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Calif. to expand coverage to illegal alien children

April 22, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

boder

Border crossing between San Diego, Calif., and Tijuana, Mexico.

Medi-Cal, California’s Medicaid program, will expand coverage to at least 170,000 children, mostly Hispanic, who are in the state, and thus nation, illegally.

The Sacramento Bee reported that “They’ll gain access to not just emergency coverage but also dental care, checkups, mental health treatment and other vital services following an unprecedented Medi-Cal expansion that provides full coverage to all low-income children in the state, regardless of immigration status.”

The expansion will probably mean lots more patients at the state’s Federal Qualified Health Centers and hospital emergency rooms.

The Bee reported that the expansion “is exclusively state-funded and is expected to cost the state Department of Health Care Services about $132 million annually. A 2015 study from the Public Policy Institute of California concluded that about half of the state’s undocumented immigrants have incomes low enough to qualify for Medi-Cal.”
Few disinterested observers believe that the $132 million figure is plausible. It will almost certainly cost much more.

Calif. Medicaid cancer patients fare worse

November 6, 2015by Robert Whitcomb in Uncategorized tagged , , ,

By BARBARA FEDER OSTROV

 

For Kaiser Health News

Cancer patients insured by California’s health plan for low-income people are less likely to get recommended treatment and also have lower survival rates than patients with other types of insurance, according to a new study by University of California-Davis researchers.

While other studies have linked Medicaid insurance status to worse cancer outcomes, the UC-Davis study appears to be the first to examine the impact of various kinds of health insurance across more than one kind of cancer.

Understanding how well Medicaid (called Medi-Cal in California) serves cancer patients is crucial, experts say, because as much as 10 percent of California’s Medicaid expenditures go to cancer care. And Medi-Cal has grown to cover more than 12 million Californians – nearly a third of the state’s population.

“What’s striking is how similar the findings were for Medi-Cal members and the uninsured,” said  Kenneth Kizer, M.D., director of the University of California at Davis’s Institute for Population Health Improvement, which conducted the study. “If we weren’t spending billions of Medi-Cal dollars on cancer care perhaps that would not be surprising, but you’d think that the outcomes might be better when you’re spending that much money.”

The UC Davis researchers used California Cancer Registry data to study the experiences of about 700,000 Californians diagnosed with breast, colon, rectal, lung and prostate cancer between 2004 and 2012. They tracked how early these patients were diagnosed, their quality of treatment and their five-year relative survival rates according to their type of insurance. The types were Medi-Cal, Medicare, dual Medi-Cal/Medicare (for lowest-income seniors), private insurance, Department of Defense (DOD) insurance and Department of Veterans Affairs (VA) insurance.

Among the findings:

* Medi-Cal patients were diagnosed with advanced (stage IV) prostate cancer more than three times as often as patients with private insurance or DOD coverage.

* Medi-Cal patients with breast, colon or rectal cancer were more likely to be diagnosed at an advanced stage and to have worse five-year survival rates than people with other types of insurance.

  • Low-income seniors covered by Medicare and Medi-Cal, known as “dual-eligible patients,” were the least likely to receive recommended treatment for breast and colon cancer.
  • VA patients waited the longest to be treated for breast, colon, rectal, lung and prostate cancers, but their outcomes compared favorably to patients with other types of health insurance and they were generally more likely to receive recommended treatment.

What researchers still don’t know, Kizer said, is the reason for these disparities. It’s possible that Medi-Cal patients drop on and off the rolls, missing preventive screenings that could help detect cancers earlier. Audits and studies also have shown that some of the state’s Medi-Cal patients have difficulty getting access to doctors and specialists.

Researchers also can’t explain why Medi-Cal patients are less likely than patients with other kinds of insurance to receive recommended treatment after they are diagnosed. And they also don’t know whether cancer patients fare better or worse in Medi-Cal managed care programs, which now cover most of California’s Medicaid population.

“It’s not acceptable to have these variations” based on insurance coverage, particularly regarding breast and colon cancers for which preventive screenings are well-established and effective, said Christina Clarke, a research scientist at the Cancer Prevention Institute of California and a consulting associate professor at the Stanford University School of Medicine. She was not involved in the study.

