On Molokai, health care providers struggle with low payments, high costs — and little support

HONOLULU (HawaiiNewsNow) - The island of Molokai has only a third as many doctors as a communities of similar size on the mainland. But experts say roots of the health care crisis there — economics and isolation — exist in rural areas on every island.

And for doctors on Molokai, the numbers just don’t add up.

Two-thirds of the people who live on Molokai have some kind of government health plan, like Medicaid or Medicare, which don’t pay very much for medical services. So doctors who come to Molokai to do medicine are not coming for the money.

Dr. Kaohimanu Dang Akiona was inspired to come to Molokai after two renowned family doctors, Emmet Aluli and William Thomas, died within months of each other just over a year ago.

“Abruptly, over a short amount of time, almost two thirds of the island lost their main source of primary care,” Akiona said, adding she felt she had to respond to the gap.

Akiona reopened Aluli’s Molokai Family and Urgent Care in Kanakakai.

But despite inheriting a large panel of patients, the practice is less than profitable.

“We’re losing money. And so coming to Molokai, yeah, I had to accept that I was going to probably lose,” Akiona said. She splits her time with her other clinic on the Big Island, which helps subsidize the Molokai practice.

Dr. Scott Grosskreutz, leader of the Hawaii Provider Shortage Crisis Task Force, said the large number of government health care recipients “dooms” practices in rural areas of Hawaii, where the reimbursements for services don’t keep pace with the higher costs of doing business.

“Nationwide most providers break even of lose money taking care of patients on Medicare, Medicaid, and TRICARE,” he said.

HNN Investigates

He says across the state, doctors like Akiona are heroically serving communities while overwhelmed with paperwork, challenges connecting their patients to specialized care and retaining staff — all while losing money.

“And they’re just continuing to practice, you know, often working 60 to 70 hours a week because there’s no one else to take care of their patients,” he said.

Grosskreutz and other independent practitioners lobbied for an exemption from the excise tax for services provided patients on government health care, which was approved by lawmakers.

But it won’t take effect until 2026.

Meanwhile, an act of Congress is needed to increase Medicare rates for rural practices.

Rosie Davis monitors the health care employment situation for Molokai as executive director of the county Area Health Education Center. “It’s hard because we cannot retain them, we can provide that salary, the housing is difficult,” Davis told HNN Investigates.

Davis runs programs to excite Molokai students about health care — and serving their home island — but it often opens their eyes to opportunities elsewhere.

“Sometimes, when they finish school, they don’t come back, because they have better opportunity, better salary,” Davis said.

The John A. Burns School of Medicine estimates on any given day there are only six doctors on Molokai, including visiting specialists, a third of what’s needed for the island’s 7,000 residents.

Johnessa Quintua, who works in Akiona’s clinic, believes the lack of care shortened the lives of both her parents.

Her dad, John died, of late-detected cancer. “We got the results that he was diagnosed with prostate cancer, and it was stage 4 already,” she said. Her mother, Dorothy, was dying from undiagnosed cirrhosis of the liver at least had time to thank the doctor for trying.

“When I sat next to her to hear my mom say that she was grateful and happy to have the help that she needed,” she said. And it sealed her decision to work for the practice.

“To show how much they care about, you know our kupuna or elderly people here,” she said.

Akiona said the times when she is unable to save patients who were underserved is one of her biggest frustrations. “Those moments kind of bring me down when I’m thinking about the patients who gave up right,” she said. “I’m like, could I have done something better?”

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