The state's five University of California medical centers -- California's fourth-largest health care delivery system -- are confronting what one state senator calls the most-pressing problem in the age of health reform: a health care provider deficit combined with capacity shortfalls.
Legislators, partly in response to a union report criticizing UC health system management, are pressing university officials to respond to allegations that bloated executive pay and misdirected investments have led to bare-bones staffing levels that in some cases jeopardize patient safety.
UC medical centers aren't the only hospitals affected by growth and changes expected under health care reform, but the UC system is the only one under direct scrutiny by the Legislature.
At a Senate hearing last month, Sen. Ed Hernandez (D-West Covina) said there are not enough hospital beds or doctors for the estimated five million Californians who are expected to become eligible for health coverage under the Affordable Care Act next year. The problem is especially acute in places most in need of doctors -- rural communities and urban centers, Hernandez said.
According to Covered California, the state's health insurance exchange, roughly 2.6 million residents will become eligible for subsidized insurance on Jan. 1, 2014, and an additional 2.4 million residents will become eligible for health care under Medi-Cal.
Hernandez said impending doctor shortages and the flood of new patients calls for swift action by state legislators. According to the senator, the state's greatest need is primary care physicians.
According to UC officials, California faces a shortfall of 17,000 doctors by 2015. There are about 30,000 for a state with roughly 38 million residents, according to the California Medical Association.
At hospitals throughout the state -- from medical teaching facilities such as the UC-San Francisco, to community health clinics that provide the bulk of safety-net care -- demand will only increase for primary care physicians, specialists and other hospital support staff as the ACA is implemented, Hernandez said.
"Pretty soon we are going to be requiring everyone to purchase medical insurance, but there is going to be a capacity and workforce shortage," Hernandez said. "We need to increase the number of individuals going into primary care and expand primary care services."
Legislature Responds to Report
A report from the American Federation of State, County and Municipal Employees Local 3299, titled "A Question of Priorities: Profits, Short Staffing, and the Shortchanging of Patient Care at UC Medical Centers," claimed that university officials are placing a higher priority on profits than on patient safety.
The report prompted Hernandez, who chairs the Senate Committee on Health, to call for last month's committee hearing. He said that as the state readies for the health care overhaul, it is critical to address allegations of skyrocketing management salaries and unprecedented borrowing by the UC system that the 22,000-member union said resulted in substandard patient care.
Assembly member Adam Gray (D-Merced) called for a state audit of staffing levels and finances at UC medical centers in light of the report's allegations.
The report also led to a two-day labor strike in late May, though most employees went to work during that time, said Shelly Meron, a spokesperson for UC's Office of the President.
Hernandez said this month that questions raised at the June hearing are becoming increasingly important to address as the state revamps the way it delivers medical care.
"Patient safety issues are important to address, and many of them revolve around the questions I've been asking about the provider workforce and hospital capacity," Hernandez said.
At the hearing last month, John Stobo, senior vice president of UC's Health and Sciences department, defended the university's decisions. Stobo said the medical centers are working to address questions about cost, access and quality of care.
Stobo said providing care in an academic medical school is between 20% and 25% more expensive than at other hospitals in California. He said the university has incurred additional costs to be a part of the state's health insurance exchange.
"We did have to take a significant decrease in our negotiated rate to go to the exchange to have an affordable product. We understand that's the future and we have to learn to live in that future," Stobo said. "We understand that with health care reform there's going to be tremendous pressure on revenues. We are preparing ourselves for that."
He also addressed access, pointing to the expansion of medical centers in Riverside and San Francisco.
"Our access has been limited over the last several years based on our capacity," Stobo said. "Our hospitals are full, and we need to increase access."
Stobo said UC's health care network also is working to improve problems with quality of care. One example the university cited recently involves the collection of patient data.
"We are involved in collecting data systemwide so we can compare medical center to medical center in terms of cost, quality outcomes, things like readmissions, complication rates, etc.," Stobo said. "We are working very hard on the quality issue."
Claudia Preparata, a research director for AFSCME Local 3299, said the union was pleased that more attention is being paid to the university's operations that involve patient care, noting that the report published by the union was timely.
"The question being posed today, in part, is: 'Are UC medical centers prepared for the huge influx expected when the Affordable Care Act comes online?'" Preparata said. "Taxpayers need to be reassured that support for a public health care system serves the public interest."
She said frontline workers who staff UC emergency departments, clean patient rooms or provide respiratory care, "witness daily a general decline in routine care that puts them or their patients at risk."
"These shortcomings will only be amplified when a large number of new patients will begin to flood UC hospitals," she said.
Hernandez asked several questions during the hearing about what UC officials are doing to address access to care and limited capacity in the system's hospital network. He stressed the importance of increasing the number of primary care physicians as the ACA is implemented. He asked for Stobo's response.
"We need to work at it," Stobo said.
Hernandez Touts Scope-of-Practice Bills
Hernandez said three of his bills moving through the Legislature would go far in addressing questions about provider shortages and patient safety.
SB 491, 492 and 493, which have passed committees on the Senate side, would expand scope of practice for nurse practitioners, optometrists, and pharmacists. Under Hernandez's bills, providers' purviews would change in many ways, including:
- Nurses would be able to provide primary care services for Medi-Cal patients without physician consent;
- Optometrists would be able to treat any eye disorder and diagnose related diseases, such as cancer, as well as give vaccinations and conduct some primary care; and
- Pharmacists would be able to diagnose diseases and conditions such as diabetes and hypertension.
The three bills will be heard in the Assembly Committee on Business, Professions and Consumer Protection in August when the Legislature reconvenes from its summer recess.
"We need to address the need for more residency slots, but that's not something we can do -- that is controlled by the federal government," Hernandez said. "Those three bills I'm carrying now play a bigger role in primary care in California. They extend the scope of practice to other professionals who are capable of picking up a lot of the primary care services."
Hernandez said legislative action, as well as changes within the UC medical centers will collectively help prepare Covered California for thousands of residents newly eligible for health care.
"I think the UC is doing the best they can to be prepared for health reform," Hernandez said. "They have limitations because of the number of residency slots available, so that's where we have to step in."