The American Medical Association president said he had the impression physicians loved to come to Hawaii—until he talked to some.

J. James Rohack said his discussions with members of the Hawaii Medical Association underscored the difficulty of making ends meet here under the payment system set up for Medicare, Medicaid and private insurance. Reimbursements fall below costs, which “;makes it very difficult to keep an office open with medical liability premiums, office rent and other challenges,”; he said.

A guest at the Hawaii Medical Association's annual business meeting Oct. 16 and gala Oct. 17 at the Hyatt Regency Hotel, Rohack expressed hope that Congress would pass Senate Bill 1776, the Medicare Physicians Fairness Act, to remedy some of the trouble.

But despite the backing of Hawaii U.S. Sens. Daniel Inouye and Daniel Akaka, the Senate killed the bill with a procedural vote Tuesday.

Barring congressional action, Rohack said, a cut in payments to doctors of nearly 25 percent will occur next year with additional 19 percent cuts each year through 2016 for a total 40 percent cut.

He said the payment formula is a big issue for Hawaii doctors because it will affect about 170,000 Medicare patients in Hawaii and 157,000 Tricare beneficiaries.

Rohack is senior staff cardiologist at Scott & White Clinic, director of the clinic's Center for Healthcare Policy and a professor at Texas A&M Health Science Center in Temple, Texas.

He called for “;evolutionary change”; in health system reforms when inaugurated in June as president of the nation's largest physician organization.

Besides a new payment formula, he said the AMA advocates health coverage for all Americans, elimination of denials for pre-existing conditions, making sure patients have a choice, ensuring that patients and doctors make health care decisions—not insurance companies or government bureaucrats—developing incentives for quality and wellness, eliminating paperwork waste, and tort reform to reduce “;defensive medicine”; and unnecessary costs.

“;Hawaii hospitals and physicians do very well as providing quality,”; Rohack said, adding that a new payment system is needed to reward that quality.

When sick, people without health care access often go to an emergency room, where they cannot be turned away, said Rohack.

“;Everybody is paying $1,000 or more per year for that model,”; he said. “;The status quo isn't working for most people. We need to make a change, recognizing it's going to get a heck of a lot worse and now's the time to do it. It can be done.”;