What used to be a secondary health provider is quickly becoming the core of Hawaii’s medical service to people of modest means. That would be the state’s 14 community health centers which, as Star-Advertiser writer Kristen Consillio reported recently, have logged an increase in patients in recent years. Among the primary reasons: low reimbursements for Medicare and especially Medicaid clients, and the burden of complex paperwork involved in the claims process, has pushed more private doctors to curtail their roster of patients with health coverage through those programs.
Finding ways to simplify the bureaucratic demands needs to be part of health care reform as it plays out nationally. But in the context of the ongoing debt-reduction debate, protecting a robust network of community health centers has to be a top priority as well.
The second phase of the deficit-cutting efforts will get under way in Congress soon after the summer hiatus, and the pressure to find savings in federal entitlement programs will be intense. Democrats are sure to be insisting on shielding beneficiaries from most of the cuts; in fact, the Obama administration’s fact sheet on the deal just struck underscores that any cuts to Medicare "would be capped and limited to the provider side."
But there’s no escaping the reality that whatever reductions are enacted will affect access to care. Medicaid already has taken cuts to reimbursement rates, and Medicare — which has avoided most of the threatened reductions in the past through "doc-fix" legislation Congress passed — will be vulnerable this time around. Private doctors’ reluctance to take patients in these programs will only intensify.
It’s a national problem, but in Hawaii, where remote island populations already face the challenge of finding specialists and even primary medical care within reach, experts are painfully aware of it. Last October, the Hawaii Primary Care Association, which oversees the 14 clinics, published a report titled "Planning the Future of Community Health Centers in Hawaii."
The report defines the problem by describing centers’ clientele as the state’s most vulnerable population: Nearly all of them live below 200 percent of the federal poverty level, and almost a quarter lack insurance coverage of any kind. If not for the health centers, many of these patients would end up in the emergency rooms of hospitals, which must then raise rates that are passed on to the insured. Dysfunction is costly for everyone.
The centers need workforce development, so it’s critical that lawmakers stay focused on educational programs and institutional support that can help to shepherd students through training and into jobs, especially on the neighbor islands.
The Affordable Care Act passed last year will rely on community health centers to deal with the expansion of coverage for the lower-income groups through Medicaid. But they lack infrastructure. "Operating from cramped, overcrowded and aging facilities, health centers are bursting at the seams," according to the report. "In some centers staff are operating out of makeshift offices set up in spare closets."
Health centers are expected to be laboratories for the transition away from fee-for-service health-care systems and toward the "medical home" model where providers work as a team centered on the patient, sharing data and finding ways of avoiding duplicative and unnecessary tests and treatment. But they can’t meet that challenge working out of closets and on a shoestring.