Forum in Honolulu to Discuss Hawaii’s Access to Care Crisis
Honolulu, HI, November 8, 2007— Hawaii Medical Association (HMA) is presenting a free forum on November 13th to discuss Hawaii’s shortage of physicians and patients’ access to health care. Physicians, legislators, and concerned public are invited to attend and participate in the question and answer session. Panelists include local health care leaders, government officials, and experts from the mainland.
Date: Tuesday November 13, 2007, 5:30 pm
Place: The Queen’s Conference Center – Mabel Smyth Auditorium
Panelists:
* Cynthia Jean Goto, MD - President, Hawaii Medical Association
* William F. McKenzie, MD - OBGYN, Oahu
* Arthur F. Roeca, Esq. - Partner, Roeca, Louie & Hiraoka LLP
* J.P. Schmidt, Esq. - Hawaii State Insurance Commissioner
* David Teuscher, MD - Texas Medical Association
HMA’s public forums in Kona, Hilo, Kahului, and Lihue drew large audiences of patients eager to express their concerns about the physician shortage and frustrating experiences in trying to find physicians to care for them.
While the access to care crisis has been most evident on neighbor islands, Hawaii's only certified trauma center located in Honolulu has an alarming shortage of doctors willing to volunteer for emergency and trauma call. The shortage jeopardizes the ability for patients to have urgent treatment in life-threatening situations.
“Our patient access to care crisis has reached a critical stage, and we implore Hawaii’s legislators to take action and fix the problem,” says Cynthia J. Goto, MD, HMA President. “This forum will highlight the issues and solutions available so that Hawaii’s citizens have physicians available when they need them most.”
To attend the November 13th forum at Queen’s, or for more details, call (808) 536-7702, toll-free (888) 536-2792; or go to www.hmaonline.net.
About Hawaii Medical Association
Since receiving its charter from King Kamehameha IV in 1856, Hawaii Medical Association (HMA) has been dedicated to serving physicians, their patients and the community through representation, advocacy and public service. HMA is the Hawaii State affiliate of the American Medical Association as well as the umbrella organization for Hawaii’s five county medical societies.
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Hawaii Medical Association Honors Local Physicians and Community Members at Ola Pono Ike Medical Ball
Hawaii Medical Association (HMA), will honor local physicians and community members at its sixth annual Ola Pono Ike Medical Ball & Silent Auction, September 15, 2007 at the Sheraton Waikiki. Ola Pono Ike, which means “Health is Knowledge”, is HMA’s annual benefit, inauguration, and awards dinner.
The purpose of Ola Pono Ike is to raise funds for a worthy cause and increase awareness of Hawaii’s health care issues. Approximately 550 guests are expected, a who’s who of physician, health care, and business leaders from across Hawaii. A portion of the proceeds will be donated to Hawaii Medical Foundation, a charitable foundation that supports quality health care in Hawaii. Ronald Davis, MD, American Medical Association will provide the keynote address.
Honorees include:
• Cynthia J. Goto, MD – will be inaugurated as HMA’s new President.
• S. Kalani Brady, MD – will receive the Physician of the Year Award, recognizing his dedication to community service above and beyond his role as a physician.
• Myron E. Shirasu, MD – will receive the “President’s Award” to recognize his outstanding contributions to Hawaii’s medical community.
• Gina Mangieri and Mike Buck - will receive the Broadcast Media Reporter of the Year Award, for distinguished medical reporting.
• The Honolulu Advertiser Editorial Board – will receive the Print Media Reporter of the Year Award, for distinguished medical reporting.
The evening also includes a silent and live auction, featuring a one-of-a-kind HMA motorcycle donated by Green Machine Alternative Transportation, as well as a wine and martini tasting (with vodka provided by Ocean Vodka). Public is invited to attend. Tables of ten are $1,500 and individual seats are $150. Tickets may be purchased online at HMA’s online store (go to www.hmaonline.net) or by calling HMA. For more information please email mandy_wilcoxson@hma-assn.org or call (808) 536-7702 x112.
