Maui Hospital Transition Complete, Cost Hike for Postpartum Rooms Questioned

The transition phase is now complete for the Maui Health System, the Kaiser Permanente subsidiary which took over management of three Maui hospitals (Kula Hospital & Clinic, Lānaʻi Community Hospital and Maui Memorial Medical Center) on July 1st.

That’s the assessment made by Hospital Administrator, Ray Hahn who updated residents about the first 25 days of operation under new management. The community update drew an estimated two dozen people to a meeting room at the Maui Arts & Cultural Center in Kahului on Tuesday afternoon.

An additional talk story session will be held in Lahaina on Wednesday, July 26, 2017 from noon to 1 p.m. at Waiola Church in West Maui.

Ray Hahn, Hospital Administrator for Maui Health System. PC: Wendy Osher

Transition Phase is Complete:

“It’s been a long journey,” said Hahn, noting that the agreement with the state for a 30-year public-private partnership was marked by two years of active negotiations and 10-15 years of informal discussion within the community.

Two weeks after the transition, all 11 command centers have since shut down and an electronic medical record keeping system is up and running, “without a glitch,” said Hahn who explained that the measure of success is patient safety and service.

During the course of the meeting, Hahn stressed the point that the three hospitals operated by the Maui Health System are community facilities that are open for all regardless of a patient’s insurance provider, and even for those with no insurance.

He said that while Kaiser Permanente is a closed system, the Maui hospitals are not Kaiser Permanente hospitals; but rather are managed by the wholly owned subsidiary, Maui Health System that is operating the facilities under a lease from the state to assist with quality, service and operational efficiency.

Hundreds of Post-Close Action Items to Be Addressed:

Administrators with Maui Health System say there are still hundreds of post-close action items that need to get addressed for everything from password resetting to ironing out work flow.

Hahn also fielded questions from the community relating to patient concerns over postpartum costs, accountability, cardiac care, and clarification of services offered at Kula Hospital.

Katie Folio (in foreground) and Nicole Skillern (middle) were among those who questioned the cost for a postpartum private room at the Maui Memorial Medical Center, which increased 350% during the transition, from $150 to $672. PC: Wendy Osher

Concerns Raised over Postpartum Private Room Rate Increase by 350%:

Among those in attendance at the meeting was a Maui doula and childbirth educator who asked why the price of a postpartum private room at the Maui Memorial Medical Center increased 350% during the transition, from $150 to $672.

Hahn said he would look into the hike and said there needs to be a “re-mapping” of the charges to determine the cause and purpose of the increase.

Katie Folio, a Kula resident who is due in mid-August with her second child, responded asking Hahn if he could “look into it quickly,” saying, “It’s a matter of my husband being able to stay the night to be with his newborn child.”

Under current guidelines, husbands are not allowed to stay overnight unless the couple is able to secure a private room.  While the availability of a private room is not guaranteed, some mothers have expressed concerns that they are unable to afford the increase; while others say allowing a father to spend those first few precious moments and days with a newborn should be a given.

Nicole Skillern of Makawao was also in attendance at the meeting and said she’s “on the fence” about doing a home birth or going to the hospital for delivery.  “I have about 10 weeks to think about it,” she said, expressing concern over the added cost.

Mothers can opt for a semi-private room, but the price was not disclosed for that option.  Under that option, a father is restricted to visiting hours and the mother shares a room with another patient also going through postpartum care.

Hospital administrators say they are investing in other areas postpartum care and are currently working to increase breast feeding rates through early education with mothers.

Maui Memorial Medical Center. Image credit: Kaiser.

Weighing Priorities: Expanded Services, Parking

During the discussion, Hahn weighed priorities saying expanded services will take time.

He noted that there is an estimated $300 million worth of facility and capital infrastructure work that needs to be done, including the acquisition of equipment and tools needed to enable specialty physicians to come in and do their work.

“I don’t know if Maui will ever have the full compliment of all specialty services,” said Hahn, but he said there are areas like cardiac care that need to be enhanced so that patients can be brought back to the island for treatment here.

He said some “out-migration” will still occur, but expressed a desire to enhance areas where there is a volume of need, as well as provide urgent care for patients to stay on island.

Hahn noted that prior practice was to send non-urgent cardiac patients to Oʻahu for care.  For expansion to go well, administrators say they would need a whole compliment of services so that all areas including pre- and post-op care goes really well.

Administrators praised the cardiac team on Maui saying the cardiac outcome on Maui is “better than many renown institutions in California and even Honolulu for that matter.”

When investing in physicians, administrators said there’s lots of interested individuals that want to come for 2-3 months; but in order to build a “culture of excellence,” Maui is looking for doctors that want to spend 20-30 years here instead.

Hospital administrators say the number one request from staff is for parking, but that hundreds of other priorities would have to be downgraded if a parking structure were to be built.

Another question was raised over the tobacco free policy at the hospital and if vaping was allowed.  The short answer is that there is a policy in place, but it needs to be enforced.

Image of Kula Hospital courtesy: http://www.kula.hhsc.org/

Plans for Kula Hospital Addressed 

Several of the questions raised involved services at Kula Hospital and suggestions for potential expansion of the facility.

Paul Harper-O’Connor, RN, Assistant Administrator for Quality, Safety and Performance at Maui Health System described Kula as a critical access hospital as opposed to a full service facility.

“It’s not a place to go for a heart attack or stroke… but anything short of that would be appropriate,” hospital administrators said, noting that there is just one emergency room doctor on call at the location and about seven patients per day seen in the emergency room during a 24 hour period.

Anything that requires an ambulance or ambulatory care will go to the Maui Memorial Medical Center, even if Kula Hospital is right next door.

He said expansion of care at the facility would be based on volume of need, making sure that the service can not only be provided, but can be done well.

Harper-O’Connor explained that if a specialty physician is brought in and is unable to maintain their skill set, or if equipment is brought in that is barely used, it’s better to deal with the specialized issue at a fully equipped full service facility.

Another resident asked about the potential expansion of the Hale Makamai ward at the Kula Hospital, which is focused on individuals with intellectual disabilities.  Hospital administrators said that the unit currently has nine beds and is serving eight clients through referral.  According to administrators, the facility has not been full in years and was not currently being eyed for expansion.

Hospital administrators said that at times it does become a numbers game, which is the downside of living in a rural service area; but that they have to be cognizant of competency and the ability to provide optimal treatment.

Maui Region serves over 11,000 in-patients with more than 45,000 people visiting the emergency room each year.