Thursday, June 14, 2001

Dispute delays

Some anesthesiologists are refusing
to do business with HMSA

By Lyn Danninger

A shortage of a vital medical specialty is creating a backlog of surgical cases in the state's hospital operating rooms this summer and, in some cases, larger bills for patients.

Dr. Livingston Wong, a Honolulu general and transplant surgeon, said he has already had to cancel and reschedule a number of surgical cases when no anesthesiologist was available.

"Last week, five (anesthesiologists) took vacations. That creates a tremendous problem," he said.

While most of the cancellations so far involve elective surgeries, Wong said more serious situations have arisen.

"We've had emergency or semi-emergency surgeries that have been delayed," he said. "While not life-threatening, it's significant."

Anesthesiologists are in short supply nationwide, with a recent national survey by the American Society of Anesthesiologists estimating as many as 4,000 jobs are unfilled. The gap could be particularly acute for Hawaii in the next few months as anesthesiologists take summer vacations.

The local problem was further complicated recently when the state's largest anesthesia specialty group, the Anesthesia Group Inc., decided its 30 physician employees would no longer participate with the state's largest insurer, the Hawaii Medical Service Association.

Their nonparticipation means patients insured through HMSA could have to pay higher fees for anesthesiologists to be present during surgery. Depending upon the procedure, those fees could range from a few hundred to a few thousand dollars.

HMSA Vice President Cliff Cisco declined to comment except to say the company is working to solve the problem.

While the effect of the group dropping out of HMSA may not be felt as acutely on Oahu, where there are perhaps 40 other private-practice anesthesiologists, it is taking a toll on the neighbor islands.

Anesthesia reimbursement for HMSA's most popular preferred provider plan averaged 25 percent to 30 percent below comparable commercial insurance plans, according to Dr. John Rausch, chief of the Anesthesia Group.

That means a constant shortage of anesthesiologists, physician burnout, people leaving for better-paying jobs on the mainland and difficulty recruiting anyone new to replace those who depart.

Rausch said he is aware that the organization's decision not to participate with HMSA could create hardships. He said the group has been working with patients and offering discounts.

Hilo's six anesthesiologists are members of the group. Since the decision, patients at Hilo Medical Center have been notified they will be responsible for any remaining balance after HMSA payment.

On Maui only one anesthesiologist now participates with HMSA. But that physician works only in a private surgery clinic, said Boyd Kleefisch, administrator at Maui Memorial Hospital.

Kleefisch said he expected to see a drop in surgeries as more patients were referred to Oahu, but that has not happened so far. He also expected to hear more patient complaints regarding anesthesia bills, but that has not happened either. "So far, I've only received a copy of one letter sent to HMSA complaining about the cost."

Kleefisch said the hospital also notified patients scheduled to undergo surgery that they would receive bills from anesthesiologists who no longer participate with HMSA for any balance the insurer would not pay. Hospital admissions staff and surgeons are also notifying patients of the change, he said.

On Oahu, Wong said fatigue is an issue for physicians and operating room staff who sometimes have to wait until late at night to begin surgery because anesthesiologists are busy elsewhere. The shortage is also taking its toll on the anesthesiologists, especially in rural areas where the problem is particularly acute.

"The demands of practice are pretty intense in rural areas," says Sam Schomaker, a former anesthesiologist in Kona and now vice dean at the University of Hawaii's John A. Burns School of Medicine. "You're on call all the time, so the burnout rate is high."

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