The 11-year-old firm, based in Modesto, was already running a handful of small, rural hospitals, but Madera had far larger and more prestigious suitors, including Trinity Health and then Adventist Health.

After those two entities had backed out, the bankruptcy judge tentatively greenlighted the AAM proposal. But a nonprofit community group later , citing concerns about AAM’s commitment to fully reopen the hospital and airing allegations of “dishonesty, fraud, perjury, and maladministration.”

The Madera Coalition for Community Justice and other critics of the AAM deal hoped that Adventist and the University of California-San Francisco, which made a in February to take over the hospital, might get another look.

But Gov. Gavin Newsom all but ended the drama on April 8 by announcing the the AAM plan and would provide a $57 million loan from a fund for distressed hospitals to help reopen and operate the Madera facility.

The same day, AAM, along with the Madera hospital and its creditors, asked the court to from the record and for the judge to consider the motion. MCCJ pushed back with objecting to the request.

The closure of the hospital in left Madera County, home to 160,000 people, largely Hispanic agricultural workers, without a general acute care facility. Like many rural hospitals in California and around the country, the Madera hospital had suffered financial and demographic challenges, including a large proportion of patients on low-paying government insurance programs, low patient volumes, and difficulty attracting talent, in addition to pandemic-related pressures.

AAM has committed to pay to creditors and reopen the hospital as soon as late summer. The company has a portfolio of nine hospitals, many of them in underserved regions of California.

“American Advanced Management has a proven track record of reopening closed hospitals in California and saving others from the brink of closure,” said Matthew Beehler, the company’s chief strategy officer.

It remains uncertain whether AAM can make the Madera hospital financially viable. Reopening alone will cost millions, and many of the same constraints that led to the bankruptcy remain. In its final two years of operations, the Madera hospital lost $14 million.

Beehler said AAM would aim for “operational efficiency” through centralized administration and “elevate the quality of care” to attract more patients. “These strategic investments and improvements are designed to stabilize the hospital’s financial footing and ensure its sustainability in the long term,” he said.

According to a by the Pittsburgh-based Center for Healthcare Quality and Payment Reform, 30% of California’s 56 rural hospitals and the same percentage of rural hospitals nationwide are at risk of closing.

“The economics of small hospitals is such that it is unlikely they are going to be highly profitable,” said Harold Miller, the center’s CEO.

The group objecting to AAM, along with many members of the community, are particularly worried that the company won’t reopen the Madera hospital’s labor and delivery department, where over in 2022.

Labor and delivery at many rural hospitals are among the first services new owners cut because they tend to lose money, said Ge Bai, professor of health policy and management at Johns Hopkins University’s Bloomberg School of Public Health.

Beehler said a reopened Madera would provide “many of the ancillary services” related to pregnancy and that AAM would “regularly evaluate” whether it makes financial and clinical sense to have a labor and delivery unit at the hospital.

鈥楽omeone Has to Take a Stand’

AAM is the brainchild of Gurpreet Singh Randhawa, who says he is its sole owner.

Singh, a gastroenterologist-turned-entrepreneur, has amassed hospitals and other health care-related companies, as well as numerous real estate holdings. dozens of businesses that are or have been associated with Singh.

After graduating from medical school in India in 2000, Singh completed further training in New York and New Jersey before moving to California in 2008. In an interview, Singh said he was inspired to open his first hospital after seeing a friend drive three hours round trip to the Sacramento area every day to visit his father in a long-term acute care hospital because Modesto didn’t have one of its own.

Singh said he thought “鈥榮omeone has to take a stand,’ so I took that stand.” He said he spent $36 million to at the site of a shuttered facility in Modesto. It opened in mid-2013, marking the beginning of AAM.

Since then, AAM has acquired numerous hospitals and clinics in Northern California and the Central Valley, including Colusa Medical Center and Glenn Medical Center in 2017, Sonoma Specialty Hospital in 2019, and Coalinga Regional Medical Center in 2020.

In 2023, the firm took over management of the troubled Orchard Hospital in Gridley, California. Last September, AAM announced it had taken over operations of Kentfield Specialty Hospital, with locations in San Francisco and Marin County. It also owns a rehabilitation hospital in Amarillo, Texas.

