"We're the only hospital in the community," said Wesley Lo, regional CEO of Maui Memorial Medical Center. "We're exploring every other option first."
The hospital group spans the archipelago and provides the only acute care on the islands of Maui and Lanai. It had asked for $150 million in financial help for 2014, but the Legislature approved $111.4 million.
Some hospitals only have several days of cash on hand to operate. The problem is caused in part because hospitals in Hawaii's rural regions can't generate enough revenue to support operational costs.
On Oahu, a long-term care facility will be out of cash in May and will be unable to make payroll payments, said Derek Akiyoshi, CEO for the Oahu region of Hawaii Health Systems Corporation. It is ending its adult day health care on Saturdays. As a last resort, he may have to consider closing a facility, he said.
"Ultimately our core long-term care services will have to be eliminated," Akiyoshi said.
On the east side of Hawaii's Big Island, three out of four patients are covered by Medicare and Medicaid, which don't fully reimburse hospitals for services, said Gary Yoshiyama, board chairman for the group's East Hawaii region. The region also is dealing with rising health care costs and an inability to pay for its collective bargaining agreements.
"We cannot absorb the cost without deep harm to our community," Yoshiyama said.
Kauai's hospitals also are feeling the pain, said Scott McFarland, CEO of the Kauai Region.
"I still have to find about $3 million bucks to make payroll every time through the end of 2015," McFarland said. "If there is one hiccup, we will not make payroll."
Lo is hoping to avoid further service reductions on Maui by entering into a partnership with a private company or securing more money from the Legislature, and the hospital is in talks with two potential partners, he said. In choosing where to cut, the hospital looks for stand-alone services like psychology or oncology instead of comprehensive areas like emergency services, he said.
The Maui region faces an $11 million deficit, which it attributes to stagnant reimbursement levels and reductions in Medicare payments.
"We will be faced with this over and over again on a model that is not sustainable right now," Lo said.