Further fee cuts force a Medi-Cal exodus

"I do a lot of calling in favors," he said.

Whether the Medi-Cal cuts signed into law by the governor will save as much as the administration projects is an open question.

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Shifting the costs around

A 2005 study commissioned by Blue Cross found that hospitals were making up for the low rates paid by Medi-Cal and Medicare by shifting the costs to private insurance companies, which then passed them on to consumers. The estimated cost to the average family with Blue Cross: $950 per year.

"The costs just get shifted around the system," said Ann O'Malley, a senior researcher with the Center for Studying Health Systems Change in Washington, D.C.

Experts warn that costs to taxpayers could go up by substantially more than will be saved through the budget cuts, as patients turn to emergency rooms. In pushing the governor's unsuccessful universal health plan, administration officials had estimated the cost of treating people in the ER at three to four times that of treating people in a physician's office. "It's ludicrous that every time we have someone who needs to see an orthopedic surgeon for a broken arm, our only option is to send them to the emergency room where they have to sit for four hours," said Ramos, the Modesto-area physician. "It is a huge waste of money, it is a huge waste of resources, and it is not good patient care."

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evan.halper@latimes.com

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Medi-Cal payments

California's health insurance program for the poor reimburses doctors at some of the lowest rates in the nation. Even Medicare, the federal government's health insurance program for the elderly and disabled, pays substantially higher rates. Here is a sampling of payments before the recently approved Medi-Cal rate cuts.

Routine office visit

Medi-Cal: $24

Medicare: $38

Treat finger fracture

Medi-Cal: $74

Medicare: $165

Place a catheter into vein

Medi-Cal: $81

Medicare: $1,372

Chemotherapy treatment (of central nervous system)

Medi-Cal: $131

Medicare: $373

Brain CT scan

Medi-Cal: $197

Medicare: $265

Complete obstetrical care

Medi-Cal: $1,089

Medicare: $1,747

Source: California Department of Health Care Services