“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks. That’s the tragic thing here,” Clarke said. “There’s a body count and we’d like to figure out a better way to insure that all Californians are getting the recommended screening for these deadly cancers and treatment according to guidelines. We have a lot of work to do.”

CMG afterword: How much of these bad figures could be improved with better coordinated care and more attention paid to the social determinants of health?

Calif. delays putting some children into managed care

September 8, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , ,

By BARBARA FEDER OSTROV, for Kaiser Health News.

California legislators passed a bill postponing a controversial plan that would have shifted tens of thousands of medically fragile children into Medi-Cal managed care plans.

The bill, AB 187, passed both houses Thursday and will be sent to Gov. Jerry Brown for his signature.

At issue was the fate of the California Children’s Services program, which serves an estimated 180,000 children younger than 21 with serious medical conditions, including spina bifida, cancer, cystic fibrosis and sickle cell disease.

State officials had been planning to fold the $2 billion program into its vast system of Medi-Cal managed care, initially transferring 31,000 CCS children into managed care plans starting next year. AB 187, if signed into law, postpones that date to 2017.

Families of CCS children, child advocates and the children’s hospital lobby had criticized the state’s transition plan, saying that Medi-Cal managed care hasn’t worked well for other vulnerable populations and is particularly risky for severely ill kids whose lives depend on access to highly specialized care.

“The time frame is just too short to ensure that the managed care networks have enough pediatric specialists, and the financing is too complicated to sort out quickly,” said Alex Johnson, executive director of the Children’s Defense Fund-California. “Let’s keep children where they are now. If we slow down and work together, we can get a program that works best for children and families.”

Kausha King was particularly relieved by the bill’s passage. She had worried about interruptions in care for her son Christian, 20, who lives with cerebral palsy and other serious health conditions.

“Oh my goodness, this is so exciting. I feel like this is a victory for families,” said King, who lives in Concord and works as a liaison for families of children with special needs. “Now we can trust that our voices are being heard. My son will continue to receive the care that he needs and not be forced into a program that I believe could use a lot more work before it’s implemented.”

Even with an extra year to plan, moving tens of thousands of sick children into managed care programs will be a daunting task. Children’s hospitals also will need to assess the financial impact of the move to managed care. CCS pays for care at higher rates than Medi-Cal.

About 90 percent of children served by CCS also qualify for Medi-Cal, the public insurance program for low-income Californians. Medi-Cal covers their general medical care, while CCS covers services related to their specific conditions.

CCS pays a fee for each service provided, whereas Medi-Cal increasingly is switching to a managed care approach, in which medical services are coordinated and covered under a single health plan for a fixed monthly payment.

Based on concerns from families, children’s advocates and health care providers, state officials have already changed their plans for the transition. They are now completing an evaluation of a pilot program in San Mateo County testing the state’s “whole child” plan for moving children into Medi-Cal managed care. The evaluation had been planned, but not finished.

“We’re encouraged that the (Department of Health Care Services) is moving in the right direction and listening to stakeholders,” said Ann-Louise Kuhns, president and CEO of the California Children’s Hospital Association. “It’s better to do an evaluation before we start a large scale move. What the legislature recognized is that we need more time to make sure that, as we look at program improvements, we do this really carefully.”

Calif. and Mass. Medicaid programs denounced

June 17, 2015by Robert Whitcomb in Uncategorized tagged

 

Two  state Medicaid programs face heavy criticism, reports Kaiser Health News:

“In California, a state auditor says that more than 9 million Medi-Cal enrollees in managed care plans may not have adequate access to doctors, while in Massachusetts, the {Medicaid} program for low-income residents misspent $500 million, according to a state audit.”

Pushing indigent mentally ill into outpatient treatment

April 3, 2015by Robert Whitcomb in Uncategorized tagged , , ,

pyscho

Early Persian psychiatric treatment.

The Sacramento Bee reports that Sacramento County will spend ”$16 million this year on hospital costs for the severely mentally ill, almost three times more than originally budgeted for care at area hospitals.’‘

Experts link much of the increase to the greater number of patients showing up because of the expansion of California’s Medicaid program (Medi-Cal) under the Affordable Care Act.

