HFH update for our patients & community

To our valued patients and community:

We are not planning on closing. Now that that is out of the way, let me please put my pride aside for a moment and ask for your help. I’ll start with a short version, and provide a more detailed explanation below for those who have more interest and time.

It is absolutely true that I have withdrawn from my retirement plan in order to replace a paycheck for the 18 months. It is true that I have wonderful staff who have taken pay cuts because they believe in our mission to provide high quality medical care to East Hawaii and the importance of the health of our community. It is also true that I am looking into locums (traveling doctor) positions 2 days / week to support my Family Practice habit and keep Hawaii Family Health open on the other days. I want all of you to know that Hawaii Family Health is here for your medical needs.

This business model is not sustainable, and that is where we need your help. You’ve watched the other doctors close their doors or go to a concierge / direct primary care practice. You’ve seen more doctors offer aesthetics in place of medical care. None of this is because of poor business practices or the physician no longer wants to practice medicine; they do it because medicine is not a sustainable business model. Sadly this is magnified in Primary Care and in Hawaii, where insurance reimbursement rates (particularly with the changes within the last 2 years) are so low we are driving physicians out of practice. We are currently asking for help in two ways:

First, please consider visiting and donating at our GoFundMe page. If insurance companies are unwilling to pay enough to keep doctors in Hilo, we are hoping the community will help support us:


Second, please consider adding your voice to speak up for Hawaii in need of physicians. The insurance companies, the insurance commissioner and the legislature have not listened to the doctors saying that insurance plans need to pay a fair and reasonable wage – but you are the consumer and perhaps your combined voices will be heard.

Write to the state legislature (https://www.capitol.hawaii.gov/members/legislators.aspx?chamber=all) for insurance reform.

Write/call to your own insurance company (address on the back of your insurance card) calling for fair wages. 

It is important to note that HFH isn’t alone in this problem. The East Hawaii Independent Physicians Association (EHIPA) has recently started working with the local physicians to establish a medical group from the previously independent practices because the costs and administrative burden of running a private practice exceed the payments received by insurance companies. They are doing this because “The IPA Board feels that the future of independent practice and the future of primary care in Hilo is [sic] at risk.”

Interestingly, the EHIPA is presenting a model where they will employ multiple physicians, hopefully including new physicians to Hilo. This is the model Hawaii Family Health has proposed for several years (except we offer the addition of our team-based care) and for which we have built our new medical office. It’s nice to see my colleagues recognizing other ways to practice medicine after firmly insisting on their independence for the last 7 years. But it’s sad to see physicians who have been pillars in our community for decades have their hand forced by insurance companies failing to pay a livable wage.

Please share this information with others so that the knowledge can be passed on.


For those of you who would like some additional information, please read on.

The State of Hawaii has a shortage of 797 physicians (increased from 769 last year).

The Big Island has a shortage of 213 physicians, 41% of the required number to serve the population, and increased from 196 last year.

The State of Hawaii has a shortage of primary care physicians of 263 (improved from 282 last year).

The Big Island has a shortage of 47 physicians, 25% of the required physicians needed to serve the population, and increased from 46 last year.

The State of Hawaii lost 51 physicians within the last year.

22% of Hawaii’s physicians are over age 65 (Compared to U.S. 12%)

50% of Hawaii’s physicians are over age 55 (Compared to U.S. 37%)

24% of Hawaii’s physicians are under age 45 (Compared to U.S. 36%)

These numbers worry me for my patients, my community, my fellow healthcare providers. And they should worry you too.


The following are published articles regarding a physician’s patient panel (number of patients):

  1. The primary care panel size of 2500, which is often cited, was unfortunately pulled from the air.  The original citation for this appears to come in an article in which the authors speculated the panels size a physician could manage (original citation in Family Practice Management 2000.  There is no data or review of actual physician panel sizes to support this)
  2. Estimates based on the time required to provide all recommended acute, chronic and preventative care for 2500 patients is 7 hours/day (Prevention of Chronic Disease 2009, American Journal of Public Health 2003, Annals of Family Medicine 2005)
  3. Estimates based on the time required to provide chronic care management to the top 10 chronic conditions, if already controlled, for a panel of 2500 patients is 828 hours/year or 5 hours/day (Annals of Family Medicine 2005)
  4. Estimates based on the time required to provide chronic care management to the top 10 chronic conditions, if not controlled, for a panel of 2500 patients is 2484 hours/year or 6 hours/day (Annals of Family Medicine 2005)

Utilizing this information, studies indicate that a conventional medical model of primary care can manage approximately 1,000 patients with appropriate care. There are time delegation models, which allow for a PCP to manage a panel of nearly 2,000 – only if there is a team (midlevel + RN) in place to which the PCP can delegate appropriate care.

