HomeMy WebLinkAboutMINUTES - 03031987 - S.12 S, I
Ta BOARD OF SUPERVISORS
C�ontra
FROM: Supervisor Sunne Wright McPeak Costa
DATE: Introduced February 24 , 1987 for Action on C01M
March 3, 1987 .
SUBJECT: MediCal Cuts and the Consequence to the Medical and Health Care
System in Contra Costa County
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) Q BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS
In order to further educate the public about the state of
pending disaster in the MediCal program, MIA funding and the
medical and health care system in Contra Costa County, the
Board of Supervisors requests:
a. The Health Services Department send copies of
testimony by Mark Finucane a.nd Sunne McPeak ( to the
Joint Legislative Task Force on February 18, 1987 )
to interested persons in Contra Costa County,
including:
- Taxpayers Association.
- Elected directors of -the three
hospital districts
- The Board of Directors of' all other hospitals
The. CEO and Medical Staff Chair of all
hospitals
- The AACMA
- Concerned Physicians '
- Contra Costa Health Coalition Board of
Directors
- The appropriate citizen advisory bodies
to the Department and Board of Supervisors
- City Councils
- Central Labor Council
- Contra Costa Council,
- Publishers and editors of all newspapers
- Other media representatives
b. Contra Costa County co-sponsor with the Contra Costa
Health Coalition a community forum on the MediCal
issues . The purpose. of theforum would be two-fold:
1 . To discuss the major concerns by all parties
regarding the MediCal program and other related
issues.
2 . To seek consensus on an action to plan to
correct the problems .
CONTINUED ON ATTACHMENT: x YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OI BOARD COMMITTEE
APPROVE OTHER
i
SIGNATURE(S)
ACTION OF BOARD ON March 3, 1987 'APPROVED AS RECOMMENDED X _ OTHER
VOTE OF SUPERVISORS
X UNANIMOUS (ABSENT I ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
CC: Health Services Director:'. ATTEST'ED
County Administrator PM sakivtlof, OtA of the board of
Uwryimn and County Adr*iwator
.
19Y 1/� �
DEPUTY
Medical Cuts and the Consequence
to the Medical and Health Care
System in Contra Costa County
February 24, 1987 Page 2
i
BACKGROUND
See attached testimonyjeditorials and letter. It is essential
that the Board of Supervisors take aggressive action to inform
the public and get a response from the state.
I
I
Qt-�0 Cl. Monday, February23 1987` • , ' ;::Oekfikod 'Caiitornin
— TYi'e Tribune.., '
,. ... '. ",.,••.� . ` ••.. :1:;, ;'fir:•. r,'•',,•'
. ore .dolkrg- OM& ®� 9
i. . .
' •California's Medi-Cal health.insurance° ` care: The law was passed after a disastrous;
prografri� and.,the; low=incom_ e ;people it",.;' ;experiment with public';HMOs.in Aritiona. ';
serves are in so much trouble that no short- A.. Rand'Cor ex' eriment .in;. Seattle.: ;
.. t P:.. p
term; Band-Aid:solutions wilFdo the.job: :' found that HMOs•can leave seriously iil,.lowv-
Doctors; hospital 'administiators,' finan-w " ` income.patients in,even,;worse shape at the''r•:'
tial experts.and patient advocates.are giving:,:..:.same time that they improve.the health ot1+:
drama tic'testimony in city after,city ..that: '.'everyone else:; The"researchers` said their;,':-
';,,the,Medi-Cal budget is so tight that patient finding was ;`a•real'jolt: They have trouble "-
j
-.,..-.care -is suffering. ; ''explaining it,':,but_suggest.,that: the, poor...;...,
The'..10 percent..cut `in.':reimbursements _ ; aren't aggressive enough:to, demand suffi=
"Gov. Deukmejian has ordered"for"the rest of tient health :care.
;;:,this, fiscal..year,will.only'make.that problem:,' . Contracting•:wittiYdoctorsT1. .1 ht save
'';.worse. The courts have.temporarily blocked some money 1without cutting,the;;quality of,
,the:cut twice. The Legislature is on Its way,._„ ;Medi,Ca1 care:::That seems to be the experi ',%
-`to blocking it per Lawmakers ' : ence with the hospital,;contracting,� . gram'..
should.override the governb"s' veto if.he'is %°,:,begun:,in,1982 .as,'one..dU.h ikserQ."`6 :cost=
1 t ...4; ... G J.
heartless enough to use;it.'G`"' # cutting
Medi:.
changes,• ,;,•;.;, ��,
Instead-of proposing more cuts.;for fiscal Coritracting.;forced_hospitals<to;'lower .:.