AAM lost a combined $22.3 million in 2021 and 2022, state data shows. But Beehler said the company returned to profitability in 2023 and expects profit margins in the high single digits this year. He estimated that AAM’s total operating revenue will jump to approximately $400 million in 2024 from $290 million in 2023, mainly due to the addition of three hospitals.

The source of the funds to finance the company’s growth is not entirely clear. Singh cited family wealth and real estate, but he declined to discuss his family’s money. The firm’s agreement with the Madera hospital says AAM will have “” to meet its obligations. The $57 million approved by the state this week will be a key source of funding.

Beehler said another source of cash to finance growth is AAM’s earnings on longer-term care. Central Valley Specialty Hospital has been profitable since its first full year of operations in 2014, posting cumulative earnings of over $66 million through 2022, according to data from the state’s Department of Health Care Access and Information. Coalinga Regional Medical Center has a 99-bed skilled nursing facility in addition to its acute care beds, and Sonoma Specialty Hospital recently added 21 beds, according to Beehler.

Acute vs. Long-Term Care

Critics fear AAM might take the Madera hospital in the direction of long-term care, depriving the community of a viable acute care facility. Cece Gallegos, who recently lost her bid for a seat on the Madera County Board of Supervisors, said in a campaign mailer that the firm would turn Madera into “a glorified nursing home.”

Beehler rebuffed that notion, saying the company couldn’t do that even if it wanted to. He said the conditions imposed by the state attorney general “require an acute care hospital with fully functional ER and ancillary services.” The , however, require AAM only to make “commercially reasonable efforts” to provide those services.

Singh and his health care businesses have hit plenty of bumps as they’ve grown.

In 2018, AAM took over management of Sonoma West Medical Center, a publicly owned hospital in the city of Sebastopol that had declared bankruptcy. In 2019, AAM acquired it outright and changed its name to Sonoma Specialty Hospital. Later that year, a bankruptcy trustee sued Singh, AAM, and the hospital for allegedly taking money that belonged to its predecessor, and the parties . Beehler said AAM did not retain any of the money but used it for hospital operations and became “an unintended victim.” The company chose to settle, he said, “to bring finality to this complex issue.”

In 2021, the state fined AAM’s Pacific Gardens Medical Center $276,000 for that put patients in “,” including one in which inadequate training caused an intravenous to drip into a patient nearly seven times as rapidly as the doctor had ordered.

AAM had reopened the hospital in January 2021, about three years after buying it out of bankruptcy. Its license was suspended less than five months later, according to the California Department of Public Health. Beehler said the hospital had reopened as a pandemic surge hospital with support, including the provision of nurses and physicians, from the state’s Emergency Medical Services Authority. “By its nature, a surge facility opening is temporary,” he said.

The accelerated timeline for getting it open contributed to the patient-jeopardy situations, he said.

In 2022, the California Department of Health Care Services sued , Singh, and AAM, accusing them of illegitimately seeking, and accepting, $270,000 from a program that provides federal financing for certain public hospitals.

DHCS said it had told AAM that it wasn’t eligible for the money, because it was now a for-profit facility, but that the company refused to pay it back. In February, a Sonoma County . DHCS spokesperson Leah Myers said in an emailed statement that the state does not typically have to sue to recover money. Beehler said AAM “disputes that there is any liability” and is appealing the decision.

Another Singh venture was Advanced College, a private vocational school for health care professionals with three locations in central and Southern California. After receiving numerous complaints, state regulators in December 2022, alleging it had falsified records and test results, and “failed to provide documentation of sufficient financial resources.”

Joshua Maruca, the school’s custodian of records, said Advanced College disagreed with the state’s allegations but had already been planning to shut down for other reasons, so it did not contest them.

Bank of the West and several of his businesses for repeated defaults on over $4.7 million in loans, mostly related to the college. The lawsuit was settled, but one of the bank’s lawyers, Wayne Terry, said he could not discuss the settlement. Beehler said the loans were not part of AAM’s financials. The bank was “paid fully,” he said.

