County May Try Wooing Doctors for Prenatal Care

County supervisors next week will consider a plan to persuade obstetricians to accept Medi-Cal patients by helping the doctors cut red tape and by doing the billing for them.

The proposal for a public-private Perinatal Provider Network was developed by Supervisors Leon Williams and Brian Bilbray, after the full board approved the concept in May 1989. The final plan has been placed on the supervisors’ agenda for consideration next Tuesday.

The prenatal network contains several innovative elements:

* A county-run electronic billing system that would bill the state for Medi-Cal patients’ are and pay doctors within 30 days.

* Addition of trained workers to Department of Social Services offices to help pregnant women obtain quick Medi-Cal certification.

* Three street outreach workers who will canvass coin-operated laundries, parks, community events and thrift shops looking for pregnant women, to inform them about available prenatal care.

These key provisions of the new system are designed to get women into prenatal care as early in their pregnancies as possible, and to overcome red tape that doctors say keeps them from taking Medi-Cal patients.

A 1988 survey of San Diego obstetricians found that heavy Medi-Cal paperwork--for instance, a 90-line billing form for even an uncomplicated birth--and slow reimbursement were their biggest objections to the Medi-Cal system. A year ago, only 49 of 241 practicing obstetricians in the county accepted Medi-Cal.

For the patient, the cumbersome Medi-Cal certification process can keep a woman from seeing a doctor for six to seven weeks, the county says. The special eligibility workers will be charged with reducing that to two to three weeks.

To become part of the county network, a physician will have to agree to accept at least one pregnant Medi-Cal patient per month.

This is similar to the requirement contained in a pilot patient referral service being operated by the American College of Obstetricians and Gynecologists in San Diego. Since its inception last spring, the program has put 55 obstetricians on its list of those accepting Medi-Cal. Of those, 34 had not accepted such patients before.

Dr. Lisa Firth, who heads a regional cooperative that monitors prenatal care, said she doesn’t expect the county program to add significantly to that total, despite the lure of help with billing.

The county program’s main function will be to coordinate services for poor, pregnant women, she said.

This leadership and coordination role will be particularly important, with UC San Diego possibly backing off from operating the Comprehensive Perinatal Program (CPP), Firth said. That program provides prenatal care and delivery to up to 130 poor women a month.

UCSD’s Reproductive Medicine Department announced Oct. 16 that it was ending the 10-year-old CPP because of financial losses. The university later said that had not been a final decision, and that it was negotiating to have the program continue somehow under the auspices of community clinics.

The proposal before the Board of Supervisors acknowledges that services to uninsured pregnant women in the county have been a patchwork that women find hard to negotiate.

“Even when services exist, indigent women must overcome formidable barriers to access them,” it says. “An increasing number of women are failing to overcome these barriers.”

It notes that, of 45,298 babies born in San Diego in 1988, more than a quarter had mothers who did not obtain care during the first trimester of the pregnancy. Early care is needed to detect complications that could lead to premature birth or other problems.

Nearly 4,000 babies were born in 1989 in San Diego County to women whose first medical care for the pregnancy was in the hospital emergency room, after they went into labor.