So that jurisdiction, as are many in America, are looking at placing more emphasis on community-based outpatient treatment and less on hospital beds. This suggests more of a focus at improving  other factors besides direct psychiatric care — such as housing and transportati0n — that also affect health and whose shortages drive up medical costs by driving the mentally ill to hospital emergency departments.

“The plan, expected within three months, will include services that help the mentally ill before they reach a full-blown crisis, alternatives for those in a crisis and better assessments to avoid unnecessary hospitalizations,”  The Bee reported.

“Preliminary estimates peg the cost of those services at around $9 million a year, much of which would be offset by federal and state funds and reduced hospitalization costs.”

This is common-sensical. However, at the same time, there’s growing opinion that there should be a revival of hospitals to care for the most severely mentally for the long-term — in the case of some patients, for the rest of their lives. The deinstitutionalization movement has gone too far for some patients and their exhausted families.

The Bee noted that “Efforts to relieve pressure on emergency rooms have led to more psychiatric hospital stays, according to a county staff report.” Not exactly a fiscal triumph for the payers.

The Mental Health Improvement Coalition, which includes area hospitals and nonprofits, said: “The system of behavioral healthcare is fundamentally broken. People in crisis have little option other than to access services through hospital emergency room departments, which are the least conducive environments for behavioral health patients to become well and receive appropriate services.”

 

Calif. counties need to step up for uninsured

March 13, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

 

By JENNY GOLD, for Kaiser Health News

With millions of Californians gaining coverage under the Affordable Care Act, counties need to strengthen their health programs to serve the remaining 3 million uninsured people, nearly half of whom are living in the state illegally, according to a report by a statewide advocacy coalition.

Under state law, each county is responsible for providing care to low-income Californians who are uninsured. But eligibility restrictions in county programs vary dramatically, leaving the uninsured with uneven access to care across the state, according to the report by Health Access California.

The coalition, which surveyed all 58 counties last fall, found that 48 of them preclude residents who are in the country illegally from enrolling  in county programs, and 43 exclude any resident earning more than twice the federal poverty level. (The poverty level is $11,770 per year for an individual and $24,250 per year for a family of four.)

In 2014, counties worked hard to enroll as many of their residents as possible into new coverage options through the Affordable Care Act, said Anthony Wright, executive director of Health Access.  Because millions were enrolled either through the insurance exchange, Covered California, or through Medi-Cal, the government program for the poor, the counties experienced a significant decline in the number of people enrolled in their programs.

But significant pockets of uninsured people remain – especially immigrants living here illegally, who are mostly ineligible for state and federal programs.

In counties with strict eligibility criteria for their programs, such as Merced, Placer and Tulare counties, no residents are enrolled. But counties with expansive programs that cover the undocumented and higher-income residents are still seeing high levels of enrollment. In Los Angeles, for example, 81,000 people were signed up with My Health LA, the county program.

The widely varying levels of enrollment among counties suggest that local governments “need to re-adjust their programs,” said Wright in a press release. “We need counties and the state to reorient their safety-net programs to serve the need that continues to this day.”

Few counties have adjusted eligibility requirements for their programs in the past two years, Wright said. Instead, they have taken a “wait-and-see” approach until the effects of the ACA and the state’s reallocation of safety-net funds were clear.  Many are reconsidering how to manage their safety-net health programs as of 2016, and advocacy groups such as Health Access are hoping the counties will expand their eligibility requirements, particularly to allow immigrants here illegally to enroll.

“These county efforts should ultimately be a bridge to a statewide solution, where all Californians can be covered regardless of immigration status,” said Wright. “Immigrants are part of our economy and society, they should be fully included in our health system as well.”

But some in the state say that expanding health coverage to additional residents would be too costly. A bill currently moving through the state legislature, for example, would expand insurance options to immigrants living in the state illegally. That bill, called the Health for All Act, would cost the state between $424 million and $436 million in 2019, according an analysis from the University of California at Berkeley’s Center for Labor Research and Education and the  University of California at Los Angeles Center for Health Policy Research.

