Isle doctors Doctors in Hawaii and across the mainland are reaching a point where they can't afford to care for elderly patients under Medicare and Medicaid rates, says a Hawaii Medical Association official.
wearing thin over
seniors’ bills
Some worry that high costs will
force them to leave the stateBy Helen Altonn
haltonn@starbulletin.com"There's no official boycott or anything. It's just individual physicians all over the country making decisions that they can't see patients at that level of reimbursement," said Dr. Philip Hellreich, Hawaii Medical Association past president, now legislative chair.
Medicare cut payments to doctors this year by 5.4 percent and the government estimates fees will be reduced a total of 17 percent in the next three years.
Significant numbers of doctors for the first time are refusing to take Medicare patients, saying the government pays too little to cover costs of care for the elderly, according to a New York Times report.
The American Academy of Family Physicians says 17 percent of family doctors are not taking new Medicare patients.
"It's extremely difficult," Hellreich said. "I think in the not-to-distant future, we will see an outflow of physicians, between ages 40 and 60, who can't afford to do business here anymore."
He said the state will lose some of its best physicians at the height of their careers because they increasingly can't pay rents, staff, insurance premiums or anything else.
"We're confronted with all the problems of small business people in Hawaii and the only industry with prices fixed by government or third-party payers," he pointed out.
And with the high costs of living in Hawaii, Hellreich added, "It becomes impossible to survive economically."
Since many private insurers link their payments to Medicare fees, the cuts could make it more difficult for elderly people to find doctors, particularly with increasing needs of an aging population, health policy experts said.
It's not a new problem, said House Health Committee Chairman Dennis Arakaki (D, Kamehameha Heights-Kalihi Valley).
"We've known in the past, although they've never said it, that doctors are starting to ration care. I guess it's just plain economics. They can't expect to take a loss on a large number of patients."
He said it's unrealistic to expect elderly patients to pay more out of pocket for health care, which means if they can't find doctors under Medicare, they would have to spend down or get rid of assets to qualify for Medicaid.
"It's really troubling that the federal government is choosing to cut back," Arakaki said. "A lot of us, including Republicans, saw the federal government as possibly the answer to some of the shortfalls on the state side."
He said legislative resolutions have gone to Congress appealing for help but nothing has happened. The National Council of State Legislatures also has tried to get Congress to expand Medicare as an answer to long-term care, but that hasn't happened either, Arakaki said.
Hospitals also are seriously affected by the low reimbursements and if the elderly can't get primary care, they're going to start going to emergency rooms, Arakaki said.
"That has been happening slowly over the past few years and hospitals are coming to us saying we've got to find a way to bail them out. Otherwise, they'll be closing their doors as well."
The state Legislature is considering bills to address long-term care and prescription cost problems. A bill also proposes to increase Medicaid reimbursements to hospitals. But the amount involved may not be possible because of the budget shortfall, Arakaki said.