;1987-88, the Deukmejian...administration ' ��,;their costs and compete'.for. llQedi=Cal' busi=
should wait:for long-term recommendations ;; :';Hess.. It limited�'the choice of'-Medi-Ca1-pa=
,•from the Joint' Legislative: Task Force antients, requiring:;them`to.go;to tiospitals,,that,
'Medi-Cal, which is conducting the 'most ex= . had contracts for,�,all' buc,.emergency,;care.-;
tensive .examination'..of.'the�,program,';since That:`appeared,x�howeve ;''to'be `the,least=.: .ti
1982 in hearings around the state..Its recom �: damaging change.made, •;;:
;menoations are tentatively due in April. With,doctors dropping.out.'of the:program
The task force is looking.at a wide range ,` PJ-. because'-of'paperwork'
of issues 'from the -dumping' p "' "
p' g of poor and � "and�•low reimbursement' ..
;;..uninsured patients to Santa Barbara,Coun- rates; `doctor contracting
t 's takeover of the Medi=Cal: ro ram`from PLEADING :•
y p• g. FOR { i should,','I et ::physicians; '
;!Lthe state. . i
i who,care.about,treating
.Other options under consideration by' the:poor'negotiate::rates
Cliff.Allenby,, 0 4eARS +
ornia's� new health and� '�''•` �they +feel they• can. live
;,.Welfare secretary, include: .:. with. ' :....:.. :.:
i :;.,
o Continuing the 10 percent rate cut now;,;. 'j�� While the, potential,:
r�:: u�num;u .While. ,
in effect for doctors, pharmacists and some "savings from doctor.con'
-other Medi-Cal services.' . ' tracting, and HMOs can , •;
m Dropping. some''of the"36 optional . -:„ not�be accurately:pre'4-
.health-care programs now available. , ; I ISI I:. dieted now; it is possible
0Placing . all, Medi-Cal recipients ,in;; r•..,-;.�;. ;,,: that: neither.--would save,
Health Maintenance Organizations; and con •very much.
—tracting.with those groups.for their.care. i:•r :°,. If so, the `state:may be;left:with'only two'
There is a fourth option Allenby.,should ;:!. choices: Finn;the"money necessacy:A6: 'pro-
,
. examine:,contracting with doctors the way- !' '.,vide an acceptable,level.of:Medi-Cal;care,.or
'the state contracts with hospitals for Medi- 'drop the levels of care again.
Cal services. If those are;the.choices;'they. need to be
Continuing the 10 percent rate cut would' faced openly;; without the Deukmejian 'Ad-
be. intolerable in human terms. It would ministration's sleight-of-hand' 'assumption
speed .up the present trend-for doctors to that the a 'are substantial savings,'yet,to,be."
,—stop taking on Medi-Cal patients; and hasten .squeezed-from Medi-Cal. '
the program's decline. ; There is ample evidence that Medi-Cal is
Dropping too many of the 36 optional already much�cheaper::and more:cost-effec-.
,health care programs available under Medi- Live than private health care.,.And Medi-Cal1r ,
.,'..:,Cal-is also a loser. The governor argues that costs have risen only 40 percent since'1978-
-.Medi-Cal recipients enjoy more choices than . 79, while private.health, care costs' soared .
are available in typical private plans. He 190 percent: ;°
forgets that -private plans assume their Faced with'those•options;A'he`staie must
:.members can afford to buy optional services fund Medi-Cal either.;..b}i::cutting.other..pro
eyeglasses and dental services — on grams, such as transportation br'}prisons,;'or•-''
the private market. Medi-Cal is for people raising taxes'and•modifying the Gann spend-,;,
-,uho cannot afford private health care. __,Ang limit. :.• `
a .Rutting .Medi-Cal recipients in HMOs- None-of thgse!options.is.'attractive. 'Cali-
might also save some money:But potentially ' fornia'already'ranks near.the bottom Ain the..
". 'serious problems would have to;.be over amount. of money per.year:it.sper-ds' on the.
