Tuesday, June 19, 2018
Hawai'i Free Press

Current Articles | Archives

Friday, February 24, 2017
SB1137: Return Control of HMSA to its Members
By Selected News Articles @ 1:26 PM :: 2069 Views :: Ethics, Health Care

SB1137 would restore control of HMSA to its members

by Larry Geller, Disappeared News, February 23, 2017

SB1137 is a deceptively simple yet powerful bill. It applies to any mutual benefit society in Hawaii. The kernel of it is this sentence:

“…notwithstanding anything in the constitution and bylaws to the contrary, the administrative board or body of the society shall permit a special meeting to be called upon the written request of not less than one thousand members of the society….”

This bill would return control of HMSA to its members. Right now, it would take something over 17,000 members to call a special meeting, an impossibility.

The bill needs testimony. It will be heard on Monday, February 27, at 9:30 in room 229 before the Senate Committee on Commerce, Consumer Protection, and Health.

The bill is certain to meet opposition from HMSA because it is an existential threat to absolute management control

Please consider even the simplest testimony. Click here and then the blue “Submit Testimony” box.

Hawaii has lived with a chronic shortage of physicians for some time. It only gets worse, never better. While doing nothing has its consequences, it hasn’t been clear what the legislature could do that would reverse this deadly spiral.

Perhaps there is a way: SB1137 gives power to the people to take action—specifically, power to HMSA members themselves. The bill has one hearing in the Senate (and testimony is needed!) on Monday, February 27.

  *   *   *   *   *

A potential fix for Hawaii’s chronic physician shortage is in sight

by Larry Geller, Disappeared News, February 23, 2017

Hawaii has lived with a chronic shortage of physicians for some time. It only gets worse, never better. While doing nothing has its consequences, it hasn’t been clear what the legislature could do that would reverse this deadly spiral.

Perhaps there is a way: SB1137 gives power to the people to take action—specifically, power to HMSA members themselves. The bill has one hearing in the Senate (and testimony is needed!) on Monday, February 27.

First, some context. If HMSA members were able to influence the operation of what is supposed to be a “mutual benefit society,” they could require that several important changes be made. In addition to revising reimbursement rates, other worthy areas of scrutiny would be denials or delays of imaging requests, and a restricted formulary that can actually endanger lives.

The declining number of physicians has long been a major threat to healthcare

The continued attrition of doctors is a kind of "sword of Damocles," which, like climate change, brings with it a sense of impending doom. Nothing that the legislature, the medical school, or anyone else has done has reversed the downward trend that must lead one day to catastrophe.

The danger of a physician shortage surfaces periodically in the press. Here, as an example, are stories from 2005–a dozen years ago:

Losing

Crisis point 2005

Every private practitioner is a small business. HMSA is the near-monopoly insurer that is so powerful that doctors either sign up or they can’t survive in the state. And HMSA sets the reimbursement rates for their services. Physicians cannot afford to practice in Hawaii largely due to low reimbursements that don’t compensate them for the high cost of doing business here. The only way out of this situation is an airplane ticket to another state.

Starting this year fundamental changes to reimbursement have been made along with an increased paperwork load that promises to accelerate the attrition.

If Hawaii’s physician shortage was a crisis in 2005, it remains a crisis today. I was recently told by my oncologist that four of his colleagues have just retired. When I visited a medical building in Wahiawa I found the number of empty office suites to be truly shocking. Physicians retired or shut down their practice and no one moved in to provide the community with care.

Restrictions on imaging can cost lives

Reimbursements are not the only issue that members can work on. Last year HMSA’s denials of doctor’s imaging requests broke into the news.

Not what the doctor ordered 20160124

As a cost-cutting measure, HMSA began requiring doctors to get pre-authorization from a mainland company before it would approve imaging tests starting December 1, 2015. But this is not the first time HMSA has attempted to put the brakes on imaging.

HMSA claimed that the restrictions were necessary, according to the newspaper article, since its imaging utilization costs were about nine percent higher than the national average. Whether or not that is accurate, a Star-Advertiser story revealed that at least for Medicare patients, who typically have a higher usage rate than the general population, Hawaii’s imaging utilization rates are in fact lower than the national average. In 2014 the Medicare utilization rate was the lowest in the nation.

Imaging already low 20160209

The effect of denying or delaying imaging would be a clear danger especially to patients wheeled into emergency rooms or for whom a delay could be life-threatening.

HMSA denials

HMSA’s imaging restrictions are not new

Digging deep into the archives turns up this Star-Bulletin story of HMSA imaging denials that nearly cost a patient his life. Fortunately, he could afford to fly to Texas and pay for the test himself. Although privacy restrictions were not in force at the time, I’m redacting the names in this article since they are not important.

[Patient L], 49, had had surgery three times in his neck for what was believed to be recurrent parathyroid cancer.