Ola Pono Ike is sponsored in part by: Medical Insurance Exchange of California (MIEC), Physicians Exchange of Honolulu, AstraZeneca, Clinical Laboratories of Hawaii, and The Queen’s Medical Center.
About the Hawai‘i Medical Association
Serving Hawai‘i since 1856, the Hawai‘i Medical Association (HMA) is a voluntary, professional membership organization for physicians, resident physicians, and medical students in the state of Hawai‘i. HMA is dedicated to serving physicians, their patients, and the community through representation, advocacy, and public service. HMA is the Hawai‘i affiliate for the American Medical Association.
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Dr. Kalani Brady Named HMA's Physician of the Year
Honolulu, July 25, 2007 – The Hawai‘i Medical Association (HMA) is proud to name S. Kalani Brady, MD its 2007 Physician of the Year. HMA will present the award at its annual medical ball, “Ola Pono Ike”, September 15th at the Sheraton Waikiki.
HMA has presented the Physician of the Year Award for Community Service since 1961. The award honors men and women in Hawai‘i who are actively engaged in the practice of medicine and whose community services are exemplary.
Dr. Brady, an internist, was nominated by colleague Scott McCaffrey, MD who describes him as “a shining star within HMA’s medical ‘ohana and throughout the community.” Dr. Brady will be honored for his commitment to the medical profession and the many ways he gives back to the people of Hawai‘i.
Dr. Brady, who traces his roots to the Keli'ikanaka'oleaipolani family from Kaua‘i, is passionate about the health care of the Hawaiian community. An associate professor of Native Hawaiian Health, University of Hawai‘i John A. Burns School of Medicine, he illuminates medical issues that affect native Hawaiians. His devotion also includes weekly trips to Moloka‘i, caring for those with Hansen’s disease.
Dr. Brady strives to educate the public by sharing his medical expertise in lay-person’s terms to local TV viewers during the segment “Ask the Doctor” on the KHON FOX Channel 2 Morning News (a volunteer role). Dr. Brady also shares his love for music and entertainment through his chants and mele at church and performing at local events.
Dr. Brady goes above and beyond the call of duty volunteering his time and efforts to provide education for physicians. He is an active member of the HMA where he serves as editor for the Hawai‘i Medical Journal and an education co-chair. He is Vice-President of the Hawai‘i Chapter of the American College of Physicians and serves as chair of the Scientific Program Committee. He also serves on the boards of the local American Heart Association, ‘Ahahui o na Kauka (Association of Native Hawaiian Physicians), and Saint Louis School. Dr. Brady is also the Director of Education at Straub Foundation.
If you would like to join HMA in celebrating Dr. Brady’s accomplishments, tickets for Ola Pono Ike, which means “Health is Knowledge”, are available for purchase. Please visit www.hmaonline.net or call (808) 536-7702, toll-free (888) 536-2792.
About the Hawai‘i Medical Association
Serving Hawai‘i since 1856, the Hawai‘i Medical Association (HMA) is a voluntary, professional membership organization for physicians, resident physicians, and medical students in the state of Hawai‘i. HMA is dedicated to serving physicians, their patients, and the community through representation, advocacy, and public service. HMA is the Hawai‘i affiliate for the American Medical Association.
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HMA Responds to a Misleading Study Rating Hawaii the Number One State in "Access to Care"
Study ignores number of physicians available to provide care
Honolulu – The Hawaii Medical Association (HMA), in response to a recent study on “access to care” in the United States, calls for clarification of the access to health care issue in Hawaii. HMA asserts the study’s conclusion that Hawaii leads the nation in access to care is deceptive and misleading, as the study results do not include availability of physicians to provide care.
“The ability for patients in Hawaii to find a physician is dangerously limited due to Hawaii’s lack of medical tort reform and low insurance reimbursements”, states Linda Rasmussen, MD, HMA President. “In fact, access to health care in Hawaii is in a state of crisis.”
As reported in the June 13, 2007 Honolulu Star-Bulletin article, “Isle leads nation in access to care” and the June 14, 2007 Honolulu Advertiser article, “Hawai’i rated top for access to healthcare”, a nationwide study conducted by the New York City-based Commonwealth Fund, a private foundation aimed at improving health care, listed Hawaii as the number one state in “access to care”. The study suggests that there are more people in Hawaii with insurance coverage than any other state. HMA physicians explain that access to health insurance does not equate access to health care.
