Sounds of Silence - Part 2

Back on April 4th, the LA Times published an op ed by two UC physicians complaining that UC Health facilities took very few Medi-Cal patients because of low reimbursement rates from that program. (Medi-Cal is the California component of federal Medicaid, which generally provides health insurance for indigent persons.) Blog readers will know that we waited a couple of days to see if there was a response by UC Health and then published excerpts from the op ed, expressing some surprise that there hadn't been an official response. We included some data from a UC publication that suggested there was a significant Medi-Cal presence among UC Health patients.*

Yesterday, two letters to the editor - one from Carrie Byington, the top executive at UC Health - appeared in response. We reproduce them below. Exactly why there was a long delay is unclear. Was it in getting a response written or a delay by the LA Times?

Letters to the Editor: If UC is abandoning Medi-Cal patients, that’s news to these doctors

To the editor: Drs. Michael Wilkes and David Schriger suggest that University of California health systems do not adequately or equitably provide care to low-income patients on Medi-Cal, the state’s health insurance program. I do not doubt that my colleagues speak from the heart or with best intentions. I simply offer a contrasting experience.

As a surgical specialist with more than 20 years in the UC system, I know my practice has never shied away from delivering care to underserved populations. As chief of the Division of Colon and Rectal Surgery at UC San Diego Health, I regularly monitor our practice’s quality, care delivery and patient satisfaction data. Our payor mix for Medi-Cal and underfunded care routinely hovers at 20%-30%.

UC hospitals are critical providers of Medi-Cal services, and by most measures, UC Health is the No. 2 provider of Medi-Cal hospital services in the state. Our hospitals received the most complex COVID-19 cases from surrounding facilities, and we partnered with border hospitals to support efforts to care for vulnerable populations. Does this sound like “shirking responsibility”?

It is true that state reimbursements for Medi-Cal patients do not cover the actual cost of care, which is often higher because this patient population more frequently requires greater intensity care due to more advanced diseases at the time of diagnosis and treatment.

Nonetheless, I have yet to encounter any clinician who would refuse to help a patient based on their funding status.** We are working collectively as a system to find creative ways to deliver extraordinary care for a fraction of the true cost while able to train new generations of providers and keeping our nationally ranked health systems financially afloat.

Can we do better? Of course. Always. We should. That’s what’s powerful about working for the University of California — we are united by our shared mission and our commitment to the people of California.

Dr. Sonia Ramamoorthy, San Diego

The writer is a professor of surgery at the UC San Diego School of Medicine.

..

To the editor: The UC system is committed to its public service mission of improving the health of all Californians, regardless of how or if individuals are insured.

The Times’ op-ed article does not accurately reflect UC’s care for Medi-Cal enrollees. UC is the second-largest provider of Medi-Cal hospital services by most measures, despite representing less than 6% of state hospital beds. Thirty-five percent of our patients are Medi-Cal enrollees, the system’s second-largest type of patients by health plan coverage, ahead of all commercial health insurers.

UC physicians also deliver primary care to Medi-Cal enrollees at federally qualified health centers. In the past year, UC cancer centers cared for nearly 10,000 active cancer patients covered by Medi-Cal.

We are proud of the care we give for Californians enrolled in Medi-Cal, are looking into the questions raised, and will address any areas for improvement identified.

Dr. Carrie L. Byington, Oakland. The writer is executive vice president of UC Health.

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Source: https://www.latimes.com/opinion/letters-to-the-editor/story/2022-04-10/uc-medi-cal-patients-response.

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*http://uclafacultyassociation.blogspot.com/2022/04/sounds-of-silence.html.

**This sentence seems to be an overstatement. I am sure blog readers have encountered questions about insurance and statements that we don't take this or that insurance from doctors' offices. It is true - as we pointed out in the original post - that hospitals with emergency rooms must provide ER treatment to anyone regardless of insurance or status. However, the problems Medi-Cal patients have in finding doctors that will accept the low reimbursements of that program are well known, as a quick Google search will reveal. Examples: 

https://www.kqed.org/stateofhealth/39062/in-medi-cal-many-managed-care-patients-cant-find-doctors; https://www.shastahealth.org/californians-medi-cal-face-hurdles-see-specialists-throughout-state; https://www.chcf.org/press-release/nearly-half-of-states-doctors-will-not-treat-medi-cal-patients/.

Exactly what policy applies to the many physicians who have some link with UC Health is unclear. It's also unclear why the LA Times chose to leave the issue as a kind of he-said/she-said debate. Was any kind of fact checking done?