Based on this information, insurance companies should either expect a physician to 1) provide appropriate care to 1,000 patients, 2) provide sufficient reimbursement to staff a team to support a physician to provide appropriate care to a larger number of patients, or 3) expect a physician to provide substandard care.


A local insurance company pays an average of $24 per patient per month and advised the doctors that we are expected to carry a panel of 1500. There is no change in this insurance reimbursement, no matter what services the patient requires – acute illness or injury, nebulizer for asthma flare-up, routine follow up, skin biopsy to check for cancer. PCPs get the same $24/month.

                1500 patients x $24 per patient per month x 12 months = $432,000 annually to run a medical office (rent, electricity, malpractice, electronic medical record, staff, licensing, billing, etc)

Other insurance models offer a fee every time you come into the office, but the payments have increased minimally (1-5%) in the last 5 years. When that is compared to inflation (9%) and the increase in minimum wage (40%) over the same time frame, it is impossible to keep up.


Once more, I’d like to say, Hawaii Family Health is still committed to proving you with high quality medical care. We’d love your support in our efforts to gain physicians a fair and reasonable wage in order to provide our community with more access to health care.


Thank you for reading and sharing.


Michelle Mitchell, M.D.


I’ve been posting information on Facebook – check it out: https://www.facebook.com/michelle.mitchell.7330763


I’m sad to report that HMSA is sending out inaccurate and inappropriate letters to our patients.  Without our knowledge or consent, HMSA has sent letters to our patients stating they need to find new PCPs because we “no longer participate with your health center.”

That sounds scary.  

However, it is a ridiculously complex way of saying that we at Hawaii Family Health have joined a more progressive Independent Physician Association and you need to change your card to reflect this.  We have been informing our patients as they come in as it is easy to do.  Somehow, HMSA has made it more complicated and they’ve even confused their own representatives to the point where they are telling our patients we no longer participate with HMSA.
This is not true.  Please contact HMSA and change your “health center” (nobody knew what that meant) from East Hawaii IPA to Hawaii IPA.  
See, simple.  
I personally apologize to all of you for this confusion. 
We have asked HMSA to correct their confusing letter to advise patients that they do not need to change their PCP, but only the “health center” or IPA.  HMSA refuses to send out a new letter or retrain their employees to help them explain the situation more clearly to patients. 
We at Hawaii Family Health understand this is especially stressful right now, given our physician shortage on the Big Island and our current volcanic eruption.  You, our patients, do not need additional stressors.  We will do everything we can to help you ease through this transition and during this difficult time.

Protecting your Hearing

According to the CDC, hearing loss is one of the most prominent debilitating health conditions in the U.S., with almost two times as many reportings as diabetes or cancer. While hearing loss has traditionally been a concern in older individuals, this issue has begun to cross all age groups. This is due to the increasing rates of hearing loss observed in young adults.

So how is sound measured? Sound is measured in decibels (dB) indicative of sound intensity or loudness. To give you a standard of comparison, an individual with normal hearing can typically hear sounds ranging from 0-140 dB. While normal conversation usually meets a level of 50-65 dB, sounds above 85 dB can be detrimental, depending on the length and intensity of sound exposure.

What causes hearing loss? [Read more…]

We’re Moving!

