The chief executive of the Queen’s Medical Center says the hospital is trying to help fix the state’s critical primary care shortage in private practice even as it offers lucrative contracts to persuade doctors to join its staff.
“The issue is significant. Patients are looking for primary care physicians and are finding that they may not be able to get access,” said Art Ushijima, the Queen’s Health Systems’ president and chief executive officer. “We as an organization, as a community of health care organizations, are trying to find ways of increasing the supply to meet the continued growing demand for physicians.”
Queen’s is recruiting full-time “hospitalists,” who work exclusively for one hospital, at a salary of $300,000 a year, double the amount physicians typically earn when starting in private practice.
While some say the hospitalist trend is taking away from primary care in the community, Queen’s says it is doing its part to encourage providers to stay in private practice. It spends about
$20 million a year supporting graduate medical education, and serves as a training site for primary care doctors and other specialists. Since 2000, 88 graduates, about a third of the 272 residents at Queen’s, have gone into primary care — as internists, family medicine providers and geriatricians.
“Many physicians are not choosing to go into private practice and are looking at alternatives such as being hospitalists because they don’t want to take the risk of private practice and other issues such as lifestyle,” Ushijima said. “The supply of physicians being produced for primary care relative to the demand is not keeping up.”
Queen’s also is attempting to lessen the administrative burden on doctors, as reporting requirements for health insurers and programs such as Medicare (the government insurance program for seniors) increases. Medicare and the Hawaii Medical Service Association, the state’s largest health insurer, are changing the way doctors are paid, with reimbursements based in part on how well a doctor improves patient care. But the new payment models require additional reporting by physicians to prove they are meeting quality measures.
Dr. Ryan Honda, a Queen’s hospitalist who was previously in private practice on the mainland, said doctors didn’t learn in medical school how to manage an office, or staffing and billing — and now additional payment reporting — which are required in private practice.
“You end up spending 10 to 20 hours on top of your clinical responsibilities trying to manage an office,” he said. “This world of quality and reporting is so complex. It is so nebulous and overwhelming. It is one of biggest dissatisfiers of being private practitioners,” Honda said. “Not only is there prior authorization and regulations; doctors are also having to report the quality of care you deliver. There’s been a sea change in the American medical system over the last five years where we’re focusing away from the quantity of care to the quality. That’s a good thing, but it is, like most journeys, one that is somewhat painful.”
Queen’s has formed the Queen’s Clinically Integrated Physician Network to help 1,100 doctors with the reporting requirements of HMSA and Medicare.
“It was put together to compete with (organizations like) Kaiser and to bring physicians together in order for us to be able to contract with HMSA or Medicare as a group, something we couldn’t do individually,” said Dr. John Houk, a primary care doctor in the Queen’s network. “We can’t get together to negotiate fees, but we can to improve the quality of care we provide. What’s being promised by Queen’s is … they will do the reporting to HMSA and Medicare in the future, and that’s huge. That’s a real burden on most independent primary care providers.”
Dr. Anna Loengard, chief medical officer for the Queen’s Clinically Integrated Physician Network, said the group intends to connect the doctors in its network through electronic medical records so that providers can share patient information and reduce duplication. The Queen’s network also has social workers and nurses available to help physicians coordinate care and follow up with the sickest patients suffering from complex medical conditions.
“There’s a lot of anxiety in the community for primary care. Everyone’s trying to find a solution to this,” she said. “Part of our role is to help physicians understand this and ensure they continue to make the money they’ve made in the past. We have additional resources for them. Social workers will help find solutions so the physician isn’t burdened. We’re trying to make them more efficient in practice. Our goal is to help them care for the population here and find again that joy in practicing medicine. We hope it actually opens up access for primary care patients.”
HMSA said the shortage of primary care physicians in Hawaii is a complex and significant problem.
“At HMSA we are working directly with provider groups to support physician recruitment,” said Dr. Mark Mugi-
ishi, HMSA’s chief medical officer. “We are working with the University of Hawaii to support primary care education and postgraduate training.”
Nearly a third of Oahu’s primary care doctors are no longer accepting new patients, with 145 of Oahu’s 463 primary care physicians not accepting new patients regardless of insurance coverage, according to a study by Crown Care LLC, a Honolulu patient advocacy company. As of June the state was short 228 primary care physicians, University of Hawaii research shows.
Many patients are left in limbo as their doctors retire, decline patients on Medicare or Medicaid — the government health insurance programs for seniors and low-income residents — or are unwilling to take on those with complicated medical problems.
Part of the shortage is due to a disparity in payments between primary care doctors and specialists, who earn at least twice the amount of general practitioners.
“Here we are today in an era where we need more primary care services, but reimbursement models have really not driven the production of primary care physicians. Now we’re doing course correction in a much more complex environment,” Ushijima said. “You need to adjust the reimbursement systems, but you also need to improve support for primary care physicians because the nature of patients today are far more complex. It’ll take a long time to increase the supply.”