Hilo’s only outpatient general surgical center could be in danger of closing its doors.
Those connected to the Hilo Community Surgery Center point to a number of factors — including what they allege is pressure by Hilo Medical Center on its surgeons to not use the center for smaller procedures.
The surgery center, which is owned by a consortium of local physicians, has been in operation since 2000. Hilo Medical Center bought a one-third stake in the outpatient facility for $500,000 in 2010, but later divested itself of its minority ownership stake.
“We lose money every month,” Dr. Peter Matsuura, an orthopedic surgeon who’s a part-owner and board member of the outpatient facility, said last week. “There’s a limit as to how long we can sustain the loss, obviously. We need 100-odd cases a month to break even, and we’ve been below that. … And our numbers fluctuate. Sometimes, we’re pretty good and other times, we’re way below.
“In the past decade or so, the hospital has been hiring all the new surgical providers, including my cousin. And they are strongly discouraged, is the right word, maybe, from coming to the surgery center. There’s one or two of them who come, but most of them do not.”
Dr. Allan Takase, a retired obstetrician and gynecologist who’s considered the surgery center’s founding father, is even stronger in his insistence HMC has actively discouraged its surgeons to make use of the outpatient facility, which he says is “more efficient for outpatient procedures than the hospital.”
“They’ll deny it, of course,” Takase said. “But this surgery center is an asset to the community. A strong hospital and a strong surgery center are both important. And before, we had a forward-thinking administrator (Ron Schurra) at Hilo Medical Center. And he used to work with us.
“He saw the benefit of having both in existence for the community. Sadly, he’s no longer here.”
Dan Brinkman is the current CEO at Hilo Medical Center and is also the East Hawaii Regional CEO of Hawaii Health Systems Corp., HMC’s parent organization.
HMC spokeswoman Elena Cabatu said the hospital doesn’t encourage or discourage its surgeons from using the outpatient facility, but said improvements made in the past few years at the hospital give the surgical staff “everything it needs to perform surgery effectively.”
“We’re not stopping anyone from doing their procedures there, nor will we do so at any point in the future, so that is sort of a nonstarter,” Cabatu said. “In the last few years, we’ve had such luck in recruiting great surgeons. Now, we have interventional radiologists, we have vascular surgeons, we have a whole slate of orthopedic surgeons — and we’re about to welcome our fifth general surgeon to our practice.
“So, we have built a robust surgical program in the hospital, for both inpatient and outpatient procedures.”
Carol Kekauoha, the surgery center’s administrator, pointed to “a number of reasons our volume has gone down.”
“COVID has had an impact. Physicians retiring has had an impact,” Kekauoha said. “We rely on our physician users to bring their cases here, because we serve as an extension to their office.”
“The thing is, as private physicians retire, the incoming physicians are contracted by the hospital, so they’re all under contract to the hospital,” added Alice Chin, the surgery center’s clinical director. “So, I’m certain they have obligations to the hospital, and the hospital has certain expectations of these surgeons.”
Takase said outpatient procedures at HCSC are “much cheaper than at the hospital” and those who undergo outpatient procedures there don’t have to worry about rescheduling or cancellation.
“When they have an emergency, they have to push people back or they have to reschedule minor cases,” he said, referring to HMC. “If the minor cases came here, they wouldn’t have to do that.”
Matsuura called the outpatient facility “a very good business.”
“The community needs it,” he said. “We provide as good or better care for the appropriate patients, the outpatient surgery.
“The future of surgery in America — and this is my opinion — much of it is outpatient surgery. A lot of stuff hospitals used to admit for a week is now outpatient. It’s great; it’s efficient. If you do the same surgery at the hospital as the outpatient center, they get paid more, double-ish.
“They get paid more because they’re less efficient. They have to pay for 24-hour staffing, etc. To me, it doesn’t make sense.”
Cabatu reiterated that the surgery center is “for profit” and is a separate entity from Hilo Medical Center.
“The larger concern is that the community have services to turn to,” she said. “On our end, the answer is yes, because we do have the capacity to take on any surgery needs that the community has. We even have some construction underway to expand our surgical capabilities.”
Email John Burnett at jburnett@hawaiitribune-herald.com.