Aloha, my name is Scott McCaffrey and I am proud to be handed the gavel of the Honolulu County Medical Society for a second term as the President of this proud organization. I am from Boulder, Colorado, have formal training in both emergency medicine and occupational medicine and am currently in group practice at the new Queen's Medical Center-West Oahu campus where, when it was St. Francis-West and Hawaii Medical Center-West, I served as Chief-of-Staff for five years until its closure two years ago. It is my hope that I have attained enough wisdom and experience since last I served as County President in 2007, to meet the exciting challenges of today's dynamic healthcare environment.
Founded in 1856 by a group of physicians in conjunction with King Kamehameha IV, the Honolulu County Medical Society is the original and oldest organization in Hawaii representing doctors and the patients they treat. Its mission statement is "to bring together the physicians of the City and County of Honolulu into one organization for the purposes of: Promoting collegial interaction among physicians, fostering and promoting the betterment of public health and maintaining the high standards of medical practice through peer review".
Let's see, 1856, Louis Pasteur would have been 34 years old and just announced the magic of pasteurization in controlling food spoilage and we were still holding people down to perform surgery on them and we were just beginning to understand what really goes on in fermentation! Thanks to microscopy we knew about bacteria and yeast but not viruses and vaccination was just a dream in Louis Pasteur's eye.
Yet Kamehameha and the founding fathers of this organization and its parent, the Hawaii Medical Association, had the foresight to understand the importance of doctors organizing for the betterment of all. Since then we have conquered most infectious diseases including the ever present Hansen's disease attended to by our own St. Damien and polio thanks to the noble efforts of Jonah Salk.
Fast forward to my lifetime, Hawaii has born witness to and enjoyed the benefits of a multitude of medical breakthroughs and miracles not the least of which was the introduction of the 9-1-1/EMS system. Better understanding of metabolic disorders such as hypertension and diabetes as well as cancer have dramatically reduced mortality and infant mortality has plummeted from 1 in 20 births to less than 1 in 4. Modern medicine has had such an impact on our lives that it is estimated that without its breakthroughs and benefits for those of you in this room, one in three would not be here now.
These are just some of the many reasons I am so proud to be part of this profession. Where else do you have an opportunity to really help other human beings in a meaningful way every day like a boy scout and earn a good living!
PROBLEMS IN PARADISE
But all is not perfect here in paradise. The dynamic that is innate to the progress of medical science brings with it many challenges. These life saving and life extending benefits come with a price tag more than a match for our economy creating economic and professional stressors, the likes of which have not been experienced in the history of healthcare. Apply such forces on the most geographically isolated island chain on the planet and we have some challenges indeed! (Run Video).
As stated in the video, we are already feeling a doctor shortage and its resultant access-to-care crisis. In the recent University of Hawaii study we currently have a 600 doctor shortage, which is projected to increase to a whopping 1,500 doctor shortfall by the year 2020!
How can this be, you ask? How can we have a physician shortage when we have this wonderful environment and a medical school? The reason is multifactorial and includes the following sobering facts:
- Hawaii pays its doctors some of the lowest fees in the Country. Our Medicare reimbursement formula is actually less than urban states like New Jersey and our workers' compensation system pays physicians the third lowest in the nation!
- Medical school education is expensive with most of our graduates $200K in debt or more at the time of graduation.
- Entry level housing here at an average of $650K is unaffordable to new graduates!
- Finally, the cost of setting up a practice and doing business here is the 5th highest in the Country.
Other demands on measurable outcomes and adoption of electronic record keeping has prompted many physicians my age and younger to either 1) retire early or 2) fly to the mainland weekly to practice their specialty. And you can see how these problems of physician shortage and access to care are compounding. The shortage of physicians has already reached critical proportion on our neighbor islands and perhaps some in this room have even had trouble finding a family doctor here on Oahu.
And to top it off, there is the ominous and ever present "sustainable growth rate" SGR provision. Have you heard about this one? In the name of cost control, our national congress has before it an automated mechanism whereby Medicare fees will automatically be cut by a practice killing 22% every March 1st unless our leaders "kick the can" down the road another year which they have, thank goodness, since its enactment 5 years ago. With such Draconian cuts looming, expansion planning and doctor recruiting are challenging to say the least.
Hospitals are particularly challenged as we have been barraged lately by the media with stories of outrageous bills for hospital stays and procedures. Yet rarely are we told the whole story that for every dollar billed by hospitals and doctors, we are lucky to collect 50 cents after the bill has been denied, processed, down coded and/or “adjusted” by insurers.
And then there is the problem of pre-authorization. Do you folks watch sports much? Have you ever noticed how, when a football player gets injured, the results of the MRI are often announced before the game is even over?! Well, I have a patient who injured her ankle at work six weeks ago and has not been healing. The ankle remains swollen and physical therapy is not helping. With x-rays negative, I ordered an MRI and received a letter that it had been denied and I should call a number, which I did (play audio tape).
Finally, we have to deal with over 100 different insurance companies and insurance types and, most recently, even attacks by our own Chamber of Commerce to limit our ability to provide important patient services such as laboratory testing, bracing, and even traditional medication dispensing!
SOLUTIONS & HOPE
But there is hope. Because in 1974, Hawaii implemented the Hawaii Prepaid Health Act, we are ahead of the power curve as the Affordable Healthcare Act also known as Obamacare is being rolled out. But in doing so, we can and must adhere to the time honored principles that have stood us through the ages as the world's second oldest profession.
For now is the time to recommit to our universally accepted Hippocratic Oath to always keep patient needs first and do no harm.
Now is the time to reach out to specialty societies and neighbor island physicians to remind them it is more important than ever to speak with a "voice of one".
Now is the time to remind our colleagues at the Chamber of Commerce that, in addition to being healers, every doctor's practice is a small business which must survive if we are to serve the populace and that a dollar invested here translates to paying jobs for everyone.
Now is the time to educate our legislators that the healthcare industry comprises 21% of our economy and has been a principle, driving force in pulling us out of this great recession.
Now is the time to rally widespread support for the removal of the sustainable growth rate.
Now is the time to revitalize our 156 year old organization to insure that it speaks on behalf of private practice and institution-based physicians.
And now is the time to insist that, as doctors and hospitals are being held to higher measureable standards, so too should insurance carriers and payers. And, in accord with the Affordable Healthcare Act, make certain that 80% of each premium dollar is spent directly on care for the patient, not claims fighting and executive bonuses!
How are we going to do all this, you may ask? Who will give us the authority and power? The public will . . . if we adhere to the fundamentals upon which our profession was founded! For the time is now to use our dedication, years of training and ethical calling to make sure the public is protected. To seize the podium when necessary and remind the world that our collective training and wisdom and dedication can never be questioned because we have always and will always stand for the patient!
If not us then who?
If not now then when?
Thank you very much.
D. Scott McCaffrey, M.D.
President--Honolulu County Medical Association
December 14, 2013