Will Fresno hospital lose doctors, top trauma status? Dispute fuels uncertainty
An expired contract — and stalled negotiations — could cost Fresno’s Community Regional Medical Center its Level I trauma center status and more than two dozen doctors.
That would be bad news for a region already short on doctors amid the coronavirus pandemic.
The money for the 28 positions expired when a contract ended Tuesday, and a new deal hasn’t been inked. The expired contract included six Central California Faculty Medical Group physicians who are also UCSF Fresno faculty and provide neurosurgical trauma services, said Lauren Nickerson, director of marketing and communications for CCFMG.
The neurosurgical trauma coverage is needed for CRMC to maintain its status as a Level I Trauma Center, Nickerson said. Those physicians were expected to be out of a contract as of 5 p.m. Wednesday.
Despite that, the hospital late Wednesday, said its trauma services will continue.
“There is no reason to alarm Central Valley residents or our healthcare partners by threatening a change in access to our trauma services at Community Regional Medical Center,” Craig S. Castro, president and chief executive officer for CRMC, said in the statement. “For decades, Community has provided our region with the highest level of care, so we prepare for the unexpected. It is unfortunate, surprising and highly irregular for the CCFMG neurosurgeons who work at Community Regional to stop treating patients with such short notice.”
However, Dr. James David, CCFMG physician and chief of trauma and surgery at CRMC, said he was “informed by Emergency Medical Services that they were notified by Community Medical Center’s senior hospital administration that Community Regional Medical Center will not have neurosurgical trauma coverage until at least Friday.”
Conflicting information
In an update Wednesday evening, Castro said in May CRMC had informed the medical group that in order for the hospital to continue to fund clinics that rely on its support, it had to do so through a new business structure — a CMC-sponsored medical foundation. As of Monday, Castro said, the hospital believed both parties were moving forward to finalize an agreement.
But on Tuesday, through local media, hospital officials became aware CCFMG neurosurgeons had decided not to cover the needs of the trauma center on Wednesday.
“To do this, the CCFMG neurosurgeons unilaterally terminated a call agreement that is unrelated to the clinic funding,” Castro said in the update.
CRMC is the region’s only Level I Trauma Center, meaning patients suffering a head injury in Fresno would need to be treated as far away as the Bay Area, Sacramento or Los Angeles.
Nickerson said CCFMG asked CRMC for a “breach funding mechanism or an ability to continue to provide services under the old contract” while negotiations were ongoing, but the request was turned down, which was disappointing.
“Obviously, the trauma center is at risk, and that’s heartbreaking because this community needs that Level I trauma center, but there’s more at risk,” Nickerson said during an interview Wednesday. “We have 28 physicians and 12 specialties that are also at risk. This community needs every specialist and every physician we can get.”
Without a new contract signed, the future of CRMC’s status as a Level I trauma center, and much-needed specialty care in the Central Valley, is uncertain, Nickerson said.
“During the COVID-19 pandemic, when vital healthcare workers are more essential than ever, the loss of funding is extremely disheartening and will undoubtedly impact patient care if a new agreement is not signed quickly,” Davis said in a statement. “We, the teaching faculty, value our relationship with both CCFMG and CRMC and believe this partnership is the best model to continue providing world-class patient care.”
Funding uncertainty
Dr. Yu-Hung Kuo, chief of neurosurgery at UCSF Fresno, said the lack of a finalized agreement is “devastating” to the program and the patients it serves.
“We have had a working agreement for funding for the last eight years, and when Community Medical Centers chose to change the agreement, we wanted to be good partners,” Kuo said. “However, we have yet to see a complete, mutually beneficial contract we can sign.”
Physicians covered under the expired contract also provide specialties such as pediatrics and oncology, Nickerson said. Inpatient and outpatient services are provided.
Dr. Christina Maser specializes in endocrine and general surgery, and is among those affected. On Wednesday, she said CRMC in late July – with only about six weeks’ notice – proposed its final plan, but didn’t present any contracts. She’s been working at CRMC and teaching at UCSF Fresno through CCFMG for the past 14 years.
“The toll that this takes is that is rattles one’s entire world,” she said. “The trust that you build with the medical system that you serve under is crucial. ... When you build that trust ... suddenly to have that ripped away, it’s devastating.”
She said it’s “difficult to see how that trust can be rebuilt,” but she remains hopeful that an agreement will be reached by both parties. Among the patients she treats include thyroid cancer patients that come from throughout the local region.
“I am hopeful because I know that there are many people, some in the (hospital’s) administration, and others, specifically a few board members, who I can’t imagine want this to happen,” she said.
Nickerson stressed stalled negotiations are not about a disagreement in the dollar amount, but rather the funding model and a funding mechanism.
“We’ve been working with CMC for 24 years and in various different forms of contract funding,” she said.
For Maser, the key points in the ongoing negotiations have been for physicians to continue to provide a high quality level of care and to educate the next generation of doctors.
“Those have been the sticking points in the negotiation,” she said.
The first proposal put forward by the hospital included a direct employment model, which meant physicians would no longer be employed by CCFMG, Nickerson said.
“Therefore they would not have UCSF faculty appointments or be able to train residents and fellows at the UCSF Fresno branch campus,” she said.
Nickerson said CRMC on Tuesday night continued to try to negotiate, but talks weren’t moving forward in a positive way after the hospital withdrew funding for 23 advanced practice providers who offer neurosurgical care at the hospital.
“It’s not getting better,” she said. “It’s getting worse.”
This story was originally published September 2, 2020 at 2:20 PM.
.jpg)