What if Natividad Disappeared?; Loss of beds, clinics would
send shock waves through hospital network
Monterey County Herald, March 19, 2006
By Joe Livernois
For more than a decade, Natividad Medical Center has been Monterey County's
medical "safety
net," caring for tens of thousands of uninsured or underinsured patients.
Along the way, the county-operated hospital has become a safety valve for
other Monterey County health centers, which would be seriously stressed
if Natividad did not exist.
"The whole health-care system in Monterey County is interrelated," said
Laura Zehm, chief financial officer at Community Hospital of the Monterey Peninsula. "What
happens at Natividad affects us all in a major way."
While no one is talking about closing Natividad, that possibility could
come under serious consideration if Monterey County administrators are
unable to find a new owner for the hospital.
Natividad is generally regarded as the health-care center for indigent
and underinsured patients in the county. It's been the principal health-care
outlet for farmworkers, hospitality industry employees and the egregiously
needy.
And it has been a drain on county government's budget, off and on, for
decades.
The Monterey County Board of Supervisors, looking at a general fund subsidy
to Natividad exceeding $20 million this year, is desperately trying to
unload the hospital.
At the moment, county representatives are meeting with officials from Salinas
Valley Memorial Hospital to possibly hammer out a solution. But the county
is poised to send requests for proposals to other health-care groups, public
and private, in case the Salinas Valley Memorial talks fall through.
During the past several weeks, the specter of shutting down Natividad has
crept into the public debate. Supervisors have said that closure of the
hospital would only be the alternative of last resort.
But the question has been raised: What would the future of county health
care look like without Natividad Medical Center?
"It would be a disaster," said Jill Foley, executive director of the
Monterey County Medical Society. "There will be a dire need for more
beds and for more physicians. Patients will need to go somewhere and, if
they can't, they will get sicker and potentially get all of us sicker."
For now, patients in Monterey County are served with 598 beds at the four
hospitals, which includes Mee Memorial in King City. Of those, 159 are
at Natividad.
All four hospitals have emergency rooms, but even now demand is high.
"There's waiting lines at Community, and a person can wait for a long time
in Salinas Valley," Foley said. If Natividad went away, "there will
be longer waiting times for all of us, the insured folks and the indigents and
everyone else."
Ripple effect
Zehm said the health-care system is "already stressed right now, even with
Natividad there. It would be a lot worse if it wasn't."
She said Community Hospital is building a new emergency room that will
alleviate much of the existing wait. The original emergency room was designed
40 years ago to handle 12,000 patients annually. It now handles nearly
50,000 patients a year.
The new ER will accommodate those 50,000 patients and will have room for
more growth, but would quickly exceed its capacity if Natividad were to
shut down, Zehm said.
"If you have one less emergency room, it will stress what's left," she
said. "We are all interested in keeping it open in some shape or form. The
most important thing is that it survives."
Alan McKay, executive director of the Central Coast Alliance for Health,
said the closure of Natividad would be a "major stress on the community and
definitely on our members."
McKay's agency administers the MediCal program on behalf of about 56,000 "members" in
Monterey County. He said MediCal patients last year spent 7,700 "patient
days" at Natividad. Patient days are defined as the number of overnight
stays patients are kept in a hospital.
Chad Chadwick, chief executive officer at Natividad, said the closure of
Natividad would have a ripple effect throughout the community.
"There will be a large segment of the population that will either defer
care or seek care at other locations, maybe outside the county," he said. "Some
would be afraid to seek care because of the financial ramifications. The impact
ripples through the work industries of the people we see."
Beyond the health-care implications, Chadwick said the loss of Natividad
would also seriously impact the economy of the Salinas Valley.
He said employers who depend on workers with no health insurance will likely
lose productivity. "Employees won't be healthy and will miss time on the
job," he said.
What's more, Natividad throws more than $110 million into the local community,
said Chadwick.
The hospital employs more than 900 people and this year runs a $59 million
payroll, said Chuck Vold, Natividad's controller.
Natividad is expected
to spend $69 million this year to contract vendors who provide everything
from paper goods to high-tech medical equipment.
