Santa Clara County readies Regional Medical Center for April 1 go‑live as emergency departments strain and federal funding risks loom

Santa Clara County health officials on Tuesday told the Health and Hospital Committee they are preparing to bring Regional Medical Center (RMC) into county operation on April 1, but said local emergency departments and public‑health programs face increased pressure from sustained high patient volumes and uncertainty about federal health funding.

Paul Lawrence, a county health system executive, said about 10,070 job offers were made to RMC employees and roughly 98% of those offers have been accepted, “around 10,050 employees,” and that technology and licensing work are on track for the transition. “We did receive a 45‑day go‑live readiness from our technology services department. And everything is on track for the implementation of Epic on day 1,” Lawrence said.

County and hospital leaders stressed that even with RMC returning to service, other capacity and throughput problems are acute now. Valley Medical Center (VMC) ED volumes have risen about 12% since November, with some days reaching roughly 300 patients and an average near 270 per day, officials said. O'Connor Hospital reported a roughly 10% increase, with highs near 240 patients and an average near 220 per day. Trauma cases are driving much of the overload: trauma volume was reported up 87% in January compared with the prior year and “major traumas are up 200% for the month,” Lawrence said.

To ease throughput pressure, the health system said it has added inpatient capacity and is pursuing other short‑term steps: it added eight medical‑surgical beds and four ICU beds at VMC, added 15 medical‑surgical beds at O'Connor, contracted with skilled nursing facilities to speed discharges, and is seeking a California Department of Public Health waiver to convert 12 express‑care beds to ED beds. Leaders also said they are triaging some patients to an adjacent express‑care/urgent‑care clinic when clinically appropriate.

“We are doing everything we can,” Lawrence said, while cautioning that sustained high acuity means “something's gotta give” and wait times have lengthened even though patients receive an initial medical evaluation on arrival.

Beyond operational pressures, county leaders warned of fiscal risks tied to possible federal policy changes. Bert (last name not specified), a county policy staffer who briefed the committee on federal and state developments, described an uncertain congressional process that could include major changes to Medicaid financing, reductions to hospital supplemental payments, and other measures that would materially affect the county’s revenue streams.

“Medicaid is facing the most serious threat to the program since it was created in 1965,” Bert said. He summarized competing House and Senate budget approaches, the reconciliation process and the potential for changes to the federal medical assistance percentage (FMAP) and other supplemental payments, including disproportionate share hospital (DSH) funding. He warned that the timing and details are uncertain but that the county’s Medicaid‑funded patient revenue — described in the meeting as a material portion of system revenue — leaves the health system exposed to large swings depending on congressional action.

Public‑health leaders also raised concerns about national erosion in public‑health capacity and the local implications. “It feels quite a bit like February and March 2020 — very uncertain,” said Dr. Cody (first name not provided), who spoke for the public health department. She described county work on surveillance and laboratory testing, noting that Santa Clara County’s public health laboratory has taken an outsized role in subtyping and early detection of threats such as H5N1 bird flu and in testing retail raw milk that led to a state recall.

Dr. Cody said the department is monitoring measles and influenza and emphasized that local immunization rates are generally high but that “there are a few little pockets” where coverage has dipped. She described the county’s role as monitoring, coordinating and filling gaps in access rather than providing routine screening broadly — and said implementing universal diabetes screening, for example, would rely on primary‑care providers and insurance coverage, with county public health supporting system‑level solutions.

Committee members asked for follow‑up reports on emergency department and trauma volumes after RMC’s transition and for continued updates on federal policy risks. Lawrence said staff will present a stand‑alone, detailed RMC acquisition report and that the emergency medical services agency will begin readiness review in early March.

The committee did not take a substantive vote specifically on RMC operations at the meeting; it approved routine consent and financial items during the session.