Updated January 15,2017
THE PROBLEM and the NEED: The GOLDEN 2 HOUR WINDOW FOR CARE: People with cardiac problems- heart attacks and strokes must be airlifted to hospitals in Honolulu or to Maui Memorial to be treated. There is a 2 hour window when patients need to be treated in order to expect a full recovery. Think about where you live on the Big Island. At least from my home it would take 45 minutes to get to Kona Community Hospital Emergency Room, then the time to be diagnosed and then get the helicopter and then the 45 minute + time to Oahu, getting checked in and a cardiologist hopefully is at the hospital and you need to be seen, an Operating Room hopefully is available. Mayor Harry Kim has had 3 heart attacks, two County Councils Chairs Dominic Yagong and Pete Hoffmann have all had to be airlifted off island to be treated for heart attacks. Who do you know?
STATISTICS FROM 2016 FOR KONA COMMUNITY HOSPITAL supplied to Representative Nicole Lowen from Judy Donovan who is the Regional Director of Marketing and Strategic Planning at Kona Community Hospital and the Kohala Hospital. She thanked Dr. Rosen for his help in compiling the following numbers:
BREAKDOWN OF CASES and TRANSFERS: Case definition = DRG Invasive Cardiology (Author Note: DRG is an insurance code)
- Total Cardiac Cases at Kona Community Hospital (KCH) = 375
- Cases admitted and discharged at KCH = 218 = 58%
- Cases transferred to other neighbor island hospitals = 16 = 4% (Maui Memorial)
- Cases transferred to Oahu hospitals = 151 = 38%**
**Note: approximately 40% of transfers to Oahu were Kaiser patients. Some of those patients may have been admitted to KCH had they been otherwise insured.” Note: These patients were airlifted to Kaiser Moanalua, Queens, Pali Momi or Straub).
REPORT FOR A CARDIAC CARE FOR WEST HAWAII Debbie Hecht reporting June 2016
A Cardiac Care Unit is needed on the Big Island. Several well-known community members have been airlifted to Queens Hospital in Honolulu or Maui Memorial Hospital with heart problems or strokes: Mayor Kim, Council Chair Pete Hoffmann, and OHA Representative Bob Lindsey
Before going to Kona, I discussed a cardiac care unit for West Hawaii with Jon Luft, Architect and Teri Oelrich, medical planner at NBBJ Architects, who specialize in planning and designing hospitals. They are currently involved in building a one million square foot, state-of-the-art replacement hospital for Loma Linda University Medical Center in Loma Linda, California. Jon lived on the Big Island in the 1980’s and Teri has also worked in Hawaii. Teri thought that a hybrid Operating Room (OR) and Catheterization Lab would be a first step to assessing the need/use of a Cardiac Care Unit. She was helpful in explaining the process for a Certificate of Need. From these discussions, I learned that hospitals make money on their operating rooms. North Hawaii Community Hospital is booked solid with orthopedic and gastroenterology procedures. Queens Medical has taken over the operations of North Hawaii Community Hospital. There is currently no facility or any cardiologists to staff a dedicated cardiac care unit for West Hawaii. We came to the conclusion that Kona Community Hospital (KCH) was the best location for a Cardiac Care unit. I also learned there is additional, unused land adjacent to the Kona Community Hospital for expansion if a full-scale cardiac care unit is needed in the future. I also learned that here is a 2-hour window where a patient must receive intervential care to recover completely. By the time a cardiac victim would get from their home to KCH is evaluated and airlifted to Maui or Oahu, much more than two hours have elapsed- 4 hours is a more likely estimate. All of the people I talked to expressed the need for a new hospital closer to the Kona International Airport.