The company’s critics say the state didn’t sufficiently scrutinize AAM before approving the loan and the operating plan this week.

“The state agencies and the Attorney General, all tasked here with protecting the public interest, have utterly failed to do the basic due diligence that would ensure Madera Community Hospital is resurrected as a viable going concern, under the stewardship of a reliable, trustworthy, and capable operator,” the MCCJ said in the court filing opposing the challenge to its objection.

AAM said in a statement that it was “grateful” to Newsom and the state for approving the deal, and “honored to serve the Madera community.” The bankruptcy court is likely to give its final blessing next week.

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Now, with the nonprofit Madera, California, hospital bankrupt and shuttered, St. Agnes looms as a dark knight, pushing to liquidate the hospital to get a loan it made to Madera paid back 鈥� even if that means dashing the hopes of the community activists, political leaders, and health care officials that the hospital can still reopen.

A pivotal moment in the case could come July 25, when a bankruptcy judge in Fresno will hear arguments on whether the Madera hospital should be allowed to spend its dwindling cash reserves on things such as building maintenance, security, utilities, and the salaries of its three top executives.

The hospital wants to run a skeletal operation while it seeks a buyer and develops a reopening plan. But the federal bankruptcy court in Fresno has authorized it to spend money . If the judge doesn’t think the hospital has a viable plan, he may refuse an extension, which would likely mean liquidation.

Problems like Madera’s are common among other small, financially challenged hospitals in California and nationwide. They typically have low patient volumes and rely disproportionately on payments from Medicaid and Medicare, which constrains revenue and makes it difficult to attract talent or invest in cutting-edge equipment. Add to the mix a crushing surge in expenses stemming from the covid-19 pandemic, and dozens of such facilities are struggling to survive. , both in California, have filed for bankruptcy this year.

Yet Madera had problems that were all of its own making. The hospital made money on patients insured by Medi-Cal, the state safety-net insurance program that pays notoriously low rates, according to financial data filed with state regulators. But it lost money on its commercially insured patients due to low volume and bad deals with insurance providers. It also funds in a timely manner. A state hospital came too late.

Plus, Madera had no backup plan when St. Agnes and its parent company, the hospital chain Trinity Health, walked away from a proposed merger with the troubled hospital late last year, giving virtually no notice and scant explanation. Their move shocked and infuriated officials, former employees, and community advocates in Madera and Sacramento.

In a brief , St. Agnes and Trinity blamed their decision on “complex circumstances” and “additional conditions” imposed by state Attorney General Rob Bonta. But industry experts said Bonta had agreed to most of what St. Agnes asked for and were baffled as to why they walked away from the deal.

The spectacle of St. Agnes and Trinity now pushing in court for the liquidation of tiny Madera has drawn Bonta’s ire.

“For Trinity, it was always about profit, not the health of the Madera community,” Bonta told 素人色情片Health News in a statement. “They are now attempting to use their position as Madera’s biggest creditor to extract every dollar possible, instead of keeping the community’s interests at heart.”

Bonta said his office had “offered maximum flexibility to Trinity in recognition of Madera’s financial circumstances.”

An agricultural area of 2,150 square miles and home to nearly 160,000 people, Madera County is 60% Hispanic, and more than one-fifth of its residents live below the poverty line, according to census data.

A Community Left in the Lurch

Jennifer Lara, a former Madera Community Hospital nursing assistant, said she and colleagues had been looking forward to positive change after the anticipated merger with St. Agnes. “We were floored when we found out the hospital was closing,” she said. “We didn’t think anything other than the hospital continuing on was going to happen.”

St. Agnes and Trinity declined to comment. The longtime CEO of St. Agnes, Nancy Hollingsworth, retired in May amid a reorganization that made the hospital part of a regional group based in Idaho. It’s unclear whether her departure was related to the collapse of the Madera deal. Hollingsworth could not be reached for comment.

St. Agnes’ considerable leverage in the bankruptcy case is the result of a $15.4 million loan it extended to Madera during merger talks last year. Madera has since repaid $8 million, leaving a debt of over $7 million, which still makes St. Agnes its largest creditor.

