It’s no secret that Hawai‘i’s health-care system was struggling even before the coronavirus outbreak, as it battled one of the worst physician shortages in a generation.
But the pandemic has exposed the serious gaps in the state’s health-care system — including the way Hawai‘i supports its physicians, physician assistants and nurse practitioners.
The recent hospital surges amid a growing shortage of health-care workers shows that it’s time to take a closer look at how practitioners are treated in the Aloha State in order to ensure that they are not overburdened and that patients can receive access to care during this crisis and beyond.
Five years ago, Hawai‘i Medical Service Association — Hawai‘i’s largest insurer, with more than 700,000 enrollees statewide — embarked on a bold plan to remake how it would be supporting physicians on the plan. Under the so-called “payment transformation,” providers would receive payment based on the number of patients they see each month, rather than the treatments they are providing.
This decision comes as Hawai‘i is facing pressure from the worst physician shortage the state has seen in decades. Last year, the University of Hawai‘i warned in its annual report to state lawmakers that the state faces a shortage of as many as 820 full-time physicians.
Now, as Hawai‘i battles a growing outbreak of the coronavirus, this shortage has left hospitals scrambling to meet these emerging challenges.
Looking to reward primary-care providers for delivering high-value — rather than high-volume — care may seem like a worthwhile strategy. But an analysis of the HMSA payment model tells a starkly different story.
A recent survey of Hawai‘i practitioners found that these lower payment rates from payment transformation have resulted in many experiencing increased financial stress on their practices. Nearly 65% of primary-care providers, for example, know a practice that has been forced to close its doors as a result of payment transformation.
The result: Payment transformation has made it difficult for Hawai‘i to bridge its worsening physician gap. In fact, an alarming 80% percent of surveyed primary-care providers said that they would not recommend that someone entering the field of medicine come to Hawai‘i to practice medicine, which would be devastating for Hawai‘i’s health-care community.
Worse yet, patients may end up being hurt by HMSA’s payment model. More and more primary-care providers, overburdened by increased administrative work and capped-out waiting rooms, are referring patients to specialists or urgent-care centers.
As a result, payment transformation is keeping patients from seeing their trusted practitioner or pediatrician for their children.
While HMSA has taken steps to meet the needs of its provider network during the pandemic, the lasting implications of how this model will continue to support PCPs (primary-care physicians) moving forward remain to be seen. The pandemic has presented an opportunity to improve the problems that these PCPs have had with the program, rather than remain complacent.
As the largest insurer in the state, HMSA has a unique responsibility to ensure adequate support for the state’s health-care providers, particularly as they face unprecedented challenges from the pandemic. The insurer should adopt policies that ease this payment model by incorporating more fee-for-service payments to maximize the quality of patient care.
The coronavirus pandemic has proven what many in Hawai‘i have long suspected. It’s time to rethink Hawai‘i’s health-care system and ensure that practitioners are properly supported to ensure the health and well-being of communities across the state.
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Stacey Worthy is counsel to Aimed Alliance, a nonprofit health-policy organization that seeks to protect and enhance the rights of health-care consumers and providers.
