Hawaii Health Systems Corp. officials told lawmakers Wednesday that they won’t be able to cut costs enough to eliminate an anticipated $48 million shortfall in the 2015 fiscal year beginning July 1.
"We’re not sure operational reductions can be realized to that magnitude, that’s the problem," said Ken Ono, board chairman of the HHSC’s finance and information systems committee.
Without additional state support, HHSC "may not be able to meet payroll (or payments) whether it be to vendors or suppliers," he said.
"You would not be able to have enough cash to pay for the ongoing operations of a hospital."
State lawmakers, attempting to find a solution for the financially strapped public hospital system, are holding a series of statewide briefings that began Wednesday with members of HHSC’s various regional boards who are each in the process of coming up with their own cost-cutting plans.
HHSC’s deficit is expected to grow to around $70 million in fiscal 2016. Part of HHSC’s financial problems are a result of its rural facilities that are unable to generate sufficient revenue to support operations.
"There are not very many options left," Ono added. "We’re at the point where it’s a very serious situation. Clearly our expenses are moving at a much faster rate than our ability to generate revenue."
HHSC had hoped to partner with a private entity to rescue the mostly rural hospitals that appeal for state subsidies year after year. Public funding through the general fund nearly tripled to $97.2 million in 2014 from $31.2 million in 2004.
Earlier this year lawmakers explored legislation that would pave the way for either a public-private partnership or the sale of some facilities to the private sector, but the bill stalled in the closing days of the session.
The Legislature granted the rural health care group $102 million for 2015. The organization had requested $150 million, leaving a $48 million deficit, mostly due to unfunded collective bargaining increases. In addition, Medicare reduced payments by 2 percent to providers nationwide.
The dire situation has forced HHSC — the largest provider of health care in the islands — to begin cutting services and staff. Last month, it announced plans to close its Kalaheo primary care clinic on Kauai’s South Shore in September, citing inadequate funding and rising medical expenses. Hilo Medical Center announced earlier this month that it will eliminate 30 positions and is facing an estimated $9 million deficit this year.
But the time it takes to eliminate services and reduce staff won’t get HHSC out of the red fast enough with the process taking as long as six months, Ono said.
"If we wanted to eliminate services we couldn’t do that without public hearings, then you have implementation," he said, adding that collective bargaining employees who are laid off have the right to bump another worker at facilities statewide, further lengthening the process. "This means you can’t make the reductions quickly. It’s going to take more time so the deficits will continue to be there and will certainly continue to grow."
In addition, since HHSC acts as a "safety net" for the state’s neediest population — the poor and chronically ill — its aging hospitals are in a unique situation.
Nearly all patients on Oahu are on Medicaid, the government insurance program for low-income residents, and for many of them, HHSC’s long-term care facilities are their home, Ono said.
"If we’re closing a wing, we’re going to say to those people that you’ve got to find a new home," Ono said. "We’ve got significant issues that we need to deal with."
Ono said HHSC likely will be asking the state for additional funds before year’s end.
HHSC comprises 12 facilities and four affiliates: Kahuku Medical Center, Roselani Place, Yukio Okutsu State Veterans Home and Alii Health Center.