State Plan Could Keep UCI Medical Center Public

A plan to boost the number of patients at UCI Medical Center--and derail the teaching hospital’s controversial proposal to merge with a private health care chain--has been quietly added to the proposed state budget in Sacramento.

Not only would the budget proposal stall the university’s negotiations with the nation’s two largest hospital chains, it also would require changes in how Orange County’s Medi-Cal HMO program operates and would mean that other local hospitals would lose patients to UCI.

Approved last week by the Legislature’s budget conference committee, the provision would require the University of California to work with local agencies to devise an “emergency plan” that would funnel an increased number of Medi-Cal and indigent patients into UCI Medical Center, where the patient load has decreased in recent years.

“We would like to keep this public university hospital public,” Assemblywoman Denise Ducheny (D-San Diego) said Tuesday.

She added the provision to the state budget after meeting repeatedly with UC officials and studying the issues causing financial troubles at several UC teaching hospitals.

The budget provision is a “first step” that would be law for only one year, she said, but it would buy the medical center and Orange County time to work out a long-range solution.

“This would get them on the road, and then they could find ways to keep this plan in place.”

Mark Laret, director of UCI Medical Center in Orange, said that if the provision passes, the teaching hospital will drop its current negotiations with Columbia/HCA and Tenet Healthcare.

“This is a go-it-alone strategy,” he said Tuesday of the budget proposal.

The proposal calls for a coalition of state and local agencies to develop a plan that would allow UCI Medical Center to attract as many Medi-Cal and indigent patients as it served in 1991-92. (According to the medical center, the daily average of publicly funded patients then was 195, compared with 119 last fiscal year.)

The proposal also calls for the group to find the medical center money from a combination of sources, including federal funding.

The proposal would directly affect CalOPTIMA, Orange County’s HMO for Medi-Cal patients, as well as the Orange County Health Care Agency and nearly all other hospitals in the county. Officials at many of those institutions learned of the budget provision only this week.

The proposal contradicts one of CalOPTIMA’s basic principles: the patient’s freedom to choose his or her doctor, said Kathleen Crowley, director of public affairs for the agency, which serves about 225,000 people.

The budget provision would require the vast majority of CalOPTIMA patients to be assigned to UCI Medical Center and require them to stay there, she said.

“This would result in a lock-in,” she said.

Further, one of the federal requirements attached to CalOPTIMA funds is that the patient have freedom of choice. “So now, we’re bumping into federal law,” Crowley said.

UCI Medical Center now has about 18,000 CalOPTIMA members, she said. In October 1995, when CalOPTIMA started, the medical center had 50,000, but many patients apparently have left for doctors closer to their homes, she said.

But Janice Wirth, division manager of the county’s Medical Services for the Indigent program, said she thinks the budget provision “would be a good thing” and would better clarify UCI Medical Center’s role in caring for the indigent.

Many critics of the center’s proposed merger with a for-profit hospital chain have questioned whether the chain would be committed to caring for poor patients. UCI Medical Center, once the county hospital, has traditionally cared for the indigent.

Ducheny said she was troubled by the merger issue. It is important to keep teaching hospitals open to the poor and accountable to the public, she said. Merging with private hospital chains compromises both of those goals, she said.

Laret said that if the Ducheny proposal is to succeed, the Legislature must be committed to this solution for the long term.

“If this is the will of the people of California and the Legislature, fine,” he said. “But we must have security that this is not a Band-Aid but a permanent commitment.”

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More Open Beds

A state budget proposal would seek to increase the number of patients at financially troubled UCI Medical Center, where the average daily private and public caseloads have dropped substantially in five years:

*

Private

‘96-’97: 98

Public*

‘96-’97: 119

* Medi-Cal and uninsured

Source: UCI Medical Center