Hospital’s Curbs Fueling Worries

Perhaps the best place to see how Orange County’s health care system for poor adults has evolved over the years is at UC Irvine Medical Center’s busy outpatient clinic in Santa Ana.

There, doctors last year treated 2,195 patients who qualified for the county’s Medical Services for Indigents program--people who live in nearby public housing and people from as far as Laguna Beach. If a doctor deemed a procedure necessary, it was done, whether the medical center would be reimbursed by the county or not.

Last year, doing business that way cost the clinic more than $1 million--part of the estimated $200 million UCI Medical Center has swallowed over the past two decades serving the bulk of the county’s poor.

“We do zero marketing,” said Nancy Downey-Hurtado, the clinic’s administrator. “But over the years, when it became known that we always take [indigent] patients, that word spread and the people came.... In the future, it’ll be different.”

One day after the medical center announced it would cap services provided to MSI patients, it was unclear how quickly the effects of the new policy would be seen.

Though county officials say they’re confident they will be able to contract with other hospitals to fill the void, advocates for the poor say the county’s already inadequate indigent health care system will be stretched to the breaking point.

“I believe there will be an impact on the emergency rooms; I believe there will be an impact on the community clinics,” said Nancy Rimsha, director of the Health Consumer Action Center at the Legal Aid Society of Orange County. “In some cases, the patients will go without care, and will get sicker.”

Medical center officials announced Wednesday that they would begin turning away all but emergency room patients who don’t live within five miles of the hospital in Orange, or two miles of its outpatient clinics in Anaheim and Santa Ana.

What’s more, nearly every procedure outside of primary care visits--including preventive tests, referrals to specialists and surgeries--now will be subject to an authorization process. That will make the MSI system function more like private health insurance and other government health plans for the poor, officials said.

“For patients who have come to UCI and gotten a wide array of services [free], this is going to be quite a blow to them,” said Cindy Winner, director of ambulatory services for the medical center. “For years, we gave away millions of dollars of services. We can no longer afford to do that.”

Figuring out what is, and isn’t, covered by MSI will be complex, Winner said. She has developed “four or five flow charts ... with decision trees” to help staff make decisions patient by patient.

The MSI program covers about 20,000 uninsured people, ages 21 through 64, who earn too much to qualify for Medi-Cal or are too young for Medicare.

Patient advocates said that unless the county can add other service providers, those hit hard by UCI Medical Center’s decision not to serve just any MSI patients will be the county’s working poor and the unemployed who aren’t covered by Medi-Cal or Medicare. At the medical center’s Santa Ana and Anaheim clinics, about 75% of MSI patients treated last year were unemployed.

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Times staff writer Phil Willon contributed to this report.