Kona Community Hospital has one cardiologist listed on their list of specialists, Dr. Michael Dang who comes periodically from Honolulu. Dr. Larry Derbes has applied for privileges at KCH and is an interventional cardiologist in private practice in Kona. He agrees that a Catheterization Lab to do stents and ablations and to treat strokes is very necessary for West Hawaii, would save lives and result in better outcomes and quality of life for cardiac patients. He is interested in helping to establish, and in working at a Cardiac Care Facility. He also outlined the challenges of a doctor trying to make a living on the Big Island because of the Medicare reimbursement rate, which is roughly 93% of the actual cost of living. He was working in Waimea, but is closing that office and moving his practice to downtown Kona, approximately 20 minutes from KCH.
Jay Kreuzer, is the CEO of KCH, and has also been a cardiac patient. He said that the problem with the the Medicare reimbursement rate of only 93% of the actual cost, is compounded by Hawaii Medical Services Association (HMSA-the State of Hawaii’s biggest healthcare insurer) compensates at only 110% of the Medicare Reimbursement Rate as compared with most mainland insurance companies which reimburse at 130% of the Medicare rate. These explanations further illustrate the negative impacts of insufficient reimbursement rates for attracting and retaining good doctors on the islands. He told me that there is an airlift almost every day from KCH to either Queens in Honolulu or Maui Memorial and they are usually for heart or stroke patients. He confided that Queens and KCH are in negotiations to acquire KCH. He said the difficulty with a Cardiac Care unit is finding cardiologists to staff the clinics, “There is no sense in building it if we don’t have the staff.” If Queens acquires KCH, he believes more doctors would be available for rotations at KCH for specialties. Queens’ strategy would be to enable more patients to stay on the outer islands instead of going to Oahu because their beds are always full. He also told me that the recent heavy rains had caused extensive flooding and damage to one of the Operating Rooms, which might represent an opportunity to remodel for a hybrid OR and Cath Lab.
I also met with Dr. Frank Sayre, Chair of the Board for the West Hawaii Regional Hospital Board of Directors, which oversees Kona Community Hospital and the North Kohala Community Hospital. He reiterated what Jay Kreuzer said about why it is difficult to keep good doctors. He told me that he had discussed setting up a “funded chair” for specialists (similar to academic chairs) as a stipend to keep doctors on the island. This discussion was between Frank and a staff member from the Hawaii Community Foundation. Frank and I also discussed setting up an annuity pool with the Kona Hospital Foundation to fund several stipends for cardiac specialists who are willing to be “on call” at the hospital. We talked about the possible need to hire a grant writer and/ or approaching several donors interested in better cardiac care on the island.
- A HYBRID CATHETERIZATION LAB/ OPERATING ROOM FOR KONA COMMUNITY HOSPITAL: According to the medical planner, Teri Oelrich, affiliated with NBBJ architects, many rural areas first create a hybrid Catheterization Lab out of an existing Operating Room. She estimated that this could be accomplished for approximately $2 million for equipment only; remodeling would be an additional cost.
- The recent flooding of the Operating Room at KCH presents an opportunity to remodel the Operating Room and accommodate Cath Lab equipment.
- STAFFING: Funding mechanisms could be established through donations to the Hawaii Community Foundation or the Kona Community Hospital Foundation
- Establish a funded “chair position” for each specialty that is needed with a yearly stipend.
- OR establish a pool of money as an annuity that will provide a stipend each year for several specialists.
STEPS TO ACHIEVE:
- COMPILE STATISTICS to show the need for the Catheterization Lab by using billing for the last 2 years, or assessing airlifted patients as to why they were being carried off-island. The goal of this would be to establish the need for a Catheterization Lab or other specialties and give direction to the hospital and the Board as to what doctors, staff and facilities would be needed. This is important because:
- With this data KCH would know what specialties and specialists were needed to treat and allow patients on the island to recover, which is a huge benefit for better outcomes for the patient and keeps interventions in the 2-hour window. In the event of a Queen’s acquisition, it would expedite a facilities upgrade and staff hiring.
- Having this data available would help determine the best strategies on how to repair the flood damaged ER (possibly into a cath lab hybrid).
- Having the data could illustrate the need for a cath lab, and support the Board and CEO’s strategic planning.
