Kilauea clinic may close

KILAUEA — A physician assistant at Hale Le’a Family Medicine said the North

Shore clinic may close if it is forced to accept the terms of a proposed HMSA

contract.

Jim Winkler, who works independently as a physician assistant at

Hale Le’a in Kilauea, said if the contract goes through, the clinic will either

have to hire an on-site physician or close.

“Our clinic treats over 100

patients a week,” Jim Winkler said. “We have provided free services to those

without financial means. We have made house calls to the elderly and the

disabled. All I wish is to be able to serve the community in which I

live.”

Nearly 100 residents have signed a petition challenging a provision

in the Hawai’i Medical Service Association (HMSA) contract, which would

eliminate insurance reimbursements to physician assistants who do not operate

under the direct supervision of a physician.

In a letter to Cliff Cisco,

HMSA senior vice president, and state Insurance Commissioner Wayne Metcalf,

residents voiced fears that approval of the contract will result in a lower

quality of medical care on Kaua’i.

Physician assistants are licensed to

practice medicine in Hawaii, augment the services of a doctor and work in every

area of surgery and medicine.

The proposed changes are intended to ensure

residents receive the best services possible, and are sorely needed, said HMSA

Vice President Fred Fortin.

“We have had situations that made us quite

nervous,” he said. “We found that independent physician assistants were off

site, never saw the patient, and we were getting requests for reimbursements

for that service.”

The contract provision also is aimed at clarifying the

relationship between the physician and the physician assistant, he said.

“In other words, we pay physician assistants when they operate under the

supervision of a physician, and that has always been our policy.”‘

Winkler

said the proposed changes conflict with the intent of the Legislature and the

Board of Medical Examiners and the standard of care all across the United

States.

“The Board of Medical Examiners has stated explicitly that a

physician’s physical presence is not required when a physician assistant

delivers medical care, as long as proper direction and supervision occurs,”

said Winkler, one of five or six physician assistants who work on

Kaua’i.

The approval of the contract will limit the delivery of health care

to patients, said Dino Altomare, a physician assistant with the Kaua’i Medical

Clinic in ‘Ele’ele.

“What they are trying to do is get rid of the physician

assistant,” he said.

The proposed action by HSMA would cripple “our

operation,” said Sally Moore, a physician assistant with Kaua’i Medical Clinic

at Kukui Grove. “It would limit access to us. It wouldn’t be good for the

doctors.”

Physician assistants are an asset to any medical institution and

play a key role in driving down the cost of medicine, Winkler said.

They

save as much as 20 percent of the costs of medical care, according to studies

done by the Rand Corporation.

If the HMSA contract is approved, the

insurance company should pass on savings to its customers, Winkler

said.

“The whole idea of physician assistants effectively reducing health

care costs is undermined by any insurance company, who then reduces

reimbursements for services provided by physician assistants,” he

said.

Donald Traller, a physician assistant with the Kaua’i Medical Clinic

in Lihu’e, said physician assistants are welcomed in remote areas.

“On

Oahu, there are doctors all over the place,” he said. “But on the neighbor

islands, you have got areas that are absolutely underserved.”

Nationwide,

70 percent of all practicing physician assistants are employed by physicians,

group practices, HMOs and outpatient clinics.

To remain certified,

physician assistants must complete 100 hours of continuing medical education

every two years and take recertification examinations every six years.

In

a letter written to HMSA’s Cisco, Hale Le’a patients said:

*The insurance

company’s contract proposal will make it impossible for them to receive care

from their provider of choice.

*They have received excellent care from

physician assistant Jim Winkler at Hale Le’a clinic and want the service to

continue.

* They felt HMSA’s decision is unprecedented. Physician

assistants across the United States routinely provide medical care to patients

under the direction of a physician who may not be physically present.

Hale

Le’a patients Tom Ochwat, 69, and his wife, Susan, 70, said they don’t want to

see it close.

“We are the customers and they (HMSA) are dictating whom we

should see,” Ochwat said. “It doesn’t seem right to me.”

Ochwat said the

services he has received from Winkler have been as good as those received from

physicians.

“He is very knowledgeable. When he gets beyond his wealth of

knowledge he refers us to specialist,” Ochwat. “We have a lot of friends who go

to the clinic because of him.”