Director Says O.C., State Can Help to Save Hospital : Mary A. Piccione remains optimistic, outlining plans to cut expenses and attract private patients.

How do you turn around a hospital that lost $10.9 million?

Mary A. Piccione, executive director of UCI Medical Center, took the question in stride.

“Some people have described it as turning--what’s that ship in Long Beach--the Queen Mary,” she said with a laugh, adding that large ships turn slowly.

And in her three years at the helm of this sprawling, debt-plagued medical center, “sometimes it’s felt that way.”

Still, during a rare interview at the hospital’s executive suite, Piccione was upbeat as she outlined plans to cut expenses, attract private patients and continue building a major university hospital.

Among her priorities are:

* Expanding “state-of-the-art” programs in cancer, cardiac surgery, psychiatry and infertility services.

* Opening a birthing center this September for low-risk patients. Staffed by nurse midwives, the center is expected to relieve crowding in Medi-Cal obstetric units and offer indigent and private patients alike a natural alternative to a high-cost hospital birth.

* Offering an innovative proposal to reduce costs and relieve crowding at the county’s emergency rooms by starting a foundation that would provide basic medical care for the poor. “I liken it to a Kaiser-Permanente for the indigent,” Piccione said, referring to the successful health maintenance organization.

Every day, patients who can’t afford a private physician go to local emergency rooms for minor complaints, she and emergency room doctors said. But “emergency rooms are one of our highest cost centers,” Piccione said. “And they’re not the most cost-effective place to provide primary care for colds, flus, bronchitis.”

A new foundation would work with physicians and community clinics to provide basic care. Piccione recently circulated a draft of a UC Irvine “community-care proposal” to state and local health leaders. Details on how it would work and how doctors would be reimbursed are still under discussion.

Piccione’s ambitious plans come at a time of crisis for her medical center.

Saying a flood of indigent patients is forcing the hospital into bankruptcy, some UC regents are threatening to close UCI Medical Center if county and state officials do not contribute more for care of the poor.

Piccione declined to discuss the regents’ threats, except to say: “I think they’re serious. They’re very concerned about financial viability.”

And she concurred that her medical center cares for too many indigent patients. Of 19,000 admissions last year, about 60%, or 11,000, had no private insurance, she said.

“I don’t speak for the regents,” she said. “But the indigent problem is the responsibility of every citizen. It’s not the responsibility of the university.”

Still, Piccione insisted, she and her staff had made gains.

“We’ve stabilized the (financial) environment,” she said. “We were able to negotiate better Medi-Cal rates. We were able to negotiate more obstetrical care” last year, persuading county officials to spend $1 million in state money on UCI’s birthing center.

Also, the medical center staff has worked to limit costs, she said. Costs per day rose 3% to 4% last year compared to a national average of 7%.

One major concern still not resolved is Piccione’s effort to restore “the Medi-Cal network” in which every Orange County hospital would take its fair share of indigent patients.

The medical center has still other initiatives, noted Gregg Masters, Piccione’s senior associate director of external affairs, who is actively marketing the hospital.

Working with surgeon Alan Gazzaniga, Masters recently organized UCI physicians into a formal Clinical Practice Group. With this unit, Masters said, the medical center hopes to market itself aggressively to health maintenance organizations and gain more private patients.

Masters also started a UCI Physicians Referral Service, which receives 250 inquiries a month from prospective patients. And since last June, the medical center has spent $100,000 promoting itself with ads in local papers and the Yellow Pages, as well as 30,000 informational flyers sent to the county’s new homeowners.

“I’m the eternal optimist . . .,” Piccione said. “We’re doing all we can now. It’s up to us to be as efficient as we can be, to be as cost effective as we can be.”

But with regents considering closing the hospital, Piccione also issued a warning: “Now it’s time for the citizens of Orange County and the state to help us,” she said. “If they do, we’ll continue.”

And if they don’t? “Somebody else will be doing it,” Piccione said.