- Consider hiring a grant writer to apply for grants from the Hawaii Community Foundation, HMSA Foundation, Kona Community Chamber of Commerce, and Rotary of Kona, Heart Association, Bill Healy Foundation, Ironman Foundation etc.
- Establish an annuity to provide stipends of $50,000 for one or two on call cardiologists or a visiting cardiologist for KCH. For example: An annuity could be set up for $1,000,000 to invest at 5% to raise $50,000 per year for a stipend to pay a cardiologist to be on-call in addition to their private practice.
BRIEF RESUMES FOR CONTRIBUTORS (in alphabetical order):
LAWRENCE DERBES, M.D., F.A.C.C., is a board-certified cardiologist who has been practicing since 1990. Dr. Derbes graduated from Vanderbilt University with his bachelor’s degree and Louisiana State University, where he obtained his degree in medicine. Subsequently, he completed fellowships in three different locations, Louisiana, California, and Florida, in cardiac electrophysiology, interventional cardiology, and internal medicine, respectively. Dr. Derbes moved from the mainland to Oahu in 2006, where he was an interventional cardiologist specializing in electrophysiology. He has extensive experience performing cardiac catheterizations and other interventional procedures, including stent and pacemaker placement. In addition to working in various hospitals on Oahu, he also practiced cardiology in two offices. Dr. Derbes moved to Waimea in September of 2013 in order to strictly practice preventive care. Concerned about patients’ post-surgery lifestyles and follow up care, Dr. Derbes’ practice integrates both lifestyle and conventional medicine in order to mediate existing cardiac problems as well as chronic illness and conditions like high cholesterol and high blood pressure. Dr. Derbes has applied for privileges at Kona Community Hospital. His TedX talk can be found at http://tedxtalks.ted.com/video/Self-Quant-%7C-Dr-Larry-Derbes-%7C. He is now in practice with Ali’i Health in Kona.
DEBBIE HECHT worked for the County Council for the County of Hawaii as a legislative specialist. She was the campaign coordinator, from 2005 to 2012, to set aside 2% of Hawaii County property taxes to purchase open space and parklands. To date the Public Access and Open Space and Natural Resources Fund has preserved over 3,000 acres of land for $32 million+, with over $7 million from matching funds. http://records.co.hawaii.hi.us/weblink/browse.aspx?dbid=1&startid=13770&cr=1 With Councilmember Brenda Ford, she wrote the legislation for the 2% Land Fund charter amendment and the 2% Land Fund Maintenance charter amendment to maintain lands that have been acquired with Fund monies. Both charter amendments were approved by 65% of voters. She is a heart patient and has had 2 stents and 2 ablations over the last 5 years and would like to be able to safely live on the Big Island. She is grateful to have survived 6 years on the island without being properly diagnosed with atrial fibrillation. She hopes to help provide care for others who may want to remain on the island with heart and cardio health issues and help to provide the facilities to educate people about better heart health through diet and exercise.
JAY KREUZER, MHA, FACHE – The HHSC West Hawaii Regional Board of Directors named Jay Kreuzer as the new Regional Chief Executive Officer (CEO) of the West Hawaii region, which includes Kona Community Hospital (KCH) and Kohala Hospital. He began work March 14, 2011. Jay Kreuzer has more than 30 years of progressive, proven health care leadership experience. He previously served as the Executive Vice President of Resurrection Health Care, a not-for-profit health system located in Chicago, that includes eight hospitals, seven nursing homes, five independent living facilities, and three assisted living facilities. He concurrently was the Chief Executive Officer for West Suburban Medical Center, a facility with $520 million in gross revenues, five ambulatory sites, 325 member medical staff, 250 volunteers, foundation and physician/hospital organization (PHO).
Prior to this, he was president of St. Francis Hospital and Health System, a 412-bed acute care hospital ranked in the top 100 hospitals nationally. He also served as the President of Good Samaritan Regional Medical Center, a 220-bed acute care hospital in rural Southern Illinois.
