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State Legislators Push Bill to Limit Emergency Room Closures

California has one the nation’s lowest number of hospital emergency rooms per capita, and Bay Area legislators are calling this shortage a crisis, as the number of people who need urgent care services keeps growing. They are pushing for a bill that would require non-profit hospitals to obtain approval from the state Attorney General and hold at least one public hearing before closing their emergency departments.

In February, California State Senator Nancy Skinner, who represents the 9th District covering both Richmond and Oakland, introduced Senate Bill 687, designed to create more public warning before an emergency room closure. “When hospitals and emergency rooms close, patients pay the price with longer wait times and decreased health outcomes,” Skinner said in a phone interview.

Existing law only requires a hospital to give a 90-day notice to the California Department of Public Health before shutting down operations. According to the American College of Emergency Room Physicians, the state has only about 6 or 7 emergency rooms per million people. The organization rates California 42 out of 50 states in terms of access to emergency care, which includes availability of medical providers and treatment centers, financial barriers to receive care, and hospital capacity. In comparison, New York, another heavily populated state, is ranked number 17 by the same standards.

On Monday, Oakland, Berkeley and Richmond officials, healthcare workers and patients gathered at Skinner’s Oakland office for a press conference in support of the bill. “The legislature needs to do everything it can to prevent ‘hospital deserts,’” meaning areas that are not served by emergency facilities, Skinner said at the event.

Richmond residents know all too well what it means to be left without access to urgent medical care, after San Pablo’s Doctors Medical Hospital was shut down in 2015, following years of financial struggles caused by low reimbursement rates for Medi-Cal and Medicare patients, who made up about 80 percent of the hospital’s patients.

The closure of Doctors Medical left Richmond residents with only one full-service small hospital, Kaiser Permanente Richmond Medical Center, which has only 50 beds. It usually takes emergency patients when it comes to “life and death” situations, said former Richmond mayor Irma Anderson. “If it is not immediately life-threatening and if you don’t have Kaiser health insurance like myself, that’s not the place you go to.”

On the day Doctors Medical Hospital closed, Anderson had internal bleeding and was rushed to a larger 200-bed facility, Alta Bates Summer Medical Center in Berkeley, which is about 10 miles away from her home in Richmond.

But during rush hour, travel time on the congested I-80 freeway adds up, a concern that has been pointed out by many politicians and residents concerned about the closing of Doctor’s Medical Center. “Even the best ambulance is impacted,” Skinner said. In the meantime, patients’ lives are at risk.

Lack of funding for Medi-Cal could become a bigger problem for hospitals serving mostly low-income patients if the Affordable Care Act gets repealed.

“It will cut the state’s funding to Medi-Cal from the federal budget by at least $20 billion, deeply affecting about 90 percent of Covered California [the state’s marketplace exchange] members that rely on federal subsidies to pay for their insurance,” said Sarah de Guia, executive director of the Oakland-based California Pan-Ethnic Health Network. Thousands on Medi-Cal might lose coverage and line up in the emergency room if they need urgent health care, she said.

Some undocumented California residents, who now have health insurance through Covered California’s program with Medi-Cal, could also add to the pool of the emergency room patients if the Affordable Care Act is repealed. Skinner said some residents who have recently obtained legal status —or are about to gain it, but are still waiting for their green cards—and are already receiving state’s benefits like Medi-Cal, have started abandoning their health care plans out of fear of deportation, as President Donald Trump’s administration begins cracking down on undocumented immigrants.

And while the number of emergency room patients could grow, more hospitals are at risk of being closed. Alta Bates Summit Medical Center in Berkeley, where Anderson was taken, is among them. It is scheduled to close by 2030 to cut operational costs and because it is not seismically compliant and requires expensive retrofitting, according to statements from officials at Sutter Health, the Northern California health system that owns Alta Bates.

The situation is better in Alameda County, but medical personnel and local officials feel the pressure, too, according to Alameda County Supervisor Wilma Chan, who supports Skinner’s bill. While the county’s residents have access to at least six hospitals with emergency room services, they also get overcrowded. “Oakland’s Highland Hospital has 150,000 emergency visits a year, and will see even more,” said Chan.

The Bay Area lawmakers say they will actively push for the bill preventing hospital closures to pass as soon as possible. It is expected to go in front of the Senate Committee on Judiciary by mid-March.

“Access to necessary hospital services is essential to the health and safety of our residents. SB 687 is one tool to help us achieve that goal,” Skinner said.

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