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Monday, January 30, 2017
January 30, 2017 News Read
By Andrew Walden @ 6:55 PM :: 2905 Views

Hawaii Attorney General to Sue Trump to Keep Muslim ‘Refugees’ Flowing Into Country?

OHA 2016 Check Register: Money Flows to Lawyers, LLCs, Insiders and More

Notice of Anticipated Judicial Vacancy – Circuit Court of the Third Circuit

Hawaii Congressional Delegation How They Voted January 30, 2017

Cancer: HMSA Puts MDs on Welfare--Begins Paying Oncologists to do Nothing

SA: A new payment model the Hawaii Medical Service Association began rolling out with its primary care physicians in April has been expanded to include paying a fixed monthly rate to specialists such as cardiologists, oncologists and orthopedists….

(These MDs will no longer be paid to perform surgery.  If they do it, it is an act of charity.  They are on welfare from HMSA.)

HMSA’s so-called bundled, or lump-sum, payments for the cost of treating a particular condition and other alternative reimbursement schemes are designed to improve health outcomes and drive down escalating costs. The insurer anticipates that 90 percent of its more than 720,000 members will soon be affected….

“The goal by 2020 is to try to have the entire state move toward alternative payment models,” said Dr. Mark Mugi­ishi, HMSA chief medical officer. “Cost is one important component, but more importantly, it’s (insert bs here.)” ….

Dr. Pradeepta Chowdhury, a primary care doctor in Hilo, said his monthly reimbursements under the new payment model plunged by nearly half to roughly $11,000 from about $20,000, and he is spending significantly more time on paperwork to meet reporting requirements than in the past….

Providers said they must invest in information technology and hire additional staff to handle the increased paperwork. They are also hiring more aides, care coordinators and social workers to follow up with patients and make sure they’re getting preventive screenings and checkups. Doctors can opt out of the new model, but they would risk losing incentive payments.

“I can’t meet my overhead with $11,000. I have an office, electricity, internet, office supplies, three staff … plus a biller. I just have to shift my strategy to other insurances and also find a way of closing my doors gradually so I don’t upset my patients,” said Chowdhury, 64, who has more than 500 HMSA patients. “I’m getting out of this business. I’m giving myself a couple years to wind down and find something else to do because of the entire health care environment and the rules and regulations. It’s not making it easier for us. I haven’t taken a vacation in five years, and I don’t get time to go to the gym more than twice a week. Why do you think Hawaii’s facing a shortage of doctors? The whole system is crazy. I’m sick and tired of all this, and I’m getting out of here in a couple years.”

Dr. Arlene Meyers, a Wahiawa pediatrician who started her independent practice in 1979, said she dropped out of HMSA’s Medicaid, or QUEST, program for low-income patients and its HMO plan last month because the monthly payments under the new payment structure were too costly.

“The way HMSA was setting it up was actually going to put me out of business,” she said, adding that most of her 840 HMSA QUEST patients have moved to another health plan to access her services. “This unfairly targets the independent physicians. This is an attempt to exclude independent providers from the provider marketplace. This is going to have a grave effect on already-reduced access to medical providers in Hawaii, and we’re going to be left with only the hospital-based physicians who are younger and less experienced. I have no intent of being part of a situation that encourages the destruction of independent medicine in Hawaii.”

Some doctors fear the changes reward physicians for seeing fewer patients and will inevitably hurt patient care.

“Payment transformation may de-incentivize physicians to treat patients who are sicker and require more resources,” said Honolulu dermatologist Dr. Greg Sakamoto. “There are too many uncertainties and unknowns. We do not know what the payment rates will be, and whether or not those payments will provide enough money to really fund the kinds of treatments that are provided. It really is so nebulous that I do not even know what to think.”

