The Affordable Care Act is triggering clinics on Hawaii Island to consider expansion, a fulfillment of plans made when the federal law passed.
Construction of a new Puna Community Medical Center campus, for example, might seem to be taking a long time to casual observers.
But the clinic’s medical director says plans include expanding services for patients who need urgent care (for medical conditions such as sinus infections, influenza, minor cuts or strep throat) and services for those needing primary care (for patients needing to set up ongoing care with a primary doctor).
That expansion in services will happen at Puna Community’s current Puna Marketplace location — even before new-campus construction begins.
Bay Clinic also recently announced it expects to build during future expansions, rather than lease, so it can better fit services to patient needs. Until now, Bay Clinic has leased most of its space, which limits the services offered to the space available at each location.
Dr. Hart Miller, a family physician who is Puna Community’s medical director, said ongoing discussions between his medical center and the state are focused on how to free up money in a $750,000 planning grant so that the clinic can include plans for primary care, urgent care and ancillary services.
“An emergency center, by itself, is a non-starter,” Miller said. An ambulance isn’t going to stop at a emergency room that has no ancillary services, he said. In addition, he said, “we want primary care — that’s what Puna needs so badly.”
And Puna isn’t the only place in need of more primary-care and urgent-care availability.
Matthew Nagato, communications director with the Hawaii Primary Care Association, said, “It’s statewide, and I think a lot of what we’re seeing now can be traced back to strategic planning.”
Primary Care Association members assessed how the Affordable Care Act would affect the flow of patients seeking medical care. The three most-clear unmet medical needs were primary care, mental health and dental health.
When the Care Association completed its assessment in 2010(http://www.hawaiipca.net/planning-the-future-of-chcs/), there were 107,000 people in Hawaii who did not previously have health insurance who were expected to qualify for it through the Affordable Care Act.
Bay Clinic, Nagato said, reported that 64 percent of the patients it treated in 2014 used Medicaid as their primary health coverage, and 10 percent remained uninsured. That means Bay Clinic doesn’t take in as much revenue as health centers that serve higher percentages of patients with private insurance.
Nagato points to West Hawaii Community Health Center as an example of the type of expansion East Hawaii might witness in the coming years.
West Hawaii Community patient census “increased astonishingly” in the past 10 years, Nagato said.
Federal recognized facilities, Nagato said, are required to make sure that at least 50 percent of their board members are patients.
“When they make a decision it’s almost always driven by the fact that the Board of Governors looked at, ‘what do we need in the community,’” he said.
Miller said Puna Community now does an outreach program the first and third Friday, every month, to Kalani with its mobile medical van.
“We’re really excited to bring our health care down the red road,” he said.
That’s just one part of an effort to expand the availability of services.
“We’re moving forward. We’ve got everybody on the goal,” said Miller.
