O.C. Hospital May Cut Its Service to Poor

Western Medical Center-Santa Ana said Friday it may no longer be able to provide medical services to some 4,300 of Orange County’s poor, citing $10 million in losses for indigent care last year.

The hospital notified CalOptima, the county’s medical care agency for the poor, that unless a better pay schedule was negotiated, it would leave the program in six months.

CalOptima disburses government funds to companies and hospitals that provide health benefits to Medi-Cal patients. About 300,000 Medi-Cal patients and an additional 30,000 in the Healthy Families plan are served in Orange County. Western Medical provides for about 4,300 patients a year.

Dan Brothman, Western Medical’s CEO, said the hospital receives about $900 a day from CalOptima to treat and provide medical services to at least a dozen indigent patients daily. But at that rate, he said, the hospital is losing money.

“We want to fix the contract with CalOptima but with the current financial arrangement, we have lost in 2005, close to $10 million. We need to negotiate,” Brothman said.

If the center quits the CalOptima program, it would mean more of the poor would have to travel farther for care and wait in longer lines.

“If Western Med leaves CalOptima it would be a loss and a substantial burden on the remaining hospitals serving the poor in the county,” said Julie Puentes, a spokeswoman for the Hospital Assn. of Southern California.

The hospital is one of seven primary hospitals that contracts with CalOptima to serve the poor. The center’s location, and the fact it is a hospital capable of providing complex medical care, has made it an important partner, said CalOptima CEO Richard Chambers.

“Their location in Santa Ana is good for our members,” Chambers said, adding that he intends to meet with the center’s representatives soon and hopefully resolve the situation. “There’s no question that hospital demands have gone up,” Chambers said.

“The problem is that more and more CalOptima enrollees are trying to get more services at Western Med,” Brothman said.

The issue of funding medical services for the poor was exacerbated after UCI Medical Center in Orange recently pulled out of the CalOptima network and switched to another.

UCI saw about 18,000 poor patients annually, including 5,000 aged and disabled and an additional 13,000 in the Healthy Families plan, CalOptima said.

The concern at Western Medical, Brothman said, is that the hospital’s losses could grow if nothing is done.

“Western Med is the oldest hospital in the county and we’ve been taking care of poor people for 103 years,” he said. “We’ve been in CalOptima since its inception 10 years ago, and want to be with it another 10 years. But we need to resolve this now.”

Chambers said that CalOptima, which has a $790-million annual budget, has had its own financial troubles. Once flush with more than $200 million in reserves, it has operated at a deficit the last three years.

A recent $50-million payment from the state as part of a rate adjustment bolstered the agency’s finances, he said.