"The physician tells the elected representative, 'You need to vote against this because I'm asking you to.' That's the same tactic CMA has used every time this has come up. Everyone gets a call," recalls a Southern California hospital government relations representative. "You can't beat that."
Rural and district hospitals in underserved areas argue that they have trouble filling their emergency room call panels because private practice physicians who take call are unlikely to get patients with insurance.
And that's true in Fresno County, where Pam Ott struggles to find doctors. A June report by the California Health Care Foundation found that Fresno County has significantly fewer specialists per capita than the state average, including anesthesiologists, cardiologists, emergency physicians, geriatric specialists, gastroenterologists, general practitioners, neonatologists, orthopedic surgeons, pathologists, psychiatrists, and pulmonologists.
According to that same California Health Care Foundation study, Medi-Cal is a large part of the problem, because the low reimbursement rates have prompted more physicians to decline to accept those patients.
"Over 50% of primary care doctors do not accept Medi-Cal or uninsured patients because what California pays doctors who treat these patients is among the lowest in the nation," says Sharon A Spurgeon, CEO/administrator for Coalinga Regional Medical Center, also in the San Joaquin Valley. "Doctors receive only $24 per office visit--less tan half of the actual cost of care. Doctors simply cannot afford to set up private practice in poor communities and hospitals in these communities are not allowed to hire doctors."
Petersen, who represents the healthcare districts, says the core message is this: "No one but those in disenfranchised populations are impacted by this. But who benefits from this policy? Who is protected? Are people better off by having their diabetes go untreated than by having it treated by an employed physician?"
"If that's true," Petersen asks, "why hasn't the CMA pursued legislation to take away the exemption that currently exists" for academic medical centers and county hospitals?
That's a good question.