“Being insured does not equal access to care if there are no doctors. HMSA insures people on the Big Island but they can't find a primary care physician,” states Richard McDowell, MD, Hawaii Chapter President, American College of Emergency Physicians. “The group that assessed ‘access to care’ left this part out.”
Stephen C. Schoenbaum, the research branch Executive Vice President for programs at Commonwealth Fund, confirmed to HMA that the study does not include availability of physicians in the study’s definition of “access to care”.
As stated by Cathy Schoen, Commonwealth Fund Senior Vice President for Research and Evaluation, “Where you live matters for getting care when you need it, getting the right care and the opportunity to live a long and healthy life.” The Hawaii islands are in fact facing a serious doctor shortage, preventing many patients from getting care when they need it. Neighbor islands and rural Oahu are the most seriously impacted, particularly in specialty and trauma care.
“Hawaii Island is not a safe place to live or to visit,” reports Doug Hiller, MD a Big Island orthopedic surgeon. “Do you know who is on call for orthopedic surgery on the Big Island today, if you have a head-on accident with an ice-head's F-350 pickup truck on the way to the airport? ... Nobody!”
HMA has been conducting a forum series throughout the state to highlight the lack of access to health care. One of the biggest concerns raised by forum attendees is that having health insurance does not guarantee physician care will be available. HMA has three more forums scheduled to continue researching and addressing patient access to care. Each forum is open to the public:
• Maui – August 16 at The Dunes at Maui Lani
• Kauai – August 22 at Wilcox Memorial Hospital
• Honolulu – November 13 (location TBA)
For more information, go to www.hmaonline.net or call (808) 536-7702, toll-free (888) 536-2792.
About the Hawaii Medical Association
Serving Hawaii since 1856, the Hawaii Medical Association (HMA) is a voluntary, professional membership organization for physicians, resident physicians, and medical students in the state of Hawaii. HMA is dedicated to serving physicians, their patients, and the community through representation, advocacy, and public service. HMA is the Hawaii affiliate for the American Medical Association.
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Physicians Announce They Have Now Settled Class Action Claims With Over 90% of All Blue Cross and Blue Shield Plans in the Country
On April 27, 2007, counsel representing a putative class of approximately 900,000 physicians, as well as the medical societies of numerous states and other medical societies across the country, announced that they had settled a national class action lawsuit pending before U.S. District Judge Federico Moreno in federal court for the Southern District of Florida in Miami.
The class action, Love et al. v. Blue Cross Blue Shield Association, et al., named numerous Blue Cross and Blue Shield plans as co-conspirators in a massive scheme to defraud doctors in violation of the federal Racketeer Influenced and Corrupt Organization Act (RICO).
Hawaii Medical Service Association (HMSA), the largest health insurer in Hawaii, is a member of the Blue Cross and Blue Shield Association. The Hawaii Medical Association (HMA) is a plaintiff in the case.
When combined with settlements with other Blues, this settlement means that more than 90% of all Blue Cross and Blue Shield Plans in the country have now settled this class action with physicians. The latest settlement represents another major development in the ongoing battle against widespread and chronic abuses perpetrated against physicians by health insurers. Physicians and medical societies have also previously settled very similar claims against almost every other managed care insurer in the nation in a prior class action, resulting in major reforms in the health insurance landscape in this country.
