Fiscal Solvency

By Marcelo R. Rivera

The Palomar-Pomerado Health System recently reported a $27 million loss on an yearly operating budget of $280 million dollars. This also reflects an $11 million yearly operating loss. The next Board will be faced with reversing this negative spiral while maintaining excellent health services. This can only be done by forming a strong coalition with patients, local businesses, nursing staff and medical staff.

This must be done by forming a strong coalition with patients, businesses, medical staff and nursing staff. This coalition will be necessary in order to bring the insurance and Managed Care industry back to negotiating table to increase reimbursements to the Health System for services provided. The insurance industry cannot be allowed to create a capitation system of payment which does not fairly address the cost of providing services. In San Diego County, 80% of the insured population receive their services under "capitation." The HMO industry in California, represented by five major companies, had earnings of between $440-770 million dollars in 1999. Meanwhile, many hospitals in San Diego County are being faced with major operational losses.

Beside increasing reimbursement rates, we will need the most experienced people on the Board to make sure that the "financial people" do not make cutbacks that will hurt patients. As a Physician who has focused on providing health services to members of the community, I will be able to provide the appropriate balance.

We need to make sure that PPHS continues to attract the best qualified nurses to provide care at the bedside. These nurses should be supported with a good working environment, proper staffing, educational training and salaries which reflect their value. When cutbacks are made, they should be made as far away as possible from direct patient services. We must recruit the medical community and seek their input on eliminating duplicative services, unnecessary costly procedures and emphasizing prevention so that catastrophic illness is avoided. At the same time that PPHS is decreasing wasteful spending, the Health System should invest in creating outpatient "Centers of Wellness" to prevent people from getting so sick that costly hospitalization becomes necessary. Examples of such programs include Flu vaccination Centers, Alzheimers Family Centers, Womens Health Services, Prostate Screening Centers, Diabetic Wellness Centers, Congestive Heart Failure and Coumadin Centers. The list of outpatient services is extensive, but with the participation of physicians and the community such centers could serve as educational and service areas which would focus on keeping people healthy or in stable conditions to prevent hospitalizations. Collaboration with other Health Systems in the county will have to be established to prevent duplication of costly services, maximize efficiency and maintain excellence.

The patients and businesses must become a part in this coalition inorder to create a united front in negotiating with the Insurance Industry. The profits of the Insurance Companies must be reinvested in the communities which generate their revenues.