2003 forecast of health care: the future of health care isn't Star Trek. (An Advertising Supplement to the San Fernando Valley Business Journal).

The Star Trek Generation knows all about the future of healthcare: tri-corder readings to discover cell anolmolies before they turn to disease, hand-held machines that knit together broken bones or heal gashes in an instant, a world where everyone receives the care they need. Gene Roddenberry had a wonderful and optimistic view of the future of healthcare. Here in California, some of us are a little less optimistic. Here in the San Fernando Valley, the wide screen shows a different picture.

If you are not insured

A young teenage girl is helping an older woman across the street. The woman is crippled, walking with a locked, straight-legged, rocking gait that requires the girl to keep hold of her arm to prevent falling. The girl has a piece of paper in her hand with three addresses on it, no names just the addresses. She points to the second address and asks "How do we get there."

The addresses belonged to three relatively nearby County health centers. Unfortunately the one that the girl and her mother were making their slow and pains-taking way toward had closed last October. A passerby explained the closure and suggested they turn around and go to the only county facility left in the mid-or east valley, the Mid-Valley Center on Van Nuys Boulevard near Sherman Way. The two then began their trek back to the bus stop at Woodman Avenue, which would ultimately take them only a mile's walking distance to the health center.

If you are insured

Many personal doctors have decided they can no longer afford to work within an HMO structure, and their patients are arbitrarily rerouted to doctors in far more distant areas. As more and more physicians opt out of HMO's and Medi-Care, the choices are limited even for those with insurance. Fewer and fewer people, insured or not, can access quality health care in their own neighborhoods.

This is the future of health care in the San Fernando Valley and elsewhere in Los Angeles County. And the United Federation of Planets is nothing like L.A. where confused and frightened people wander from bus stop to bus stop searching for a county health center that no longer exists, searching for a doctor that they can afford to see. Other people, no less confused and certainly concerned, search the insurance company lists for a doctor in their relative geographical area.

At a dinner last year, state elected officials discussed the issue of health care. Several prominent legislators suggested that part of the answer is to divert more funds to support one of the most cost effective methods of healthcare delivery available: the nonprofit community clinic. If this could be the future, Valley Community Clinic is ready. Beam us up, Scottie!

Judi Rose is Director of Public Affairs for Valley Community Clinic, a non-profit agency providing free and low-cost health care to the uninsured.

Hospital Services: Outlook for 2003

In 2003, hospital services will continue a trend that began two years ago. The demand for hospital inpatient services has increased for the first time in over a decade. The increase in demand has changed the dynamics of healthcare costs that were largely restrained in the past decade as hospitals competed for contracts with government and private insures who significantly changed and limited how hospitals are reimbursed. Hospitals responded by limiting costs through consolidations and closures and restraining capital expenditures. Now there is an increasing gap between demand and supply. In 2003, the effect of increased demand for hospital services, increased costs, and limited reimbursement will challenge hospitals as they continue to serve as the community safety net in a post 9/11 era.

Two years ago, for the first time in over a decade, the demand for inpatient hospital services increased in the San Fernando Valley. In the past the population increase did not offset the technology shift that reduced admissions and length of stays in hospitals. More and more services can be performed on an outpatient basis. Even complicated surgeries, such as coronary artery bypass surgery, now have length of stays half of those a decade ago. While these shifts will continue beyond 2003, they no longer offset the affect of an aging population. For example, for non-birth related healthcare, the use of healthcare services doubles after age 55, doubles again after the age of 70 and doubles again after the age of 85. The demographic shift of the baby boomer generation becoming seniors will cause healthcare spending to consume. 17% of the gross national product by 2010-up from 13% today.

Recently enacted legislation will continue to increase hospital costs in 2003. Mandatory nurse staffing ratios will further exacerbate an already severe nursing shortage and further drive up labor costs. There is currently a 20% nurse vacancy rate in the state of California with an anticipated shortfall of more than 25,000 registered nurses by 2006. The Health Insurance Portability and Accountability Act will increase reporting by hospitals and increase staff dedicated to assuring compliance. State mandated earthquake standards will require hospitals to significantly increase capital expenditures despite the fact that sixty percent of hospitals in the State of California loose money. State legislation passed last year will significantly increase workers compensation costs this year for hospitals as well as other businesses.

