LIHU‘E — Members of Hawai‘i Medical Services Association may soon lose their primary care physicians or have to pay higher out-of-network costs for using Hawai‘i Pacific Health hospitals and clinics if the two organizations cannot reach an agreement on reimbursement
LIHU‘E — Members of Hawai‘i Medical Services Association may soon lose their primary care physicians or have to pay higher out-of-network costs for using Hawai‘i Pacific Health hospitals and clinics if the two organizations cannot reach an agreement on reimbursement levels before their contract expires Jan. 31.
HPH is the biggest private hospital group in the state. It includes nonprofit Wilcox Memorial Hospital, as well as Straub Clinic and Hospital, Pali Momi Medical Center, and Kapi‘olani Medical Center for Women and Children.
In a letter distributed to employers this month, HMSA warned negotiations have reached a critical point, and HPH is likely to end its participation in HMSA’s provider network.
“Hawai‘i Pacific Health is demanding an increase in reimbursement levels that is extravagant, unreasonable and unfair,” the letter said, “and would result in significantly higher health plan rates.”
On Friday, HMSA Vice President of Consumer Affairs Elisa Yadao said Kaua‘i represents a special challenge.
“We are making arrangements to provide alternatives for Kaua‘i residents, to find alternate physicians doctors and providers, and, if necessary, fly people to O‘ahu.”
If an agreement cannot be reached, HMSA members who have an HMO plan would be required to find new primary care physicians outside of HPH’s network. Those with a PPO plan could still continue to use HPH clinics and hospitals, but it would require significantly higher out-of-pocket costs an out-of-network provider.
“Our hope is to reach a contract settlement and none of this will have to happen,” she said. “We certainly understand that there needs to be a fair reimbursement rate for hospitals, but we need to balance that with the needs of our members and costs that are as reasonable as they can be.”
In written response to questions Friday regarding to what extent health care costs have risen, Wilcox Memorial Hospital President and CEO Kathy Clark said, “Adequate funds are needed to maintain medical equipment and technology, purchase drugs and supplies, accommodate visiting specialists and ensure the quality patient care everyone on Kaua‘i deserves.
“Last year alone, we provided $22.5 million in care and services that were not covered by insurance… According to data provided by HMSA, Wilcox Memorial Hospital is among the highest quality and the lowest-cost hospitals in Hawai‘i.”
Clark said their proposed increase is to help keep them in pace with inflation.
“HMSA’s recent scare tactics are inaccurate and deeply disappointing. This is not a good-faith approach to negotiations, and it has no place in our community,” she said. “From our perspective, the negotiations have been progressing well, and we were surprised by HMSA’s unexpected ploy to infringe on the physician-patient relationship.”
Until an agreement is reached or the contract expires, Clark said there is no need for patients to change physicians or hospitals.
“Our contract does not expire with HMSA for more than three months and we are committed to using that time to come to an agreement,” she said.
The organizations are scheduled to continue negotiations next week.
