Chat Transcript: Doctor, reporter answer health care questions

Following the publication of "Don't Get Sick: Crisis in Coverage," Dr. Eric Ramos, chief medical officer of Doctors Medical Center, and Modesto Bee health reporter Ken Carlson, answered questions from readers concerning health coverage in Stanislaus County.

Click here to download the transcript as a PDF or scroll through the chat below.

Don’t Get Sick: Crisis in Coverage Live Chat, Feb. 23, 2011, Noon-1 p.m. @ www.modbee.com

11:54

 

Brian Clark: 

Good afternoon. This is Brian Clark, online news editor at The Bee. I’ll be moderating today’s chat on health care. We are joined by Dr. Eric Ramos, chief medical officer of Doctors Medical Center, and Ken Carlson, the Bee’s health reporter. We’ll try to get to everyone’s questions. The chat will conclude at 1 p.m.

 

11:56

 

[Comment From From Turlock ] 

I’m new to Medi-Cal and have to travel to San Francisco to see a dermatologist and rheumatologist because those specialist in Modesto don’t accept Medi-Cal. I had to take my son to Children’s Hospital in Madera to have his broken leg casted? This is a common issue for Medi-Cal patients. Why is this?

 

11:57

 

Ken Carlson: 

The Stanislaus County health clinics have specialists to treat most common medical conditions, but there is a gap with rheumatology and dermatology. Local orthopedists have stepped up to treat foot problems for diabetics who lost optional Medi-Cal benefits in 2009. It’s fairly common for people on Medi-Cal to have trouble finding specialists who will treat them, because of the low reimbursement rates for doctors. During our reporting for the series, we were told the county Health Services Agencies was trying to close the gaps in specialty care.

 

11:59

 

[Comment From Guest ] 

Can anyone give one day free health care once day a month. That would include blood tests, ex-rays to people so if there is something wrong it can be diagnosed sooner? If all health care agencys did this one day a month, this could help a lot of people.

 

12:01

 

Eric Ramos MD: 

There are many centers that do have local health screenings and health fairs. It is difficult to screen all patients for these diseases. The bigger problem is what do we do with patients that are found to have diabetes into treatment. Your idea is a good first step into changes that need to occur and move us forward.

 

12:02

 

[Comment From Bill Braskey ] 

Dr. Ramos, as a employee in the healthcare field, what can be done to help organizations receive payment from Medicare and Medi-Cal? Some estimates have my company receiving 18 cents on every dollar billed to Medi-Cal. So with virtually every Medi-Cal patient we see, we are losing money. Any organization cannot stand long with this sort of unbalance. Your thoughts?

 

12:04

 

Eric Ramos MD: 

That is the crux of the healthcare problem. What we need to do is create a system of care that doesn't duplicate services. the Patient Centered Medical Home concept does a good job to address this problem. Group visits, e-visits work well to decrease the cost of care. The development of care teams is vital to our future

 

12:05

 

[Comment From Guest ] 

I am confused about the optional Medi-Cal benefits cuts. What services were cut?

 

12:06

 

Ken Carlson: 

The suspension of optional Medi-Cal benefits in 2009 resulted in suffering for many people who were cut off and it created confusion. The remaining Denti-Cal benefits are limited, but the program still provides services for children and covers tooth extractions and abscess treatment for adults. Another source of confusion was the elimination of optometry service (eyeglasses). The program still pays for opthamalogical services. In other words, it covers the retinal exams recommended for diabetic patients. Information about Medi-Cal services is available at the California Department of health Care Services Web site, at www.dhcs.ca.gov.

 

12:07

 

Eric Ramos MD: 

The more important issue is that for every service cut it decreases the amount of money to the system and will decrease what we can provide to patients 

12:08

 

[Comment From Linda Loveday ] 

Follow up question on my one day free health care. I was wondering if the drug companies could step in and supply meds free or at a very low cost for the ones that have serious medical conditions but no insurance?

 

12:09

 

Eric Ramos MD: 

Thank you for your question Linda. Many companies have stepped up and offer discounted medications to those who qualify. The biggest problem is they don't do a very good job publishing the offers. 

