Posted on: Thursday, March 25, 2004
ISLAND VOICES
Legislature imperiling Maui Memorial
By Steven M. Moser
Maui physician
Last week the state House of Representatives passed across to the Senate a budget bill, HB 1800, that includes an $11 million cut in funding for the Hawaii Health Systems Corporation (HHSC). Once again, as it has done many times in the past, the Legislature threatens to jeopardize the health and welfare of the people of Maui and our many visitors.
As the outgoing medical director of our "safety net" hospital for the last two years, I can say categorically that if this funding is not reinstated, not only will we be unable to expand services as we have been planning to do, but we will need to cut some services and severely restrict others.
When the state took the hospital over from the county over 30 years ago, it assumed full responsibility for the health and welfare of the people of Maui in terms of hospital care. It was clearly not up to the job. Because of the gross inefficiencies of trying to run local hospitals (ours is one of 12 state-run healthcare facilities) with a massive state bureaucracy, the Legislature in 1996 established the HHSC as a quasi-public corporation to manage the Maui hospital (along with the 11 other facilities).
However, Act 296 was born bearing the seeds of failure. From the start, the HHSC was underfunded to deal with the antiquated and dilapidated condition of many of its buildings; it maintained a Honolulu-centric civil service system of employment, with collective bargaining done at a state level; it centralized budgetary and decision-making with the HHSC board and CEO, with Maui Memorial still at its mercy.
Despite all of these problems, our hospital has continued to provide good service to our community. We have the second busiest emergency room in the state. We handle all serious medical conditions except neonatal intensive care, interventional coronary procedures, transplants and other highly specialized treatments. We have just opened the finest angiography unit in the state. We routinely do well in many outcome measures of performance when reviewed by national quality-assurance organizations.
We are in the process of redefining ourselves by establishing service lines for cardiology, oncology, surgery, and women's and children's services. We are restructuring our medical staff to improve efficiency and peer review, and are very close to starting construction on a new wing using a hard-fought $38 million capital improvement bond.
In short, we are on the verge of great things, and are trying to be progressive in a regressive time.
And yet, because of apparent political considerations, all the work we have done is in jeopardy. Like a house of cards, we on Maui are in danger of collapse as our operational underpinnings are being removed.
There are many in the Legislature who don't trust the leadership of the HHSC and want to punish it by cutting its funding. They think that the HHSC is being wasteful with its expenditures, and apparently don't know how to read a financial statement. We need to remind these legislators, and the public, that Maui Memorial does not, in and of itself, depend on state general funds. The hospital usually makes a small profit, i.e., it collects enough money from third-party insurance to pay for its operational and some CIP expenses, and is the only state hospital in Hawai'i to do so. We would probably always be profitable were it not for the funds that we pay HHSC to administer us from Honolulu.
Why is the HHSC not more profitable? Because hospitals, Maui Memorial included, do a lot of free care for the uninsured and under-insured; because reimbursements from Medicare and Medicaid, as well as HMSA, are always being reduced; because we are mandated to pay salary increases for our union employees given by the Legislature and for the recent market losses of their expensive pension plan without consideration for our ability to pay.
Also, the practice of medicine is continually changing with the advent of new technologies, equipment needs and drugs, not to speak of routine supplies that cost more and more. It is all expensive, but all necessary to maintain quality of care and stay current. Some of our facilities are 50 years old and should be replaced. This takes state money — it cannot come out of hospital revenues, which barely keep up with day-to-day operations.
The legislators who dare to talk about their reasons for cutting us are under the false impression that by raising our special funding ceiling, they are somehow allowing us to spend more. They mistakenly assume that we can just raise our prices, charge more and collect more revenue. We can't — we are at the maximum reimbursements allowed by law. In fact, the cuts they propose would have the opposite effect: We would become rapidly less profitable as we lose business to Honolulu or encourage competing entities on Maui.
The cuts proposed by the Legislature would have some or all of the following effects: loss of child and adult psychiatric inpatient services, loss of orthopedic inpatient services (and therefore trauma services), decreased staffing levels for all clinical services, inability to fund many projects in the works (such as ER renovations, upgrading endoscopic and inpatient dialysis services, upgrading information technology systems, health and safety repairs and upgrades, etc.), and cutting leadership positions. Service line development would be retarded. Recruitment of qualified staff and talented physicians to our hospital would be jeopardized. Good nurses and clinicians, unable to perform to their potential, would leave.
And so will you, the patients — you will be flying to Honolulu to get the quality of care you need and deserve. From being the only profitable hospital in the system, we would lose market share and join the rest of the HHSC facilities swimming in red ink.
Either they provide for us, or they should get out of the hospital business and allow this hospital to go on its own, or allow another to be built by private concerns. Or at least anesthetize us before they use the axe (when we run out of scalpels).
