Governor’s Plan Could Hurt Many, Task Force Told : Medi-Cal Cuts Called Bad for County’s Health

Health care for 150,000 poor and uninsured people in San Diego County will be severely jeopardized by the broad cuts proposed for the state’s Medi-Cal program, county medical authorities warned a legislative task force Wednesday at a hearing in San Diego.

Already, one hospital has terminated its contract to care for Medi-Cal patients, and three others have considered following suit. Low Medi-Cal reimbursement rates have convinced all but 10 obstetricians in the county to refuse to take Medi-Cal patients, authorities claimed.

They said the county’s problems are especially acute because of its large population of legal and illegal immigrants needing medical care, its growing numbers of women of child-bearing age, and because it is the fastest-growing county in the state.

“Hospitals will experience an increase in patients showing up at their emergency rooms with problems already in advanced stages that could have been prevented with adequate primary care,” warned Gabriel Arce, chief executive officer of the San Ysidro Health Center.

“This would increase the cost of medical care to the state, and institutions will find themselves absorbing losses beyond what they can afford,” he told the bipartisan task force, which was formed last month to try to solve Medi-Cal’s $280-million budget deficit.

The Deukmejian Administration has proposed a 10% cut in fees paid to physicians and other providers, and a $150-million general cut in the program’s $5-billion annual budget as a way of solving the program’s financial problems.

The 10% fee cut was scheduled to take effect Monday, but has been delayed by lawsuits filed by several medical associations. Meanwhile, the legislative task force is holding a series of hearings statewide and intends to come up with a counterproposal.

“Far from being the ‘Cadillac’ of programs the present Administration claims it to be, we are finding our Medi-Cal program seriously under-funded and we lag behind 10 other industrial states,” said Sen. Alfred E. Alquist (D-Santa Clara), one of two legislators at the hearing.

The specialty perhaps hardest hit by Medi-Cal cutbacks is obstetrics, county medical authorities testified Wednesday. They said the $675-per-case reimbursement rate is inadequate to cover nine months of prenatal care, delivery and postpartum care.

In part as a result, a poll of 207 women who gave birth in local hospitals in a recent 48-hour period showed that 10% of them had had no prenatal care, testified Kim Warma, coordinator for the system that manages perinatal services in San Diego and Imperial counties.

She said that figure is 43% higher than the state average. The women reported that they couldn’t afford a doctor, couldn’t find one who accepted Medi-Cal, had no transportation or were Mexican nationals, Warma said.

Another recent study found that 1,200 pregnant women were turned away from community clinics in a recent three-month period. The study said that clinics have had to cap the number of new obstetrics cases they take on because of the shortage of doctors who accept Medi-Cal.

Jacquelin Trestrail, president of the San Diego County Medical Society, testified that obstetricians are also refusing Medi-Cal emergency room cases because of the lack of prenatal care and the disproportionately high chance of malpractice litigation.

As a result, Trestrail and others said, three hospitals are hiring private obstetricians to handle emergency walk-in deliveries, and the hospitals are considering paying the malpractice insurance themselves.

Meanwhile, Tri-City Medical Center has terminated its Medi-Cal contract. Palomar Memorial and Pomerado hospitals recently moved to terminate, then negotiated a new agreement with the state. Grossmont and Paradise Valley hospitals have also considered termination.

Paradise Valley Hospital, where 35% of its patients are in the Medi-Cal program, last year lost $1.67 million on Medi-Cal patients alone, said Dr. William D. O’Riordan, chief of the medical staff. He said it has lost $3.6 million on Medi-Cal since 1983.

O’Riordan said the 10% cut in Medi-Cal reimbursements for doctors could force physicians who use the nonprofit National City hospital to stop accepting Medi-Cal patients, thus cutting into a large source of the hospital’s patients.

But if the hospital terminates its Medi-Cal contract because it can no longer afford the losses, it runs the risk of losing a third of its caseload and could be forced to go out of business, said O’Riordan.

“Either way, we’re in a Catch-22 situation,” O’Riordan said in an interview after the hearing. “ . . . We’re in trouble because of the present rates paid on a per diem basis. If they go down, God help us.”

The heaviest burden from Medi-Cal cutbacks will fall on Southeast San Diego, where 47,000 of the county’s Medi-Cal recipients live, testified Dr. Richard O. Butcher, who said that nearly two-thirds of his patients are in the Medi-Cal program.

He said the doctor-patient ratio in Southeast is already a mere one to 1,800, compared to one to 300 in some parts of the county. Butcher warned that the proposed Medi-Cal changes could further reduce the number of doctors serving Medi-Cal patients in Southeast.

“This could shift a patient to a more costly emergency room visit than the physician’s office,” he added. “In a survey of emergency rooms and physicians’ offices, the average cost is $215 versus $75.”

Countywide, the caseload of indigent and uninsured adults increased substantially last year, according to Ruth Martin, vice president of Medicus Systems Corp., the county’s administrative contractor for medically indigent adult health services.

She said hospital admissions rose 11%, hospital days 9%, emergency room visits 5% and outpatient visits 27%. Without an increase in state funding, Martin said, the county will have to tighten eligibility standards or cut services.

Either way, the county would simply be denying care or transfering its own bad debt to hospitals and other facilities, she said.

“Increased productivity isn’t enough,” said Martin, noting that many rising costs cannot be controlled because they come from increased immigration, an aging population and changing technology. “There needs to be more money in the system.”

Steve Schubert of the San Diego Council of Community Clinics said: “If you’re going to deliver quality health care to a population that’s obviously in need, it’s going to cost.”