Hawaii is “most hostile health environment to practice,” says doctor – State of Reform


Worsened tax policy, low reimbursement rates, and more are straining Hawaii’s healthcare workers to the point that facilities, especially on neighboring islands, are starting to shut down. These gaps in care contribute to otherwise preventable health disparities in Hawaii.

The Reform State met with Dr Scott Grosskreutz, a Hilo-based physician, on the perfect storm of conditions that make Hawaii the “most hostile healthcare environment to practice.”

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Lack of access to care:

Access to a specialist is difficult for residents of neighboring islands due to travel costs. Grosskreutz estimated that an average person would spend $ 1,000 to visit a specialist in Oahu.

“Unlike life on the mainland, you just can’t get in your car and drive to the next city or state to see your oncologist or neurologist or find someone to help you care for your health. diabetes. “

Access to suppliers on the neighboring islands of Hawaii is also difficult. Based on 2021 nursing education to study, three of Hawaii’s five counties — Kauai, Maui, and Hawaii — are among the top 15 counties in the country with the greatest shortages of primary health care workers.

Health disparities, especially in the neighboring islands:

A to study from the Journal of Breast Imaging, co-authored by Grosskreutz, found that 30% of cancers in black, Hispanic, Asian and Pacific Islander women in the United States occur before the age of 50. Research indicates that breast cancer death rates are highest among Native Hawaiians. . Grosskreutz attributed these poorer health outcomes to a lack of access to care.

“Much of this research has to do with the ability to access health care, to be referred for a mammogram or, once diagnosed,[the ability] be treated quickly if you live in Moloka’i, or Maui, or Kauai or the Big Island versus Honolulu, or if you are in Los Angeles or New York.

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High cost of living combined with a tax on health care

It costs nearly double the national average to live in Hawaii, according to a 2021 WalletHub to study. Lawyers estimate that a family of four would need an average annual income of over $ 90,000 to meet basic needs. Social determinants of health, such as housing and child care costs, are among the biggest drivers of cost increases. Grosskreutz said current provider reimbursement rates do not take into account the high cost of living.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released 2022 final rule for the reimbursement of the supplier. Due to the expiration of some 2021 payment increases and other general reductions, rates could drop as much as 9.75%.

On top of that, Hawaii’s General Excise Tax (GET) translates into higher costs for providers, especially for Medicaid and Medicare services. Grosskreutz said:

“With Medicare and Medicaid patients, the margins for these patients are often extremely slim.
When the state steps in and says, “We’re going to have a 4.5% general excise tax on your gross income,” the margins are so slim that it actually translates to a 15-20% tax on your gross income. average family practice. “

Aging workforce

A third of Hawaii’s suppliers, including Grosskreutz himself, practice after retirement age. At one point in the pandemic, he saw a doctor in his 60s – who recently had hip replacement surgery – on call late at night. Grosskreutz said the industry needs to focus on recruiting newer and younger providers who come out of training to practice in Hawaii.

However, recruiting more people into the workforce under the conditions outlined above is no small feat, and Grosskreutz fears the shortages will permanently affect healthcare facilities across the state.

“Once you start to see these clinics collapse, which sometimes took decades to build, you see [providers with] that level of expertise… go. They lose their jobs or have to move to the mainland to find work. It is extremely difficult to reconstruct these [clinics]. And once you lose these facilities … it becomes even more difficult to recruit because, say you are a specialist and you don’t have an endoscopy clinic to work in, then you will have a much harder time recruiting these. people.

So what do we do about it?

Grosskreutz and other labor advocates have emphasized the workforce crisis for years. Some solutions include legislation. A invoice this would exempt health care providers from the EEG was passed by the Senate last year and may have passed the House if it weren’t for a shortened session during the pandemic.

Advocates are also urging the state’s congressional delegation to follow Alaska’s Medicare reimbursement model, which helps provide care to patients in remote locations.

To support possible legislation, the Hawaii Physician Shortage Crisis Task Force works to survey Big Island providers, residents and other healthcare stakeholders to create a reliable database on the workforce shortage. Grosskreutz said the task force plans to replicate the survey on the other islands as well.


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