EDs Serving Medi-Cal, Minority Patients at Higher Risk of Closing & Calif. Medical Groups File Lawsuit Challenging Medi-Cal Payment Cuts

Fri Nov 25 06:41:18 PST 2011

Description: Description: Description: Description: CAL/AAEM: California
Chapter of the American Academy of Emergency Medicine

November 17, 2011

EDs Serving Medi-Cal, Minority Patients at Higher Risk of Closing 

CaliforniaHealthline
<http://www.californiahealthline.org/articles/2011/11/17/eds-serving-medi-ca
l-minority-patients-at-higher-risk-of-closing.aspx#ixzz1eHl63QKc> 

California hospital emergency departments that treat large numbers of blacks
and Medi-Cal beneficiaries face a greater risk of closing than other EDs,
according to a study published on Thursday in the Annals of Emergency
Medicine, NPR's "Shots" reports. Medi-Cal is California's Medicaid program
(Husted, "Shots," NPR, 11/16).

For the study, UC-San Francisco researchers used Office of Statewide Health
Planning and Development data from 1998 to 2008. During this time, about 7%
of EDs in California closed (Barr, Modern Healthcare, 11/16).

Key Findings

Renee Hsia -- a study author and assistant professor of emergency medicine
at UCSF -- said financial factors, including how much hospitals relied on
Medi-Cal payments, contributed to closures.

The study also found that for every 10% increase in black patients a
hospital treated, its risk of closing its ED rose by 40%.

A 10% increase in Medi-Cal patients served correlated with a 17% increase in
risk of ED closure, according to the study ("Shots," NPR, 11/16).

Researchers also found that:

For-profit hospitals had a 65% higher risk of closing their EDs than
not-for-profit hospitals (Modern Healthcare, 11/16); and

Hospitals were more likely to add ED capacity in suburban neighborhoods
where patients had private insurance (Cheung, Fierce Healthcare, 11/16).

Comments

Hsia said, "[ED] closures disproportionately affect vulnerable populations,
but there are system-wide ripple effects felt everywhere."

Hsia said, "Future research on [ED] closures must examine their impact on
health outcomes," adding, "It is concerning that the very populations who
most rely on emergency services may experience declines in access to
emergency care" (Fierce Healthcare, 11/16).

November 22, 2011

Calif. Medical Groups File Lawsuit Challenging Medi-Cal Payment Cuts

CaliforniaHealthline
<http://www.californiahealthline.org/articles/2011/11/22/calif-medical-group
s-file-lawsuit-challenging-medi-cal-payment-cuts.aspx#ixzz1eeefnGK1> 

On Monday, a number of professional medical associations filed a lawsuit
against HHS and the state Department of Health Care Services over the recent
approval of a 10% cut in Medi-Cal reimbursement rates, the AP/Sacramento Bee
reports. Medi-Cal is California's Medicaid program (AP/Sacramento Bee,
11/21).

The California Medical Association, the California Dental Association, the
California Pharmacists Association, the National Association of Chain Drug
Stores and the National Community Pharmacists Association filed the lawsuit
(CMA release, 11/21).

Background

In October, CMS approved the state's plan to reduce certain Medi-Cal
payments by 10%. State officials have projected that the cuts will save $623
million.

According to DHCS, CMS has allowed the state to make a 10% reimbursement cut
to:

.         A number of providers and outpatient services, including clinics,
dentists, laboratories, optometrists and pharmacists; and

.         Freestanding nursing and adult subacute care facilities, as well
as other nursing facilities.

The cuts are retroactive to June 1.

Heath care providers and patient advocates have argued that the cuts would
cause more health care providers to stop treating Medi-Cal beneficiaries.

They also have said that the Obama administration could be jeopardizing the
federal health reform law because the Medi-Cal system will be ill prepared
to handle the large number of low-income patients who will become newly
eligible for coverage (California Healthline, 11/3).

Lawsuit Details

According to the lawsuit, the 10% cut to reimbursement rates did not go
through the appropriate legal procedures (AP/Sacramento Bee, 11/21).

Francisco Silva, CMA general counsel and vice president, said that in
September, CMS asked DHCS for more data to substantiate the state's plan to
enact. Medi-Cal payment cuts. Silva said, "Without receiving that
information, CMS went ahead and approved the cuts," adding, "It is clear
that CMS did not follow protocol and applied the wrong legal standard" (CMA
release, 11/21).

The medical professionals also argue that the cuts will further harm the
Medi-Cal system and that beneficiaries already find it challenging to find
physicians who participate in Medi-Cal (AP/Sacramento Bee, 11/21).

Marcus Williams &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

For more articles, visit our archives
<http://maillists.uci.edu/mailman/public/calaaem/> . 

 <mailto:somcaaem at uci.edu> To
<https://maillists.uci.edu/mailman/listinfo/calaaem>  unsubscribe from this
list, visit our mail server.

CAL/AAEM, a nonprofit professional organization for emergency physicians,
operates the CAL/AAEM News Service solely as an educational resource for
physicians. Dissemination of an article by CAL/AAEM News Service does not
imply endorsement, agreement, or recommendation by CAL/AAEM News Service,
CAL/AAEM, or AAEM.

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://maillists.uci.edu/mailman/public/calaaem/attachments/20111125/f2076ffa/attachment-0001.html 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: image/jpeg
Size: 25019 bytes
Desc: not available
Url : http://maillists.uci.edu/mailman/public/calaaem/attachments/20111125/f2076ffa/attachment-0001.jpe 