February 4, 2023
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As access to health care spreads, costs need reining in


PHorum moderator Lynda Tanner, president and CEO of Visiting Nurse & Hospice Care, left, with panelists Kurt Ransohoff, Bob Freeman, Fred Kass, Steven Fellows and Michael Bordofsky. (Courtesy photo)

PHorum moderator Lynda Tanner, president and CEO of Visiting Nurse & Hospice Care, left, with panelists Kurt Ransohoff, Bob Freeman, Fred Kass, Steven Fellows and Michael Bordofsky. (Courtesy photo)


Though the Affordable Care Act has succeeded in expanding access to health care, the medical community is now saddled with the task of extending efforts to control cost.

That was the leading narrative as leaders in Santa Barbara’s health care community gathered for Visiting Nurse & Hospice Care’s second-annual PHorum at the Fess Parker last Thursday evening to discuss the state of health services in the region. Though panelists were optimistic about the community’s increased access to health care, the challenge now will be gathering resources to accommodate the influx of new patients and providing medical services at a fair cost.

CenCal Health — which administers Medi-Cal in the region — expected to enroll 30,000 new members over the initial 18-month period, according to its CEO Bob Freeman. Instead, it added between 45,000 and 50,000 in 12 months in Ventura and Santa Barbara counties.

That means the medical community is absorbing 5,000 new members every month and is having to quickly increase the number of physicians, Freeman said.

“Medi-Cal is traditionally viewed as the program for the destitute and people who have no other access to care, and that’s evolving,” he said. “We have to start looking at Medi-Cal like Medicare — a very large, publicly sponsored program that serves a lot of people; new patients entering we have to accommodate.”

Santa Barbara County counts 106,000 Medi-Cal patients, or a fourth of its residents, and the state predicts that one in three Californians will be on Medi-Cal in the near future.

Steven Fellows, chief operating officer of Cottage Health System, said the growing Medi-Cal population and increasing reimbursement rates also mean a larger volume of people are accessing medical services — shifting the community toward preventative care.

Fellows said evidence of increasing community access can be found in patients’ decreasing reliance on charity care. According to Fellows, Cottage provided $17 million in charity care in 2012. That number dropped to $8.5 million in 2014, while reimbursed care is going up.

Nursing visits at Cottage are also up 4,000 in the last year, Fellows said. “That may not seem like very much, but that’s about a 325 visit per month increase over what we were seeing before. And those are actually paying patients.”

To help accommodate the new patients, the health system is expanding all of its emergency room facilities, going from 20 to 44 ER beds in Santa Barbara, from eight to 20 in Goleta, and from four to eight in Santa Ynez.

“That will allow us at each of these campuses, as these facilities come online, to streamline the patient flow from emergency patients to the more urgent care kinds of patients,” Fellow said.

But Michael Bordofsky, medical director of VNHC and president of Santa Barbara Preferred Health Partners, said there is still a lot of uncertainty surrounding the ACA, and independent physicians who want to focus on practicing medicine “are not the happiest bunch these days.”

While independent practitioners haven’t been affected much by Obamacare yet, some of the legislation and changes that preceded the law have produced lingering inefficiencies. Bordofsky cites the Health Information Technology “debacle we all had to endure as health technology was subsidized and promoted, creating essentially a gold rush of opportunity for people who were selling software.”

But that technology isn’t working as well as it should be, he said. “Something that was done to try to solve a few problems has resulted in us not feeling comfortable talking to a patient’s family when they’re in the ICU because we’re not sure we’re supposed to, and that’s frustrating to us.”

But the largest hole in health policy is still the government’s reluctance to closely regulate pharmaceutical firms and drug pricing. Fred Kass, medical director of research and wellness at the Cancer Center of Santa Barbara with Sansum Clinic, said this is in fact what’s driving “a huge percentage of health care costs,” and even generic drug prices are now shooting through the roof.

“Until we have the political courage to do that, I think we’re going to be making doctors miserable, hospitals miserable and patients miserable,” Kass said.

According to Kurt Ransohoff, CEO and chief medical officer at Sansum Clinic, the U.S. is one of two countries that allows direct-to-consumer advertising of pharmaceuticals. The other is New Zealand, but their government controls the price of drugs.