Name in the News: Alan MacPhee

Kahuku Medical Center will celebrate its 10th anniversary on Saturday. And next year will mark 90 years since the nonprofit facility, previously Kahuku Hospital, opened as a sugar plantation hospital-clinic on the North Shore.

Serving as the sole inpatient-outpatient hospital serving Ko‘olauloa communities, it provides clutch emergency services and a full-service primary care clinic for adults and children. Among its ancillary medical services: rehabilitation, clinical laboratory work and radiology including computed tomography (CAT scan). There’s also an inpatient pharmacy, social services, dietary and long-term care.

Without the facility, which is designated by Medicare and Medicaid as a “critical access hospital,” area residents and tourists in need of emergency care could have a long drive, said Alan MacPhee, who began serving as Kahuku Medical Center’s chief executive officer in March.

“KMC is the only acute care hospital offering 24-hour emergency services in the North Shore area between Kailua and Wahiawa,” MacPhee said. “If people had to head south down to (Adventist Health) Castle in the Kaneohe area, that could be an hour’s drive,” which could be complicated by traffic-flow delays for everything from tree-trimming to road repair.

“On the other side, to get to Wahiawa (General Hospital), you might run into bumper-to-bumper” travel by mid-morning on any weekday, MacPhee said, noting that the 15-mile stretch from Kahuku to Haleiwa can take an hour amid heavy tourist traffic. “Everyone is stopping to watch the surfers; people are trying to park. Pedestrians are back and forth, crossing the road. It can be very difficult to get through.”

Back in November 2006, after years of financial struggle, Kahuku Hospital’s board of directors voted for closure. That prompted community outcry asserting that the hospital was a necessity due to residential growth and tourism. Concurring, the Legislature, state administration and Hawaii Health Systems Corp. then started working with the community to keep the facility alive. In 2008 it had a new name and became an HHSC affiliate.

Born and raised in Santa Barbara, Calif., MacPhee previously lived on Oahu for a few years, starting in the mid-1960s, while serving in the Coast Guard. He has held CEO and chief financial officer positions in various critical access hospitals.

“Most of my career has been in rural acute-care hospitals that were experiencing financial difficulties. I enjoy assisting in bringing about changes necessary to improve financial performance.” At KMC, he said, “We have a lot of potential going forward.”

Question: What does it mean for KMC to be an affiliate in the Hawaii Health Systems Corp. lineup?

Answer: Through HHSC the state is the principal provider of institutional medical care. While HHSC exercises oversight and control of hospital management, our hospital has a board of directors that helps determine our medical center’s long-term direction and policies.

We receive an annual $1.8 million subsidy from the state, which goes toward operations. In addition, we compete with other HHSC facilities around the state for construction funds, which can be used for projects like air conditioning or electrical upgrades, for example. Other sources of funding come from grants and patient care.

Q:Last year, KMC was named one of the Top 100 Critical Access Hospitals in the U.S. by iVantage Health Analytics and The Chartis Center for Rural Health. How is that significant?

A: “Critical access hospitals” are acute care facilities with 25 or fewer beds and are 15 miles from the closest hospital on secondary roads. It means that this facility is critical to the health and safety of the community. Our service area is approximately 32,000 people, from Waialua to Kaaawa. Tourists in the North Shore area are also a large population year-round, but especially during the summer months and winter surf season, of course.

Q: Does Kahuku Medical Center have enough beds to handle current and projected demands?

A: Of our 21 hospital beds, 15 are for acute care or rehabilitation services. As we grow our base of primary care and specialty physicians, potentially including OB/maternity services, we will need more beds to fill the needs of the community.

Q: Since starting work at KMC about seven months ago, what do you see as facility strengths and weaknesses?

A: Top strengths of the hospital are our quality of care and dedication of our employees to the organization. … KMC is a major employment center in the Kahuku/Laie area, providing jobs to over 200 workers. We have received honors for the quality of care. Our top challenge is access to capital that is necessary to expand services, or to provide new services.

Q: What are your short-term goals?

A: My top priority is to expand services to better meet community health care needs and to bring about financial stability. … We’re not as healthy as we should be that way. … We only have 35 to 45 days cash on hand; we should bring that up to be a good credit risk (for grants and lending institutions).

We can become stronger by investing in more services, like mammography. That service was dropped more than a decade ago. We’re now planning to bring it back, and we’re looking to expand our outpatient clinic to allow for the inclusion of specialist physicians.

Q: What’s the timeline for starting mammography screenings?

A: We’ll have a unit here at KMC in about three weeks. So, we will be in the mammography business before December.

We also want to have a mobile unit. However, that still needs board-of-directors approval. We would be able to put that unit in a trailer and drive it to places like Haleiwa, Makaha and Waianae. The convenience would benefit patients and their employers (by drastically reducing drive time to and from appointments). We think it’s a good business model. It would be the first mobile unit in the islands.

Q: How about long-term goals?

A: In the years to come, I’d like to take a serious look at bringing OB/maternity back to the hospital. That’s a real community need. That’s what a hospital like ours should be doing to meet community needs. … We have a lot of deliveries up in our neighborhood. (The services were eliminated several years ago due, in part, to rising costs for medical care and liability insurance.)

Q: Any health issue emerging as a big concern in the area that KMC serves?

A: Other than offering maternity services, probably the most pressing issue is the lack of dialysis services here locally. (Prediabetes and type 2 diabetes affects roughly 1 in 2 Hawaii residents. There are now about 3,000 to 4,000 dialysis patients in the islands.)

Dialysis is a badly needed service for the community, but logistically, it is very difficult to be provided in this area. Reimbursement, professional physician services, building and water issues are the primary considerations.

Q: Water issues?

A: It’s water-intensive, and it’s unclear how we would handle disposal. It’s also labor-intensive, and it doesn’t pay particularly well from Medicare, the primary payer.

Q: What sorts of new/recent technologies does KMC tap to help improve delivery of health care?

A: Telemedicine is currently used in the emergency department for cardiology services. … We will probably be getting the same thing within the next year for neurology services.

It can help save lives. If someone comes in with a stroke or a heart attack, for example, the first thing our board-certified ER physicians are going to do is get in touch with a cardiologist attached to the (telemedicine) machine. The cardiologist can then review all of the patient information, such as lab scores, and can see the patient, talk to the patient and make prescriptions about what the patient needs.

The ER doctors can then start the patient on the regimen … and get the patient sent safely to an institution with a higher level of cardiac care than what we can provide here. And the doctor that we’re transferring to, he or she knows what’s coming.

Q: Most hospitals serving rural populations have trouble recruiting and retaining doctors. How is KMC faring?

A: We sometimes have to use temporary employees that are very expensive while we recruit from wherever we can. Often we have to go to the mainland to fill positions. This is very expensive in recruiting and relocation costs.