The settlement consideration includes a guaranteed cash payment of over $128 million to class members. HMSA’s exact portion is yet to be determined. In addition, the settling defendants have agreed to implement important business practice changes that bring the estimated value of the entire settlement consideration to well over $1 billion. These changes include commitments to do the following:
•Implement a definition of medical necessity that ensures that patients are entitled to receive medically necessary care as determined by a physician exercising clinically prudent judgment in accordance with generally accepted standards of medical practice;
•Use clinical guidelines that are based on credible scientific evidence published in peer-reviewed medical literature (taking into account Physician Specialty Society recommendations, the views of physicians practicing in the relevant clinical areas, and other relevant factors) when making medical necessity determinations;
•Provide physicians with access to an independent medical necessity external review process;
•Establish an independent external review board for resolving disputes with physicians concerning many common billing disputes;
•Pay for the cost of recommended vaccines and injectibles and for the administration of such vaccines and injectibles;
•Not automatically reduce the intensity coding of evaluation and management codes billed for covered services;
•Ensure the payment of valid clean claims within fifteen (15) days for electronically-submitted claims and thirty (30) days for paper claims;
•Provide fee schedules to physicians;
•Establish a compliance dispute mechanism to address disputes regarding the Blues’ compliance with the agreement;
•Establish and/or maintain physician advisory committees; and
•Provide ninety (90) days’ notice of changes in practices and policies and annual changes to fee schedules.
These practice changes are expected to result in hundreds of millions of dollars in real savings to physician practices throughout the country. The end result will leave doctors more time for patient care instead of dealing with what was a complex, cumbersome, costly and frustrating system put in place by Blue Cross and Blue Shield plans.
The agreement follows similar settlements with virtually every other managed care company in the nation, with the exception of United Healthcare, who continues to litigate against physicians rather than making the kinds of positive practice changes other insurers have agreed to make. Indeed, United Healthcare has repeatedly refused to address the significant concerns raised by representatives of the more than 400,000 physicians nationwide who care for United’s health plan members.
“This agreement forces health insurers to play fair with physicians and the patients they insure. Hawaii physicians have waged battles with HMSA for decades over unfair business practices and to obtain medical treatment their patients need. While I am encouraged our Federal suit will provide physicians and patients some relief, here at home our Hawaii legislature needs to do its part and approve medical liability reform for Hawaii”, said Linda Rasmussen, MD, HMA President.
“Locally, the settlement of this case with Blue Cross Blue Shield has important implications because HMSA is the dominant health insurer in Hawaii. We are hopeful that this settlement will help to improve the ability of Hawaii patients to obtain the healthcare they need and deserve. On the national level, we hope that United Healthcare will follow the example set by other health insurers and participate in efforts to improve healthcare in this country,” stated Cynthia Goto, MD, HMA President Elect.
“The commitments contained in this agreement and prior agreements with over 90% of the Blues plans in the country are premised on achieving the highest quality delivery of healthcare, and brings the settling Blues into compliance with what has become the standard for the industry that is truly in the best interest of physicians and their patients,” said Edith Kallas, also co-lead counsel and a partner at Whatley Drake & Kallas.
HMA’s case against HMSA in state court is ongoing. In 2002, HMA along with Drs. Maxwell Cooper and Michon Morita, filed lawsuits alleging HMSA had breached its contracts with the physicians and engaged in unlawful business practices under the Hawaii unfair and deceptive trade practices statute. These practices include, among other things: arbitrarily overruling physicians’ “medical necessity” determinations, failing to pay physicians in a timely fashion, and arbitrarily reducing physicians’ payments by downcoding.
These and other practices, identified in the Hawaii lawsuits, impact both physicians and patients because HMSA has attempted to limit physicians' abilities to make “medical necessity” determinations and reduced payment to the physicians drastically, forcing physicians to absorb the costs or patients to pay hundreds of thousands of dollars out of their own pockets to receive medical treatment or service.
In 2006, HMA and Drs. Cooper and Morita successfully appealed a 2003 Hawaii Circuit Court ruling stating that HMA had no standing for making a claim. The Supreme Court of the State of Hawaii ruled in favor of HMA and physicians on the following issues, among others:
•HMA has standing to bring claims on its members' behalf and on its own behalf;
•HMA and the physicians can proceed with their claims in court, as opposed to individual arbitrations; and
•The plaintiffs had properly stated claims for unfair methods of competition and tortuous interference with prospective economic advantage.
Physicians across the state of Hawaii hailed the decision as an important victory in the battle against the wrongful payment practices of health insurance. The case is ongoing.