Hawaii Family Health has been working hard, not just at making sure you receive the best healthcare in Hilo, but making sure all of Hilo has access to the highest quality health care around.  We been working for years to build our integrated healthcare team, currently including medicine, psychology, psychiatry, nutrition, nursing, care management and education of the next generation of healthcare providers.  And, as we have done so, we have outgrown our small office.  With the help of Koa Architects and Sun Construction, we have a new building on the way. [Read more…]

Broken Heart Syndrome

What do an octopus and your heart have in common? Well, sometimes they both can get stressed out. Dahhaha; ok not such a great punchline – but it is an interesting thing to think about. With the holidays coming up, I think most everyone is aware that it’s a tricky time to make healthy choices with all the sweets, and treats surrounding us. But all the festivities can also bring additional stress– with all the last minute shopping, countless potlucks you have to bring food for, and family tensions running high as everyone flies home. It’s a time of sharing happiness and love, but also it’s pretty darn hectic – and while we’re watching out for our waistlines, we need to also remember to look out for our heart in other ways too. So let’s learn a little bit more about this interesting phenomenon that can affect one of our most vital organs.   [Read more…]

Local Health Insurer Shutting Down

First – Hawaii Family Health is intact and staying here!

Family Health Hawaii (yes, they stole our name!) has been ordered to liquidate – that is a fancy way of saying they are shutting down. Family Health Hawaii is a health insurance plan, not our office. 


This website has some frequently asked questions:


But the most important is: can I still see my doctor? This is complicated.  You can still see your doctor, as you are still technically insured.  However, your doctor may not get paid.  Bummer. 

It looks like they Liquidator (I didn’t even know that job title existed) will be holding all of the medical claims and then reviewing them after they are all received. Only then will they be able to determine if Family Health Hawaii will be able to afford to pay the claims and at what rate, meaning it might only be a portion of the previously agreed upon rate. 

So, your doctor may usually get $60 when you go for a visit (1-3 months later), but now your doctor won’t even know for 6-12 months (or longer) if he will get paid at all and he may get anywhere from $0-$60 for that visit. The doctor cannot charge you for this difference, but it is kind of a problem for the doctor who already put in the work and was counting on that money to pay his staff, rent and other bills. 


 What can you do?

Please make sure you are working with your employer to get new health insurance. It’s important to stay insured. 

If you have a routine appointment scheduled prior to May 6,2016 or before you get a new health insurance plan, please push it back so you have more stable insurance.

Please be understanding to the doctors who are asking you to change your appointment until after you change insurance plans. We are people too – we are in this profession because we care but this is also our employment and we too have grocery bills!

If you have an urgent issue, please contact our office. We are still your health care home and will help you!

Thank you, Hilo Heart Walkers!

Another year of the Hilo Heart and Stroke Walk was a success!  Thank you to all of the walkers and the organizers and supporters for making the Big Island a healthier place. 

Hawaii Family Health put in a good showing – with a majority of our staff and families participating in the day. 

Getting a running start.

Getting a running start.

Looking bright and fresh at the beginning!

Looking bright and fresh at the beginning!


The day was beautiful, if you don’t count the vog, which we rarely do here.

Liliuokalani Park is really pretty if there isn't some big guy and cute doggy blocking your view.

Liliuokalani Park is really pretty if there isn’t some big guy and cute doggy blocking your view.


Even the dogs put in a good showing for HFH!

Just keep swimming, just keep swimming.

Just keep swimming, just keep swimming.


Most of the staff finished the walk.  We’ll find out who is missing when they don’t show up for work this week.  We’ll send out the search party and have them back by Friday. 

Finally, the end is in sight.

Finally, the end is in sight.


Thank you for all of the donations to the help the American Heart Association!

Now, rest up.  The next project is Relay for Life for the American Cancer Society on Saturday July 16, 2016.  Keep your walking shoes ready!

Join us for the Hilo Heart Walk!

We will be participating as an office in the Hilo Heart & Stroke Walk  – this Saturday, March 5 at Liliuokalani Park.  Come by for the walk between 6:30 – 11:00 AM to support healthier lives, free of cardiovascular disease and stroke!

Or swing by our office anytime to provide a donation to the American Heart Association.

Here is Hawaii Family Health wearing our red dresses on National Wear Red Day (February 5) in support of women’s heart health.  Don’t we look healthy and gorgeous!

Red office

Take care of your hearts, Everyone.  You aren’t given a spare!