Barely Insured

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Cancer Care for Medi-Cal Patients in Jeopardy

by Isabelle T. Walker

The doctors who have provided cancer care to impoverished residents of central and south Santa Barbara County since 1991 are still taking appointments from the barely and publicly insured. But in mid-December, a billing dispute between this physician group and the Santa Barbara Regional Health Authority — which is the local administrator for Medi-Cal, California’s version of Medicaid health insurance — briefly jeopardized this community lifeline.

Dr. Frederic Kass, the oncologist who heads the Santa Barbara Hematology and Oncology Medical Group, said the Regional Health Authority had accumulated a level of outstanding payments to his organization that had become untenable. In the past, the group had always been able to balance low or late payments against compensation from private insurance companies, but this time the amount was too big. “We kept doing the work and didn’t scream until it got out of hand,” Kass said. That was when he told the Health Authority that unless the two parties could reach a mutually acceptable agreement, the medical group would stop taking new Medi-Cal patients. In mid-December, a nurse reported difficulty scheduling a new Medi-Cal patient with the oncologists at Santa Barbara Hematology and Oncology, only to have one of these doctors call back days later to get the person in. “To my knowledge, there was no patient that didn’t get care [during this time period],” Kass said.

Concerned about negotiating in the press, Kass would say only that, since then, an agreement allowing his group to keep caring for very low-income patients, and even perhaps give them a better level of care, was taking shape. It may include bringing in Sansum Clinic’s four oncologists to share the responsibility for indigent care. Sansum Clinic CEO Dr. Kurt Ransohoff said the clinic was discussing this possibility with the Regional Health Authority.

Because the Regional Health Authority guarantees its enrollees access to care, Deputy CEO Bob Freeman said that if Santa Barbara Hematology and Oncology doctors permanently stopped taking Medi-Cal patients, the authority would secure another provider for subscribers, either here or in a neighboring county. “They had claims issues,” Freeman said of the oncology group. “Medical claims issues can be complicated but, as far as I know, those claims have been resolved to everybody’s satisfaction.”

As fissures in the private health care system spread, medical oncology groups are struggling to stay viable. Though Santa Barbara Hematology and Oncology is associated with the nonprofit Santa Barbara Cancer Center, it is a financially and organizationally separate for-profit enterprise. Roughly 15 percent of the group’s patients get state- or county-financed health insurance. Chemotherapy drugs are getting more expensive, Kass said, so insurers look for other ways to save money. “The only thing they can regulate is what they pay me for my time,” he said. “They make it harder for me to get reimbursement.” And that makes it harder for him and other oncologists to accept the even lower rates paid by government programs like Medi-Cal.

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