Health care hardships

KALAHEO — Jo Ann Kahawai said she has been bringing her children to the Kalaheo Clinic since she and her family moved to the South Shore in 1984.

At that time, her son was 5 years old.

Even though she and her family later moved to Hanapepe, nearly five miles away from the Kalaheo Clinic, Kahawai said she and her son continued to make the nearly 10-minute drive to the clinic for her son’s appointments when he was 21 years old.

Now, Kahawai said she is worried about what may happen if regional Hawaii Health Systems Corporation officials on Kauai decide not to renew the Kalaheo Clinic’s building lease later this year — a move that would essentially close the decades-old community clinic.

“Those of you who have kupunas know they come here in the mornings and they talk story with each other, and when they get their blood tests done, they go in the back and with our friendly nurses and talk story with them, too,” Kahawai said to a crowd of nearly 50 people on Thursday who gathered at the Kalaheo Neighborhood Center to protest the clinic’s closure.

“That’s because it’s a family clinic,” Kahawai continued. “It’s not just a clinic and that’s why I want to see it stay.”

Kahawai is not alone.

When Kalaheo resident Sheila Heathcote stood up in the front of the room and asked how many people are patients at the Kalaheo Clinic, nearly every hand in the room raised.

Under a current cost-reduction proposal being considered by Kauai officials from HHSC, the state’s public health care system, the Kalaheo Clinic’s doors will be closed and services provided there will be consolidated with another clinic about four miles away in Port Allen.

It is a move that, officials say, could save the region at least $300,000 just in lease payments alone.

“I think you’re doing the exact, right thing in terms of organizing, assembling and expressing your interest in keeping our great doctors and resources available to you here in the Kalaheo area,” HHSC Kauai Region Interim CEO Scott McFarland said. “It has definitely been noticed and is being considered by the Kauai regional board of directors about how we move forward and navigate through this very, very difficult financial situation that find ourselves in and how we can continue to exceed the expectations of our patients and our families who need medical care.”

The state public health care system’s Kauai region, McFarland said, is considering the closure, along with other cost-saving measures, to offset a projected $11 million shortfall for the upcoming 2014-2015 fiscal year, which begins on July 1 — a fraction of the $48 million shortfall affecting the entire statewide corporation.

Some progress, however, has been made.

HHSC’s Kauai region, McFarland said, had the two best performance months in April and May, as far as collecting payments, in about four or five years. This has resulted in about $1 million that the region will be able to carry over into the 2015 fiscal year.

“That’s a very, very positive trend that we will continue,” McFarland said. “That being said, we need to reassure our local vendors and stakeholders that we have a viable plan to not only survive but also thrive and exceed our residents’ needs through 2015.”

All four HHSC regions, McFarland said, are now working to create 2015 fiscal year sustainability plans and are continuing discussions into next week on what can be done to shore up the struggling health care system.      

“I’ll be honest. Right now, the clinic is losing money, and this is not unusual for primary care clinics throughout our region,” said McFarland, who cited high overhead costs, including payroll expenses, as one of the factors behind it. “It’s just a reality … but with these changes and roughly 7,899 patient encounters that we have had to date over at the Kalaheo Clinic, we can take a sharper pencil and look at the revenue side of the equation and hopefully be able to bring in an understanding and bring comfort to the board that there’s a financial story here as well that makes a lot of sense.”

Some residents questioned why the Kalaheo Clinic was not performing well financially since patients regularly visit the community facility.

The answer isn’t an easy one, McFarland said.

“You have to see such a high volume or a high number of patients every day to even pay the rent, keep the lights on and pay entire medical teams a modest salary,” McFarland said. “I get the economics very acutely, and medical practices, in terms of primary care, have to see in excess of 35 to 37 patients a day to really hit the numbers, because some times the encounter you have, based on the reimbursement we get from insurance companies, will bring in only about $12 to $18.”

Rep. Daynette “Dee” Morikawa, D, Koloa-Niihau, said she has been going to the Kalaheo clinic for years and wants to help the community clinic survive.

State lawmakers, she added, will be holding community briefings across all HHSC regions, beginning next month on Oahu.

Until those discussions are complete and made available to the Legislature, Morikawa said she hopes that the regional board will not close the Kalaheo Clinic.

“I’m very concerned when you say you’re already thinking of cutting back services when you’re not sure what your budget is going to look like toward the middle of the year,” Morikawa said to McFarland. “I think we’re pushing the panic button too early and I just want to tell you guys that now is not the time. The state hospital is supposed to be state subsidized, right? We’re not a private, nonprofit hospital, so we don’t need to make money — we just need to provide the services.”

McFarland said he and other regional officials are continuing discussions with the clinic’s building owners to negotiate “lease terms that will be able to pencil out something financially viable for the fiscal year 2015.”

“The building owners have been working assertively with us, which we greatly appreciate, to see if there’s a viable path forward,” McFarland said.

HHSC officials from Kauai, he added, will hold another community meeting July 15 at the Kalaheo Neighborhood Center to provide more information once more solid plans and strategies have been developed.

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