1. Hawaii’s Physician Workforce: Update Kelley Withy, MD, PhD David Sakamoto, MD, MBA withy@hawaii.eduwithy@hawaii.edu dts@hawaii.edudts@hawaii.edu Healthcare Association of Hawaii May 20, 2011

2. Primary Care Estimates for APRN, 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

3. Primary Care Estimates for APRN, 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%

10. Government Business Medical Community Community Third party payers 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

11. 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

12. 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

13. 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

14. 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