Barely Insured

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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