-By Tammy

How are we supposed to grow a practice when we keep getting cuts around every corner.  First we find out that we can not collect Hawaii General Excise Tax from Medicare, Medicaid, military, or government employees.  That means that the practice gets to pay it instead.  That also means almost a 5% discount to these patients at our expense.  Then Quest/Medicaid plans to delay payment to save the state money.  Now this.  Taken from an email from HMA:


Medicare Payment Update 2/26/10

HMA Press Release: United States Senate Failure to Avert Medicare Cuts Hurts Hawaii

Reports that the U.S. Senate adjourned early for the weekend without averting the drastic 21 percent cut in Medicare and TRICARE reimbursements are a serious cause of concern for Hawaii. The cuts, scheduled to take effect Monday, March 1st, are likely to further decrease access to care for Hawaii’s current and future seniors and military families.

“We are shocked that the U.S. Senate could take this issue so lightly,” said Hawaii Medical Association President Robert Marvit, MD. “Hawaii’s patients will bear the brunt of the Senate’s inaction to protect access to health care in our state and across the nation.”

Medicare reimbursements do not cover the ever-increasing costs of providing care, and recently reduced Hawaii Medicaid reimbursements, which are based on Medicare rates, will likely be cut further. Many physicians and health care providers in Hawaii, in order to keep their practices open, have already taken the difficult step of limiting the number of Medicare and Medicaid patients they see. Combined with possible delays in Medicaid reimbursements to Hawaii’s providers due to the state’s financial shortfalls, these steep cuts will exacerbate the issue.

MedPAC, Congress’ advisory body on Medicare, has noted that about one in four Medicare patients seeking a primary care physician have trouble finding one. In Hawaii, where physician shortages are critical in many areas of the state, the results of cuts could surpass crisis levels.

“After years of requests to Congress that they fix the Medicare payment system, it was high time the Senate took action once and for all,” said Dr. Marvit. “Hopefully, our state legislators will take the initiative this year to help offset this crisis.”

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CMS Plans

The Centers for Medicare & Medicaid Services (CMS) has instructed its contractors to hold claims containing services by physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule (MPFS) for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward. CMS reports that this hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.


Physicians have until March 17 to change their Medicare participation or nonparticipation status for this year. View a document developed by the AMA ( that explains the current situation with respect to Medicare payment updates for 2010 and the various participation options available to physicians.

# # #

April Donahue, HMA Executive Director



I, being clueless about building a practice let alone building an office or space, have been enlightened to the detailed process here in Hawaii.  It has been challenging, but oh so rewarding.  Excitement fills the air.  We enjoy each day of the process, but we look to the future of being our own bosses with anticipation.

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