UHA boosting payments to physicians on neighbor isles
Starting in April, neighbor island physicians for the first time will get reimbursed more for working in rural areas outside of Oahu.
University Health Alliance, the third-largest commercial health insurer in Hawaii with more than 1,500 employers, is increasing its reimbursements to physicians to address a shortage on the neighbor islands.
The health plan said yesterday that the new schedule, which takes effect April 1, will boost payments for primary and preventive care services on all islands, with a differential paid to physicians practicing on the neighbor islands.
University Health has 40,000 members, including 12,000 members primarily on the Big Island and Maui. The new reimbursement schedule is an attempt to keep physicians working on the neighbor islands, which has seen an exodus of doctors in recent years due to increasing financial pressures.
The Hawaii Medical Service Association, the state's largest health plan, currently reimburses physicians at the same rate across the board. It has considered geographically weighted reimbursements, but has said the issue has faced resistance from Oahu doctors, who also want higher payments for their services.
HMSA this year is increasing reimbursements for physicians by a total of $10.3 million.
"If HMSA and other health plans followed (University Health's) lead this could be a significant move," said Linda Rasmussen, president of the Hawaii Medical Association, a professional organization of 900 doctors statewide.
Many physicians say it is nearly impossible to make a living on the neighbor islands, where costs are rising while reimbursements to providers continue to shrink.
The problem is exacerbated by the limited number of physician specialists who share onerous on-call duties and are often hard hit by high malpractice insurance premiums.
"Our high cost of living, rising malpractice insurance costs and inadequate Medicare and Medicaid reimbursements have made it increasingly difficult for Hawaii physicians to sustain their medical practices," UHA Chief Executive Max Botticelli said yesterday. "Physicians -- especially in our neighbor island communities -- are leaving Hawaii, and the result is serious lack of access to medical care."
University Health's new provider agreement includes a 5 percent increase in physician reimbursement that totals more than $1 million. UHA said it elected to distribute 60 percent of the total to providers statewide rather than distributing the increase evenly on all islands.
An additional 20 percent will be distributed to neighbor island physicians, and the remaining 20 percent will be distributed to providers who perform specific preventive services such as mammograms or childhood preventive health examinations.
Sylvia Sonnenschein, an internist and primary care physician on the Big Island, said the differential will be well received by neighbor island physicians.
"I was able to remain in practice in Kohala because of direct UHA support of the Kohala Family Health Center, a Hamakua Health Center satellite clinic in Kapaau," she said.
UHA, founded in 1996, had annual revenue of more than $98 million in 2006.