North County Indigent Health Plan Rescued : 11th-Hour Agreement Signed With Medicus Systems

As a North County medical system for indigents approached collapse Thursday, health services officials announced a last-minute plan that would continue to provide essential care for hundreds of patients.

The county has signed an six-month agreement with Medicus Systems Corp., its private medical administrator. Medicus will replace North-East San Diego Health Plan, which ended its contract Tuesday with the county, citing losses in excess of $1 million and stating that it would no longer administer the county’s network of clinics, physicians and hospitals in North County, said Supervisor John MacDonald.

North-East San Diego Health Plan was one of four regional medical coordinators that participated in the County Medical Service (CMS) program that treats indigent patients, usually in hospital emergency rooms. The four regional coordinators, in turn, have been overseen by Medicus Systems Corp. at an annual cost to the county of $740,000.

A review of the North County program by health officials and county supervisors determined that the CMS program in North County could not only be salvaged, but also improved by expanding the role of Medicus Systems, which is based in Evanston, Ill., and by increasing the number of clinics.

Medicus Corp.’s contract with the county will be increased by $370,000. As the North County’s regional coordinator, Medicus will conduct hospital reviews, distribute payment for services and coordinate patient referrals.

The county has signed a contract with Medicus and participating North County medical facilities that should alleviate CMS program flaws, said Paul B. Simms, deputy director of the County Department of Health Services.

The new contract targets problems such as delays in payments to hospitals that provide indigent care, excessive use of emergency rooms for minor problems and difficulties in case management.

The CMS program cares for patients between the ages of 21 and 64 who cannot afford medical insurance nor qualify for the state Medi-Cal program. During fiscal 1987, 4,548 individuals were treated at participating hospitals, clinics and by specialists 11,414 times under the CMS program.

“One of the consistent complaints we received was that the hospitals were not being reimbursed on an effective and regular basis,” MacDonald said. The new contract counters that by ensuring all hospitals will be paid in advance from a set of special funds, Simms said.

State funds provided to the county for indigent care will be divided into three accounts: $4.5 million for acute care; $2.1 million for specialist care and $1 million for primary care.

North County hospitals participating in the program are Tri-City Medical Center, Palomar Medical Center, Sharp Memorial Hospital, Scripps Memorial Hospital-La Jolla, Fallbrook Hospital, Pomerado Hospital and Scripps Hospital-Encinitas.

Although still “gravely concerned” about losing revenue from providing indigent care, Wayne Wilson, marketing director at Tri-City Medical Center, said he was pleased with the new CMS contract.

“We are budgeting a $60-million deduction in revenues for the upcoming fiscal year” because of bad debts and partial reimbursement from the state, Wilson said. “We are fully aware that we are being underpaid under this contract, but without it we would be paid nothing.”

Wilson called the rapid formation of the new contract a “yeoman’s effort,” and particularly praised the addition of more clinics to the primary care network, through which indigents receive routine medical tests and treatment of minor injuries. He said the additional clinics will help ease the burden of caring for indigents that sometimes fall on acute medical treatment centers such as Tri-City Medical Center.

“We are an acute medical treatment center that is suited primarily to deal with urgent emergency cases,” he said. “There are many cases that are better suited to be handled in the clinics. We’re hoping the new program will siphon those cases away from us.”

The new clinics in the primary care network are the Vista Community Clinic, Fallbrook Community Clinic, ECS-Family Health Center, Linda Vista Health Center, Escondido Community Clinic, Samahan Clinic, and Tri-City Medical Center.