Waianae ER needs money triage


POSTED: Friday, July 10, 2009

Hawaii's congressional delegation should vigorously support the Waianae Coast Comprehensive Health Center's efforts to increase Medicare reimbursements from the federal government. The effort, if successful, could help prevent the vital facility from closing its emergency department one night a week and correct a long-standing inequity based on the center's unique status.

As the nation moves toward the elusive goal of universal health care, it is unacceptable that budget cuts force a Hawaii facility in the opposite direction, curtailing necessary and well-used medical services for an underserved native population in a remote area.

Access is an especially critical issue at a health center on the front lines of the Leeward Coast's rapidly fraying social services safety net. WCCHC's emergency room, with only eight beds, treats more than 25,000 patients a year, some of whom have complex health problems exacerbated by homelessness and related issues.

Administrators said a large chunk of the operating budget shortfall stems from low reimbursements from Medicare, averaging less than 50 cents on the dollar, for emergency care of eligible patients.

The problem is that Medicare does not recognize the center as having a “;true”; emergency department because the department is attached to a community health center, not a major hospital. Under the complicated rules that govern Medicare reimbursements, Waianae therefore receives less than other hospitals providing similar emergency care.

But the center is the main medical facility for the more than 50,000 people who live on the Waianae Coast, and provides a full array of medical care typical of a busy rural hospital, including orthopedics, urology, obstetrics-gynecology, laboratory and radiology services — as well as the emergency care that is now available 24 hours a day, seven days a week.

If the health center cannot come up with $330,000 to fill a gap in the operating budget, the emergency room will close on Sunday nights, starting Oct. 1. Administrators picked the midnight to 8 a.m. shift because it is generally the slowest, but that will be no solace to the patient who ends up getting sick or injured during that time period, and finds the place locked up tight.

The center's budget woes are not solely linked to the Medicare classification, as the state also has steadily cut funding, but amid the current fiscal crisis the Medicare administrative triage seems essential.

Center administrators said they are reaching out to Hawaii's congressional delegation for help in urging Medicare to make an administrative change and recognize WCCHC's urgent-care services as a fully eligible emergency department, thereby raising reimbursements.

Although such a change would not close the budget gap completely, it would help greatly, and provide a long-term solution that would help ease the annual scramble for operating funds.

The loss of one 8-hour shift a week may not seem like much, but for a feverish, wheezing child, a homeless person racked by a persistent infection or a bleeding accident victim, it could be life or death.

The congressional delegation should make the issue a priority, recognizing that health care in an underserved community largely populated by Hawaii's native people is a must-have, seven days a week.