The Hawaii County Medical Society applauds the recent legal ruling by Circuit Judge Robert Kim, which found Hawaii Medical Services Association (HMSA) contracts to be “unconscionable and unenforceable.”
The American Medical Association reports that one-third of U.S. physicians report prior authorization has led to an adverse event, including hospitalization, disability and death. Nearly all doctors report care delays, waiting for insurance to authorize necessary diagnosis, treatment and care.
HMSA often reimburses at levels that do not cover the cost of providing medical services in Hawaii. This has put most health care providers under significant financial stress, driving many practices to bankruptcy and closure.
Our state has the worst shortage of primary care providers in America. We are at a crisis level, with Hawaii County’s doctor shortage estimated at 41% in 2023.
As stated by James Winkler, CEO/board director of Hale Lea Medicine: “After 30 years of practice, our nonprofit community medical center closed its doors due to unsustainably low reimbursement, primarily from HMSA. We provided primary care on the North Shore of Kauai, seeing approximately 15,000-17,000 visits annually. We provided pediatric, adult and geriatric medicine, and urgent care services. We also had three psychologists providing behavioral health services, as well as a full rehab and physical therapy department. In an open letter, Gov. Josh Green stated Hale Lea was vital for health care services to North Kauai.
“All of these services went out of business after 30 years of struggling to survive, leaving a major void in health care on Kauai’s North Shore.
“HMSA ignored our pleas, refused to negotiate reimbursement, admitted that its reimbursements were BELOW Medicare (with Medicare reimbursement in Hawaii the lowest in the country).
“HMSA is the largest insurer in Hawaii and represented the majority of our patients, and as such, its unconscionably low reimbursement schedule had the most profound effect on our inability to survive.”
I am a breast cancer patient undergoing treatment and am HMSA-insured. I have experienced problems with prior authorization, finding providers, and even with my medical knowledge it has been challenging. I hear the frustrations of providers, just trying to do their best for the community, but their hands are tied by insurance companies.
The last private practice on Maui will no longer provide obstetrical services on the island. This will cause a crisis for expectant mothers, who may have to fly off island to deliver their babies.
Maui Lani physicians and surgeons announced low reimbursement from insurance companies was the main reason, as well as staffing challenges.
Prior authorization policies are so resource-burdensome in Hawaii that they limit the number of patients providers can care for, making our communities’ access to care crisis that much more severe.
Providers state that prior authorization can take up to two weeks for approval, at times considerably longer, and at times can be denied outright. Medical staff, including providers themselves, are forced to deal with the insurers obstruction of care, lobbying for their patients to get the care that’s been recommended, robbing them of the time they need to care for other patients that can’t find a provider.
The people of Hawaii are gravely affected by our access-to-care crisis, with more than half a million people living in federally designated Health Professional Shortage Areas (HPSA).
Hawaii must reform these prior authorization practices and abuses, insisting insurers such as HMSA negotiate fair and equitable contracts with health care providers.
The people of Hawaii deserve this.
Jo-Ann Sarubbi, M.D., is president of the Hawaii County Medical Society; she recently retired after 27 years as an emergency physician on Hawaii island.
