Medical Care Industry California

As many of California's 366 nonprofit hospitals fight for survival in a cutthroat health care market, the prospect of a deep-pocketed partner coming to their financial rescue is enticing. When the would-be rescuer is a for-profit enterprise, however, many of the people who run nonprofit hospitals think the white knight is wearing a black hat.

The Supreme Court on Wednesday will take up the health insurance industry's challenge to what many experts laud as the most promising legal reform in health care: independent medical review of HMO disputes. In recent years, California and 41 other states have adopted laws that give patients a right to a second opinion if their HMO refuses to pay for a medical treatment.

MedPartners Inc., parent company of the health-care services firm that was seized by state regulators last week, said Monday that it was under no obligation to continue to fund its troubled California operations. The statement was intended to reassure stockholders that the parent company is in sound financial shape, a spokesman said, and will not be forced to prop up the bankrupt clinics and health plan, which provide services for 1.3 million Californians.

Finding the right nurse-to-patient ratio for California hospitals is proving harder than expected, delaying the release of new state-mandated staffing guidelines. The state has yet to finish developing the regulations, which were supposed to take effect by Tuesday. They may not be ready for several months, according to officials. "We're not going to meet the Jan. 1 deadline," said Lea Brooks, spokeswoman for the state Department of Health Services, the agency charged with setting the ratios.

Michael Smushkevich, a Russian immigrant who allegedly masterminded a $1-billion health insurance billing fraud--the nation's largest--was indicted Wednesday by a federal grand jury in Los Angeles. Smushkevich, 44, who is already in federal custody, was indicted on 54 counts of mail fraud and one count of conspiracy along with his girlfriend, two Southern California physicians and a key manager involved in running a massive mobile diagnostic testing service. The physicians charged were Dr.

Californians would have easier access to second medical opinions and coverage for treatment of severe mental illness under measures passed by the Legislature on Thursday. Accelerating efforts to reform managed care as the lawmaking year ends, the Senate approved a bill, sponsored by the consumer group Health Access of California, requiring providers to pay for a second doctor's opinion if a patient or primary physician requests one.

With the Wilson Administration poised to advance toward its goal of putting 2.5 million low-income Californians into managed care health plans, significant questions remain about whether the effort will work. Although advocates say the proposal will provide the same mainstream health care to the poor that many other Californians enjoy, critics fear that it may backfire and cause millions of low-income Californians to fall through the cracks.

In the course of announcing this summer that he would take a pay cut of as much as $2 million, Foundation Health Corp. Chairman Daniel D. Crowley put into words what many people think about the economics of modern medicine. "In this environment," he told a Sacramento audience of physicians and other health care professionals, "it's doggone piggy to put your face that far in the trough when other people are hurting."

Scarcely a year ago, health reform in America was declared dead. The Clinton Administration's reform package, two years in the making, was buried by Congress in a matter of months. Americans, it was said, were not ready for a health care revolution. But for millions of Californians, the revolution is here.

Nursing home operator Regency Health Services Inc. is being acquired by a New Mexico company twice its size for $369 million in cash, or $22 a share, the companies announced Monday. Sun Healthcare Group Inc., based in Albuquerque, will also assume about $220 million of Regency's debt. The proposed buyout, approved by the companies' boards, is the latest of several deals this year in the rapidly consolidating nursing home industry. Richard K.

The HMOs and physician groups that serve California's 18 million managed care members have stepped up legal challenges against the fledgling state Department of Managed Health Care in an attempt to limit its authority. The tactics range from lawsuits and appeals of department orders to simple refusals to comply. Already, such actions have limited the department's reach in cases involving Medicare patients, prescription drugs and fiscal solvency for the state's teetering medical groups.

A consumer advocacy group filed a lawsuit last week charging that state regulators have failed to adequately investigate many patients' complaints against HMOs and have kept consumers in the dark about their cases.

As many large HMOs enjoy a year of renewed prosperity, Santa Ana-based PacifiCare Health Systems Inc. can't seem to turn the corner in the eyes of investors and analysts. Profit is down. A junk-bond sale flopped. Doctors groups are fuming. Lawsuits are piling up. And the company's method of paying hospitals has been turned on its head.

Underscoring the degree to which Californians lack health insurance, a study has found that three-fourths of the state's legislative districts have uninsured rates exceeding the national average. An analysis released Tuesday by the UCLA Center for Health Policy Research shows that 60 of 80 Assembly districts and 29 of 40 Senate districts have uninsured rates above the national average of 17%.

California has become the second state in which a woman can buy the morning-after contraceptive pill, a prescription drug, at a neighborhood pharmacy without first being seen by a doctor. A handful of drugstores began offering the pills late last month to potentially thousands of women in a low-key experiment made possible by a 2-year-old law. The program in Los Angeles and seven other counties is part of a nationwide push to make the morning-after pill available without a prescription.

Just two months after Southern California's largest medical group received a $30-million bailout from health plans, KPC Medical Management is again experiencing a financial shortfall, prompting state regulators to launch an investigation of the Anaheim company's clinics and finances.

In a settlement underscoring the government's commitment to regulate physicians' financial ties to private health-care providers, a unit of a Newport Beach home-infusion company has agreed to pay $500,000 to end a two-year investigation. The agreement between T2 Medical, an Atlanta company that supplies intravenous drugs and nutrients to patients in their homes, and the U.S. Department of Health and Human Services was filed Monday in U.S. District Court in Atlanta.

Just two months after Southern California's largest medical group received a $30-million bailout from health plans, KPC Medical Management is again experiencing a financial shortfall, prompting state regulators to launch an investigation of the Anaheim company's clinics and finances.

The doctor groups that form the backbone of managed health care in California, which have been collapsing at an alarming rate in the last two years, appear to be at a new crisis point, threatening the entire system. Last month Family Health Care of Ventura County, which managed 130,000 patients, suddenly folded and began liquidating its clinics and equipment, leaving as many as 50,000 people with little or no access to their doctors for several days.

"Power to the patients" could be the slogan for a spate of new laws and other changes that are giving California consumers more tools to grapple with the complexities of managed care. Having a dispute with your HMO about a denial of medical services? Beginning Jan. 1, you will have the right to have your case reviewed by medical experts outside your health plan. It won't cost you a dime, and your health plan will have to abide by the experts' decision.