1. Crisis in Riverside County Access to Health Care Presented By: Rebecca J. Patchin, M.D. RCMA Past President, Coalition to Preserve Access to Care in Riverside County, Chair

2. Crisis in Riverside County We do not have enough doctors We do not have enough Federally Qualified Health Centers We do have the lowest reimbursement rates in the State

3. Riverside County Ranks Second to Last in State Reimbursements Riverside County 45.24 Median 75.75 San Francisco County 199.82

4. State Allocations per Poverty Capita in CA Riverside County 391.11 Median 619.87 San Francisco County 1,989.28

5. State Alignment Allocations County Health & Mental Health Realignment Total Allocation Total Population Allocation per Capita & Ranking Poverty Population Allocation per Poverty Capita & Ranking San Francisco159,693,804.63799,185199.82 = #180,2771,989.28 = #1 Humboldt20,139,598.28128,614156.59 = #221,180950.88 = #7 Marin28,718,792.27246,932116.30 = #616,2451,767.85 = #2 Napa13,270,528.74131,781100.70 = #1211,0041,205.97 = #4 Los Angeles857,433,340.889,807,87082.42 = #171,423,245602.45 = #29 Fresno74,785,591.43894,74883.58 = #19176,300424.20 = #44 Alameda120,121,058.211,453,64682.63 = #20158,223759.19 = #15 Kern51,029,386.20787,17964.83 = #36135,992375.24 = #48 San Diego189,827,441.652,959,73464.14 = #37319,404594.32 = #30 San Bernardino114,227,166.942,002,20857.05 = #44236,246483.51 = #39 Orange160,419,474.912,976,74253.89 = #45264,467606.58 = #26 Riverside93,384,968.312,0644,36545.24 = #48238,772391.11 = #46 California2,755,561,179.5936,377,53475.75 4,445,392619.87 Data abstracted from State Controller’s Office, FY 2006-2007

6. Medicare Inequities for a 10 Minute Office Exam More Than Riv. More Than Riv. Paid

7. Riverside County has 3x the indigent population of San Francisco County & receives 1/5 of the reimbursement 18% of Riverside County Emergency Medical Services allotments were cut by the state this fiscal year Riverside County participating Emergency Medical Services physicians provided $35 Million in services and were paid just $3.5 Million Inequities & Budget Cuts Cripple System

8. Unfair Reimbursement Damages Our Health Care System Riverside County has half of the doctors needed for adequate health care Benchmark Ratio60-80/100,000 Riverside County 34/100,000 Physicians provided $105 Million in unpaid emergency medical care (2004-2008)

9. Riverside County physician shortage robs millions from our economy Practitioner = $1 Million in Economic Activity $4.95 Billion impact on Riverside County Riverside County hospitals employ 13,600 31,000 jobs in the community Unfair Reimbursement Damages Our Economy

10. 11 Federally Qualified Health Centers 10 eligible Health Centers Leaves Millions of $ on the table Too few Federally Qualified Health Centers in Riverside County

11. Riverside County Community Clinics 2009

12. Population to Federally Qualified Health Centers Ratio Riverside County 2.1 Million+/- Residents San Francisco County 850,000+/- Residents 1 FQHC For every 191,605 1 FQHC For every 30,358 11 FQHCs 28 FQHCs

13. Hurting Our Hospitals; Hurting Us All Inadequate Reimbursements Lead to Inadequate Care

14. Family Care Visits Unmet Due to Budget Constraints Patient Visit Demand # of Patients Seen Projected Actual

15. Enrollment in Indigent Services Program has doubled in less than 3 years 28% (513,860) of Riverside County Residents are uninsured as of 2007 Public Assistance has Grown: MediCal Caseload12% Food Stamps60% TANF25% Riverside County Unemployment Rate 14.3% Public Assistance Has Grown

16. Riverside County Deserves Fair Share FIX THE DISPARITIES

17. 1. Understand and recognize issue 2. Urge federal and state legislators to take action/establish fair reimbursement rates 3. Support & develop UCR Medical School to help with physician supply 4. Increase the number of residency slots 5. Reinstate EMSA funds to help physicians cover costs on ER care 6. Unfreeze FQHC application process BEST SOLUTIONS

18. Repair Our Healthcare System Riverside County does not have enough doctors Riverside County does not have enough FQHCs Riverside County does not receive adequate reimbursement rates We must fix this now before it gets worse

19. FIX THE DISPARITIES Every County Gets its Fair Share

20. Crisis in Riverside County Access to Health Care Presented By: Rebecca J. Patchin, M.D. RCMA Past President, Coalition to Preserve Access to Care in Riverside County, Chair 3993 Jurupa Avenue, Riverside, Ca 92506 951-686-3342 rebecca.patchin@ama-assn.org www.rcmanet.org

21. Coalition to Preserve Access to Care in Riverside County Coalition Partners  Riverside County Supervisor Bob Buster  Kaiser Permanente/Southern Permanente Medical Group Contact: Richard Rajaratnam, MD, Area Director  Hospital Association of Southern CA (HASC) Contact: Christina Bivona-Tellez, Area Vice President, 951-222-2284  Community Health Agency, Riverside County (CHA) Contact: Eric Frykman, MD, Health Officer, 951-358-5058  Inland Empire Health Plan (IEHP) Contact: Bradley Gilbert, MD, CEO William Henning, DO, Medical Director  Riverside County Medical Association (RCMA) Contact: Harold Jackson, DO, President, 951-686-3342 Rebecca Patchin, MD, Coalition Chair  Riverside County Regional Medical Center (RCRMC) Contact: Douglas Bagley, CEO, 951-486-4470