L.A. County slashes doctors’ reimbursement rate


Emergency room doctors and on-call specialists treating poor, uninsured patients at private hospitals in Los Angeles County saw their reimbursement rate slashed by county supervisors Tuesday.

The rate cut could lead private hospitals to close emergency rooms and send more patients to crowded county hospitals, officials said.

L.A. County reimburses doctors 27% of estimated fees for patients’ first three days of care at private hospitals under the Physician Services for Indigents Program. Supervisors voted unanimously Tuesday to reduce the rate to 18% as of July 1. Supervisors last reduced the rate from 29% in January 2009.

Supervisor Don Knabe said he regretted the rate cut.

“Financing at that level to pay doctors for 24/7 lifesaving emergency care is an insult to the doctors and a further threat to the already-fraying hospital emergency care safety net upon which we all depend,” Knabe said. “I will move approval only because the alternative is even worse -- no payment at all.”

L.A. County Department of Health Services had suspended the reimbursements July 1, meaning no doctors have received payments for treating uninsured patients since then. Knabe has demanded that county heath officials make those payments, but at the reduced rate.

About 4,700 doctors will see their reimbursements cut countywide, said Carol Meyer, the health department’s chief network officer. Under the new rate, doctors would receive 43% of what Medi-Cal pays for the same services. Medi-Cal is the state’s public healthcare program for low-income residents. Recipients must meet certain qualifications for coverage.

“The [county] health department has a $200-million deficit. The state’s not going to give us anything to fix it. There is no one to backfill,” Meyer said.

The county had expected to pay doctors with $9 million from the state’s Emergency Medical Services Appropriation. But state lawmakers eliminated the fund, and as the number of uninsured grows, private doctors are expected to file more claims than ever with the county this year, Meyer said.

Meyer estimates that Tuesday’s action will affect roughly 150,000 patients. Those patients are predominantly childless men between the ages of 18 and 50, who are not disabled and do not qualify for Medi-Cal.

“There’s no new source of funding to fill that gap,” Meyer said.

Doctors will probably look to hospitals to make up the difference, officials said. If they can’t, hospitals may lose doctors and be forced to close emergency rooms.

“It depends just how much pressure is put on those hospitals,” said Jim Lott, executive vice president of the Hospital Assn. of Southern California, “Some hospitals could be pushed over the edge by this.”

More than half of Los Angeles County’s 72 hospitals are operating at a deficit and two are in bankruptcy, Lott said. Countywide, 11 hospitals have closed since 2002, all of which had emergency rooms, he said.

Meyer said county officials consulted with doctors and hospital officials before proposing the rate cuts. But doctors said they would have appreciated more time to develop alternatives.

“It seemed like it happened all of a sudden,” said Dr. Robert Bitonte, president of the Los Angeles County Medical Assn. “It will impact indigent care, there’s no doubt.”

At White Memorial Medical Center in Los Angeles, Dr. Brian Johnston, medical director of the emergency department, said he was glad supervisors planned to revive the reimbursements, but that the rate reduction will probably drive away many on-call specialists and emergency room doctors. He said that roughly 25% of patients he treats are uninsured.

“We have physicians who are working now who are not being paid for caring for those patients. They can decide to move to another state or another specialty. It’s a real threat,” Johnston said.