The Love et al. v. Blue Cross Blue Shield Association, et al., case is being heard in the United States District Court, Southern District of Florida, Miami Division: 03-21296-CIV-Moreno. Additional background information on the case can be found online at www.hmocrisis.com. That site includes a complete copy of the settlement agreement as well as the joint press release announcing the settlement. For more information regarding HMO litigation please visit the HMO Crisis Newsroom.
HMA and Drs. Cooper and Morita are represented by Whatley Drake & Kallas LLC, Price Okamoto Himeno & Lum; and Robert Miller. Whatley Drake is a litigation law firm established in 1998 with offices in Alabama and New York. The firm is involved in complex litigation against some of the largest insurance and managed care companies in the world.
Hawaii Medical Association, a not for profit professional membership organization representing 1300 members, which received its charter from King Kamehameha IV in 1856, is the Hawaii State affiliate of the American Medical Association as well as the umbrella organization for Hawaii's five county medical societies.
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Forum to Discuss Hawaii's Need for Medical Liability Reform
Honolulu, HI, March 9, 2007— Approximately 80 physicians, legislators, government officials, and health care industry professionals are gathering tonight to discuss Hawaii’s need for medical liability reform, despite recent setbacks in the State House of Representatives. The meeting is part of a series of forums that focus on social and legislative topics in medicine. It is hosted by Hawaii Medical Association (HMA).
The panel includes speakers from states that were successful in implementing reform. Dr. Bohn Allen, past president of the Texas Medical Association, and Jill McLain, Texas Medical Liability Trust, will attest to the dramatic improvements they have seen, such as high-risk medical specialists flooding back into Texas to care for patients in underserved and rural communities.
Date: March 6, 2007, 5:30 PM
Place: The Queen’s Conference Center, Mabel Smyth Auditorium
Panelists:
• Bohn Allen, MD –Past President, Texas Medical Association
• Hal Dasinger –Government Relations, The Doctor's Company
• Cynthia Goto, MD –Past Hawaii Section Chair, American College of OBGYN
• Jill McLain - Vice President, Texas Medical Liability Trust
• Ron Neupauer –President, Medical Insurance Exchange of California
• Linda Rasmussen, MD –President, Hawaii Medical Association
• Arthur Roeca, Esq. –Founding Partner of Roeca, Louie & Hiraoka
• J.P. Schmidt, Esq. –Hawaii State Insurance Commissioner
For more information, call (808) 536-7702 or go to www.hmaonline.net.
About Hawaii Medical Association
Since receiving its charter from King Kamehameha IV in 1856, Hawaii Medical Association (HMA) has been dedicated to serving physicians, their patients and the community through representation, advocacy and public service. HMA is the Hawaii State affiliate of the American Medical Association as well as the umbrella organization for Hawaii’s five county medical societies.
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Forum to Discuss Hawaii's Access to Medical Care Crisis
Honolulu, HI, February 1, 2007—Physicians, legislators, government officials, and health care industry professionals are gathering to discuss the patient access to medical care crisis in Hawaii. It is the first installment in a new series of forums hosted by Hawaii Medical Association, featuring a variety of social, economic, and legislative topics in medicine.
Date: February 6, 2007, 5:30 PM
Place: The Queen’s Conference Center, Mabel Smythe Auditorium
Panelists:
• Rep. Josh Green, MD - Chair, House Health Committee
• Michael Hahn, MD - Orthopedic Surgeon, Kailua
• Morris Mitsunaga, MD - Orthopedic Surgeon, Honolulu
• Linda Rasmussen, MD - President, Hawaii Medical Association
• Linda Smith - Senior Policy Advisor, Office of the Governor
• Jim Walsh - Vice President of Provider Services, HMSA
• Elizabeth Wyld - Patient
The panel will be moderated by Dr. John Smith, Associate Clinical Professor at the University of Hawaii school of medicine and past chief of Orthopedic Surgery, The Queen’s Medical Center.
For more information, call (808) 536-7702 or go to www.hmaonline.net.
About Hawaii Medical Association
Since receiving its charter from King Kamehameha IV in 1856, Hawaii Medical Association has been dedicated to serving physicians, their patients and the community through representation, advocacy and public service. HMA is the Hawaii State affiliate of the American Medical Association as well as the umbrella organization for Hawaii’s five county medical societies.
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