When Sen. Mark Ridley-Thomas (D-Culver City) knocked on Brotman Medical Center’s front door at the noon hour today, he nearly was blown down the steps from the blitz of complaints and pleas that officials directed at his colleagues in the state legislature and about the “forbidding climate” in California for the acute care industry.
An unsigned state budget that was supposed to be enacted 6 weeks ago when the new fiscal year began, was fingered as a leading culprit — but hardly the only target that crtics shot at.
No matter who from the Brotman staff was was speaking out, the conversation during Sen. Ridley-Thomas’s listening tour kept returning to the slow pace, and almost record low level, of reimbursement for MediCal patient care.
Low and slow reimbursements are devastating for an embattled hospital such as Brotman, which has been trying for the last 10 months to battle its way out of bankruptcy, said CEO Stan Otake.
A Case of Paralysis
Because Republicans and Democrats in the state legislature are unable to reach a compromise on the budget while the state is $15 billion in the red, he calculates that Brotman is losing millions in MediCal reimbursements.
Sen. Ridley-Thomas, as chair of the new Senate Select Committee on the Los Angeles County Health Care Crisis, Sen. Ridley-Thomas led a retinue of two dozen healthcare experts on a day-long bus tour of 4 medical facilities to see exactly how the crisis is affecting water-treading hospitals.
For 90 minutes, he was bombarded with an earful, both during a roundtable discussion and while striding through the corridors of the 84-year-old Culver City hospital that, nevertheless, is optimistic about overcoming bankruptcy by October, the first anniversary of its filing.
Yes, but…
“I think it’s great that the state Senate Select Committee on Distressed Hospitals in Los Angeles County is visiting Brotman Medical Center,” Mr. Otake told the newspaper.
“However, I think it is equally important for him to understand some of the money issues. Nearly $2.5 million is being withheld from Brotman because of the lack of a signed budget.
“For a bankrupt hospital, such as ours, that money can be used for daily operations. I would like to have that resolved.
“These visits are important. But they should know it is equally important that business in Sacramento needs to be resolved so that we won’t have further discussions regarding stress hospitals in California.”
Republicans Blamed
Sen. Ridley-Thomas said the feuding legislators are not even close to settling their stalemate.
“The end is not in sight,” he said.
“It’s because of the resistance of the Republicans to even give any considerations to revenue enhancements. They simply want to borrow. And if you continue to borrow, the only thing you’re going to do is saddle local government with these huge problems for years to come.”
“September may dawn before there is a settlement,” he said.
Greg Schwarz, Brotman’s Vice President of Business Development, said a rudimentary problem terrorizing the hospital industry is that MediCal reimbursements have not come close “to keeping pace with the care of patients we see.”
No Room to Stablize
Factor in the paralyzed legislature, nursing shortages, and “it becomes more difficult every day to stabilize a hospital.”
Reimbursement is a statewide problem, said Mr. Otake. “California really needs to take a look at MediCal reimbursement to providers,” he said. “We rank 37th among the 50 states in Medicaid reimbursement for acute care hospitals.”
One of the most outspoken Brotman officers was Dr. Robert Rosenbloom, secretary of the medical staff, and Medical Director of the Emergency Room.
He was asked the most important theme that Sen. Ridley-Thomas should carry back to Sacramento.
“That emergency care is very much dependent on fair reimbursements, “ he said, “the solutions to boarding of admitted patients in the emergency department, and that overcrowding in the emergency department is not the result of people who have non-urgent conditions.
Not the Patients’ Fault
“We are not full of people who have something very simple. We have sick patients. Many of them are because they couldn’t access their doctors in a timely manner because their doctors either are overwhelmed with managed care patients — those are HMO patients — or they are unwilling to see any more MediCal patients.
“This state has now cut the reimbursement another 10 percent. Currently, we are last among all 50 states in how much we pay for MediCal patients, and California is one of the richest and most progressive states.”
Dr. Rosenbloom said he could not explain why because “I would have to get into the minds of lawmakers.
“Unfortunately, it is a problem that needs to be solved with a $15 billion budget deficit. There isn’t a quick fix for poor reimbursement for MediCal patients.
“On the other hand, when you pay so low for MediCal patients, and those patients defer their care, and don’t seek care, the cost of their care, eventually, is going to be higher, significantly.
Now This Is a Crisis
“So if my high-blood pressure pills run out, and I can’t get to my doctor because they have 6-week waiting periods, I will go without my medicine for 6 weeks. By the time I get to my doctor, I might be in the Emergency Room with a stroke or a heart attack. And the cost of that far outstretches the cost of seeing someone in the office for 15 minutes, checking their blood pressure and refilling their prescription.”
Sen. Ridley-Thomas offered a single word of observation: “Enlightening.”
He was, of course, prepared to elaborate.
“This tour has helped to clarify the nature of the health crisis in L.A. County. As indicated by one of the chief officers of Brotman, there has been a cloud over this facility, and I think it goes to the issue of Blue Cross, our friend (the CEO of stormily controversial Prime Healthcare, which is on its way out, possibly within 30 days, as the chief lender of Brotman).
Brotman’s Reputation
“Brotman long has been thought of as one of the best facilities in the County to receive medical care. The last few years have been very difficult. We are trying to learn how we can better help them get out of this circumstance.
“That is why we have this host of people traveling with us. Some are providers, some are experts in the area of healthcare, not providers but policymakers, those from the L.A. County Medical Assn. and those from the (state) Hospital Assn., to get a first-hand look at a facility that was in the top tier, but now is seen as being challenged because of the industry’s standards and the financial challenges that have beset many hospitals.
“This really is quite enlightening.”
What about Mr. Otake’s complaint about the $2.5 million being held up. What can Sen. Ridley-Thomas do about it?
“I will work very hard on this,” he promised. “It’s the first time it has been called to my attention. All of it is tied into a resolution of the budget. As soon as that is done…”