T he primary safety-net provider in Orange County, Calif., University of California Irvine Medical Center, has clamped down on the number of indigent patients it will treat, saying it wants the county to come up with more funding.
At the beginning of this month, the academic medical center said it would no longer accept new nonemergency patients who qualify for Orange County's Medical Services for Indigents Program unless they live within five miles of the hospital or two miles of its two outpatient clinics. The hospital said it also would establish a "utilization system" for specialized services, similar to managed care.
The 385-bed hospital said it provides 63% of all outpatient care under the MSI program and 30% of inpatient care, although it operates just 9% of the county's licensed acute-care beds. Yet the county pays far below the cost of providing care. The disproportionate and growing burden has led to shortages of intensive-care-unit beds, emergency room capacity, operating room time and physician availability, UCI said, as well as an exodus of some of its best doctors.
Chief Executive Officer Ralph Cygan, M.D., an internist who used to run the hospital's medicine clinic, acknowledged last week the action likely means some patients will go without care for chronic conditions, at least temporarily.
"I must admit this is not something that comes comfortably to me," Cygan said. "I believe these patients, like everybody else, deserve to have outstanding medical care, and they deserve to have it conveniently located."
Cygan said the system works well for emergencies, but "falls apart completely" when it comes to outpatient follow-up and nonemergency care, which hospitals and physicians are not required to provide. "What happens is that a huge proportion of those patients end up finding their way to the medical center," he said.
While county officials have not openly reacted to UCI's move, hospitals and physicians in the county hope the medical center's actions will force the county to increase funding and take other steps to improve services for indigent patients, said Jon Gilwee, vice president of the Healthcare Association of Southern California in charge of its Orange County office.
Twenty-five hospitals contract with the county to provide indigent services, but they refused to renew an annual agreement that expired June 30 because the county refused to increase the pool of available funds, Gilwee said. Services continue to be provided under a 90-day "bridge" agreement.
Many officials expressed sympathy with the plight of UCI, which has suffered severe cuts in Medicare disproportionate-share funding.
"Unfortunately, (UCI and its physicians) take the brunt of the indigent patient load in the county. We feel it's the county's responsibility to resolve the issues," said Perry Cain, spokesman for the Orange County Medical Association.
UCI finished its last fiscal year, ended June 30, in the black, with net income of about $30 million on revenue of about $330 million, Cygan said. But he said the hospital is under pressure to build reserves in order to fund a replacement facility mandated by state seismic requirements.