Calif. A.G. okays Daughters of Charity sale

March 3, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

cap

California Capitol 

California  Atty. Gen. Kamala Harris has approved Prime Healthcare’s  controversial purchase of six nonprofit hospitals comprising the Daughters of Charity Health System, presumably ending a battle  that has, among other things, divided powerful labor unions.

The Sacramento Bee reported that Harris ”called the deal the largest ever overseen by the office, and it carries a hefty set of conditions requiring Prime to provide charity care ‘at historical levels’ and reproductive care without ‘restriction or limitation’; to spend $150 million on capital improvements at the newly acquired facilities; to cover the pension obligations of 17,000 active and retired employees; and to remain certified to treat Medi-Cal and Medicare patients for a decade.”

When healthcare, if not beauty, is far away

March 2, 2015by Robert Whitcomb in Uncategorized tagged , , , , , ,

Trinity_Alps_near_Granite_Lake

The Trinity Alps, in the northern California region discussed here.

By DANIELA HERNANDEZ, for Kaiser Health News

HAYFORK, Calif. — It’s Tuesday morning, half past eight and already hot, when the small bus pulls up to the community clinic. Most of the passengers are waiting in front — an old man with a cane, two mothers with four kids between them, packed lunches in hand.

Two more arrive. A gray-bearded man with a pirate bandana steps from the shelter of his Subaru. A sunken-cheeked woman rushes up on her bike.

“Woohoo! We have a full car!” the driver says brightly after they’ve all climbed aboard. The riders smile back, some with a hint of resignation. It’s time for the weekly trip to the clinic in Mad River, about 30 miles down a winding mountain road near the Trinity Alps. The tight twists and turns are hard on the stomach, but even harder on the joints — especially if you have chronic Lyme disease, as more than a few of these riders do.

Jeff Clarke, the 58-year-old in the black bandana, has Lyme, acquired long ago from deer ticks that dwell in the region’s sprawling forests. But today he’s going to ask about a lump that’s been growing in his left breast. It’s starting to hurt, and he’s worried. His fellow riders list their own ailments matter-of-factly: asthma, dental decay, diabetes, drug addiction, heart disease and much more.
Like so many isolated American towns, Hayfork has lost its vitality and much of its youth to bigger places.

For all its tree-lined ridges and breathtaking views, Hayfork is well beyond the tourists’ byways — more than an hour from the city of Eureka on the west and Redding on the east. It’s a 45-minute drive just to Weaverville, the tiny Trinity County seat.They wouldn’t be making this trip if they didn’t have to. In Hayfork, “we’re down to the remnants of the medical personnel,” says Clarke, a well-spoken musician with a love for science, cats and NPR. “It just came to the point where if I needed to deal with anything important I just felt much more comfortable going over to Mad River.”

Whether they’re too poor to leave or charmed by the star-filled skies, Hayforkers have mostly made their peace with isolation: No retail stores, theaters, museums, fancy restaurants – and Internet access that is iffy at best.

“We were always 20 years behind everything,” says Shannon Barnett, a 41-year-old a former school teacher who grew up here. “We were all just fine with that. Now it’s different.”

She’s referring to the exodus of basic health services.

For decades, Hayfork had been fortunate. Well after the rise of urban health systems and their intricate business models, it had a tight-knit local “system” founded on the simple, generous commitment of two people: a general practitioner and a pharmacist.

“He was everybody’s doctor,” Barnett says of Dr. Earl Mercill, a GP who moved up from the Central Valley almost 50 years ago. “You never thought about going to anyone else.”

But it’s been years since Mercill retired. Now his clinic is staffed by doctors who rotate in from Weaverville once or twice a week, and otherwise it’s run by physician’s assistants. There are no hospitals for miles, though helicopters swoop in for emergencies when needed.

In these tiny towns of California’s  far north, lacking insurance is not the biggest obstacle to care. Even before Obamacare took effect, about four of five people were insured, roughly the same as in the rest of the state. A good number are on Medi-Cal. The Mad River clinic isn’t an ideal alternative.  It’s bigger than Hayfork’s and offers a wider array of services but it’s still staffed mostly by physician’s assistants and about an hour away by bus. It’s so backed up with patients it can take weeks to get an appointment, Clarke says.

