San Jose Hospital Expected To Limit Services for Medi-Cal Beneficiaries
Regional Medical Center of San Jose on Monday will "almost certain[ly]" stop accepting "a major form" of Medi-Cal, the San Jose Mercury News reports. Regional will continue to treat Medi-Cal beneficiaries seeking emergency care and beneficiaries whose Medi-Cal benefits are provided through a third party.
Hospital spokesperson Leslie Kelsay said, "This is part of stabilizing the finances at Regional," adding that area hospitals "are carrying a disproportionate share" of Medi-Cal patients (Lynch, San Jose Mercury News, 10/30).
Kelsay attributed about $10 million of Regional's $24 million loss for fiscal year 2003 to the difference between the cost of providing services to Medi-Cal beneficiaries and Medi-Cal reimbursement (AP/San Jose Mercury News, 10/31).
As a result of the decision, other hospitals must treat a larger share of Medi-Cal beneficiaries, although the exact implications are "unclear," according to the Mercury News.
Dr. Dale Rai, a director of the Family Practice Residency Program, said, "This is going to have a big impact on patients -- on people who are pregnant, and on the elderly, and anyone who has problems with transportation to another hospital."
Some Medi-Cal beneficiaries will have to wait to see if they will continue to receive coverage at Regional. The Santa Clara Family Health Plan -- a not-for-profit health care provider that manages Medi-Cal benefits for some patients -- has a contract with Regional that expires at the end of November, and the two parties are currently "in the midst of contract negotiations," according to the Mercury News (San Jose Mercury News, 10/30).
In related news, Regional officials on Monday filed an application with Santa Clara County health officials to open a trauma center. In September, HCA, the owner of Regional and San Jose Medical Center, announced that SJMC will close in December, leaving only two other trauma centers in Santa Clara County (Feder Ostrov/Rombeck, San Jose Mercury News, 11/2).
Hospital officials said after the SJMC announcement in September that Regional plans this month to offer restricted trauma services "to soften the impact" of SJMC's scheduled closure. Regional has not been designated an official trauma center by Santa Clara County health officials, and, as a result, only walk-in patients will be treated. Some people have voiced concern that the hospital will not be able to serve the estimated 95% of trauma patients who come to hospitals by ambulance and helicopter.
Approval would require the hospital to make infrastructural changes, including increasing the number of beds and nurses in its intensive care unit. Moreover, emergency departments typically handle patients with medical conditions such as heart attacks and certain injuries, while trauma centers serve patients with life-threatening injuries from car or industrial accidents and gunshot or knife wounds. (California Healthline, 9/29).
Kelsay said Regional's trauma center would have two beds and serve about 2,000 patients annually.
The San Jose Planning Commission on Monday unanimously approved the proposed trauma center's environmental impact report and land-use and zoning changes for the site.
Bob Sillen, executive director of the Santa Clara Valley Health and Hospital System, said he would not automatically approve Regional's application because of community pressure to maintain three trauma centers in Santa Clara County, according to the Mercury News.
Kelsay said that most of the SJMC trauma center staff later this month will move to Regional in preparation for the proposed opening of a trauma center there (San Jose Mercury News, 11/2).
In addition, the Family Health Center -- a health and medical training center sponsored by HCA and located across the street from SJMC -- will move to O'Connor Hospital in July if it receives approval from the hospital's governing board on Wednesday. HCA officials said the company next summer would stop sponsoring the clinic, which provides medical care to low-income county residents who are uninsured or under-insured (Lynch, San Jose Mercury News, 11/2).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.