 

12:10

 

Eric Ramos MD: 

For example Lipitor is now being offered at 4 dollars a month from the company 

 

12:11

 

Ken Carlson: 

People often apply for these free programs through a community health clinic or their doctors.

 

12:12

 

[Comment From Guest ] 

For people in their 40's on unemployment and are unable to afford COBRA or private insurance, are there clinics available to them for medical treatment?

 

12:13

 

Eric Ramos MD: 

Most of the County Clinics and Golden Valley will accept cash as payment. If you have a previous physician many of them will accept cash as payment and might be able to help with your medication. Sometimes you can qualify for assistance through a program as well.

 

12:15

 

Ken Carlson: 

The county clinics and Golden Valley have a sliding fee scale for uninsured patients. Depending on your income, you may have to pay $30 to $35 for a doctor visit. You may be eligible for the county indigent health program if your income is below $1,805 a month. But, you may have steep co-pays with the indigent health program if your incomce is more than $1,175 a month.

 

12:15

 

[Comment From Dave ] 

What can be done between now and when health care reform takes effect in a few years to help those in need in Stanislaus County? What are 2 or 3 of the most important first steps to take?

 

12:16

 

Eric Ramos MD: 

We have to change the structure of our health care system. Physicians need to oversee patients health through healthcare teams, patient education need to be on a widescale manner such as through local cable channels, community health workers and work on prevention. 

 

12:18

 

[Comment From Guest ] 

I’m 48 and got laid off from my job last year. At this point, I have no health insurance. I run and get daily exercise. I’m in great health. If, for instance, I got terribly sick, where would I go? Do I just show up in any emergency room? I haven’t used health care much and have no idea where to go.

 

12:20

 

Ken Carlson: 

Regarding what can be done before when health care reform takes place ... The county may get invovled with the Bridge to Reform initiative, which could give the county more federal funding to cover thousands of more uninsured patients. The county is doing a feasibility analysis on this to measure the costs and could make a decision by August on whether to commit. This could come down to a policy decision by county leaders.

 

12:21

 

Eric Ramos MD: 

Do you have a physician? If so contact them first. If you don't have a primary care physician get into see someone to develop a relationship. Then when you need help you have somewhere to go. Try to safe yourself 3-4 hour waits in the Emergency room. You can also use an Urgent care center 

 

12:22

 

Ken Carlson: 

You could try going to a county clinic or somewhere like St. Luke's in Modesto.

 

12:23

 

[Comment From Guest ] 

If I’m uninsured, are there some counties that do health care better than others? We’ve read about the problems facing Stanislaus County residents. Are there one or two counties in the state with a solid reputation regarding care for the uninsured?

 

12:24

 

Eric Ramos MD: 

Most counties are in a similar position, increased costs and decreasing services. However, some counties have more speciality services than others and it depends on what your needs are 

 

12:25

 

[Comment From Guest ] 

Is it difficult to get an appointment with Golden Valley

 

12:26

 

[Comment From Guest ] 

Do you think expansion of weight-loss surgery (such as last week's approval of more Lap-Band procedures) is an effective way to handle the obesity epidemic?

 

12:27

 

Eric Ramos MD: 

It's interesting wheen looking at our obesity epidemic. What we need to do is exercise, eat right, and watch our weight. The fact that these surgeries are so effective is that they only allow you to eat a certain amount of food. We should be able to restrict our intake without the risk of surgery. 

 

12:28

 

Eric Ramos MD: 

That being said, it is a very sucessful way of addressing morbidly obese patients

 

12:29

 

Eric Ramos MD: 

is good evidence that childhood obesity even when corrected still has lasting health consequences into adult life

 

12:29

 

Ken Carlson: 

Regarding Golden Valley, I haven't heard that it takes a long time to get an appointment. Sometimes it takes longer for a community health clinic. You can try calling Golden Valley at 383-1848. You can get information on other places by going to modbee.com/uninsured ... scroll to the bottom in the Day 3 area and click on the headline "Where to get Help."

