The recent closure of the Hawai‘i Medical Centers (HMC) East and West is an unfortunate event. Nearly 1,000 employees were suddenly unemployed and two emergency rooms were taken out of rotation on O‘ahu. On top of that, the state’s only transplant program – a service offered only by HMC-East – was in jeopardy, leaving many patients who were scheduled for a transplant procedure wondering about the status of their care. Add to that the number of inpatients at both HMC facilities that needed to be transferred to other hospitals and we had a potential health care crisis.

In fact, a crisis was averted due to the quick collaborative action of all O‘ahu acute care hospitals along with the City and County Emergency Medical Services (EMS), the Healthcare Association of Hawai‘i, long term care and home care providers, and many others who all pitched in to assure that patients were appropriately served. The loss of two emergency rooms, particularly the one located at HMC-West, quickly put a strain on the remaining O‘ahu facilities. Every emergency room, including those as far away as Kahuku Hospital and Wahiawa General Hospital, saw huge increases in patient volumes and ambulance arrivals.

At Hawai‘i Pacific Health, our O‘ahu hospitals immediately felt the impact of the closures. Straub Clinic & Hospital and Kapi‘olani Medical Center for Women & Children both had a 10% increase in volume while Pali Momi Medical Center in Aiea experienced a 28% increase. Other hospitals such as the Queen’s Medical Center, Kaiser Permanente Hawai‘i and Kuakini Medical Center, also experienced double-digit increases.

Even though it was expected that HMC would close at some point, their sudden exit did surprise many. Fortunately, there were no adverse patient outcomes for emergency patients. At a recent Senate informational hearing, Dr. James Ireland of EMS reported that there was no change in their ambulance response times and while transport times may have increased slightly; there were no deaths due to the closure of HMC facilities.

O‘ahu hospitals continue to see high ER volumes and have been able to serve everyone who requires emergency medical care. Over the longer term we will need a new community hospital for West O‘ahu and must address the underlying fundamental factors that got us to this point.

So how did we end up in this situation? There were many contributing factors that underscore the need for transformative change in our industry.

First of all, reimbursement for medical services in Hawai‘i is inadequate to cover the full costs of physician, hospital, and post acute care. In spite of a higher cost of living in Hawai‘i, we have the third lowest commercial health care premiums for family coverage in the nation. To make matters worse, government payers such as Medicare and Medicaid cover only 75% and 77% respectively of actual costs of hospital care.

Another pressing issue for acute care hospitals in Hawai‘i is the lack of skilled nursing and long-term care beds. Some of these private facilities will argue that beds do exist but what’s not being said is that those beds are for patients who have private insurance or the financial means to cover the cost of care. For Medicaid or Medicare patients, reimbursement for long term care does not adequately compensate for more complicated cases. Since these patients have no where to go, they remain in an acute care bed that could be used for a patient that is critically ill. Medicare does not pay any additional money to the hospital for additional days spent by the patient waiting for a long term care placement and Medicaid pays approximately 20%-30% of the cost of those additional waitlisted days. By continuing to care for these long-term care patients, acute care hospitals in Hawai‘i lost approximately $72.5 million for 2008.

The closure of the HMC hospitals should serve as a wake up call for all of us in the state. There are numerous bills in the legislature this year to address the reimbursement shortfalls and patient wait listed issues. In addition, we all need to focus on improving access, quality, patient satisfaction and efficiencies to create a health care network in Hawai‘i that is truly sustainable.

One important factor is working with our patients to insure that they are playing an active role in managing their health. At Hawai‘i Pacific Health, we are doing just that with HealthAdvantage¹, our new way of delivering health care that is focused on wellness, prevention, and patient engagement.

Finally, the growing community of West O‘ahu deserves to have a community hospital that continues the legacy of care established by the Sisters of St. Francis more than 80 years ago. Hawai‘i Pacific Health is committed to that effort. Should we be given the opportunity to acquire the facility, we expect to invest up to $20 million in renovations and technology upgrades and plan to have the emergency room, imaging services and at least one inpatient floor open as soon as practical.

