Medicaid payments: State reimbursements are in public interest

We are writing in response to your June 25 editorial, “Lingle should release Medicaid payments.”

As an interfaith organization, we thank and appreciate your acknowledgment that it is in the public interest to provide quality care to those in Hawai’i who cannot afford it.

Our governor, in her own 2007 State of the State address, said, “High costs and low reimbursements are driving hospitals out of business and physicians out of the practice of medicine.” Her words have consistently been, “Increasing physician reimbursement rates to help cover their out-of-pocket expenses is essential to keeping medical services providers in Hawai’i.”

And in May 2008 she said to Big Island Mayor Harry Kim, “Fair and appropriate reimbursements to the medical community remain one of my highest priorities.”

We at FACE cannot accept the reality that the governor is now refusing to release millions of dollars to reimburse physicians who cared for thousands of elderly, poor, blind or disabled citizens during the past year.

The state received these services, and the governor promised to pay for these past services with $8 million in state funding and more than $10 million in additional federal matching funds.

Failure to do so is incomprehensible.

Why are we throwing away $10 million in federal matching funds?

This investment is in the public interest, and keeps our physicians and hospitals in the practice of medicine for our most vulnerable.

Clementina D. Ceria-Ulep
Chairwoman, FACE Healthcare Committee

Go to original Letter to the Editor (4th from top).

Lingle should release Medicaid payments

Editorial

Does it serve the public interest to help provide quality healthcare to those in Hawai’i who can’t afford it?

Of course it does.

Certainly this was the motivation behind Act 284, which appropriates $16 million in state money — $8 million for fiscal year 2008 (which ends on Monday) and $8 million for FY 2009 (which begins Tuesday) — to reimburse physicians who provide care under the state’s Medicaid and QUEST programs.

It’s an expensive investment, to be sure. But to support broad access to medical services, it’s a proper one.

For the Lingle administration, letting go of that first $8 million is a painful prospect: With revenue forecasts worsening, it’s tempting — or prudent, the administration says — to let the June 30 deadline pass without releasing the $8 million for FY 2008.

The administration argues that using separate budget appropriations to make retroactive payments is fiscally unwise, especially in such a difficult budget climate.

But the state did derive a long-term benefit — needed healthcare for its Medicaid and QUEST patients — and in fairness should pay for it.

The doctors who provided the care often incur costs higher than current reimbursement rates. The $16 million, along with about $20 million in matching federal funds over two years, would help correct that imbalance and encourage doctors to stay in business in Hawai’i. Certainly this is worth investing in: We need all the doctors we can get, especially in rural and other underserved areas.

Even Lingle, who allowed Act 284 to become law without her signature, praised its objective as “laudable.” And she will release the second $8 million effective July 1, which will provide real-time payments to doctors for Medicaid services for FY 2009.

Her objection to Act 284′s funding method — using separate appropriations rather than as part of the Department of Human Services budget — is worth a full debate.

But that’s for another time; the release of these funds has been anticipated since the bill became law in July 2007 and should not be withheld now.

The Lingle administration has made steady progress in improving reimbursements for its Medicaid and QUEST programs. It should continue to do so, and release the money.

CONTACT THE GOVERNOR BEFORE JUNE 30!

Why is Gov. Lingle refusing to release millions of dollars to strengthen reimbursements for physicians who treated our most at-risk and underserved citizens?  Given the Governor’s excellent track record on healthcare issues, perhaps she’s not getting good advice. 

In her 2007 State of the State address, Gov. Lingle said, “High costs and low reimbursements are driving hospitals out of business and physicians out of the practice of medicine.”  The Legislature heard the Governor’s message and passed Act 284, which provides $8 million in relief funds for physicians.  Release of the state monies will unlock more than $10 million in additional federal matching funds – more than $18 million for tens of thousands of vulnerable patients.  If Gov. Lingle doesn’t act by June 30, the money will be gone and a golden opportunity to help ease Hawaii’s healthcare access crisis will be lost.

It’s time the Governor benefitted from good advice.  Ask her to act today to release the funding for Act 284 before June 30!

Email the Governor:  governor.lingle@hawaii.gov
Call the Governor:  808-586-0034

High-quality healthcare helps us all

By Jim Tollefson

One of the top priority issues of The Chamber of Commerce of Hawai’i has consistently been the quality of healthcare, which includes increasing long-term-care capacity and access statewide, as well as improving payments to providers of essential healthcare services.
 In the 2007 legislative session, the Legislature passed a bill that would provide much needed reimbursements to healthcare providers. The governor signed the bill into law, which became Act 284.

We recognize that the state is facing challenging issues that deservedly need attention. The slowing economy is having an impact on the state, business, and citizens of Hawai’i. One of the issues, however, affects everyone — the quality of healthcare.