St. Agnes, one of 88 hospitals belonging to Trinity, a multistate, Catholic, nonprofit health system headquartered in Livonia, Michigan, argued in a recent that Madera still has made no significant progress finding a buyer, more than four months after filing for Chapter 11 bankruptcy protection , and should not be allowed to continue spending money “without a serious path forward to either sell or mothball the hospital.”

The hospital has been talking to three potential partners, “one of whom is late to the game,” said Riley Walter, Madera’s bankruptcy lawyer.

Mohammad Ashraf, a cardiologist and member of the executive committee of Madera’s medical staff, said the first two entities in question, whom he declined to identify, are management service organizations, not hospital groups. “They don’t want to spend any money to buy it. They just want to run it,” he said.

Without a convincing strategy for the future of Madera Community Hospital, the end of the bankruptcy case could come quickly.

Ranjit S. Rajpal, a Madera cardiologist for over 40 years, said the closure of the hospital is bad news for patients who need time-sensitive care, such as for heart attacks, strokes, or other traumas, and who now must travel greater distances to get it.

And the closure will exacerbate existing health inequities for people who face challenges getting care because of immigration status, language barriers, lack of transportation, or other socioeconomic factors, he said. “Those disparities will be compounded as time goes by.”

Community leaders and the hospital’s leadership hold out hope for reopening. The hospital has applied for $80 million from California’s new, $300 million loan fund for distressed hospitals. Hospital leaders must produce a reopening plan by July 31, but even if it does, it’s unlikely to get the full requested amount: Sixteen hospitals have already applied for loans totaling over $385 million, said Joe DeAnda, spokesperson for the California State Treasurer’s Office.

“They’re not going to give a quarter of their total fund to one hospital that doesn’t even have a partner,” said Glenn Melnick, a health economist at the University of Southern California who commissioned by the AG’s office of the proposed St. Agnes-Madera merger. “Eighteen months ago, the ask would have been a lot smaller.”

Even if Madera Community Hospital finds a viable partner and gets the funding it needs, reopening would be daunting and expensive. The hospital would need to hire hundreds of nurses, technicians, and other staffers in a tight and expensive health care labor market and find a way to avoid the financial problems that landed it in bankruptcy.

“Some things an acute care hospital offers are profitable, and others are not,” said Jay Varney, Madera County’s administrative officer, whose role is akin to a CEO. “It doesn’t make much sense to have it reopen like it was and have it go bankrupt again.”

鈥楻unning Out of Time’

Reopening the facility with all the services it provided before is not the only option. Baldwin Moy, an attorney for California Rural Legal Assistance, a community advocacy group, said he and colleagues have been arguing for the court to allow Madera additional time either to find a buyer or for the county “to put together a package that can reopen the emergency room with some stripped-down clinical operation.” But, Moy said, they are “running out of time.”

Karen Paolinelli, the hospital’s CEO, said the current suitors are interested in reopening it as an acute care facility that “may or may not have all services that were previously offered by Madera Hospital on day one.”

If the hospital can hold out for a few more months, it says, $23.5 million owed by the state for “provider fees,” and possibly an additional $10 million from the Federal Emergency Management Agency. Those payments would more than cover the hospital’s entire debt of $30 million. But the amount and timing of payments are unclear.

Paolinelli, voicing a common industry complaint, said the hospital has a disproportionately high number of Medi-Cal patients and Medi-Cal rates do not cover the cost of providing care. But shows that Madera received enough supplemental payments to earn nearly $15 million from Medi-Cal in 2021, though it lost over $11 million treating Medicare patients. Madera also lost about $6.8 million on commercially insured patients in 2021, the state data shows. Commercial insurance payments covered only 59.5% of what it cost to care for those patients. That compares with a statewide average of 156%, according to Melnick.

Paolinelli said Madera tried to negotiate better rates with commercial health plans but “does not have much leverage with the payors.” She added that many residents of Madera who get commercial insurance through their employers choose Kaiser Permanente, whose nearest acute care hospital is in Fresno, 20 miles away.