While the closure of the HMC hospitals has significantly stressed the health care system in Hawai‘i and is adversely affecting countless families, it’s also brought out the best in those in our profession who make it their life’s work to care and heal. It also has the power to bring about much needed transformative change if we heed the call.

About the author: Dr. Pressler is Executive Vice President and Chief Strategic Officer for Hawaii Pacific Health (HPH). Hawaii Pacific Health is a non-profit healthcare network that includes Kapi‘olani Medical Center for Women & Children, Straub Clinic & Hospital, Pali Momi Medical Center, and Wilcox Hospital & Kauai Medical Clinic on Kauai. HPH is the largest healthcare provider in Hawaii, serving the entire state as well as the Pacific islands. Dr. Pressler joined HPH in 2002 and is responsible for specialty service line development, philanthropy and government relations. She also serves as President and Chair of HPH Partners, the subsidiary of Hawaii Pacific Health that oversees all joint ventures.

Prior to joining Hawaii Pacific Health, Dr. Pressler’s career included Deputy Director of the Hawaii State Dept. of Health, President & CEO of the Queen’s/HMSA Premier Plan, Vice President at The Queen’s Health Systems, Director of Surgical Education at Queen’s, Associate Professor of surgery at the John A. Burns School of Medicine, private practice in general surgery, and five years in management at Bank of Hawaii. Dr. Pressler grew up on Maui and was in the first graduating class of Seabury Hall. Dr. Pressler holds a Bachelor of Arts degree from Cornell University, and MBA, MS in physiology and MD degrees from the University of Hawaii at Manoa.

Dr. Pressler is active in the community in a wide variety of volunteer roles. She is the incoming Chair of the Chamber of Commerce of Hawai‘i and has been a board member and chair of the health issues committee of the Chamber for many years. She was involved with the American Cancer Society for more than 20 years. She is a Past President of the Hawaii Pacific Division and a former National Assembly Delegate for the American Cancer Society. She also serves on the executive committee for the UH Cancer Center, is immediate past chair of the Cancer Center of Hawai‘i, vice chair of the Board of North Hawai‘i Community Hospital, and a member of the UH Manoa Chancellor’s Circle. She has served on numerous state commissions and task forces. Dr. Pressler also served on a U.S. Congressional Commerce Committee on health information technology and was recently appointed to the Advisory Committee on Infant Mortality for the Secretary of Health & Human Services Kathleen Sebelius.

As Deputy Director of the Hawai‘i State Department of Health, Dr. Pressler initiated the Tobacco Trust Fund, the Healthy Hawaii Initiative, the Hawai‘i Outcomes Institute, the Hawaii Uninsured Project and helped initiate the Hawaii Comprehensive Cancer Control Program, serving as chair from 2003 to 2005.

1.: HealthAdvantage: Working Together For Better Health

HealthAdvantage is Hawai‘i Pacific Health’s new way of delivering health care that is focused on wellness and preventive care. You may have heard the term “Patient Centered Medical Home” and that’s what HealthAdvantage does – it partners patients with their primary care physician (PCP) and an extended team of nurses and health educators who are all focused on good health.

Through the use of our electronic medical record system (EMR) that seamlessly connects all of our physicians and hospitals, our care teams can track the health of a large patient population and quickly identify at-risk patients and get them into the office for immediate treatment.

What does that mean for you? By helping patients manage chronic conditions such as diabetes, they are able to live healthier lives and reduce their risk for adverse outcomes and that ultimately results in lower medical costs for everyone.

HealthAdvantage also allows our patients to manage their own health through our patient portal, MyHealthAdvantage. Available as an app for the iPhone, iPad and Android devices, patients can access portions of their EMR to:

• Schedule medical appointments
• View test results
• Request prescription refills
• View portions of their health record
• Receive reminders of upcoming tests
• Send secure messages to their doctor
• Track their blood pressure and other health measures

To date, more than 25,000 patients are taking charge of their health through MyHealthAdvantage. ↩