Healthcare plays a crucial role in the economy and economic sustainability of businesses. The lack of these funds will not only dangerously deny citizens in need of healthcare, but it also will inflict damage on a healthcare system that is vital to Hawai’i's ability to continue economic growth in an increasingly competitive marketplace.

Healthcare is our second largest private industry, providing an important source of attractive, high-paying jobs. The sector is projected to show significant growth for years to come. Between 1990 and 2005, the number of jobs in the healthcare and social assistance fields in Hawai’i grew by 49 percent — outstripping job growth in trade and hospitality, the state’s two other economic engines. The healthcare field, including ambulatory care services, hospitals, and nursing and residential care facilities, generates approximately $4 billion in revenues, nearly 45,000 jobs and a collective payroll of nearly $2 billion annually.

Accessible, quality care plays a major role in our ability to retain and recruit current and future employees. Hawai’i boasts one of the lowest unemployment rates in the nation. We are proud of that distinction, but the state’s small, skilled labor pool carries a hidden downside because supply-side pressure means we must compete harder and better to continue sustained economic growth. Strong healthcare access must be part of the offer when we seek to attract skilled professionals and their families here.

A comprehensive, stable healthcare infrastructure is an important element of support and growth for business, including but not limited to the tourism and hospitality industry. Our economy and standard of living depends on the activity generated by visitors. Strong healthcare services are an important component of our state’s ability to attract and serve potential visitors from the Mainland, the Pacific region and throughout the world.

Maintaining a quality and accessible healthcare system is vital to the welfare of Hawai’i's citizens, to the quality of life and to the state economy.

Physician reimbursement helps pay the out-of-pocket expenses of physicians who treat thousands of our most vulnerable citizens — the elderly, the poor, the blind and the disabled. The current low reimbursement rates pose a significant economic threat by eroding the ability of our employees, citizens and visitors to access the care they need when they need it. Too many physicians are being forced to consider following the physicians and specialists who have already left our state. Too many state and private healthcare providers are risking their financial stability because of growing reimbursement shortfalls.

We appreciate the governor and the Legislature for recognizing the critical situation of the healthcare system and supporting the effort to allocate the much-needed reimbursements to providers.

This fund, however, expires soon. Essentially, if the administration does not release the funds by June 30, the state would forfeit more than $10 million in federal matching funds as well, and a chance to invest more than $18 million in a struggling healthcare system that deserves our wholehearted support.

The Chamber of Commerce of Hawai’i considers the stability of our state’s healthcare industry to be an equally valuable economic driver and an important ingredient for our employees, their families and for Hawai’i's tourism and hospitality customers, as well as for the health of the state of Hawai’i.

We hope that the funds associated with Act 284 will be released by June 30 to preserve our healthcare system and continue to make Hawai’i a better place to live and do business.
Jim Tollefson is president and CEO of The Chamber of Commerce of Hawai’i. He wrote this commentary for The Advertiser.

Go to original article.

Doctors: Lingle broke promise on funding

by Linda Chiem:  lchiem@bizjournals.com  /955-8042

Hawaii health-care advocates and doctors are at odds with Gov. Linda Lingle over her refusal to release $8 million earmarked last year to reimburse doctors who care for underinsured or uninsured patients.

The doctors say Lingle has reneged on a promise she made last year to release the money by June 30, which now jeopardizes an additional $10 million in federal matching funds.

Lingle has indicated through a spokeswoman that she will release $8 million for the coming fiscal year, which begins July 1, but not for the current year.

The money was appropriated last year under Act 284, which Lingle allowed to become law without her signature citing “serious concerns” that the funds were appropriated outside of the state’s six-year budget. It was designed to increase payments to doctors who treat Medicaid and Quest patients — mostly the aged, blind and disabled.

Doctors on average get reimbursed less than 60 percent of what it costs them to treat these Medicaid patients. The measure passed by the Legislature would raise reimbursements to 100 percent for services offered in 2007 and 2008.

The measure was aimed at deterring doctors from dropping out of the program or refusing altogether to treat Medicaid patients. Doctors are not required to treat Medicaid patients in Hawaii but many do despite the lack of full reimbursements.

“It is extremely upsetting because these doctors have been treating patients in good faith on what was promised to them,” said Virginia Pressler, executive vice president of strategic business development for Hawaii Pacific Health. “It just does not make sense to me.”

Act 284 set aside a total of $16 million in the two-year budget for fiscal 2008 and 2009 to reimburse the doctors. Lingle said last year she was prepared to release the first $8 million to cover services provided since last July, but has since decided not to release it because of budgetary concerns amid the shaky economy.

