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L.A. County may further cut reimbursements to doctors treating uninsured patients

February 16, 2010 |  8:04 am

Emergency room doctors and on-call specialists treating uninsured patients at private hospitals in Los Angeles County could see county payments slashed under a proposal before supervisors today.

The rate cuts could force private hospitals to close emergency rooms, sending more patients to crowded county hospitals, officials said.

L.A. County reimburses doctors 27% of the cost of providing care to the uninsured during their first three days of care at private hospitals. Under the proposal, that reimbursement rate would be reduced to 18% as of July 1. Supervisors last reduced the rate from 29% in January 2009.

About 4,700 doctors would see payments cut under the proposal, according to Carol Meyer, chief network officer for the county’s Department of Health Services. Under the new rate, doctors would receive 43% of what Medi-Cal pays for the same services.

“The 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 — an estimated 350,000.

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

Doctors will likely 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 propose 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.”

-- Molly Hennessy-Fiske

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