Meathead politics

John Taylor: August 23, 20130 Comments

It’s bonehead logic time, courtesy of Sacramento bean-counters. It’s a reminder why you can be accurate, correct  and legal but also be an ethical and moral dingbat.

A wee bit of fiscal cognitive dissonance is playing out. At the same time that Medi-Cal and other forms of insurance coverage are expanding to cover more people under the Affordable Care Act, California is implementing a 10% cut in reimbursement to doctors and other providers who serve Medi-Cal patients. And, for many of them, that cut is retroactive to 2011 – it’s often called a “clawback,” which is roughly equivalent to its harshness.

The cuts were approved by Gov. Brown and lawmakers during dark fiscal times. A cross-section of the medical community has since fought them through the courts which, last June, gave the final go-ahead. The federal government has blessed them, too.

The state has already counted the cuts as savings in its budgets. And, despite the current burst of budgetary sunshine, Sacramento says the cuts should go ahead to maintain “fiscal discipline.”  The state threw a bone recently to appease some caregivers and those lawmakers who’ve pushed legislation to reverse the consequences of Assembly Bill 97. It will roll out the cuts in stages to dentists, medical transporters, pharmacists and nursing facilities – including a 58-bed unit operated by Community Medical Centers, which will lose millions in the state’s recovery efforts and future lost payments. And the state agreed to exempt rural, distinct-part nursing facilities from the cut going forward – but not the two-year “clawback.”

Let’s put some flesh and blood to this bureaucratic “whatever.” Skilled nursing facilities – where frail and injured go for rehabilitation or for care until they die – are on the verge of going out of business. Great news to the droves of aging Baby Boomers. Some of those facilities are part of a community’s only acute-care hospital care and provider of clinic services – the hospital and clinics may close up shop, too.

The California Department of Healthcare Services insist there are enough skilled nursing beds in the state to handle patient needs. The department also said it would “address access problems should they arise.”

More flesh and blood: Enough capacity in the system?

The distance between Plumas and San Diego counties is about 650 miles or 12 hours of hard driving. If the skilled nursing beds in the Eastern Plumas Health Care system close because of the cuts/clawbacks, which has been publicly discussed, will the 66 patients there be carted that far south if that’s where the capacity is?

The distance between Fresno and Coalinga is about 70 miles, or an hourlong drive through huge expanses of cattle and crops. Coalinga Regional Medical Center operates 24 acute care beds and 99 skilled nursing beds. If income from the acute-care beds can’t offset the sizable losses from the skilled nursing beds, as has been reported in the media, the result of the state’s actions could eliminate the only emergency medical care just off I-5 in western Fresno County and put in peril the residents of places like Huron, Avenal and Helm.

Address problems if they arise?

Unless California regulators have suddenly been gifted the powers of Tabitha, the fanciful nose-wiggling witch of the TV show “Bewitched,” they need to be reminded that not only can’t you conjure up scads of sorely needed physicians overnight but you also can’t flick a switch and reopen (and re-staff) a hospital and a skilled nursing facility once your fiscal discipline has deemed it superfluous.


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