NOTE: MDs are already drug dealers (marijuana, oxycontin), soon they will be murderers (assisted suicide), so why not finish the job by making them into welfare bums.  Then we can all see “a ‘puzzling’ decrease in our life expectancy”.

read … Doctors praise and pan HMSA’s new payment plan

Proposed tax hikes carry steep costs for drivers

SA: Oahu vehicle owners could see their motor vehicle weight and fuel taxes, as well as their registration fees, rise significantly if both the Ige and Caldwell administrations get their way in the coming months.

Honolulu Mayor Kirk Caldwell last week told state lawmakers that his upcoming budget package will include increases in the city’s portion of the motor vehicle weight tax — by 1 cent in 2018 and an additional penny in 2019 — and the city’s share of at-the-pump fuel tax — by 3.5 cents a gallon.

For the owner of a 3,520-pound Toyota Camry sedan, that computes to a jump in vehicle weight taxes of $35.20 in 2018 and an additional $35.20 in 2019, meaning the bill would go from the current $176 (at 5 cents a pound) to $211.20 on Jan. 1, and then $246.40 starting Jan. 1, 2019. The owner of a lighter vehicle would pay less while the owner of a heavier vehicle would pay more.

Meanwhile, the vehicle owner who uses the average 750 gallons of gasoline annually (about 14.4 gallons a week) would pay about $26.25 more annually in fuel tax starting later this year, under the city’s proposal. At 20 cents a gallon, that’s a bill of about $150, up from the current $123.75 annually.

The money raised from the two tax hikes would generate about $60 million annually when all the new taxes are instituted by Jan. 1, 2019, city officials said. The money raised would go into the city’s (insert excuse here.)

But that’s just the city share of the motor vehicle weight and fuel taxes.

Gov. David Ige’s administration is proposing to raise the state’s portion of the motor vehicle weight and fuel taxes, but also the state registration fee.

House Bill 1146 calls for the state slice of the motor vehicle weight tax to go to 2.75 cents a pound from the current 1.75 cents a pound, and the state’s share of the at-the-pump fuel tax to 22 cents a gallon from the current 16 cents a gallon.

The owner of the 3,520-pound Camry would then be paying an additional $35.20 in state vehicle weight taxes starting July 1, or $96.80 annually, up from the current $61.60.

The vehicle owner using the typical 750 gallons of gasoline annually would pay about $165 annually in fuel tax starting July 1, up from the current $120.

What’s more, the Ige administration wants to raise the state’s registration fee to $75 annually, up $30 from the current $45….

Tom Yamachika, president of the Tax Foundation of Hawaii, was among those who testified against Ige’s 2016 hike proposals. Both bills are regressive, he said. “The taxes are based not on how much you make, but how far you drive or how heavy the car you use is.” ….

HNN: State Department of Transportation looking to increase fines

read … Proposed tax hikes carry steep costs for drivers

SB366/HB1283: Automatic Rate Hikes for Electric Utilities which Shovel Money to Green Energy Scammers

IM: …Two legislative bills have been introduced in the 2017 Hawai`i legislative session which require the Public Utilities Commission (PUC) to adopt incentive regulation for electric, but not gas, utilities.

HB 1283 “requires the PUC to establish performance incentive mechanisms that directly tie electric utility revenues to the utility's achievement on performance metrics. Allows the PUC to delay implementation until no later than January 1, 2020.” The bill was authored by Representative Lee and co-authored by Representatives Creagan, Evans, Lopresti, Lowen, McKelvey, and Morikawa.

SB 366 “requires, on or before 1/1/2020, the public utilities commission to establish performance incentive and penalty mechanisms that directly tie electric utility revenues to the utility's achievement on performance metrics.” The bill was authored by Senator Inouye. Senators Baker, Dela Cruz, English, Keith-Agaran, and Kidani signed on….