Five doctors agreed a magnetic resonant imaging study was needed to pinpoint the cancer.

Despite doctors' requests, HMSA refused to cover an MRI because medical directors gave an opinion "that an MRI would not detect recurrence of metastatic parathyroid cancer . . ."

[Patient L’s wife] said her husband's doctors ~ N.R., S.V., A.L, J.D. and J.A. ~ were flabbergasted.

HMSA was very wrong. The article continues with Patient L in Texas:

An MRI was done on [L] immediately after they went there in May last year, [wife] said. Two days later, surgery was done to remove a cancerous parathyroid gland from her husband's throat and a cancerous tumor from his chest, she said.

"If they had done exploratory surgery in the neck (the only option without an MRI), they would never have found it in the chest."

Thanks to this next case, HMSA allows PET scans to detect colon cancer

In another denial that made the news, HMSA turned down a PET scan (Positron Emission Tomography) request that would have quickly, painlessly and in fact inexpensively ruled out colon cancer after a polyp was detected in [Patient E]. As the Star-Bulletin reported, the patient paid for the test himself (about $3,500) and learned that the polyp was definitively not cancerous. So he had it shaved off in a simple procedure.

The alternative was painful and far more risky abdominal surgery involving five or six days in the hospital with recovery of another five or six weeks, and, in fact, much higher expense.

Patient E brought his case as an appeal before the insurance commissioner and prevailed. As a result if the same thing happens to you or me, we can have our PET scan if we need it. That is if you or your attorney are able to cite this case if denied.

Epipen denied

I need to carry an Epipen these days. If I should go into shock and don’t have it, I could die. The company that makes it was recently in the news for alleged price gouging, and as a result, a far cheaper competitive version came on the market. The cost to me was only $109.99 instead of over $600. I paid because HMSA refused to cover the pen.

Families across the country have to dig into their kids’ college funds or their retirement savings to provide allergic children (and adults) with their life-saving Epipens. That’s why the manufacturer’s price increases made the news.

Although the consequences of not having this device are dire, HMSA declined to pay for it. Now, $109.99 is less than the cost of many medications that they do cover, and far less than the cost of treating me if I didn’t have my pen (and if I survived!).

Maybe I’m better off dead to them.

But I’m not dead, and will testify on Monday in favor of SB1137 so that HMSA members can change this and many other things we need to pay attention to.

A potential solution to Hawaii’s physician shortage

This problem has eluded solution through legislation. But there is another approach that has promise–and it has to do with member control of HMSA, the near-monopoly insurer that effectively sets reimbursement rates for physicians in Hawaii.

HMSA is, at least in a technical sense, a mutual benefit society. But right now, according to HMSA bylaws, members cannot effectively call a special meeting to work on outstanding issues–and those issues are more than just reimbursements. The bylaws require something more than about 17,000 members to get together to request such a meeting. Here is the relevant paragraph:

VIII Membership Meetings 2. Special Meetings. Special meetings of the members of the Association shall be held at any time upon the call of the Chairperson, upon the written request of a majority of the Directors, or upon the written request of not less than three percent (3%) of the members.

Since the number of members needed to call a meeting is so high, it is in practice impossible for members to exercise any control whatsoever over the conduct of their own organization. Nor are there shareholders to whom management would be responsible since HMSA is not a for-profit company.

If members could dialogue with and control the conduct of their own mutual benefit society, issues such as inadequate reimbursements could be resolved.

Will you testify before Monday’s hearing? Click the LINK. It’s quick and easy. Tell your story if you have one.

---30---

This work is licensed under a Creative Commons License.  NonCommercial-ShareAlike.

Links

TEXT "follow HawaiiFreePress" to 40404

Register to Vote

2aHawaii

808 Silent Majority

808 State Update AM940

ABCDEFG Blog

ACA Signups Hawaii

ACCE

ALEC

Alliance Defending Freedom

Aloha Conservative Alliance

Aloha Life Advocates

Aloha Pregnancy Care Center

American Council of Trustees and Alumni

American Mothers of Hawaii

AMVETS-Hawaii

AntiPlanner

Antonio Gramsci Reading List

A Place for Women in Waipio

Audit The Rail

Ballotpedia Hawaii

Better Hawaii 

Blaisdell Memorial Project

Broken Trust

CAFR Hawaii

Castaway Conservative

Children's Alliance Hawaii

Children's Rights Institute

Christian Homeschoolers of Hawaii

Citizens for Recall

Cliff Slater's Second Opinion

Coffee Break

Conservative Forum for Hawaii

CSIS Pacific Forum

DAR Hawaii

DeedySupport.com

DVids Hawaii

E Hana Kakou Kelii Akina

E Māua Ola i Moku o Keawe

Farmers For Choice Hawaii

FIRE

Fix Oahu!

