Hawaii’s Physician Workforce: Update

Kelley Withy, MD, PhD David Sakamoto, MD, MBAwithy@hawaii.edu dts@hawaii.edu

Healthcare Association of HawaiiMay 20, 2011

Primary Care Estimates forAPRN, PA, MD & DOs

•PA: Supply estimate: 35 FTE• Demand Estimate: 59 FTE

•Physicians: Supply estimate: 892 FTE• Demand estimate: 1,228 FTE

•APRN: Supply estimate: 209 FTE • Demand estimate: 268 FTE

Primary Care Estimates forAPRN, PA, MD & DOs

• Current Total Supply, using .75 productivity conversion factor for PAs & APRNs = 1,075• Current Total Demand = 1,473

2010 Shortage of Primary Care Providers is 27%

New systems of care,Administrative simplification,Reimbursement changes

Loan repayment, Sin tax, Tort reform

Tort reform, loan repayment

Pipeline,Appreciation,Social Integration 

Office space,Business Services  

Pipeline Programs, Targeted Training, Implement EHR, Group Formation, Increase non-Physician Clinicians, Medical Home Model

Solutions Priorities, Designated at June, 2010 Summit

Change Model of Care

• Care teams, Care Coordination, Increase Non-physician clinicians• Patient centered medical home• Kaiser, HMSA, HPCA, HPH• Should we have a conference for education and

consensus building?• Accountable Care Organizations

Revenue Support

• Medicare reimbursement to physicians (#8)• US Bureau of Labor has Hawaii in bottom

quartile (except peds)• MGMA not assess HI, but current hiring at

MGMA average?• Fairhealth doing a claims database study of

reimbursement rates (previously Ingenix)Rural payment differential (UHA and AlohaCare)• Business assistance• Loan repayment

Administrative Simplification

• Central web portal with current enrollment data • Eligibility, plan benefits/restrictions, co-

payment• Drug formularies, rules, forms (standard

preauthorization forms would save staff time)• Single credentialing service

• Standard contract (provider : insurer)• Standardized claims processing, CPT conventions

and ability to track claims• Uniform Health ID card

Tort Reform

• Workgroup:• Pretrial Hearing Process Review/New Ideas

• Enterprise Medical Liability• Broadens the prospects for holding healthcare

organizations, such as hospitals and health plans, directly responsible for medical injuries, in addition to or instead of holding the individual providers liable• Payors demand reduced utilization; legal system says, do

everything