Emergency room misuse contributes to overcrowding

The state continues to experience ripple effects from the closure of Hawaii Medical Center’s two hospitals following its second bankruptcy in recent years. One casualty is its liver and kidney transplant center. To minimize the need for locals to go to the mainland for organ transplants, Gov. Neil Abercrombie just signed HB 608, a $1.5 million appropriation enabling the Queen’s Medical Center to open its own organ transplant center.

Both Queen’s and Hawaii Pacific Health have expressed an interest in purchasing HMC-West in Ewa. At the same time, Hawaii Health Systems Corp. and St. Francis Healthcare System of Hawaii are in discussion on a potential collaboration at HMC-East in Liliha for long-term and palliative care.

St. Francis Healthcare System of Hawaii also has asked that lawmakers approve an $80 million bond backed by the state to facilitate next steps. On Friday the House Health Committee advanced two measures related to this request.

In the meantime Oahu’s remaining emergency departments and hospitals are faced with the burden of seeing more patients than they can safely care for. As a result, neighbor islands have encountered difficulty finding hospitals on Oahu willing to accept transfer of care for complicated cases that they are ill-equipped to handle.

Inappropriate and wasteful use of emergency departments (ED) throughout the state is a chronic problem. For most of Hawaii’s uninsured, the ED is their only access to care. However, many of these patients qualify for some type of government insurance but have not applied. Others have insurance that requires them to select a primary care provider but have not done so. Still others have physicians but neglect to receive routine screening because they "feel fine" and wind up in the ED for a problem that could have been easily managed in a doctor’s office. Common examples include diabetes, high blood pressure and heart disease. Estimates are that in some areas, more than half of all ED visits either are not actual emergencies or could have been readily prevented.

According to Hilton Raethel, senior vice president at HMSA, our largest local insurer is injecting resources into primary care in Hawaii and will continue to do so with the goal of developing a robust sustainable primary care delivery system across the state. Unfortunately, reversing the impact of decades of underfunding of the primary care delivery system cannot be corrected overnight. It will take time, but, according to Raethel, "we are on the right track and moving aggressively to remedy this situation."

With the closure of HMC’s two hospitals, particularly HMC-West, physicians in some of our remaining hospitals have reported 30 percent to 40 percent increases in ED volume. This continuing waste of valuable ED resources coupled with an acute spike in demand related to HMC’s shutdown hurts everyone. Hawaii needs to mount a concerted effort to divert inappropriate use of our local EDs by helping those who qualify to obtain insurance and encouraging those who are insured to identify a primary care provider and become active partners in a health maintenance program. We all want ready access to care in the event of a true emergency, but for now that access may be compromised.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.