KILAUEA — The head of the Kaua‘i Community Health Alliance (KCHA) has announced the North Shore medical provider will permanently close its doors in the coming weeks due to circumstances, including low insurance reimbursement rates and labor shortages.
“Even with extremely generous charitable organizations from our community, KCHA is simply unable to generate enough revenue to meet its payroll demands and keep its doors open,” said the alliance’s president and CEO Jim Winkler in an email response to The Garden Island.
The alliance runs both Hale Lea Medicine and Urgent Care and the North Shore Wellness Center in Kilauea, which are set to close on Sept. 7 and Aug. 31, respectively.
Christie Thompson, who said she has been going to Hale Lea Clinic for 25 years, sent an email to The Garden Island after hearing news of the clinic’s closure.
“This is a potential health disaster for hundreds and hundreds of Kaua’i residents. I don’t know if you have tried to make a doctor’s appointment recently, but every doctor on the island is booked up for months and most are not even taking new patients at all,” she said.
“We are being left without medical care by the closing of the clinic, and literally have no idea how we will find a new doctor on Kauai!” she said, adding that the clinic was also unique due to its combination of Western and alternative medical practices.
‘Pushed us over the edge’
KCHA has been operating since 1994, but has faced financial difficulties for years, according to Winkler. In 2008, the alliance became a registered 501 (c) (3) nonprofit to be able to receive donations in order to try to stay afloat.
“Finances have always been tenuous, but the last few years have pushed us over the edge,” said Winkler.
Winkler attributed his organization’s hardships to low Medicare, Medicaid and state health insurer HMSA reimbursement rates for medical providers.
“Throughout Hawai‘i, it has become increasingly difficult to recruit and retain medical providers and nurses due to the low reimbursements, relative to the extremely high cost of living,” said Winkler.
“HMSA’s insurance reimbursement rates are below the low Medicare rate and Medicaid Quest is even lower still,” he said.
Medicaid reimburses providers at 62 percent of Medicare rates in Hawai‘i, as well as Missouri and Ohio, according to 2019 data from the Kaiser Family Foundation. The only state with a lower reimbursement rate was Florida, at 52 percent.
According to Winkler, 65 percent of KCHA patients are on Medicare and Medicaid, the federal and state-funded health insurance programs that primarily serve low-income residents.
He noted financial challenges have also been compounded in more recent years by the opening of Princeville’s Makana North Shore Clinic in 2015.
“Because of Makana’s focus on urgent care, KCHA lost the bulk of its tourist and urgent care patients, which historically provided the higher reimbursement visits that helped underwriter KCHA’s ability to care for its more poorly un- and under-insured local primary care patients,” said Winkler.
“Then Covid-19 came along and moved more and more families onto low-reimbursing Medicaid Quest coverages,” he said, adding that “administrative burden from insurance companies also accelerated KCHA’s financial shortfall.”
Even though Winkler and KCHA’s three other board members have made the decision to close, they are “very concerned” about finding health care for their current patients, as well as the future of their staff members.
KCHA was averaging 15,000 patients per year and had 26 employees on staff, according to Winkler.
“One of KCHA’s medical providers will be practicing in Kapa‘a, and another one at the remaining clinic in Kilauea. Three other medical providers may stop practicing altogether on Kaua‘i,” he said.
Winkler also noted that KCHA will strive to remain open “for as long as possible” at an administrative level due to “the gravity of this potential public safety concern” to help patients find new medical providers.
He called the chances of KHCA opening again “impossible,” and said it was also “highly unlikely” that he would continue working as a doctor elsewhere.
“There is no “elsewhere” on the North Shore for most of us to practice,” said Winkler.
“It’s been an amazing run of nearly 30 years, a testament to sheer tenacity and perseverance driven by a need to serve others in our neighborhood.”
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Emma Grunwald, reporter, can be reached 808-652-0638 or egrunwald@thegardenisland.com.
