Across the nation, our system of care is strained, and San Diego County is no exception. The sale of Paradise Valley Hospital, the reorganization of the UCSD Medical Center, and a whole host of other developments have raised a number of serious questions. To help us answer them, Chairman Roberts and Vice Chairman Cox asked the Board of Supervisors to commission a first-of-its-kind study to look at the long-term viability of our region’s healthcare safety net. The findings from that study, along with a multitude of recommendations, were presented in a report to the Board of Supervisors in December of 2006.

To show its commitment, the Board of Supervisors approved the allocation of $5 million to enhance care coordination, particularly between clinics and hospitals. Over the past few months, working groups have been developing proposals to recommend where exactly that money should be spent, to enhance and leverage funding, and to assist with legislative advocacy.

In other related activities, the County has submitted a state grant request, which sought funds to increase coverage for uninsured San Diegans who suffer from chronic diseases. The purpose of the initiative is to strengthen the safety net system by identifying those who are using expensive and unnecessary emergency room care, and instead, link them with a community clinic for more appropriate medical care.

Medicare Reimbursement Lawsuit

The Healthcare Safety Net Report identified that San Diego County physicians receive inadequate compensation under the current Medicare fee structure. Over the past several years, there have been many attempts to try to get this changed, but to no avail. In fact, in early 2007, Chairman Roberts and his colleagues initiated a claim against the federal government regarding this matter. It, too, was rejected.

As a result, the County of San Diego has joined in a class action lawsuit against the U.S. Department of Health and Human Services. This lawsuit, filed in partnership with other affected counties, asks the U.S. District Court to require the federal government to reimburse doctors for underpaid Medicare costs that have been incurred over the past six years and to deem the current system unconstitutional. Further, it is the county's goal that this lawsuit will, once and for all, require the federal government to restructure the outdated Medicare Rate Formula used to determine fees for our physicians so that these inequities can be remedied.

The California Medical Society reports that physicians practicing in affected counties are finding it more and more difficult to afford to serve these patients and are either opting out of the program or refusing to take new patients. Physicians in certain counties in the state of California are being paid between 12 and 24% less than their colleagues in similar neighboring counties for providing the same exact services.

It is estimated that San Diego health providers have been shorted $155 million by Medicare over the past six years; this deficit was $35 million last year alone. This is the largest underpayment to any county in the United States.

San Diego has one of the highest costs of living anywhere in the nation. The doctors here deserve to be reimbursed at levels consistent with similar urban areas. This is a fight that will continue until the federal government changes their reimbursement policy.