Meanwhile: 2 Hawaii Utility Companies Now Offering $10,000 Rebates On 2017 Nissan LEAF (See how this works?)

read … Incentivizing HECO Companies to do the ‘Right’ Thing

Star-Adv: HTA should open financial records

SA: Amid ongoing criticism from state lawmakers and others that HTA’s disclosure policies and reliance on lengthy behind-closed-doors sessions make it impossible to evaluate public spending, the agency is considering a move to step up transparency. HTA Board Chairman Rick Fried said Thursday that the agency may adopt a new policy to require board approval for expenditures over $250,000. It also could establish a marketing advisory committee to provide more oversight of staff marketing decisions.

Those are steps in the right direction — but fall short of a satisfactory correction for an agency that gets an annual $82 million in transient accommodation taxes for marketing and operations, and another $26.5 million for the Hawai‘i Convention Center….

read … HTA should open financial records

20 Years on Diamond Head—Shooting Drugs and Panhandling in Waikiki

CB: …The state plans to evict homeless people encamped on the slopes of Diamond Head next month.

That would mean the ouster of 50-70 people now living in tents or under tarps in kiawe thickets above the Diamond Head Lighthouse. Some of them have been there for more than 20 years.

The city is responsible for the ocean-side of Diamond Head, where other homeless encampments dot the cliffs. State Homeless Coordinator Scott Morishige says the city is aware of the upcoming operation….

“They are here because they like living off the grid,” says homeless outreach worker Justin Phillips. “It’s only a short walk into Waikiki to get access to services they need. They can walk across Kapiolani Park into Waikiki in the evening to panhandle, make a few bucks and come back here to sleep all day. It’s a lifestyle.” …

Hiking up the slopes, we saw a lot of trash piled up in front of abandoned camps. A heap of garbage near one former encampment was filled with used hypodermic needles.

I asked Phillips if he thought the area was the former home of a heroin user.

“The person could have been a diabetic,” he said. “But hey, that’s just me being nice. Could have been a crystal meth or heroin or cocaine user.” …

Many of Diamond Head campers have mental health and substance abuse problems. They fit the category of the “chronic homeless” that Morishige says the state will focus on helping this year….

“They don’t want help,” Phillips says. “They don’t want services. Most of them are resigned to living there for free. They don’t want to be a part of society.” ….

He says only a handful of people, maybe three or four, have agreed to move off the crater to seek services and housing….

HTH: “A lot of these folks have drug or alcohol problems”

read … Lifestyle

Medical vans to aid homeless could cost state $1.4M annually

SA: The state would spend $1.4 million every year to operate two mobile medical clinics aimed at helping sick or injured homeless people under a Senate bill aimed at cutting emergency room costs to treat homeless people for non-life-threatening issues.

State Sen. Josh Green (D, Kona-Kau) moved SB 347 out of his Human Services Committee on Friday on a vote of 3-0….

Related: Mental Health: Can Reform Solve Hawaii’s Homeless, Prison and Unfunded Liability Problems?

read … Money Saver?

Pot Decriminalization Has A Shot This Session, But Ige Wants To Wait

CB: Advocates for decriminalizing marijuana and drug paraphernalia think this may be the year the Hawaii Legislature takes action.  But Gov. David Ige doesn’t want to pass new laws regarding marijuana until the state’s medical marijuana dispensaries get up and running….

With the 2017 legislative session kicking off, there are several bills to decriminalize possession of drug paraphernalia and marijuana — or even legalize the drug for recreational use. Sen. Russell Ruderman and Rep. Richard Creagan, both from the Big Island, also introduced measures to allow individual counties to legalize the drug….

Sen. Will Espero, a longtime proponent of decriminalizing marijuana who is behind a bill to make the use, possession and delivery of drug paraphernalia a civil offense….

read … Keep the People Doped Up so they won’t notice

Civil Beat: Report Trump Voters and Bloggers to Us

CB: “Current databases are inadequate, so ProPublica is organizing a coalition of media outlets to keep better track of these cases….”

AP: Activists upset because bank won’t give free money to Muslims

read … See a Trump Voter?  Report it here! 

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