Health care official
says isle hospitals
have financial ills

The nursing homes are also 'in
very serious trouble' and some facilities
are in danger of closing, he says

By Helen Altonn
Star-Bulletin

Hawaii's nursing homes and hospitals are in the worst financial shape they've ever been, says Richard E. Meiers, Healthcare Association of Hawaii president and chief executive officer.

"We are in very serious trouble," he said in an interview. "Most of our facilities are losing money big."

Meiers hopes to meet with Hawaii's congressional delegates this month and warn them: "If we don't watch this, we could see some facilities close in the next few years."

He said payments to health-care providers must be increased or there will be "a very bad impact" on health care throughout the state.

Robert Ogawa, president of the Hawaii Long Term Care Association, said island nursing facilities are trying to cope with increased regulations, higher operational costs and reduced payments and "a number of them are teetering."

Rose Ann Poyzer, president of the Hawaii Association for Home Care, said five of the state's 18 Medicare-certified home health agencies have closed and others "are treading water."

Meiers pointed out that only about 27 percent of the 1997 Balanced Budget Act has been implemented so far, "and it's already done this amount of damage.

He said the law's restrictions on Medicare and Medicaid funding are so tight most facilities are having trouble staying open.

Regulations stemming from the law also are oppressive, Ogawa and Poyzer said.

Facilities must be hooked into a national computer network to provide information on care, Ogawa said. They're required to transmit certain data regularly to the state Department of Health, which must send it to the U.S. Health Care and Financing Administration.

The nursing facilities and home health agencies must have compliance officers, as well as computers and software, and there is no reimbursement for those costs, Poyzer said. A lot of staff time also is involved in meeting the regulations, she said.

"As a layman," Ogawa said, "I am bewildered and incredibly impressed that these people can even do the great work that they do."

Ogawa, former assistant to U.S. Sen. Daniel Akaka, said Congress intended to save $9.6 billion over five years from Budget Balanced Act spending reductions for skilled nursing care.

The Congressional Budget Office now reports expected savings from skilled nursing care cuts will be $7.1 billion, or 74 percent more than projected, he said.

He said 66 senators recently sent a letter to Health and Human Services Secretary Donna Shalala expressing concern that the lower-than-envisioned payment rates "could seriously erode the quality of care."

Hospital waiting lists of patients needing skilled nursing care are starting to climb because facilities are being much more careful in assessing them, Ogawa said.

"Requirements have become so burdensome and reimbursements are so inadequate that there are times we're required to say, "Well, if we took this patient, we will lose money.' "

Loss of money on many patients "impacts on ability to provide quality across the board," Ogawa said.

He said the Balanced Budget Act "is a big hammer but there are myriad aspects of the industry that make it astoundingly difficult to be in business." Even more federal inspection and enforcement measures are being planned, he said.

Meiers plans to attend a meeting this week in Colorado with health-care representatives from every state.

He said he will bring Hawaii's hospital and nursing home executives together to discuss options.

When they had more money in the past, private facilities took over operations for the state, such as running the Poison Control Center, Meiers said.

With shrinking state dollars, all private programs have been asked to do more, he said, adding, "That may have to stop. The money just isn't going to be there."

Queen's and Castle Medical Centers, for instance, see a lot of psychiatric patients for whom "reimbursements aren't there," he said.

"If they don't have money to hire people, eventually they're going to have to shut down some of these programs."

He said hospital and nursing home chief executive officers have been asked to identify programs they picked up when the state said it couldn't afford them.

After determining how bad the situation is, health care leaders must work with the governor and Legislature to increase health care payments, Meiers said.

He said a bill is pending in Congress to provide some relief, such as in some long-term care areas. "However, we haven't seen anything being talked about yet for the acute side of the health spectrum."

Hawaii's hospitals are trying to work together because they can't make it alone, Meiers said.

"It hit the mainland earlier," he said. "We're just now beginning. It's just compounding some other problems. In my many, many years in health care, this is the most troublesome."

Health care officials across the country are working with their congressional delegations to reopen the Balanced Budget Act, he said.

Meiers said the American Hospital Association is getting postcards out to hospitals so every employee can send them to their congressional delegates.

"Fortunately, we're a smaller state and we communicate closely with our delegation."