ISLE CRISIS: MEDICAL COST IMBALANCE WIDENS
Ailing ledgers are part of health care outlook
Rising costs and declining payments continue to plague Hawaii's hospitals and nursing facilities, yet the 50th state remains one of the best in the country in providing health care, national officials say.
Emily Friedman, writer, lecturer and health policy and ethics analyst, "scolded" Healthcare Association of Hawaii members at an annual meeting yesterday "for not sharing what has been learned in Hawaii as a leader."
Following Friedman's talk, Terri Fujii, managing partner of Ernst and Young, painted a grim financial picture of Hawaii's hospitals and nursing facilities.
"It's the same story," she said. "Costs are going up. Payments are going down. The industry is still in financial crisis. Losses are getting bigger."
She said "something needs to be done" before the quality of care is affected.
Costs exceeded revenue by $110 million in 2005 and $150 million last year, she said. Charity care and bad debt amounted to $140 million in uncollected payments, she said.
Hawaii has the lowest overall coverage of health care costs in the nation, with payments at 92.3 percent, she said, meaning providers are paid only about 92 cents on a dollar.
She said Medicare pays 79 percent of the cost, Medicaid/QUEST 80 percent, and commercial insurers 111 percent, and added, "It doesn't make up for losses."
Costs for wait-listed patients are about $110 million above reimbursements, Fujii said. These are patients ready for discharge who are kept in acute care because alternative facilities are not available.
She said costs for medical education (interns and residents) also are about $20 million above reimbursements.
"How do we relate that to being a leader?" asked Art Ushijima, president and chief executive officer of the Queen's Health Systems and president of the medical center.
"Hawaii is a leader in many ways," responded Friedman, who has said in previous visits that Hawaii can be a model for the nation because it has advantages over other states.
Among them, Hawaii has mandated employer coverage for employees and is second to Minnesota with only 9 percent uninsured, she said. Also favoring Hawaii is one of the lowest rates of hospitalization and an ohana culture, she said.
"Bad as it seems," she said, "talk to your colleagues" in other states. Hawaii and Minnesota are at one end of the spectrum, and Texas at the other end, she said.
Health care policy and coverage are the big issues nationally, she said, citing fiscal and political barriers to solutions.
In other talks at the meeting at the Hawaii Prince Hotel, Coral Andrews, Healthcare Association of Hawaii vice president, said a task force is looking for solutions to wait-listed patients.
The problem is unique to Hawaii because of its geographic isolation and fewer options, she said, citing problems of reimbursement, inadequate capacity, regulatory challenges and work-force shortages.
She said the task force will develop recommendations and brief legislators in the next session.