Reporter's notebook: Hawaii's not paradise if you need HME

Monday, February 25, 2013

KAHULUI, Hawaii – When it comes time for providers here to say “aloha” to competitive bidding, provider Paul Gammie worries that service will become a thing of the past.

“What’s going to happen when Round 2 comes to these rural areas, which are already suffering and where patients are already doing without?” said Gammie, owner of Gammie Home Care, which has locations on the islands of Maui and Kauai.

Hawaii has a population of 1.3 million spread mostly over eight main islands. While some areas, such as the city of Honolulu with its nearly 1 million residents, are heavily populated, the areas Gammie services are more rural. He worries that when Round 2 of competitive bidding kicks off in Honolulu in July, the expected drop in reimbursement will make it even harder for patients in remote areas to receive services. 

That’s already happening on the rural island of Lanai. Low Medicare reimbursement is compounded by the high cost of living more than 2,000 miles from the mainland, including gas prices close to $5 a gallon. 

“They’re seven miles off the coast of Maui and they have zero DME coverage,” said Gammie. “There are no willing oxygen providers that are willing to take them on. Our congressional delegation has been informed of this, but there are no changes happening.”

While providers in landlocked states can rely on GPS routing and other efficiencies to control the costs of deliveries, Gammie’s island state requires different planning.

“We only go to the backside of the island of Maui three times a year,” said Gammie. “Other remote areas we go to on scheduled timeframes—it might be every four months.”

In between visits, patients use home fill systems and backup tanks, and Gammie amps up preventative maintenance to reduce equipment breakdowns. Residents do their part, too, to make sure people get what they need.

“People in distinctly rural areas have a different mindset,” said Gammie. “They’re used to taking care of their own. If someone’s wheelchair needs a new armrest, a neighbor heading this way will bring it in.”