More funding needed to serve Quest patients
Finding a primary care physician who accepts new patients can be a daunting task, even for those who are privately insured. So imagine the difficulty that Quest patients face — especially now that Kaiser Permanente Hawaii has closed its doors to new Medicaid enrollees.
It’s no mystery why Medicaid patients are being turned away. The federal government doesn’t fully reimburse the cost of caring for low-income patients, the aged, blind or disabled. Quest, the state’s version of Medicaid on Oahu and Maui, essentially shortchanges providers, forcing them to limit the number of new enrollees to remain sustainable.
It’s unfortunate but understandable why Kaiser, the state’s largest health maintenance organization (HMO), will no longer accept new Quest patients — having gone beyond its limit of 25,000 Medicaid enrollees to its current 31,500. “If a government payer doesn’t pay enough, people can only take on so many of those patients,” said Kaiser spokeswoman Laura Lott.
Doctors in private practice have long complained about the low reimbursements, and Kaiser’s experience has been no different. Ironically, while many local providers are refusing to take on more Quest patients, the federal Affordable Care Act has produced even more enrollees.
The state and federal governments must find a way to increase reimbursement rates if it expects physicians and HMOs to continue providing care for Medicaid patients. With so many health care providers refusing Quest patients, soon the only option will be to receive care at community health centers, which do solid work but are limited in the services they provide.
Hawaii does not want to follow in the footsteps of California, which is grappling with an over- reliance on Medicaid that negatively affects health-care quality and access. A recent Forbes article said the median wait time to see a health care specialist under Medicaid in California is 20 days, but even more disheartening is research that reveals Medicaid coverage fails to make enrollees any healthier than the uninsured.
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Emmanuel Kintu, CEO and executive director of Kalihi-Palama Health Center, said community health centers are having to fill in the gaps when other providers aren’t able. As a result, those centers will require more grant support to ensure Quest patients receive adequate care.
Compounding the issue is that there are simply too few physicians who treat patients — Medicaid or otherwise — across the state. Hawaii needs an additional 450 primary care doctors to meet its residents’ needs, according to the Hawaii/Pacific Basin Area Health Education Center — a staggering number that requires more vigor and vigilance in recruiting and retaining doctors, especially general practitioners.
High schools across the state need to encourage and mold students for early acceptance programs at the University of Hawaii John A. Burns School of Medicine. Such programs give high school graduates the opportunity to pursue a medical degree and encourage applicants to serve in Hawaii upon completion of medical training.
Clearly, drastic changes are needed so that Hawaii physicians — affiliated or not with HMOs like Kaiser — are better able to take on Medicaid patients. To do nothing will only lead to overburdened community health centers and frustrated Quest enrollees with scant care options.
5 responses to “More funding needed to serve Quest patients”
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Ah, the perils of socialized medicine. Unfortunately, all medical care suffers as a result.
For many years, the tiny impoverished island of Cuba has produced a surplus of well-trained Physicians, and has even “exported” many to needy communities around the world. Maybe we can ask them to send a few over here after all we another island people victimized buy racist American imperialism.
While it is shameful that greed and mismanagement in such a wealthy Nation as ours has left us with this Healthcare mess. The shortage of Physicians is directly related to the lack of political integrity. While trillions are spent on armies of security apparatus bureaucrats and contractors, not to mention our other Army, we won’t pay for decent schools or enough doctors. Looks like our manifest destiny is to be yet another corrupt police state.
agree…bring in more docs. UH Medical School is solid but does not produce many docs for the islands.
In 2013, the two for-profit Quest plans (Ohana-Wellcare and UnitedHealth) were left with $180 million for the year after paying claims. That’s a lot of money for just 2 plans.
Even these plans they did not have enough doctors, meaning their “provider networks” were inadequate, even though this violated their contracts with the state (and Federal law), and even though beneficiaries were unable to get the care the state had paid for with our taxes, there was no effective monitoring or enforcement to hold the plans accountable. The plans did not use that $180 million to train or recruit more doctors. They used it on executive compensation and shareholder profits.
This has been happening year after year. Over six years, this is approximately $1 billion – just for these two plans!
The Federal Centers for Medicare and Medicaid Services (CMS) requires responsible state agencies to ensure that all contracted Medicaid plans comply with all program requirements. The most important requirement is having an adequate provider Network. If Medicaid beneficiaries are unable to access care, then nothing else about a health plan’s operations the matters.
Plans are able to request a temporary waiver of this requirement in special circumstances, and with extra reporting requirements, but it doesn’t appear this is being done here in Hawaii. Instead, it appears MedQuest officials have been turning a blind eye to the facts and certifying that these plans do maintain adequate provider networks.
To add insult to injury for beneficiaries and taxpayers, in 2014, MedQuest awarded Ohana-Wellcare with the contract to care for all of the most severely mentally ill beneficiaries (SMI). This has contributed to the lack of access to psychiatric care. For example, one patient had to stop care with their established psychiatrist once Ohana took over. The patient had a year and a half delay for an initial evaluation by an Ohana psychiatrist, and only after complaining. This patient ended up with under the care of a psychiatric nurse from an Ohana subcontractor. MedQuest officials in charge of the SMI program reviewed the complaint and concluded that he had received proper care.
MedQuest and DHS appear to have been violating Federal law requiring proper oversight of the Medicaid program, and billions of Federal funds, here in Hawaii.
When Kaiser chooses not to take additional patients based on a self imposed cap, it merely shifts the the burden of providing medical care to the private physicians and/or to hospital emergency rooms. Those costs do not go away. Private insures ultimately covers those costs by requiring higher premiums (from employers) in order to pay higher fees required by the physicians and hospitals. The Kaiser system manages its profitability simply by not accepting patients that do not return them the fees they charge. Its responsibility to the community goes unchecked. It would be prudent to monitor how well they fulfill its responsibilities to the Maui community in providing hospital and medical care to All of its residents. Will its members be given priority over non members?