State Democratic Sen. Anna Caballero, whose district includes parts of Madera, Merced, and Fresno counties, said that if Madera Community Hospital were to successfully reopen, more people with commercial insurance would have to choose it over other hospitals outside the county, which they had not been doing frequently.

“The county and the city may need to say, 鈥業f you need hospitalization, you need to go to Madera, and there will be no copay, but if you go out of the county, there’s a copay you have to pay,’” Caballero said.

But with no clear path to reopening yet in sight, Caballero said, that discussion is premature.

Melissa Montalvo covers Latino communities for The Fresno Bee as part of the Central Valley News Collaborative, a partnership that includes The Fresno Bee, Vida en el Valle, Valley Public Radio, and Radio Biling眉e. This article is part of the Central Valley News Collaborative, which is supported by the Central Valley Community Foundation with technology and training support from Microsoft Corp.

素人色情片Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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Ahora, después que el hospital sin fines de lucro de Madera cerrara y se declarara en bancarrota, la situación no podría ser más distinta.

St. Agnes está impulsando la liquidación de los bienes del hospital para recuperar un préstamo que le hizo a Madera, aunque signifique acabar con las esperanzas de los activistas comunitarios, líderes políticos y funcionarios de salud que esperan que el centro de salud todavía pueda reabrir.

Un momento crucial en el caso podría ocurrir el 25 de julio, cuando el juez de un tribunal de bancarrota de Fresno escuche argumentos sobre si se debería permitir que el hospital de Madera gaste sus escasas reservas de efectivo para cubrir el mantenimiento del edificio, costos de seguridad, servicios públicos y los salarios de sus tres ejecutivos.

El hospital quiere mantener una operación con un mínimo de personal mientras busca un comprador y desarrolla su plan de reapertura. Pero el tribunal federal de bancarrota de Fresno le permitió gastar dinero . Si el juez piensa que el plan del hospital no es viable, podría rechazar una extensión, lo cual probablemente significaría la liquidación.

Problemas como el de Madera son comunes en otros hospitales pequeños con situaciones financieras precarias en California, y en todo el país. Por lo general, estos hospitales tienen un bajo volumen de pacientes y dependen desproporcionadamente de los pagos de Medicaid y Medicare, lo cual limita los ingresos y la posibilidad de atraer talento o invertir en equipos de última generación.

A esto se le suman los gastos abrumadores ocasionados por la pandemia de covid-19. Docenas de estos hospitales luchan por sobrevivir; , también en California, se declararon en bancarrota este año.

Sin embargo, Madera también tenía problemas generados internamente. El hospital ganó dinero con pacientes asegurados por Medi-Cal, el programa de seguro para californianos de bajos ingresos cuyas tarifas son notoriamente bajas, según datos financieros presentados ante los reguladores estatales. Pero perdió dinero con pacientes cubiertos por seguros comerciales, debido al bajo volumen y a acuerdos no favorables con los proveedores de seguros.

Y no recurrió de manera oportuna a programas de durante la pandemia de covid. Un estatal para el hospital llegó demasiado tarde.

Además, Madera no contaba con un plan de contingencia cuando St. Agnes y su compañía matriz, la cadena de hospitales Trinity Health, abandonaron su propuesta de fusionarse con el hospital a fines del año pasado, prácticamente sin aviso y con pocas explicaciones. Esta decisión conmocionó y enfureció a los funcionarios, ex empleados y defensores comunitarios en Madera y Sacramento.

En un en diciembre, St. Agnes y Trinity atribuyeron su decisión a “circunstancias complejas” y “condiciones adicionales” impuestas por el fiscal general estatal Rob Bonta. Pero expertos en la industria dijeron que Bonta había aceptado la mayor parte de lo que pedía St. Agnes y que las razones por las que abandonaron el acuerdo eran un misterio.

El hecho de que St. Agnes y Trinity ahora estén impulsando la liquidación del pequeño hospital ha provocado la ira de Bonta.

