Hawaii senator urges medical reforms to attract doctors, provide affordable care

By Hadley Catalano

Is there a diagnosis to Hawai`i’s health care crisis? According to state Sen. Josh Green, Third District (West Hawai`i), the cure rests in the state’s willingness to pass legislation on medical malpractice and reimbursement reform.

“In the upcoming legislative session, I will introduce a comprehensive health care reform bill in the state Senate which addresses insurance reimbursements, medical malpractice reform, rural access to care, the continuing uninsured problem and most importantly, changes to reinvent our safety-net hospital system,” said Green, who is an emergency room physician.

Green’s interest in reimbursement reform has stemmed from what he feels is the Hawai`i Medical Service Association’s (HMSA) “robbing our health care system.” He said the insurance company spends more than $150 million each year to administer the system and maintain its monopoly. HMSA’s exemption from the premium tax amounts to more than $80 million in lost revenue annually to the state.

“The annual $230 million that goes to HMSA is draining the lifeblood of Hawaii’s health care system, and our hospitals are collapsing as a result,” Green said. He feels the insurer is a bullying entity allowed self-governance. The result has been that it pays doctors too little to keep their practices open and has forced state hospitals into a deepening financial crisis, leaving taxpayers to bail them out in what amounts to massive corporate welfare for HMSA, he said.

“In effect (our tax money goes) to pay HMSA’s inflated executive salaries and outrageous bonuses, and to pad their half-billion-dollar surplus,” he said. “The money to keep our hospitals open and our doctors in Hawai`i is going directly to HMSA in the form of their tax exemption and administrative costs. And they lavish it on their executives and maintain a gigantic financial surplus while they keep reimbursements artificially low and our hospitals go broke.”

In addition to reimbursement reform, Green hopes to petition a compromise on medical malpractice reform. He said that it remains necessary to bring physicians to Hawai`i and to “change the climate of medical practice in the state from one of costly and inefficient defensive medicine to a system focused on compassionate and efficient preventive medicine.”

According to Green, states that have reached a compromise on this issue have been able to attract and retain health care providers across all disciplines.

Medical liability or tort reform has been an uphill battle for Green since he first introduced House Bill 1992 before Judiciary Committee Chairman Tommy Waters, District 51 (Waimanalo, Lanikai), during the last legislative session. The bill, supported by the Hawai`i Medical Association (HMA), aimed to curb the migration of island doctors, attract specialized physicians and provide access to quality health care.

Waters told the media in February that he denied the bill a hearing because it was identical to one that had failed in the last session and he felt that tort reform didn’t attract doctors to rural areas or help victims.

Originally, the reform bill addressed the increasing cost of health care due to malpractice insurance, which often results in neighbor island doctors refusing to take on new patients, moving or relocating. This causes a rapid decrease in specialized doctors and hospital care services, forcing many to travel to O`ahu or the mainland to receive adequate care.

The tort bill proposed a $500,000 cap on non-economic damages as determined by the state Department of Health. This included losses not associated with a dollar value, such as pain and suffering and loss of quality of life. In the circumstance of catastrophic damages, the bill would have placed a $3 million limit on “irreversible, life-altering injuries.”

These monetary limitations were criticized by Waters, who claimed the bill denied compensation rights to victims of malpractice. Green noted that the potential awards could be higher than the cap. When economic damages are included, the award could be as high as $10 to $15 million and would assign no limits to the economic damages a victim could collect, including compensation for calculated damages such as wages lost, medical bills and harm to property.

“It’s not doctors vs. lawyers. I know the proponents of the bill want to frame it that way. For me, it’s about victims’ rights,” said Waters, one of a dozen attorneys in the Legislature, as reported to KHNL reporter Leland Kim.

Some reformists, concerned about the influence of special interest groups and lobbyists at the Capitol, claim that sending the tort reform bill to Waters’ committee was meant to force a dialogue and compromise aimed at solving the statewide health care crisis.

When Green’s bill was denied a hearing, he told media sources in late February that he would seek an alternative vessel in which to have his bill heard before the Senate during the early 2008 session. A later hearing on the tort reform bill resulted in what many saw as a “vendetta” ethics bill brought before the Senate in mid-April.

Some say Waters amended the controversial Senate Bill 945 in the House so that it targeted Green, causing many in the Capitol to consider the bill to be a direct warning to Green over their tort reform differences. Sen. Lorraine Inouye told reporters that it was “appalling to draft legislation to target political foes.”

The amendment proposed by Waters, who was elected to judiciary chair by Speaker of the House Calvin Say and is backed by the Consumer Attorney Association, prohibited state officials or lawmakers from establishing contracts with any state agency for $10,000 or more. Green is contracted by the Hawaii Health Systems Corp. If S.B. 945 had been approved, it would have forced Green to choose between working as physician or serving in the Senate. The bill died in the Senate.

Waters has not sought re-election this term and has been seen frequently on Hawai`i Island campaigning heavily for Billy Kenoi, a friend and fellow graduate of the University of Hawai`i at Manoa William S. Richardson School of Law.

However, during this election year, Green will look to try his hand again at passing medical liability legislation.

“I believe that leaders in the health care community, including doctors, hospital administrators and even many in the insurance industry, will support a comprehensive solution that addresses medical malpractice reform as part of a broader solution that includes insurance reimbursement reform,” Green said. “It is a commitment to our public hospitals and universal access to health care.”

HMA Executive Director Paula Arcena also will be keeping a close watch on the election results. She will be supporting the Constitutional Convention (ConCon) on this year’s ballot as a means of addressing boarder health care issues.

“Right now the nation’s economy is of top concern but health care has been a long-standing problem and people’s concern will return there,” explained Arcena, noting that the American Medical Association’s recent poll showed that in the year 2020 there will be a shortage of 200,000 physicians nationwide.

“They were looking at the projected population, an aging population,” she said. “We are part of the crisis. Hawai`i needs to compete. We need to make ourselves attractive and deal with three major problems: the high cost of living and the rural locations of Hawai`i, low reimbursement rates and the high cost issues of business.”

Arcena pointed to Hawai`i Island as a case in point. As of last week, three out of five island orthopedic surgeons gave notice that they are preparing to leave by January, increasing the already serious doctor shortage on the island.

All three doctors claimed financial issues such as the rising cost of malpractice insurance, low reimbursements from HMSA and huge workloads as the reasons they can no longer maintain their practices.

According to an Oct. 3 Honolulu Advertiser article, senior vice president of HMSA Cliff Cisco claimed that its reimbursement fees for doctors are comparable with other parts of the country.

“We’re not the highest, we’re not the lowest,” Cisco told the Advertiser. “HMSA invests more than anyone on trying to recruit new physicians to the community. It’s been well documented that 95 cents of every dollar we collect from employers goes back to providers in benefits, and we’ve had operating losses. It’s not that simple to change reimbursements.”

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