What’s ailing these people is geography – that, and poverty. The median household income in Hayfork is about $34,000 a year, well below the statewide figure of about $60,000, according to the American Community Survey.  Unemployment is extraordinarily high – estimates range between 9 and 26 percent. Many people lack a sturdy car to drive, or even money for gas.

In the federal government’s parlance, Hayfork is a “medically underserved” community – one of roughly 3,500 in the country and 170 in California, according to the federal government’s latest numbers. By definition, these areas have too few primary care providers, high infant mortality, pervasive poverty or a significant elderly population. Some are islands of deprivation within otherwise well-stocked urban areas. Others are dots on the map like Hayfork, far from where doctors and medical services are clustered. According to the National Rural Health Association, only about 10 percent of physicians practice in rural America, where nearly a quarter of the population lives.

healthcare is available on the other side of the mountain, says Greg Schneider, a 65-year-old writer and band mate of Clarke’s. “The problem,” he says, “is getting there.”

Lumberjacks and Janes

In 1967, long after its rise and fall as a gold-mining town, Hayfork struck it rich. That’s when a friend told Mercill, then practicing in tiny Arvin, Calif., that an even tinier town south of Oregon badly needed a doctor.

Mercill was intrigued. He visited a few times with his large and growing family (he and his wife Marianne eventually raised eight kids, four of them adopted).
After praying on the decision, the family moved up north, built a house and settled on 40 acres outside town. A few months afterward, Mercill opened his clinic downtown. Hayfork was still a mill town then, filled with lumberjacks and janes, as the women were known. It had restaurants, shops and even a thriving art and music scene.

He was beloved almost from the beginning. He made house calls in the middle of the night — sometimes walking over precariously narrow log bridges or shuttling to his patients’ homes by snowmobile.

He delivered babies by flashlight after storms knocked down power and waited by his patients’ bedsides for hours until they felt better, sometimes charging little more than a slice of cake.

“If they didn’t have any money, I saw them,” Mercill recalls, frail now, but with a keen long-term memory. “If they could pay later, fine. If they didn’t, they didn’t. I never went hungry.”

Mercill couldn’t do everything, of course. If a patient needed a specialist or surgery he sent them to colleagues in Redding or Weaverville. Sometimes he drove along with them and assisted in the operating room.

In 1982, pharmacist Gerry Reichelderfer came to Hayfork, also on a friend’s recommendation. He fell in love with mountain life, and took over the drug store next to Mercill’s clinic.

Reichelderfer lived just seven minutes and a single stop sign away from his shop. He’d drive over and open up anytime people needed a prescription. If they couldn’t pay right then, he’d put it on an I.O.U. or let it slide.

The men joined forces, talking daily by intercom. The partnership would last nearly two decades.

A Turn of Fortune

In the late 1980s, the logging industry started to crumble. Under pressure from conservation groups, the mills in Northern California dominoed shut. By the time Hayfork’s mill closed in the mid-1990s, the population had dwindled to the low thousands.

“When all the workers left, they took all the families and young children,” says Rick Simmons of the Trinity County Historical Society.  “What was left over was people unable to go anywhere.”

Homelessness, poverty and drug addiction took hold. An underground market began to sprout around marijuana — bringing drifters, seasonal trimmers and unofficial security forces to town. The forests became a dangerous place to wander.
He wanted to get sober for her, if not himself. Seeing no hope for professional help locally, he drove to a clinic in Weaverville. His first need, he told the counselor at the desk, was housing — a roof over his head.Clarke, a runaway and hitchhiker in his youth, was in some ways typical of Hayfork’s new generation. He arrived in the 1980s, in the clutches of methamphetamine addiction, a habit he picked up in the bars where he played guitar. For years, he landed jobs and lost them — working as a wood chopper, sandwich maker and cabinet craftsman. He started seeing a woman he met in rehab, then split with her, but not before they had a daughter. They named her Stormy Brooke. He gained custody and lost it more than once.

“He repeatedly said that’s not my job,” Clarke says.

Clarke stopped trying to seek addiction treatment after that. “Most of the progress I’ve made in the last few years has been behind the 12-step stuff I do,” he says.

The meetings at Hayfork’s Solid Rock Church saved his life, he says. He goes every Monday and has been sober 10 years.