Kreuzer earned a Bachelor of Science degree at Valparaiso University in Indiana and received a Master in Health Administration at Xavier University in Ohio. He is a Fellow in the American College of Healthcare Executives. He moved to the Big Island with his wife, Jean (a school nurse for 20 years).
JON LUFT, Architect, LEED AP: Jon is a broadly experienced architect whose portfolio includes projects at every scale and complexity across multiple market sectors, project types and construction delivery methods. His professional experience spans almost 40 years and involves hands-on experience in a wide range of domestic and international projects in health care, hospitality, higher and K-12 education, municipal and public safety, commercial and high rise buildings, public transit, urban mixed-use and residential projects. Jon is a licensed architect in California, Arizona, Hawaii and Massachusetts and his recent practice has focused on large, acute healthcare projects in the California marketplace. He is skilled at leading large, multi-disciplinary teams on challenging projects, from planning and design through construction and project closeout. Jon has a proven ability to effectively manage complex projects that have critical design, construction, phasing, and operational requirements while fostering an atmosphere of teamwork and open communication. Jon has developed his professional experience among the worlds leading design firms including Cesar Pelli & Associates, Skidmore Owings & Merrill, HDR, HKS, Leo A Daly and currently with NBBJ, Los Angeles. Recent acute healthcare work has included design and implementation for the new Emergency Department at Scripps Mercy, San Diego, CA, and as senior project manager for replacement hospitals at Camp Pendleton, Oceanside, CA ($450M, 500,000sf, Design Build)), San Gorgonio Memorial Hospital, Banning, CA ($120M, 120,000sf, CM Multiple-Prime), and currently for the Campus Transformation Project at Loma Linda University Medical Center, Loma Linda, CA ($1B, 1,000,000sf, Negotiated w/GMP).
TERI OELRICH, RN, BSN, MBA, leads the Healthcare Analytics at NBBJ, the second-largest healthcare architecture firm in the world and named one of the most innovative by Fast Company. She has a clinical background in nursing, working in a variety of settings, including orthopedics, medical-surgical units, and adult and pediatric intensive care units. She also holds an MBA, and coupled with her operational knowledge, she brings a valuable mix of clinical and business acumen to healthcare projects. Teri is available to the client from planning to completion and beyond. She works closely with our medical planners and Lean consultants to “right size” projects based on a rigorous analysis of both historical data across healthcare systems and the client-specific data. Teri uses the data-analysis process to assist our clients with determining what they need to meet projected clinical case volumes as opposed to what they want based purely on today’s environment. This process of using analytics to drive planning and design is increasingly important in the current data-driven healthcare industry. Her recent work includes planning for University of Washington Medical Center, Sutter Health Regional Ambulatory Care Master Plan, and Legacy Emanuel Medical Center Intensive Care and Surgery Replacement.
She is the Co-President for the Center for Women’s Health at OHSU and is also on the Foundation Board of Trustees for Legacy Meridian Park. She is also a previous presenter at conferences for ASHE, American Institute of Architects (AIA), Healthcare Design (HCD), and National Association of Children’s Hospitals and Related Institutions (NACHRI).
FRANK SAYRE, Chairman of the Board, West Hawaii Regional Hospital Board of Directors, which oversees Kona Community Hospital and North Kohala Community Hospital. Sayre joined the board in July 2014. He was previously a member of the KCH surgical staff and HHSC’s Management Advisory Committee for West Hawai’i. He is a volunteer Board member for the Peoples Advocacy for Trails Hawai’i, and the Pu’u Wa’a Wa’a Advisory Council. He is a founding board member of the Daniel Sayre Memorial Foundation along with his wife, Laura Mallery Sayre, which has donated more that $700,000 for equipment to first responders on the Big Island. Dr. Sayre was a dentist in private practice in Kailua Kona for many years.
There is an ongoing problem to keeping doctors in Hawaii that is outlined in the report. There is more information needed on how to best serve the Community.
Please contact me to become part of the movement to have community needs met by the Kona Community Hospital. Mahalo! Debbie Hecht