Cuts Sought in Cost of Indigent Care
The county Health Department is seeking to cut back on its reimbursements to doctors who treat the poorest patients, and for now has stopped paying them altogether because it is running out of funds.
In a memo this week, Health Director Mitch Katz said he has "no option" but to suspend payments until the Board of Supervisors reduces the rates that doctors are paid.
But medical experts and county officials are warning that the consequence of reducing those rates is that fewer doctors will want to be on call to treat the county's most destitute residents.
"This could potentially exacerbate an already challenging situation by further limiting availability of physicians willing to be on-call to private ERs," Katz wrote in the memo.
"Ultimately, this could result in further ER closures, longer ambulance transport times, and increased ER waiting times."
Currently, emergency room doctors who have failed at least twice to collect payment from their indigent patients - those who are uninsured and do not qualify for Medi-Cal - can ask the county to reimburse 18 percent of the bill.
Katz proposed lowering that rate to 12 percent for claims filed in the previous fiscal year - or the department would end up $1.2 million in the red.
He also called for adjusting the rate to 14 percent for claims filed in the current fiscal year, to avoid racking up a $3.3 million deficit.
Cathy Chidester, director of the county's
Emergency Medical Services Agency, said doctors receive an average of $50 per claim at the 18 percent reimbursement rate.
Even as he proposed the cuts, Katz warned it might reduce access to care.
Dr. Robert Rosenbloom, who works in the ERs at Olive View Medical Center in Sylmar and Beverly Hospital in Montebello, said the cuts are very "disheartening."
He said it would further discourage not only emergency physicians but also specialists such as surgeons, pediatricians and orthopedists, from being on-call at the ER.
"Those physicians make a determination whether or not they want to be available to be called on weekends, in the middle of the night, for anybody who needs care," Rosenbloom said. "And those physicians en masse have decided that fewer and fewer of them want to take calls and subject themselves to working all night long when they have patients all day Monday, etc."
As recently as two years ago, the reimbursement rate for the Physician Services For Indigents Program (PSIP) was 27 percent, with the money coming from both the state and the county.
The state, however, withdrew the funding in 2009. Now, the county Health Department relies almost exclusively on the Maddy Fund, a portion of the fines charged for traffic violations, to reimburse doctors.
Jim Lott, executive vice president of the Hospital Association of Southern California, expressed frustration.
"How do government officials expect us to keep hospital costs down when they keep cutting payments for the medical care provided to the poor, the uninsured, Medicare and Medi-Cal patients?" he said. "The care still must be provided, and hospitals have no choice but to try to get private insurers to help cover the cost."
The county Health Department's chief deputy director, John Schunhoff, said the recommendation to lower the reimbursement rate seemed better than the alternative.
"One way to do it is to pay (at the current rate) until the money runs out and then the doctors who submit their claim after that just don't get paid anything," he said.
"What we're proposing is to reduce the percentage that you pay everybody, so that everybody gets paid something for a claim, but they won't get as much as they would have."
Lott noted 40 hospitals in California have closed their doors in the last 10 years or so, including 11 in Los Angeles County, almost all of whom cited payment cuts for treating patients sponsored by government programs.
Rosenbloom said everyone who seeks emergency care would feel the pain of the cuts, not just doctors.
"No matter what your insurance is, or even if you have a wad of cash in your pocket, you're going to be affected too," he said.
"That's because the emergency department sees everybody who comes in the door, and when the emergency department is dangerously overcrowded, everybody is negatively affected."