His health is ok, considering.  He lost his teeth. His bottom denture wore out long ago and his top one is breaking. He has high blood pressure, a detached bicep and hepatitis C from a jailhouse tattoo. He developed chronic Lyme disease because he wasn’t treated right away with antibiotics.

Nowadays, Clarke lives behind the Trinity County Fairgrounds, in a two-room trailer next to the town cemetery. Supported by $889 a month in disability insurance, he spends his time organizing 12-step meetings, reading library books and science magazines, and volunteering as a sound engineer for gigs at a local coffee shop. On good nights, he gets paid a little. Most important to him, he says, is staying as healthy as possible so he can look after 23-year-old Stormy and her 2-year-old son, Tony, who lives with his dad.

Stormy, a tall beauty too insecure to know it, cuts herself and has made several attempts at suicide. Her porcelain arms bear the scars.

“She has no self-esteem,” Clarke says. “She has no faith in love, or trust for any other human beings. She has some real darkness inside her, you know? I’m sure I’m responsible for a majority of that.”
After three hours, her doctors released her with a prescription for klonopin to control her seizures and panic attacks, and told her to follow-up with her primary care physician.In June, during a fight with her father, she had what Jeff thought was a stroke. En route to Redding in an ambulance, she started seizing so they put her on a chopper. At the hospital, the doctors said she’d had a stress-induced seizure.

“I had to laugh,” Clarke says. “We’re in Hayfork!”
Dr. Mercill hung onto his clinic as long as he could, finally selling it to a doctor based in Weaverville. That doctor recently sold it to Trinity Hospital, part of the Mountain Communities Healthcare District, also based in the city.

Like losing a limb

The saddened community dedicated a clock to him in the town center.  “It was like a limb being cut off,” Barnett says. ”I know at first I didn’t have another doctor for a long time. Other people didn’t either. They bounced around for a long time.”

Every once in a while, Mercill treated people who asked, but he’s 91 now, and hasn’t done that in years.

Two of Mercill’s kids grew up to be medical professionals – one a dentist, another a physical therapist–but they live and practice in bigger towns. The other children also moved away. One son, Steve, moved back from Southern California 21 years ago to care for his mother before she died. Now he’s caring for his dad.

Reichelderfer carried on at his pharmacy after Mercill retired, lending credit to Clarke and others when he could. But the economics of healthcare shifted under his feet. His business began to struggle. The reimbursements from insurers were too low, he said, and the clinic next door — a long time ally — began referring patients to bigger stores in Weaverville.

In Trinity County, where Hayfork is located, medical services overall became hard to find. In 2012, according to the Office of Statewide Health Planning and Development, there were 11 medical doctors currently practicing, roughly one per 1,200 residents. Statewide, the ratio is roughly 1 per 300.
A county behavioral office offers counseling in Hayfork, but a counselor isn’t there every day and in-person visits are by appointment only. Sometimes the most expedient treatment comes in jail — Clarke calls it the “nudge from the judge.”Specialists like dentists and psychiatrists are nearly non-existent here.

That lack of specialty care – particularly in mental health – wears on some residents. Stormy Clarke says that when she feels a panic attack or depression coming on, she simply tries to breathe deeply and distract herself by keeping busy. She also has a medical marijuana card and smokes regularly.

He mentions an acquaintance named Robbie, who suffers from paranoid schizophrenia. Since being released from jail, he’s been off his meds, Clarke says. He walks up and down Hayfork’s main strip along Highway 3, muttering to passers-by about the many people who are after him.

“In cities, you have places like outpatient programs for these types of people to go to, every single day,” said Julie Bussman, a psychologist at the Mad River clinic. “It’s a real hardship for people who are severely mentally ill to live out here because there’s not a lot of resources.”

In August, Bussman quit and moved back to Minnesota, leaving no psychologist for miles.

Back on the Bus
Everybody has to be seen before the bus can head back.After the bus pulls into the Mad River clinic — a remodeled blue cottage that used to serve as a the local forest service office — the riders start their wait. They are used to it by now: The kids pull out games and books; the adults chat in the waiting room or by a weathered picnic table on the back lawn.

