Ka Wai Ola - Office of Hawaiian Affairs, Volume 26, Number 8, 1 August 2009 — Waiʻanae ER may close once a week [ARTICLE+ILLUSTRATION]

Waiʻanae ER may close once a week

Native Hawaiians make up 56% ofER's patients By ī. Ilihia Giansan Publicatians Editur Due to a dire financial situation exacerbated by Medicare reimbursements that don't quite cover the cost of seeing a patient, Wai'anae Coast Comprehensive Heahh Center is looking to close its emergency room for eight hours a week, from midnight Sunday through 8 a.m. Monday. Located between Mā'ili and Wai'anae, the center's emergency room is the only emergency medical care available on 0'ahu's Leeward Coast. The next nearest emergency room is at Hawai'i Medical Center-

West in 'Ewa, ahnost 20 miles away from the Wai'anae center. The area it serves includes Hawaiian homestead communities in Wai'anae, Lualualei and Nānākuli, as well as Native Hawaiians living outside homestead communities. The center serves as the medical home for 14,000 Native Hawaiians, of whieh two-thirds have ineome below poverty level, according to CEO Richard Bettini. And statistics provided by the center show that 56 percent of patients seen in the ER are Native Hawaiian. As unportant as the 24-hour emergency room is at the center - h serves upwards of 15,000 patients a year - it is not a core service by the definition of the federal government, Bettini said. "As a federally qualified heahh center, we are obligated to maintain our

core service - family medicine for all - and we are not allowed to divert funds from this core to 'optional' services like 24-hour emergency care," he said. The proposal to close the ER comes as part of the center's third round of cuts for the fiscal year 2009-2010. Initiatives targeting efficiencies and fundraising cut a projected $3 million shortfall down to $1.3 million, whieh was further reduced by some personnel cuts, salary freezes and cuts to services after the first quarter - the ER being one of those services. Bettini said that Sunday night was considered because there is slightly less activity, and that h would be an easier night for the community to remember. "But believe me, I do recognize that no night is a good night," said Bettini, who lives in Mākaha - about 30 miles away from the emergency room at Hawai'i Medical Center-West. Community members have expressed eoneem about the extra time it would take to get to another emergency facility should something happen while the Wai'anae ER is closed. "It's essential that they have the emergency service available for the people in Wai'anae," said John, a part-Hawaiian Wai'anae resident who declined to give his last name. "It's

needed to keep our people well and alive." The move would save $330,000 a year, and is slated to begin Oct. 1 - unless the center is able to avoid elosure. Closure could be averted by increasing paid visits to the ER by 5 percent or by receiving grants, but the biggest drag on ER ineome is the failure of Medicare to pay its fair share, Bettini said. "Medicare pays us well below half of what it costs to see patients in the ER, and because we are not eonnected to a hospital, Medicare is the only payor not to pay us a facility or standby fee for our ER," he said. "We are asking our congressional delegation to help us with this." Even with the dire financial situation, Bettini is confident that the center ean continue to care for the Wai'anae Coast through working together. "We may have to work more synergistically with other community agencies that are facing deep cuts, such as Ke Ola Mamo. Our Hawaiian programs are governed by a Kupuna Council and we are committed to targeting the specific needs of Native Hawaiians," Bettini said. "I believe with a little give and take, and hard work by our staff, we will get through this period without having to make drastic changes." ■

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