Vote on County/USC raises concerns.

Private L.A. hospitals and labor unions are already mobilizing to protect their interests in the wake of last week's decision to downsize County/USC Medical Center to 600 beds.

At the heart of their concerns: money.

Hospital officials are worried they will not be adequately compensated for providing care to indigent patients, and unions are worried that indigent care will be diverted to non-union hospitals, causing losses of union jobs.

Diverting indigents to private hospitals under so-called "public-private partnerships" would require the county to pay private hospitals at least $1,250 per patient per day, according to a county-funded study done by APM Inc.

But serious doubts are being raised about the county's ability to shell out that amount once the replacement hospital is completed in 2004.

Four years prior to that, in 2000, the county will stop getting the $250 million a year in Medicaid reimbursements it now receives from the federal government for outpatient care.

And in the county health department's own information package to county supervisors, the wide cost range of $800 to $2,000 per bed per day was used to make financial projections.

"The county has a tendency to start out with a reasonable proposal and then ratchet down the proposals so many times," said David Langness, spokesman for COHR Inc., a Chatsworth health care outsourcing company. "We are very skeptical that what we will end up with here will be something we can live with."

Jim Lott, spokesman for the Healthcare Association of Southern California, also expressed concern: "If the rates are too low, hospitals may not agree to accept the patients."

The hospitals most likely to receive indigent patients are those in and around downtown, where the bulk of County/USC's uninsured patients reside. Among these: White Memorial Medical Center, California Hospital Medical Center, St. Vincent Medical Center and Queen of Angels/Hollywood Presbyterian Medical Center.

Robert Carmen, president and chief executive of White Memorial, said his greatest concern is not the actual pay rate from the county but the types of care that will be included in the county's reimbursement package.

"We want to know if all indigent patient care will be covered or only certain types of patients or certain types of procedures. That will make a big difference to our bottom line," Carmen said.

Fred MacFarlane, spokesman for the L.A. County Department of Health Services, said the concerns expressed by the unions and hospital advocates will be addressed in negotiations starting early next year.

"The county will have to sit down individually and collectively with the hospitals to arrive at the financial arrangements necessary to treat patients by the year 2004," MacFarlane said. "It will not be a cakewalk and it will be done with care and deliberateness. And the financial stability of the hospitals in question will be discussed."

He added that it is too early to address financial concerns related to the County/USC replacement hospital.

"At this stage, we do not know what the county health system's financial position will be in the year 2004, so it's premature to start throwing figures out there," McFarlane said. "I cannot say whether the hospitals' fears will be founded or unfounded."

As for union officials' fears, they are based on the possibility that the county's outsourcing of indigent patients will put union members out of work.

Union officials are insisting on requirements that county workers get preference in hiring at local hospitals where indigent patients will be diverted.

They also vowed to push the county to route the contracts to hospitals that are already unionized; if that does not work, the unions will try to organize the hospitals that do receive the contracts.

"Whatever the county does in the way of contracting out, we the union intend to follow the work," said Bart Diener, assistant general manger of Service Employees International Union Local 660.

"We would prefer to see the work go to union hospitals, but if the county decides to contract out to non-union hospitals, then we will be on the doorsteps of those hospitals ready to organize the entire work force," Diener said.

MacFarlane said the unions will have to make their case to the county Board of Supervisors.

"That is a policy issue and is up to the board. We will work with whatever directives the board gives us. Right now, we are not at that stage yet."