If it happens, it will represent one of the biggest changes to public health care in Kern County since the establishment of the Medi-Cal safety net.
While Kern County supervisors on Monday cheered a proposal to merge Kern Medical Center with Kern Health Systems, the reaction was not quite so supportive at a packed Kern Health board meeting held Thursday morning.
"It's like Obamacare for Kern County," Truxtun Radiology founder Girish Patel said during the meeting's public comment period. "You pass the legislation before you find out what it means."
Others, however, welcomed the proposal as an important step toward establishing an integrated delivery system of health care for low-income and indigent patients, an eventuality even opponents acknowledge is the future of managed care.
Already winding its way through the California Assembly and Senate, the legislation introduced by Assemblyman Rudy Salas, D-Bakersfield, would link the perpetually troubled county-owned hospital with KHS, the well-heeled, 159,000-member Medi-Cal HMO. But each would maintain its own balance sheets.
Patients' freedom to choose their own health care providers is also central to the proposal, supporters said.
Proponents emphasized the legislation simply enables the changes. The details will come later, not in top-down state law, but in a county ordinance hammered out with input from KHS, KMC, and the two other safety net providers, Clinica Sierra Vista and Omni Family Health.
"To be partners moving on the same path, together toward the same end..." That's how Board of Supervisors Chairwoman Leticia Perez characterized the plan when she addressed the KHS board Thursday.
While some criticized the proposed partnership, many health care professionals in the audience and on the board said they would wait to see the details before they took a position.
"We will be an integrated system in the future," said KHS board member and local cardiologist Dr. William Nyitray. "The key is how we get there."
Longtime KHS board member Estela Casas asked several questions of KMC Chief Executive Russell Judd, who presented many of the goals and tenets of the plan to the board, of which he is also a member.
Casas said she was withholding judgement until she had more facts.
"I'm in the investigation stage," she said.
Bakersfield radiologist Dr. Donald Cornforth, who is affiliated with San Joaquin Community Hospital, counseled caution moving forward, and suggested the proposed merger could rob KHS of its multimillion-dollar cash reserve.
He wasn't alone in his suspicion that the merger could be a thinly disguised cash-grab.
"This is a fabulous initiative that has evolved not by accident but by discipline," Cornforth said of Kern Health Systems. "That can't be said about KMC."
Yet, despite his reservations, Cornforth applauded the efforts of those exploring the merger and their efforts to create an integrated network of care.
"I'm in favor of the concept," he said, "but I don't want to rush into it."
Clinica Sierra Vista CEO Steve Schilling was also cautious, although he said he believed the establishment of the new Kern County Health Systems Authority is inevitable.
"This has the possibility to be a positive fix for a perpetually tenuous health care system, which has been existing on the edge of solvency for 40 years," Schilling said.
If the legislation passes, there's no stopping it, Schilling added. But the county ordinance will take months to hammer out.
"It's not a sprint," he said. "It's a bit of a marathon."