The Hawaiʻi Medical Service Association (HMSA) has granted physicians a six-month extension to transition into a new fee-for-service payment model. Following discussions between Gov. Josh Green—a medical doctor—and HMSA leadership, the deadline was moved to Jan. 1. This shift aims to help medical practices stabilize their workflows, billing processes, and revenue cycles while maintaining continuity of care for patients across the state.
Why HMSA Extended the Payment Model Deadline
The decision to delay the transition stems from concerns raised by both physicians and state leadership regarding the operational pressures on primary care practices. According to HMSA CEO Mark M. Mugiishi, the extra time is intended to ensure the transition is implemented responsibly. Mugiishi noted that the organization understands primary care is essential to the health care system in Hawaiʻi and aims to protect member access during this period.
What Changes for Primary Care Physicians
While the implementation deadline is now Jan. 1, primary care doctors have the flexibility to move to the new model immediately if they choose. For those on neighbor islands, the new payment structure includes a 15% increase in payment rates, designed to account for the higher costs of operating in those regions. Practices that prefer to maintain their current arrangements may do so until the new deadline.
How the Proposed Merger Fits In
The payment model adjustment occurs as HMSA and Hawai‘i Pacific Health move toward creating a new entity known as One Health Hawaii. This proposed merger seeks to integrate the state’s largest health insurer with one of its largest health care providers. Leaders from both organizations have stated that the goal of this conglomeration is to improve both affordability and access to health care, particularly as the industry faces rising costs.
Did you know?
Gov. Josh Green is currently the only governor in the United States who is also a practicing medical doctor. His administration worked directly with HMSA to facilitate the transition period for local physicians.
Frequently Asked Questions
When is the new deadline for the fee-for-service transition?
The new deadline for physicians to transition into the model is Jan. 1.
Do physicians have to wait until January to switch?
No. Primary care physicians have the option to move to the new fee-for-service payment model now or continue with their current arrangement until the January deadline.
Is there extra support for struggling practices?
Yes. HMSA has indicated that doctors experiencing significant and unforeseen financial hardships due to the transition can receive temporary financial support.
What is the goal of the One Health Hawaii merger?
HMSA and Hawai‘i Pacific Health have stated that the merger is designed to improve health care affordability and access for patients during a time of increasing costs.
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