“Lo importante para Trinity siempre ha sido el dinero y no la salud de la comunidad de Madera”, dijo Bonta a 素人色情片Health News en un comunicado. “Ahora están tratando de usar su posición como el mayor acreedor de Madera para extraer cada dólar posible, en lugar de tener en cuenta los intereses de la comunidad”.

Bonta dijo que le había “ofrecido la máxima flexibilidad a Trinity en reconocimiento a las circunstancias financieras de Madera”.

Madera es una zona agrícola de 2,150 millas cuadradas con una población de casi 160,000 personas. El condado es 60% hispano y más de una quinta parte de sus residentes viven por debajo de la línea de pobreza, según datos del censo.

Una comunidad abandonada

Jennifer Lara, ex asistente de enfermería del Madera Community Hospital, dijo que ella y sus colegas esperaban cambios positivos después de la esperada fusión con St. Agnes. “Cuando nos enteramos de que el hospital iba a cerrar, no lo podíamos creer”, dijo. “Solo pensamos que el hospital iba a continuar”.

St. Agnes y Trinity se negaron a hacer comentarios. Nancy Hollingsworth, directora ejecutiva de St. Agnes por muchos años, se jubiló en mayo en medio de una reorganización de la compañía que hizo al hospital parte de un grupo regional con sede en Idaho. No está claro si su salida estuvo relacionada con lo que pasó con el acuerdo con Madera. No se pudo contactar a Hollingsworth para un comentario.

La considerable ventaja de St. Agnes en el caso de bancarrota es el resultado de un préstamo de $15.4 millones que le otorgó a Madera durante las conversaciones sobre la fusión el año pasado. Desde entonces, Madera pagó $8 millones, dejando una deuda de más de $7 millones. St. Agnes sigue siendo su mayor acreedor.

St. Agnes, uno de los 88 hospitales pertenecientes a Trinity, un sistema de salud sin fines de lucro católico y multiestatal con sede en Livonia, Michigan, argumentó recientemente en un para el tribunal de bancarrota que Madera todavía no ha hecho avances聽significativos en su búsqueda de un comprador, más de cuatro meses después de solicitar la protección por bancarrota del Capítulo 11 el , y que no se le debe permitir seguir gastando dinero “sin un camino serio hacia la venta o el cierre del hospital”.

El hospital ha estado hablando con tres socios potenciales, “uno de los cuales llega tarde al juego”, dijo Riley Walter, abogado de Madera especialista en bancarrotas.

Mohammad Ashraf, cardiólogo y miembro del comité ejecutivo del personal médico de Madera, dijo que las dos primeras entidades en cuestión, a las que se negó a identificar, son organizaciones de servicios de gestión, no grupos hospitalarios. “No quieren gastar dinero para comprarlo. Solo quieren ejecutarlo”, dijo.

Sin una estrategia convincente para el futuro de Madera Community Hospital, el final del caso de bancarrota podría llegar rápidamente.

Ranjit S. Rajpal, cardiólogo de Madera durante más de 40 años, dijo que el cierre del hospital es una mala noticia para los pacientes que necesitan atención de urgencia, como aquellos que sufren un ataque cardíaco, un accidente cerebrovascular u otros traumas, y que ahora deben viajar más lejos para recibir atención.

Y el cierre profundizará las desigualdades de salud existentes para las personas que enfrentan desafíos para recibir atención debido a su estatus migratorio, barreras de idioma, falta de transporte u otros factores socioeconómicos, dijo. “Esas disparidades se agravarán con el tiempo”.

Los líderes comunitarios y la dirección del hospital tienen la esperanza de reabrir. El hospital ha solicitado $80 millones del nuevo fondo de préstamo de $300 millones de California para hospitales en apuros.

Los líderes de los hospitales deben diseñar un plan de reapertura antes del 31 de julio, pero incluso si lo hacen, es poco probable que obtengan el monto total solicitado: 16 hospitales ya pidieron préstamos por un total de más de $385 millones, dijo Joe DeAnda, vocero de la Oficina del Tesorero del Estado de California.