±
;come. "•:care of its poor. it cannot•humanely;do less
. : A federal law prohibits public HMOs for .::::,than it is. doing now, and it'should,do.more'.
poor people, unless they are offered the
: .
choice of: an alternative form of medical :;:Tomorrow: ,Where to find.therevenue?..'...,
T
... kk, — i'he• Tribune ®attaa�d, CraBitoSim
ra P' rog
They are not pretty, these human trage- " • percent of.what insurance.companies pay,
:. dies coming to light in California's $5 billion; paperwork is staggering, and repayment de-
Medi-Cal health program for.the poor. Hor-: lays of months are common. A year,ago,
,.nor story after horror story is emerging Southeastern'San Diego County had 33 obste-
from the most extensive series of legislative ; tries-gynecology doctors who accepted.Me'di
hearings `on Medi-Cal care since the last 'Cal patients. Now there are only four,.Task
."major round of cuts five years ago. ' ...'..force 'staff. members estimate that more
After listening to hours.of testimony-ear- -than $2:5,billion in costs this year will not be.
'.lier this month in Oakland, Sacramento, San reimbursed by the state. '
Diego and Los Angeles, the chair of the Joint a Alameda County is considering closing
Leislative Task Force or, Medi-Cal, Assem-. some health clinics, and Supervisor Don Per-
blyman Bruce Bronzan;'D-Fresno; concluded ata has wondered aloud whether. Alameda
that "the system is on the verge of collapse",- County should,pull out. ;
from underfunding. Contra 'Costa County could lose as .
Slowly tightening Medi-Cal purse strings much .as 25 `percent 'of its.skilled'nursing
, ,are squeezing people out through the,bottom facility M66-Cal beds this year because of :..I
-of.the "safety net," leaving them unable to ' long-term underfunding ,of long-term.:care.. ': ,
,(:fend for themselves in 'a high-priced jungle This is.devasiating to theelderly.
' of private health care. m San Bernardino County canceled` its
Gov:.: Deukmejian, by. speaking only in county hospital Medi-Cal
to ms of .a need .for still.' more. Medi-Cal contract after treatment
al budget cuts, is not being forthright about the ����®g� costs reached $200 more
crisis. Nor is his Department of lHealth and per patient per day.than,
Welfare,�as it delays for an average of two FOR ! the state would pay.
to*. three months payment tohospitals and Now,it can't find doctors
'doctors for justified medical costs. RS to.accept.."a large num-
Some-examples
umSome examples of the testimony: ger" of Medi-Cal pa-
®The 1982 Medi-Cal budget. cuts, which.. . tients who need sched-
n�aiiunne�
.saved about $574 million in their first year, uled surgery: .These in=
';clearly added to the burden of illness borne _ elude "patients '.who
by the poor, in many cases with serious 1 q II have' been diagnosed as
'adverse consequences both for access to 11 having cancer and re-
care and for their health, according to E. quire surgery within. a
Richard Brown of the UCLA School of Pub- short period of time, but not immediately."
lie Health. o Each Medi-Cal cutback throws more
s ®California ranks 47th of the 50 states in : patients"onto.overloaded county health sys-
,the amount spent on.each eligible Medi-Cal terns already staggering from reductions in
recipient .per year. Only three states, Ala- other state. medical aid. The results are
i '.,'<bama, Mississippi and West Virginia, spend waits of months for non-emergency exams, a
less than California's $1,300 per person..The virtual end'to preventive health care, sicker
national average is $1,800 per person. New. .,patients, and. patients being turned away.
—York state spends $3,400 per person. Los Angeles'County,'which has been repeat-'
s California's drop from, seventh best in edly sued for charging patients who should,
'the nation in infant mortality in 1970 to 14th get. €ree 'care,.threatens to shut down clinics',
best .in 1983, and from 10th best in early if the state make's further cuts. 1
I prenatal care to women in 1970 to 1.4th best Given these conditions, the impact of ad-
in 1983, is attributed partly to cuts in medi- ditional cuts the, governor favors — a 10
;cal care for the poor. percent.reimbursement cut now, and a, $150.
e The only careful study of medically.. million .slash in the.1987-88 Medi-Cal budget
indigent.adults found their health and access = will 'be intolerable in human terms.
to care became significantly worse after "The bottom line is that people are going
' they were pushed out of the Medi-Cal pro- to die," says Contra Costa County Medical
gram by the 1982 cuts, and forced into conn- Director Dr. William Walker. "The state is
ty-run health care systems. Some died as a basically adopting; a policy. of cutting back
result .of losing Medi-Cal benefits. until the squeal level is high enough, and the
.m Large numbers of doctorsall over the question is how many tragedies there will
state are refusing to accept new Medi-Cal have'to be before the need is seen."
patients, because payment rates average 47 Tomorrow: A look at khat-can be-done.
