Schatz, Tokuda seek higher payments for physicians

U.S. Sen. Brian Schatz, alongside Hawaii’s congressional delegation, on Thursday introduced legislation seeking higher Medicare reimbursements for the state’s health care providers.

The Protecting Access To Care in Hawaii Act — or PATCH Act — seeks a 24% increase, which would bring it in line with what Alaska gets, according to Schatz. He said it is key to helping the state retain and recruit doctors for a growing number of seniors.


The timing is more urgent than ever, he added, as Hawaii faces an increasingly acute provider shortage, especially on neighbor islands.

“As more people reach Medicare age in Hawaii, we are seeing fewer health care providers because of the rising operating and living costs in our state,” said Schatz. “Our bill would help fix that, boosting Medicare payments to providers and protecting health care access for the 300,000 seniors in Hawaii that rely on Medicare.”

It is also a matter of fairness, according to Schatz.

Currently, Medicare physician payments per beneficiary in Hawaii are the lowest in the U.S, and reimbursement rates do not factor in Hawaii’s higher health care operating costs due to its geographic isolation.

The bill would revise a “work geographic index” to reflect those higher costs, and is basically seeking the same level of reimbursements as Alaska.

“In lots of other areas of federal reimbursement, there’s a recognition that Hawaii and Alaska are in a category of their own as it relates to costs that would better reflect our reality,” said Schatz.

U.S. Rep. Jill Tokuda, who introduced the companion House bill, said Hawaii consistently ranks among the healthiest states in the U.S., yet remains one of the worst states in which to practice medicine because of lower compensation and higher operating costs.

“Especially on our Neighbor Islands, this is exacerbating the access to the health care crisis that exists, often making it difficult to recruit and retain physicians and to get patients the timely quality care they need,” Tokuda said in a statement. “My legislation would ensure Medicare reimbursements more accurately reflect the real cost to provide care in Hawaii so that we can keep more local doctors and attract new physicians to the state.”

U.S. Sen. Mazie Hirono said the low physician reimbursements in Hawaii add another obstacle to accessing and providing health care.

“I’m proud to support this legislation to help ensure that our physicians — and other health professionals — are being fairly compensated, while also expanding access to health care across the state,” she said.

U.S. Rep. Ed Case said medical practitioners have struggled for years to provide quality care while dealing with the mounting cost of doing business in Hawaii.

“This bill will help our health care providers focus on providing care through Medicare and spend less time worrying about inadequate reimbursement,” he said.

Earlier this year, Sens. Schatz and Hirono also introduced a bill alongside their Alaska colleagues, seeking higher Medicare reimbursements for outpatient care from hospitals, including emergency room visits, for enrolled seniors in the two states.

In 2021, they also sought to boost Medicare reimbursements for nursing homes in Hawaii and Alaska through the bipartisan Equitable Payments for Nursing Facilities Act.

Those bills are still pending.

Hawaii has a shortage of about 800 full-time physicians, according to the University of Hawaii John A. Burns School of Medicine.

Other efforts to address the doctor shortage include an educational loan reimbursement program for health care workers that commit to two years of service in Hawaii. The state Legislature also passed a bill this year exempting private health care providers from general excise taxes for services to patients with Medicaid, Medicare and TRICARE.

“Everything costs more in Hawaii,” said Schatz, “and so the federal reimbursement has to reflect that, and that should go for nursing home care and Medicare services in clinics. We just have to be on an equal footing. Otherwise, we will have Medicare but really Medicare in name only because Medicare without providers is really nothing.”

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