A Wilcox Health official have informed employees, medical staff and volunteers at Wilcox Memorial Hospital and Kauai Medical Clinic that doctors with the healthcare provider would continue to provide workers’ compensation care, and accept workers’ compensation patients. It is unclear
A Wilcox Health official have informed employees, medical staff and volunteers at Wilcox Memorial Hospital and Kauai Medical Clinic that doctors with the healthcare provider would continue to provide workers’ compensation care, and accept workers’ compensation patients.
It is unclear whether this memorandum was sent to workers’ compensation patients.
The memorandum, titled “Update on Workers Compensation Issue,” was dated Tuesday, July 19, from Paula Dias, chief operations officer.
According to the memorandum, “there has been some understandable confusion on the Workers’ Compensation issue that is so important to businesses, workers comp patients, residents, the state’s Department of Labor and Industrial Relations (DLIR) that oversees Hawai‘i’s worker’s compensation program, and to providers like Wilcox and KMC.”
Wilcox Health is comprised of Wilcox Memorial Hospital and Kauai Medical Clinic (KMC).
Kaua‘i doctors saw more than 1,600 new workers’ compensation patients last year, according to Dennis Seino, labor program field manager for the state Department of Labor and Industrial Relations. He said that, in addition to these new claims, staff in his office deals with another 1,600 or so ongoing and open cases each month.
Seino said the number of claims had actually declined, due to what he perceived as safer workplaces and workers better educated about safety issues.
According to the Wilcox Health memo, “not everyone knows that a few months ago the DLIR instituted new rules to the state’s worker’s compensation program. After careful review, which included obtaining physician input, we determined that the additional burdens placed on providers by these new rules were beyond what we could reasonably handle, and so discussion was raised regarding whether the clinic could continue as a provider of WC services was raised,” Dias wrote.
Part of a letter electronically signed June 30 by a Wilcox Health orthopedist to a patient reads: “As a final note, this office will no longer be accepting worker’s compensation as a form of insurance, so we will be unable to continue (this named patient’s) care. The two doctors on the island who participate in workers’ compensation insurance are Dr. Rick Goding at Kauai Veterans Medical Hospital (at the West Kauai Medical Clinic in Waimea), and Dr. Hayato Mori, who practices out of Kuakini Medical Center.”
The patient who received this letter said they had not received any follow-up communication as of Thursday.
According to the DLIR, based upon the results of a 2003 study by the National Academy of Social Insurance of workers’ compensation-cases, Hawai‘i’s costs remained significantly higher than the national average.
Hawai‘i employers paid 26 percent higher than their Mainland counterparts, at $1.57 per $100 dollars of payroll.
With regard to medical costs, Hawai‘i employers paid seven cents more per $100 than the national average, according to a DLIR spokesperson. With regard to cash payments (wage replacement, disability payments) Hawai‘i employers paid 34 cents more per $100 than the national average.
The Dias memorandum continued, “the situation recently changed again when the new rules were revoked by the state legislature last week. Today, WC (workers’ compensation) is essentially back to where it was before the new rules were instituted.
“However, what has changed is that based on physician feedback and a better understanding of our own worker’s compensation operations, we are now actively talking to the state’s DLIR to discuss and negotiate more favorable considerations of issues that we have with the program, which include the program’s complexity and documentation requirements, inadequate reimbursement, and delays in payment. In our initial discussions, the Department has said that while they are optimistic about being able to address some of our concerns, others are longer-term efforts that can only be changed through legislative action.”
James Hardway, special assistant to the director of the state Department of Labor and Industrial Relations, said earlier this week leaders in his office have spoken with officials from Hawaii Pacific Health, the parent organization for Wilcox Health and for Straub Clinic & Hospital, which last year stopped taking workers’ compensation cases (involving employees injured while on the job), closing their occupational-health clinics in Honolulu.
According to the Dias memorandum, “another thing we are doing is an internal review and evaluation of the actual costs and amount of work and effort it takes for us to provide worker’s compensation services. This factual information will be helpful to us in our discussions with the state, as well as be important to any changes or adjustments that may be needed to improve our internal operations.”
Dias advised, “If you get any calls or questions about our position on the workers compensation program you can say that Wilcox and KMC continue to provide workers compensation care. You can also share that like so many others, we feel that things need to be changed within the program to make it more responsive to employer, patient and provider needs.”
Hardway said the topic of workers’ compensation had been a subject of discussion among members of the Hawaii Medical Association since 1995.
He said the amount of paper-work was a “hassle” for doctors, as were the low reimbursement rates from insurers.
Workers’ compensation fees, which are pegged to Medicare, have dropped 54 percent since 1995, when members of the state Legislature approved legislation to decrease the fee schedule, according to a published report.