Follow the Money Hawaii

Frank in Hawaii

Friends of Lanai

Front Page Magazine

Frontline: The Fixers

Genetic Literacy Project

Get Off Your Butts!

God, Freedom, America

Grassroot Institute

Habele.org

Hawaii Aganst Assisted Suicide

Hawaii Aquarium Fish Report

Hawaii Aviation Preservation Society

Hawaii Catholic TV

Hawaii Christian Coalition

Hawaii Cigar Association

Hawaii Coalition Against Legalized Gambling

Hawaii ConCon Info

Hawaii Credit Union Watch

Hawaii Crime Victims' Rights

Hawaii Crop Improvement Association

Hawaii Debt Clock

Hawaii Defending Marriage

Hawaii Defense Foundation

Hawaii Families for Educational Choice

Hawaii Family Advocates

Hawaii Family Forum

Hawaii Farmers and Ranchers United

Hawaii Farmer's Daughter

Hawaii Federalist Society

Hawaii Federation of Republican Women

Hawaii Firearm Community

Hawaii Fishermen's Alliance

Hawaii Future Project

Hawaii Gathering of Eagles

Hawaii History Blog

Hawaii Homeschool Association

Hawaii Jihadi Trial

Hawaii March for Life

Hawaii Meth Project

Hawaii's Partnership for Appropriate & Compassionate Care

Hawaii Public Charter School Network

Hawaii Rifle Association

Hawaii Right to Life -- Big Island

Hawaii Right to Life -- Oahu

Hawaii Senate Informer

Hawaii Shield Law Coalition

Hawaii Shippers Council

Hawaii Smokers Alliance

Hawaii State Data Lab

Hawaii Together

Hawaii Votes

Heritage Foundation

HI Coalition Against Legalized Gambling

HIEC.Coop

Hiram Fong Papers

Homeschool Legal Defense Hawaii

Honolulu Homeless Crisis

Honolulu Navy League

Honolulu Traffic

Horns of Jericho Blog

House Minority Blog

House Republican Caucus YouTube

HPACC

Hump Day Report

Hunting, Farming and Fishing Assoc.

I Vote Hawaii

If Hawaii News

Inouye-Kwock, NYT 1992

Inside the Nature Conservancy

Inverse Condemnation

Investigative Project on Terrorism

Iowa Meets Maui

Jackson v Abercrombie

Jihad Watch

Judgepedia Hawaii

July 4 in Hawaii

Kahle v New Hope

Kakaako Cares

Kau TEA Party

Kauai Co GOP

Keep Hawaii's Heroes

KeyWiki

Land and Power in Hawaii

Legislative Committee Analysis Tool

Lessons in Firearm Education

Lingle Years

Malulani Foundation

Managed Care Matters -- Hawaii

Malama Pregnancy Center of Maui

Mauna Kea Recreational Users Group

MentalIllnessPolicy.org

Middle East Forum--The Legal Project

Mililani Conservatives for Change

Military Home Educators' Network Oahu

Missile Defense Advocacy

MIS Veterans Hawaii

Muslim Brotherhood in America

NAMI Hawaii

NARTH

Natatorium.org

National Christian Foundation Hawaii

National Parents Org Hawaii

National Wind Watch

New Zeal

NFIB Hawaii News

No GMO Means No Aloha

Northwest Economic Policy Seminar

Not Dead Yet, Hawaii

Now What I Really Think

NRA-ILA Hawaii

Oahu Alternative Transport

ObamaCare Abortion Hawaii

OHA Lies

Ohana Policy Group

OpenHawaii.org

OurFutureHawaii.com

Pacific Aviation Museum

Patients Rights Council Hawaii

PEACE Hawaii

People vs Machine

Pritchett Cartoons 

Pro-GMO Hawaii

P.U.E.O.

RailRipoff.com

Rental by Owner Awareness Assn

Republican Party -- Hawaii State

Research Institute for Hawaii USA

Rick Hamada Show

RJ Rummel

Robotics Organizing Committee

Salvage The Rail

Save the Plastic Bag

School Choice in Hawaii

SenatorFong.com

SIFE Remington

SIFE W. Oahu 

Sink the Jones Act

Smart About Marijuana--Hawaii

St Marianne Copenull

State Budget Solutions Hawaii

State Policy Network

Statehood for Guam

Tax Foundation of Hawaii

TEA Party Maui

TFB Micronesia

The Harriet Tubman Agenda

The Long War Journal

The Real Hanabusa

Time Out Honolulu

Truth About Trade & Technology - Hawaii

UCC Truths

Union Members Know Your Rights

United Veterans Hawaii

US Tax Foundation Hawaii Info

Valor in the Pacific

VAREP Honolulu

Waagey.org

West Maui Taxpayers Association

What Natalie Thinks

Whole Life Hawaii

Yes2TMT