KILAUEA — The Kaua‘i Community Health Alliance receives between 17,000 and 20,000 patient visits each year, providing a range of treatment to largely working-class people from the Ha‘ena to Kapa‘a.
They soon may be unable to keep their doors open, their CEO says.
“Every month is a cliffhanger,” said Jim Winkler, who serves as CEO and president of KCHA while also practicing at the Hale Lea Medicine clinic.
“The clinic is currently running at a deficit. While we have not missed payroll in 28 years, we are not able to operate for much longer due to a confluence of circumstances.”
The clinic has been in operation since 1994 and has functioned as a nonprofit since 2008. KCHA houses both the Hale Lea Medicine and Urgent Care and the North Shore Wellness Center. Since they treat a large number of underinsured patients, they struggle to make ends meet and rely on community support for a portion of their budget.
If the center were to close, it could result in significant disruption for its patients, who would have to scramble to access care in the limited North Shore market. There is only one other primary-care clinic on the North Shore — the North Shore Medical Center — which has limited hours and a smaller staff than KCHA. The next closest clinic is Ho‘ola Lahui in Kapa‘a.
“A lot of those people (on the North Shore) don’t want to go to Kapa‘a. Location is an issue regardless of who is providing the services,” said Dr. Kapono Chong-Hanssen, chief medical director at Ho‘ola Lahui.
“We could take some of them, and if all of our community partners got together (the island) could accommodate all of them. But if you’re thinking that you’re just going to snap your fingers and they’re all going to go to our clinic in Kapa‘a, that’s unrealistic.”
Low reimbursement, high cost of living
A major factor in KCHA’s financial struggles is the rate of Medicare reimbursement, decided at the federal level, which is lower in Hawai‘i than anywhere else in the nation.
The low rate and the fact that Hale Lea treats a high number of patients with government insurance (64.2%) — which reimburses at a lower rate than private insurance, contribute to the clinic’s financial struggle.
When coupled with the high cost of living on island, it becomes tough for clinics like KCHA to retain workers. They are currently short two physical therapists and have recently had to close on Sundays due to lack of staff. They forced to turn patients away, and some face a four-to-six-week wait to begin physical therapy.
“I have physicians working at our facility getting less than 50% of a mainland salary, yet trying to live in the most expensive state in the US,” said Winkler. “I myself have been working as both medical provider and CEO without any compensation for the last three months.”
Last week, Hale Lea brought a physical therapist to Kaua‘i in hopes of offering her a job.
“She called us and said she couldn’t find a place to live,” said Winkler. “We’ve been advertising for almost a year now and we can’t find another physical therapist.”
Health outcomes on Kaua‘i
Kaua‘i currently has the lowest rate of primary-care providers per 100,000 people among the counties, according to data from Hawai‘i Health Matters.
An Aug. 2021 nursing education article lists Kaua‘i county as having the 13th-greatest primary-health-care-worker shortage in the country (Maui is fifth).
While many other areas on this list are in close proximity to other counties, Kaua‘i is geographically isolated, making the problem more extreme, according to Scott Grosskreutz of the Hawai‘i Physician Shortage Crisis Task Force. If KCHA were to close, this could move Kaua‘i up to first place, Grosskreutz said.
This is a factor that leads to worse health outcomes on Kaua‘i and the other neighbor islands.
“When you don’t have access to care your mortality and morbidity rate go up a lot,” said Grosskreutz. “If you take a look at the death rate from heart attack, trauma, cancer, asthma, hepatitis-B, suicide, it’s all significantly higher on the neighbor islands than on O‘ahu. It’s the impact on the population that’s the tragic part.”
Kaua‘i’s rates of hepatitis C-related death, melanoma cancer death and adults who did not see a doctor due to costs are all higher than Honolulu according to the state Department of Health.
The Kaua‘i suicide death rate is the highest of all the islands, about 22 per 100,000 people.
Grosskreutz sees maintaining clinics like KCHA as vital to improving these health outcomes, and advocates for a change to the reimbursement rate in order to make these clinics more financially viable.
“If Hale Lea closes, who will their rural Kaua‘i patients see for health care?” Grosskreutz asked.
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Guthrie Scrimgeour, reporter, can be reached at 647-0329 or gscrimgeour@thegardenisland.com.
This story as been updated for clarity.