Few county hospitals left
Monterey County is one of only 14 counties in California that still operates
its own hospital. Most recently, the Board of Supervisors in San Luis Obispo
County shut down its hospital almost three years ago. Compared with Natividad,
though, San Luis Obispo General Hospital had been eviscerated for years
and offered few of the services and saw far fewer patients than Natividad.
By the time General Hospital closed, most uninsured and underinsured patients
in San Luis Obispo County had already assimilated into the rest of the
health-care system in the county, according to officials from that county.
Even if Natividad Medical Center was shut down, the county and its taxpayers
would still be responsible for the treatment and care of what are referred
to as Medically Indigent Adults, or MIAs.
The county currently handles its state-required obligation to finance the
care of indigent adults with a self-funded insurance program through Natividad.
This year, the program would cost $7.8 million and would provide care to
about 2,500 patients.
If Natividad went away, the county would need to continue care for indigents,
most likely through contracts with the remaining hospitals.
Rachael Kagan, a spokeswoman for the California Association of Public Health
Hospitals, said counties that have shut down public hospitals in the past
employ "a
wide range of approaches" for dealing with indigent care. In some cases,
counties have even redefined who they consider indigent, she said.
She said she does not know whether closing a county hospital results in
higher indigent-care costs for the county. It depends, she said, on how
a county redesigns its indigent program. Also, the tens of thousands
of MediCal-insured patients who now depend on Natividad for their care
will be forced into the other hospitals and clinics.
Statistics kept by the Central Coast Alliance for Health indicate that
MediCal patients with serious health problems who require overnight stays
rely heavily on Natividad. Last year, MediCal patients accounted for 7,700
patient days at Natividad, out of a total of 31,000 patient days.
Across town, at Salinas Valley Memorial, MediCal patients spent 6,500 patient
days during the same period. Officials at Memorial were not available Friday
to provide total patient-day figures.
Loss of clinics
Administrators say much of Natividad's fiscal trouble is a result of the
hospital's inability to attract a diverse "payer mix" that includes a significant
number of patients covered by private insurance companies, which command better
reimbursement for hospital care.
Last year, for instance, only 17 percent of the patients seen at Natividad
carried commercial insurance. MediCal patients accounted for 53 percent
of the volume, while 12 percent of the patients were uninsured and medically
indigent adults.
If Natividad were to close, the MediCal and uninsured patients would likely
flood private clinics and the remaining local hospitals, said Cherie Stock,
a spokeswoman at Natividad.
Even worse, the closure of Natividad clinics would likely discourage MediCal
or uninsured patients from seeking immediate help for their relatively
minor ailments, but would flood emergency rooms when those minor ailments
turn into full-blown medical emergencies, she said.
McKay said about 84 percent of the primary care physicians in the county
-- and 63 percent of the specialists -- accept MediCal patients.
Those figures are considerably higher on the eastern half of Monterey County,
along the Highway 101 corridor, McKay said. Some specialists -- orthopedists,
in particular -- are much less likely to treat patients with MediCal coverage,
he said.
"But some of those specialties are difficult to access no matter what insurance
you have," McKay said.
Also, according to Stock, many private doctors enrolled with MediCal limit
the number of MediCal patients they see and are not willing to accept many
new ones.
McKay acknowledged that any closure at Natividad would have significant
effects on health care throughout the county.
"On the inpatient side, the specialty care clinics at Natividad have been
a key source of care for our members," he said, especially the hospital's
cardiac disease, orthopedics, general surgery and physical medicine.
If Natividad went away, the demand for those services would overwhelm the
rest of the county, he said.
McKay said his agency is trying to encourage what he calls "care coordination," advising
its members of the importance of seeing primary care physicians to treat medical
conditions early, before they become full-blown medical emergencies that require
more expensive treatment.
At the same time, he said his agency is also trying to promote itself to
doctors who do not now accept MediCal patients. "We want to
take some of the stigma off MediCal, that it can be as friendly to providers
as possible," he
said.
By enlightening patients of the importance of early treatment and creating
a larger pool of physicians willing to see MediCal patients, the agency
could relieve the growing stress on local emergency rooms and other critical-care
clinics, McKay said.