“No van a dar una cuarta parte del total de su fondo a un hospital que ni siquiera tiene un socio”, dijo Glenn Melnick, economista de salud de la Universidad del Sur de California y autor de un sobre la propuesta de fusión de St. Agnes y Madera encargado por la oficina del Procurador General. “Hace dieciocho meses, la demanda habría sido mucho menor”.

Incluso si Madera Community Hospital encuentra un socio viable y obtiene los fondos que necesita, la reapertura sería difícil y costosa. El hospital tendría que contratar a cientos de enfermeros, técnicos y otro personal en un mercado laboral de atención de salud limitado y caro, y encontrar la manera de evitar los problemas financieros que lo llevaron a la bancarrota.

“Algunas cosas que ofrece un hospital de cuidados intensivos son rentables y otras no”, dijo Jay Varney, oficial administrativo del condado de Madera, cuyo trabajo es similar al de un director ejecutivo. “No tiene mucho sentido que se vuelva a abrir como estaba y que quiebre de nuevo”.

“Se está acabando el tiempo”

Reabrir el hospital con todos los servicios que brindaba antes no es la única opción.

Baldwin Moy, abogado de California Rural Legal Assistance, un grupo de defensa de la comunidad, dijo que él y sus colegas han estado abogando para que el tribunal le otorgue a Madera tiempo adicional para encontrar un comprador o para que el condado “reúna fondos para reabrir la sala de emergencias con una operación clínica simplificada”. Pero “se les está acabando el tiempo”, dijo Moy.

Karen Paolinelli, directora ejecutiva del hospital, dijo que los postulantes actuales están interesados 鈥嬧�媏n reabrirlo como un centro de cuidados intensivos que “tendría o no todos los servicios que ofrecía el hospital de Madera antes”.

Si el hospital pudiera resistir unos meses más, dice, podría $23.5 millones que debe el estado en “tarifas de proveedores” y posiblemente $10 millones más de la Agencia Federal para el Manejo de Emergencias (FEMA). Esos pagos cubrirían con creces la deuda total del hospital de $30 millones. Pero la cantidad y fecha de los pagos no están claros.

Paolinelli, al expresar una queja común de la industria, dijo que el hospital tiene una cantidad desproporcionadamente alta de pacientes de Medi-Cal y que las tarifas que tiene este programa no cubren el costo de brindar atención.

Pero los muestran que Madera recibió pagos suplementarios que suman casi $15 millones de Medi-Cal en 2021, aunque perdió más de $11 millones en el tratamiento de pacientes de Medicare. Madera también perdió alrededor de $6.8 millones en pacientes con seguros comerciales en 2021, según muestran los datos estatales. Los pagos de seguros comerciales cubrieron solo el 59.5% de lo que costó atender a esos pacientes. Eso se compara con un promedio estatal de 156%, según Melnick.

Paolinelli dijo que Madera trató de negociar mejores tarifas con los planes de salud comerciales, pero “no tienen mucha influencia sobre los proveedores”. Agregó que muchos residentes de Madera que obtienen un seguro comercial a través de sus empleadores eligen Kaiser Permanente, cuyo hospital de atención aguda más cercano está en Fresno, a 20 millas de distancia.

La senadora estatal demócrata Anna Caballero, cuyo distrito incluye partes de los condados de Madera, Merced y Fresno, dijo que si Madera Community Hospital reabriera con éxito, más personas con seguro comercial tendrían que elegirlo en lugar de ir a otros hospitales fuera del condado, algo que no habían estado haciendo con frecuencia.

“El condado y la ciudad van a tener que decir: 鈥楽i necesitas hospitalización, debes ir a Madera y no habrá copago, pero si sales del condado, tendrás un copago”, dijo Caballero.

Pero sin un plan claro para la reapertura, esa discusión es prematura, agregó.

Melissa Montalvo cubre las comunidades latinas para The Fresno Bee como parte de Central Valley News Collaborative, una asociación que incluye The Fresno Bee, Vida en el Valle, Valley Public Radio y Radio Biling眉e. Este artículo es parte de Central Valley News Collaborative, que cuenta con el respaldo de Central Valley Community Foundation con tecnología y soporte de capacitación de Microsoft Corp.

素人色情片Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).