in Hawaii. However, the Abercrombie administration stripped the HHA of its funding and refused to allow it to influence policy, and now the Ige administration has introduced bills to repeal the HHA. Sen. Roz Baker, chairwoman of the Senate Health Committee, strong-armed this bill through her committee despite overwhelming testimony against repeal. Rep. Della Au Belatti, chairwoman of the House Health Committee, refused to schedule a bill to revitalize the HHA.
It is now clear that key political leaders are determined to protect the HMSA government echo chamber that is aiding and abetting HMSA in its health care “transformation” reforms. Medicare is now imposing similar reforms.
These are the reforms that are “fixing” a fabricated, fake problem – fee-for-service payment of doctors – by piling on more and more of the real problem, crushing administrative costs and burdens and escalating micromanagement and interference in day-to-day patient care.
These are the cause of an epidemic of physician “burnout,” driving older doctors out of practice, and deterring younger doctors from entering primary care and specialties such as psychiatry that are being subjected to the worst micromanagement and administrative burdens.
Primary care practices in Hawaii are closing to new referrals at an accelerating pace. Crown Care, a physician finder service on Oahu, found that as of five months ago, 31 percent were already closed to all referrals and almost half were closed to new Medicare referrals. As older doctors retire, their patients are dumped into a shrinking pool of remaining primary care practices, which then start closing to new referrals also. As the availability of doctors collapses, we will see tremendous pressure on already overloaded emergency rooms and hospitals from those who cannot get care anywhere else, and our once-exemplary health care system will collapse.
In contrast, HHA’s proposal would focus on administrative simplification by keeping payment for physicians and hospitals as incentive-neutral as possible, eliminating the justification for micromanagement of care. The proposal would base physician pay on professional education and training and time spent on patient care, and end “pay-for documentation.”
It would eliminate pay-for-performance and most prior authorizations by removing unaccountable middle men – such as prior authorization contractors and pharmacy benefits managers – from health care, and greatly simplify billing and collections. Physician practice overhead could be reduced by 10-20 percent. With incentive-neutral pay, doctors would be guided by professional ethics and concern for the best interest of their patients, instead of manipulation with financial incentives controlled by clueless bureaucrats.
Given that administrative costs now consume about a third of the health care dollar, the administrative simplification recommended by the HHA could save 20-30 percent of Hawaii’s health care cost without harming doctors and hospitals, and free doctors from the suffocating administrative burdens now being imposed. Hawaii would become a magnet for doctors wishing to practice in a state that supported them instead of micromanaging them.
The public needs to know that it is bad government policy that is causing Hawaii’s worsening doctor shortage. It is time for a change, and we need the reforms proposed by the Hawaii Health Authority more than ever.
Stephen B. Kemble, M.D., is a psychiatrist and former Hawaii Health Authority member.