. 1161 Leisure Lane No . 7
Walnut Creek , Calif 94595
February 1 ; 1987
Honorable Nancy F'ailden ; Supervisor District 2
Honorable Sunne Wright McPeak ,. Supervisor District 4 - Chair
Contra Costa County Hoard of .Supervisors
Honorable Supervisors: . RE : County Health Care System etc .
Today ' s Times carried: an article. , "Should county stay in the hospital
business?" .
Some of my thoui,hts on the -overall subject o.f County Ilealth. care
services. werle incorporated: in a letter ' to the Editor of the Tunes ;
copy provided to your IIonorable Board . (Letter not printed)
It seems to me at least some of the argument now extant is
philosophical and really has little to nothing; to do with providing
of health care to people .
r.irst. oI:f , if I we e' a hospital administrator I ' d look w- t:h great
favor on the closing; ' of- the County facility . I would expect many
Patients now domiciled in tlie . County facility.. would be in °DIY``
institution . That :leans my average occupancy rate �-jould ba JP;
V Hosai.tal ' s, ero'ss; income should likewise be up . My doctors. , • at
the intern and resident level would have some "interesting," cases,
to care for . My staff doctors would be pleased (diespite protestations
about the low -il fPecz) i'or they would have some rather guaranteed
income resultinn from c. .r-: and troatment of County patients .
Assertions I r the Ta xpayC-,.-s Associatioa are , IT; mV view no.t
particularly i.n point . IL. Is certainly true that many iiosp-li.tals ,
both public and private are no longer in. existanc.e . . Reasons for
each suc11 facility ooi.nn . out; of business" would have to be .e:talyi-n6d
to develop why the facility � no longer exists : Suffice it here to
s11V a r( o 1 u t i o n has— ocCUr r:ed in provi.i.ii-ng acute h o s p i Lai care.
T.he revolution has seated a:' .surplus of acute care hospital beds .
Fla,vin;; 1400 er.:pty beds i.r. other hospitals is no criteria for the
County to make a health care decision . ti critic could caGi .Iky argue
(if the County did 'close its hospital and contract w:i.th other
hospitals for care. for Gounty patients) , that the county was
subsidizing, the other hospitals, at the expense of the taxpayer .
I don ` t know the physical state of the 'present County facility but
gather it is in need of modernization . 0n that as.suniption , it 140uld
make a great deal of tsense to me for the Count; to develop a Ilan
for iip;,rading; an acute general hospital . High specialty diagnostic
problems could be contracted for . In this sense the other faci.1ities.
that provide s�uch services would be com?. etin;; with each other . The
County could develo a: contractual arrangement that would be favorable
to the County .
There may also be some problemwith the Board of 'directors of the
institution . i am not well enough I n f o r m e.1 to do other than present
the point just asserted .
From. :my vantage )oirt one of '1"1{E major pr6blems. 'for the County is
the issue of fuiiding . The States :participation in -fundin.0 for care
for Medi-cal patients - .1-i-as not kept pace with the needs of the people ,
t
T . . I
counties and/or health care p r(5b I em S i s, 'extremely difficult
to maiDt'ain quality of c.-are , service., and employee moral-6 if there
3
contirojous issu.e over continued'- ey.istance of the County Ho s p i ta 1
.')o, the f thn 1. IIA gh riora le st i 1.1 c'X.ist s, is revresentat,iv e of the
interest and and dedication of h c! Sta'ff .
A nalli C On L.r C,I f %:I-I i S J t i i t in n h-i s s i g n i f 1.c a n t mean i.nv, f o r
maintaining control of staff , quality, of car( I%Ihen patient
Care -.i.s con't-racted ou' L I wciild believ2 the r0ounty will 1--ileely Find
--i i n n
siOr- if icLi;it problems c o F3 L c.o,,i t..,
Respecufully
A . B . Mc?'Iabney
N