About 30,000 people in Santa Barbara County are newly insured through Medi-Cal since the Affordable Care Act took effect, bringing the total number of recipients to about 106,000, or roughly one fourth of the county. In California, families of four living on $33,465 or less now qualify for the state health-care program, and the amount of people uninsured nationwide has dropped considerably.
But how will the government pay for such expanded access? That was one big unanswered question posed last week by a handful of area health officials during a Visiting Nurse & Hospice Care-sponsored forum at the DoubleTree Resort.
One purpose of the Affordable Care Act was to increase preventative treatment, freeing up emergency rooms that have long been bursting at the seams. Since 2012, however, Santa Barbara ER visits have increased by about 1,400 patients every year. Just last year, the ER in Goleta saw a 12-14 percent uptick, and Santa Ynez’s hospital ER saw an 11 percent hike.
“We are actually busier now than we have been in a long time,” said Cottage Executive Vice President Steven Fellows. To accommodate the influx, the hospital took steps toward doubling the number of ER beds with the demolition of its central wing last week; along with other upgrades, the renovations will allow for more than 60,000 visits each year. Goleta and Santa Ynez will also double the size of their ERs.
Despite the increased volume, wait times for the ER haven’t changed. On average, a Cottage patient waits 37 minutes to see a doctor (higher than the state and national average) and four hours and 18 minutes before being admitted to hospital (lower than the state and national average), according to ProPublica. Hospitals are required to evaluate everyone who arrives at an emergency room. At that point, “we might as well just treat you,” Fellows said.
A surge of patients — most newly insured — shows up on the weekends, perhaps when they have access to transportation, explained CenCal CEO Bob Freeman. “Old habits die hard,” he said, adding that health-care providers need to educate people about seeing a primary care doctor rather than waiting to go to the hospital, which is much pricier. “Treat bronchitis [now] as opposed to pneumonia later,” he added.
While reimbursed care is going up, charity care services are going down. In 2012, the Cottage Health System provided $17 million in charity; in 2013, it decreased to $13 million. Last year, the amount was $8.5 million. “That’s a good thing,” Fellows said.
The shortage of primary care doctors was also discussed at the forum. “We have 50,000 new patients. We did not add 25 new primary care doctors,” said Sansum Clinic CEO Kurt Ransohoff. “Younger people aren’t going into medicine,” he added, pointing to medical school debt. Dr. Michael Bordofsky, speaking on behalf of independent physicians, said the future is bright for nurse practitioners, and Dr. Fred Kass with the Sansum Clinic Cancer Center offered the team health-care model as a possible solution.
The panelists also talked about end-of-life health care. They agreed it’s a difficult but necessary conversation for people to have with their families. “If you don’t have an advance directive, get an advance directive,” Fellows declared.
Providing care to seniors in their own homes is the Santa Barbara–based program known as DASH (Doctors Assisting Seniors at Home); 1,200 people over age 60 have signed up, alleviating some of the ER congestion.
As they did at last year’s forum, the panelists emphasized serious problems in the pharmaceutical industry — particularly with prices. “It’s not all bad,” Ransohoff said, noting illnesses that are now completely curable because of drugs, “but there’s enough bad to talk about.” The biggest issue, Ransohoff said, is direct consumer advertising with no price regulation, calling drug commercials with puppies playing on the beach while a voiceover lists negative side effects one of his biggest pet peeves. “I think they should act out the side effects,” he said.
Though there was no mention of it at last week’s forum, the potential merger of Sansum and Cottage is still on the table. The Attorney General’s Office is still reviewing the proposal, which has remained unchanged since the news went public in 2013.