[Hpn] S.F. General risks service cuts, reputation to serve poor

chance martin streetsheet@sf-homeless-coalition.org
Mon, 18 Jun 2001 13:17:07 -0700

Ailing hospital turns private payers away
S.F. General risks service cuts, reputation to serve poor
Sabin Russell, Chronicle Medical Writer
Monday, June 18, 2001
©2001 San Francisco Chronicle


Even as doctors at San Francisco General Hospital are scrambling for a
last-minute infusion of city money to stave off service cuts, the revered
institution is turning away patients who can pay their bills with private

It is a controversial and seemingly paradoxical policy endorsed by San
Francisco Department of Public Health Director Dr. Mitch Katz, part of an
effort to bring San Francisco General back to the core mission of most
county hospitals -- serving exclusively as a safety net for the indigent.

Katz's policy toward private payers is grounded in the hard economic fact
that even well-heeled patients drawn to San Francisco General cost more to
treat than their private policies will pay.

But critics say it also leaves the hospital more reliant than ever on city
tax money to pay for patient care -- and money this year is tight.

Unhappy doctors who work at the hospital say it comes at an additional cost:

It threatens San Francisco General's long-standing role as an elite public
hospital able to attract the best and brightest doctors.

"We are on the verge of blowing this place back to the Dark Ages," said Dr.
Lee Goldman, associate dean of clinical affairs at UC San Francisco. Doctors
at San Francisco General are paid by UCSF to care for indigent patients and
to teach interns and residents. The city pays UCSF for those services, a
contract valued at $54 million in the fiscal year beginning July 1.

At issue this week before the Board of Supervisors is a request by UCSF for
$5.2 million in additional funds that would give doctors at San Francisco
General 1.5 percent cost-of-living increases and merit pay.

For years, San Francisco General has attracted outstanding physicians
largely on prestige alone. Salaries are roughly 20 percent below the
national average, despite the Bay Area's notoriously expensive housing

"We're not in a position not to grant pay raises," said Dr. Phil Hopewell,
UCSF's liaison with the staff at San Francisco General. "If we lose people,
we're not going to be able to recruit replacements."


Anesthesiologists across the bay at Highland Hospital in Oakland are making
$300,000 a year, he said. San Francisco General's anesthesiologists are
making half as much.

Morale at the hospital is sagging from years of lean budgets, leading to a
range of belt-tightening efforts from minor indignities, such as forcing
doctors to take out their own trash, to significant cuts in service.

Patients with private insurance may have cost the hospital money, but they
also generated fees for doctors, fees that are now drying up. But Katz
contends that the effort to use private dollars to subsidize the public
hospital has failed and cannot work.

"Eight years ago, the advice was compete in every market you could. It
didn't pan out," Katz said. "Today, with decreases in Medicare, Medi-Cal and
from private payers, hospitals are not making their expenses. We're no
different . . . but our obligation is to take care of poor people."

So rather than spend dollars processing money-losing private insurance
claims -- or even Medicare claims -- insured patients are being encouraged
to get their care elsewhere.

"Doctors tell me that I am sending away dollars," Katz said. "But I am
sending away both dollars and expenses."


Meanwhile, budget constraints continue to erode San Francisco General's
reputation as an elite medical institution.

This year, the hospital's cardiology department had to abandon its bid to
install state-of-the-art cardiac care equipment to treat heart attack

The new equipment would permit doctors to clear blood clots that cause heart
attacks using a thin wire threaded into the coronary arteries, a procedure
called primary angioplasty.

When the equipment wasn't delivered as promised, according to Goldman, the
cardiologist who had counted on it quit. Instead, heart attacks at the
hospital are still treated with clot-busting drugs -- adequate, but not the
superior standard of care doctors have long-considered standard at the
public hospital. 

This year, Katz has fought successfully to pump more money into programs
that could reduce hospitalization costs in the future -- an innovative
program to provide health insurance to every child and a program to house
indigent patients in residential hotels rather than turning them back onto
the street. 

"There's a payoff, but we would not see it for several years," said Mark
Leno, chairman of the San Francisco Board of Supervisor's Finance Committee.
"This is Mitch's bet."


Supervisor Aaron Peskin indicated that the doctors' bid for pay increases
might win out. The doctors are competing with dozens of other city functions
for a fraction of the budget traditionally allocated by the board before it
is approved. This year, the supervisors estimate they may have a pot of $8
million to $15 million.

"I'd like to give them a booster shot, if I could," Peskin said.

While the sum is a tiny fraction of the city's $5.2 billion budget, they are
vying against dozens of other competing interests, such as a bid by the Cal
Works welfare-to-work program to raise wages for employees to $8 an hour
from $6.26. 

Katz himself is completely supportive of the bid to add $5.6 million to the
UCSF contract. "For many doctors, this year has reached a breaking point,"
he said. "We are skating on the edge, and we can't afford to lose people or

A doctor who trained at San Francisco General and still sees patients there
once a week, Katz said he wanted the hospital to prosper. He adamantly
denies any intent to downgrade the hospital as a prelude to selling it off.
"We have no plans to privatize it," he said.

But Katz said he would continue to fend off proposals to spend money for
amenities that would attract paying patients, even if that would make his
doctors happier. "We will not run two classes of service," he said. "We will
run only one standard of care."

E-mail Sabin Russell at srussell@sfchronicle.com.

©2001 San Francisco Chronicle   Page A - 1

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