Lawmakers, doctors, commercial health insurers and community groups such as Faith Action for Community Equity and Hawaii Coalition for Health have been pushing hard for the release of the money saying the $8 million is desperately needed and they’re not buying the “budgetary concerns” reasoning.

The governor’s office directed PBN’s requests for comment to Lillian Koller, director of the state Department of Human Services, who oversees the state’s Medicaid fee-for-service and Quest managed-care programs.

In a statement to PBN, Koller said Lingle is taking the “most prudent approach” by withholding the 2008 money, which she considers a retroactive pay hike for services already rendered. However, she intends to release the $8 million for fiscal 2009, which starts July 1, which will come with $10 million in federal matching funds, Koller said.

“The administration’s decision to withhold Act 284 funding for the 2008 state fiscal year is a cautious move,” Koller said in the prepared statement. “This decision reflects a commitment to keep the state fiscally sound, both now and in the future, in light of reduced revenue projections and rising expenditures.”

She said the state will begin sending checks today to doctors, hospitals and outpatient Medicaid providers that reflect an increase in the reimbursement rate to 60 percent, part of a previous law. The higher rate applies to services going back to July 1, 2006, and is the first such across-the-board increase in 11 years, she said.

Doctors say it’s still not enough to make up for years of underpayments.

“I think it’s unreasonable and there’s resentment because it’s treating us like we’re stupid … ,” said Dennis Ayon, an internist who practices in Wahiawa. “Medicaid or Quest patients make up 10 percent of my practice, [and that percentage] keeps growing, and with my overhead we can’t afford to just take the loss on the reimbursements.”

Medicaid Aid

JAMM AQUINO / JAQUINO@STARBULLETIN.COM
Faith Action for Community Equity members waved signs and delivered a “prescription” to Gov. Linda Lingle’s office and home yesterday, asking her to release $8 million appropriated by the Legislature to supplement payments to doctors providing Medicaid services. Lingle’s budget director has said the funds won’t be released because of lack of time.

Activists want answers about Medicaid funding

By Zahid Arab

HONOLULU- (KHNL) Community activists are prescribing a direct plan for Governor Linda Lingle to release crucial Medicaid funds to ease the financial burden on hospitals and doctors.

Doctors say they were promised eight million dollars in Medicaid funds and even though it’s been federally approved, they’re frustrated why the money hasn’t been released to medical providers.

You go to your doctor to get better when you’re sick, but who helps the hospitals? Activists are pleading with the governor to not let this important action sit in the waiting room any longer.

For more than 50 activists with the Faith Action for Community Group (FACE), demands to release millions in Medicaid funds are just what the doctor ordered.

They’re counting down the days until Governor Lingle releases 8 million dollars in Medicaid, which will send an additional 4.5 million in matching Federal funds to the state.

“The public is fairly unaware of the crisis and so it’s like an undertow suddenly they’ll be swept under without knowing what hit them,” said Bob Nakata.

FACE Leaders say Medicaid patients are suffering, doctors aren’t getting reimbursed. They say if Governor Lingle doesn’t release the additional 8 million dollars in Medicaid funds they may loose it all by the end of the month. A disappearing act that could be detrimental to Hawaii’s Healthcare.

Chief of Staff Dr. Rodney Boychuk at Kapi’olani Medical Center says right now it’s costing doctors more to see patients than they get paid.

5-year-old Jordan relies on the treatment of his care providers, but because the funds aren’t there to pay them, two of his specialists will no longer be able to treat him.

Go to original video.

Reneging on funds will have impact on needy

I am writing in response to the June 9 article by Curtis Lum, “Isle doctors, hospitals press Lingle for cash.”

Act 284 was passed last year to correct a grossly inadequate physician reimbursement system. With money promised and allocated, physicians were able to continue treating the state’s most vulnerable citizens despite the physicians’ own economic situation.

Department of Human Services Director Lillian Koller now says that the state’s budget woes have put Act 284 funds in question.

Since Act 284 was passed by the Legislature last year, physicians across Hawai’i have been providing medical care in advance of payment and in good faith, assuming they would receive reimbursement by our governor. Our doctors relied on payment, as prescribed by law.

To renege on a commitment by the state in reimbursing the physicians for services already provided will undoubtedly have a huge impact on our state’s neediest citizens.

It is disheartening now at the 11th hour that the governor is going to allow the first half of the funding of $16 million, of which $8 million is for 2007, to lapse. This will cause the loss of additional federal funding.

If the governor decides not to release all the appropriated funds, our community should worry about every poor, elderly and disabled citizen’s access to quality healthcare in Hawai’i.

Rev. Bob Nakata
President, Faith Action for Community Equity

Go to original Letter to the Editor (5th from top).