SAN DIEGO COUNTY: CMS ‘Stretched’ To Serve Indigent
Sunday's San Diego Union-Tribune profiled Dr. Nicholas Yphantides, director of the Escondido Community Clinic, and his efforts to shore up the San Diego County Medical Services (CMS). Yphantides serves on the board of Palomar Pomerado Health System, which three years ago voted to "stop accepting nonemergency patients who qualified under" CMS, the tax supported program to provide health care for "the working poor." Two North County hospitals, Tri-City Medical Center and Fallbrook Hospital, also cut off CMS patients. As a result, area clinics such as Yphantides' picked up the slack, but the influx of patients and the low reimbursement rates have strained their budgets. The $34 million CMS budget is "stretched" to provide services to 21,000 adults, according Joan Zinser, a deputy director of the county Department of Health Services. Yphantides noted that the county expenditure is "much less than what other counties spend on health care for the indigent, and much too little for San Diego County." He said that many patients in need of specialized care such as "a pulmonary test for emphysema, a hernia repair or back surgery" are forced to travel up to Sharp or Scripps hospital systems that accept CMS reimbursement, which are often up to 50 miles away. "These are people with limited transportation," explained Yphantides. Noting that the funding crisis precipitates a trim medication list, Yphantides said that he must avoid costly diabetes drugs and instead prescribe alternatives "that can have more frequent and severe side effects, making his job even more complicated."
It's Not Enough
The Union-Tribune reports that Yphantides "has been quietly nudging his board colleagues to reconsider their rejection" of CMS, but the "board members have declined." In addition, County Health Director Dr. Robert Ross has promised to boost CMS funding by $800,000 in an effort to win over the defecting hospitals. The funding increase would come provided that "one or more of the North County hospitals elect to become a contracting provider this fiscal year." But for their part, Tri- City and Palomar Pomerado are reluctant to make the move, calling the $800,000 systemwide incentive too low to offset the expected costs. But even with the incentive, the CMS rates are pegged 20% to 30% below Medi-Cal reimbursement rates. The Union- Tribune reports that Palomar Pomerado saved $1 million during the first year it turned away CMS patients (Clark, 1/10).