On this day, Clarke is among the first in line. The physician’s assistant on duty examines his chest lump and advises against a biopsy, an invasive procedure, because he wants to run more tests. Clarke takes the news with some concern.

“I was pretty freaked out. I went in there with the agenda of the biopsy. They wanted to explore other options,” he says afterward.

By the time the bus gets back to Hayfork, it’s mid-afternoon. He drives back to his trailer, frustrated and spent.

A few Tuesdays later, he takes the bus back to Mad River and is referred to a specialist in Weaverville.

It is another two months before he learns the lump is a side effect of the medications he’s taking — a hypothesis he’d mentioned earlier to physicians and their assistants in Hayfork and Mad River.

Now he has to start thinking about replacing those dentures, which means another bus trip — or several – around the mountain.

Reichelderfer, 82 and in failing health, began looking earlier this year for someone to buy his store. He looked for months. Even the independents weren’t interested, in part because pharmacists’ family members weren’t keen on moving to Hayfork.

The Final Loss

With great sadness, he shut his doors on Sept. 18.

“I wish I could have been able to sell it to somebody,” he said, “for the convenience of the people.”

From now on, Hayforkers will have to get a ride to Owens Pharmacy in Weaverville or to Walmart or CVS in Redding.

It took only a few days to board up a drug store open for 32 years.

It’s a relic now, standing just yards from the clock the town dedicated to Dr. Mercill, with his years of service gratefully memorialized on a plaque.

Heidi de Marco and Carol Eisenberg contributed reporting.

Low-income Californians happy with ACA effects

February 17, 2015by Robert Whitcomb in Uncategorized tagged , , , , , ,

 

By ANNA GORMAN, for Kaiser Health News

agorman@kff.org | @AnnaGorman

 

Low-income Californians are increasingly satisfied with the healthcare they receive, underscoring the impact of changes made by clinics and providers since the Affordable Care Act went into effect, according to a report released Wednesday.

More than half of low-income patients – 53 percent — rated their quality of care as excellent or very good in 2014, up 5 percentage points from 2011, according to the survey by the Blue Shield of California Foundation. That means that about 400,000 patients were happier with their care, the report said. (Kaiser Health News receives funding from the foundation.)

Compared with patients who were uninsured in 2011, low-income residents who in 2014 had coverage through the state’s insurance exchange, Covered California, reported much higher satisfaction with their care. Low-income Californians were defined in the survey as having household incomes less than 200 percent of the federal poverty level, or $48,000 for a family of four.

Some of the biggest gains in satisfaction were at community health centers, which see the largest share of the low-income population and received billions of dollars underthe health law to improve their services. Patients there gave higher scores to courtesy and cleanliness than in 2011, and more said somebody at their facility knew them well.

Community clinics have undergone a culture shift because of the Affordable Care Act and started to focus more on patient satisfaction, said Peter V. Long, president of the foundation.

“They realized, ‘We have to do things differently or it’s going to be a challenging world for us,’” he said. “They have prioritized this and actually made a difference.”

Many, for example, began assigning patients to a specific doctor. That continuity of care makes a big difference to patients and helps them develop a relationship with the community clinics,  Long said. “Having the same doctor and having someone who knows me and cares about me builds that level of trust,” he said.

There is still room for improvement, the report said. Just 34 percent of patients at clinics serving low-income patients gave high marks for wait times. And low-income patients in general said it was difficult to get a night or weekend appointment and to access specialists.

Carmela Castellano-Garcia, president of the California Primary Care Association,  said there was an understanding among clinics that the environment would be more competitive after the health law took fuller effect. Under Obamacare, many uninsured patients became eligible for free coverage through Medi-Cal or subsidized plans through

Covered California, the insurance exchange. As a result, they had more choices about where to seek care.

To retain patients, Castellano-Garcia said they devoted significant resources to improving both care and customer service. The survey showed that the changes made a difference, she said.

“This is a great shot in the arm and shows the clinics that their efforts and investments are paying off,” she said.

Researchers surveyed more than 1,500 Californians between August and October of 2014. The margin of error was plus or minus 4 percentage points for the low-income sample. The survey included patients at community clinics, public  and private clinics, as well as doctors’ offices and other settings.

 

 

 

 

 

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