 

12:32

 

Eric Ramos MD: 

The concept of chronic disease management has increased over the recent years. Patient run groups with similar diseases has proven to improve compliance and outcomes Group visits with patient with physicians is also a great way to reduce the costs of care 

 

12:33

 

Eric Ramos MD: 

Patients actually feel like they are part of a team and will listen to others in a group setting instead of 1 on 1 counseling behind the closed door of a physicians office 

 

12:34

 

[Comment From Guest ] 

Dr. Ramos, won't it be increasingly hard to institute the changes in care you recommend when state and local programs that support them keep getting cut?

 

12:36

 

Eric Ramos MD: 

The fact that 1/3 of our economy is spent on healthcare mandates that we provide care differently. That is what so exciting about our future. It mandates us to think outside the box

 

12:36

 

[Comment From Guest ] 

I have a friend uninsured and out of work. Has a knee injury, may need an ortho dr. any suggestions?

 

12:38

 

Eric Ramos MD: 

The first step is to get him into see a primary care physician. After evaluation x-rays may or may not be needed. If referral is necessary then they can help make the referral for him//her

 

12:38

 

[Comment From Guest ] 

If I'm uninsured, but own a home, and soemthing catostrophic happens, will I lose my house?

 

12:39

 

Ken Carlson: 

If you have medical debts, some hospitals may attach a lein to your home to recover the debt if your home is sold. You may want to contact an attorney about your options in protecting your property.

 

12:40

 

[Comment From Guest ] 

I'm uninsured, but my daughter wants to play high school sports. Before she can play, she has to have a mandated physical. I can't afford it. What are my options?

 

12:41

 

Eric Ramos MD: 

a sports physical is usually a basic evaluation and should not cost much, some high schools also provide free sport physicals for their students. Check with them first 

 

12:43

 

Ken Carlson: 

Talk to her coach about physicals that take place at the school prior to the start of the season.

 

12:45

 

Eric Ramos MD: 

There are some schools have a team physician that will help with physicals or do them for free. Talk to the altheltic director

 

12:46

 

[Comment From Frank H. ] 

I thought Doctor's Hospital was supposed to open a small hospital in Patterson. Is that still in the works?

 

12:48

 

Eric Ramos MD: 

Frank, 
I haven't heard about any development about this. The healthcare on the west side is underserved. They are in desparate need of specialty care as well as primary care

 

12:49

 

[Comment From Frank H. ] 

Golden Valley is overcrowded. lots of Dr.s have retired. How do we get more Dr.s?

 

12:51

 

Eric Ramos MD: 

We need more primary care physicians without doubt, but we also need to use the team concept and utilize mid level providers, nurses and the rest of our team to provide care.

 

12:52

 

Eric Ramos MD: 

Nurse Practitioner, Physician Assistants, Registered Nurses, Community health workers all need to work together to provide care

 

12:52

 

Ken Carlson: 

There's talk of expanding the residency program that trains doctors in Stanislaus County. Organizations like Golden Valley often are given incentives to recruit more physicians and the health reform will provide more funding to build clinics. The problem will be recruiting the necessary number of doctors to staff those clinics.

 

12:53

 

[Comment From Guest ] 

Do you know where someone would look for a low cost therapist? Or programs aimed at helping with therapy costs?

 

12:53

 

Ken Carlson: 

What kind of therapy?

 

12:54

 

[Comment From Frank H. ] 

how do we get the medical professionals to work together when they all compete in different organizations, ie. Del Puerto, Gould, Golden Valley, First Care etc.?

 

12:55

 

Eric Ramos MD: 

We have started the process. We have had discussions with Golden Valley, HSA and hospitals to discuss how we move forward. This is very exciting! Stay tuned Frank, we are finally making headway.

 

12:56

 

Eric Ramos MD: 

We will need the participation and guidnace from the public

 

12:56

 

[Comment From Guest ] 

psychological.

 

12:58

 

Eric Ramos MD: 

I know the county has a sliding scale for it's patients. Check with your community clinic, they might help as well

 

 

12:59

 

Ken Carlson: 

If you are eligible for county indigent health program, the county clinics coordinate with with county mental health to serve patients with potential mental disorders.

 

1:00

 

Eric Ramos MD: 

Thank you for all the wonderful questions. Togeher we will solve this crisis

 

1:00

 

Brian Clark: 

That concludes our chat. Thanks to Dr. Ramos and to Ken for your participation. And thanks to all the people who came in with some great questions. Talk to you later.

 

 

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