Hospital emergency departments -- virtually all of which lose money -- are the community's safety net. While the public is acutely aware of the need, in the post 9/11 climate, for hospitals to have the ability to serve the community 24 hours a day and to be prepared, at all times, to meet virtually any healthcare crisis for community emergencies, no one gives thought to who will bear the burden of the preparation and standby costs -- none of which are reimbursed. Hospital emergency departments will be under further strain to stay open given the closure of LA County health clinics. California already has seven million uninsured representing one-fourth of the population under age 65. Caring for the uninsured adds another burden to hospitals and other healthcare providers who bear the costs and liability of treatment without compensation. The parallel cost/reimbursement problem for physicians makes it increasingly difficult for hospitals to provide 24-hour on-call physician specialist panels for emergency rooms and trauma centers.

Twenty-three hospitals in California have closed in the last seven years. Two local hospitals have declared bankruptcy in the last year. The struggle to meet the increased demand for hospital services in light of limited reimbursement and increasing costs will continue through 2003 and beyond until the underlying issues are dealt with. These issues will challenge hospitals in their ability to serve the community that views them as essential community resources.

This article was provided by West Hills Hospital & Medical Center.

Association health plans: a cure worse than the disease

Cal Lockett

Two of our nation's greatest healthcare challenges are closely tied together 1) skyrocketing health costs and 2) the swelling ranks of uninsured Americans. Some in Washington mistakenly believe that proposed federal legislation to exempt Association Health Plans (AHPs) from state insurance oversight is just what the doctor ordered to address both of these challenges. The evidence is overwhelming, however, that AHPs are a textbook case of the proposed cure being worse than the disease.

Today, many business associations operate health plans for their members under state law. In a misguided effort to reduce costs for small firms, proponents of a federal AHP exemption want to override of state laws guaranteeing benefit requirements (i.e., prenatal care, mental health services), financial solvency standards, and consumer protections.

In theory, this would reduce health coverage costs for AHPs and more small employers would provide coverage for their employees. In practice, however, the story is very different. Rather than improving healthcare access for small firms, a federal AHP exemption would create a massive loophole for these plans to avoid important state reforms designed to make coverage affordable and accessible for all small firms.

In fact, a study by the Congressional Budget Office (CBO) found that 80 percent of workers in small firms - 20 million people - would see a premium increase under AHP legislation. The CBO concluded that any cost savings for the few remaining small business employees would come from AHPs siphoning off those who are young and healthy from the traditional insurance market. With AHPs able to leave behind older, less healthy people, the vast majority of individuals and small firms insured through traditional coverage would ultimately face increased costs.

Moreover, it is not only those who remain in the traditional insurance market who would suffer under a federal AHP exemption. A federal AHP exemption would place consumers at considerable risk for fraud and abuse. Just in the past few months, the failures of similar small business health plans left over 100,000 workers and dependents with millions of dollars in unpaid claims.

Over 50 organizations are part of a broad-based coalition opposed to a federal AHP exemption. To learn more about the dangers of unregulated AHPs, visit www.insureourfuture.org.

Higher costs...fraud and abuse....unpaid medical bills. Indeed, a federal AHP exemption would be bad medicine for the very small businesses and consumers it purports to help. Congress should reject a federal AHP exemption.

Cal Lockett is Vice President of Public Affairs for WellPoint.

Americans Need to Make Exercising a Priority

Declan Moyet

The news made major headlines late last year -- American's are getting heavier -- and that means less healthy!! Fast food gets blamed as a culprit responsible for America's expanding waist-line, but lack of exercise -- usually because the individual is "too busy" seems to play an equal factor.

To be fair, exercise can be a time-consuming affair for people who lead busy lives. Some merely use it as an excuse to dodge their personal fitness responsibilities, but others really do face a dilemma.

Successful business executives and corporate personnel often do not have much time proper workouts. And whenever they do have the time, they usually don't feel up to it.

It is a fact of modern life that time equals money.... no doubt about that! However, time also equals health! It is no use having all the riches in the world if poor health won't allow us to enjoy it.

Let's face it, our health is a priceless commodity. No matter how much money we spend on state-of-the-art fitness equipment, expensive nutritional supplements or trendy health club memberships, our personal fitness will always be a long-term investment that requires a minimum amount of time and effort.

Fortunately research suggests that exercise does not have to take up much of your day. Moderate activities done at intervals throughout the day can be as beneficial as demanding, serious workouts. Try the following tips to fit more exercise into a busy day:

Get Serious. Make a commitment to your personal health. Fitness is a responsibility, and exercise is an act of self-respect. You owe it to yourself, your family and your employer. One day, when you retire, your career achievements will soon be forgotten, but your health and fitness will remain a joyous part of your life.

Set Goals. Goal-setting is your road map to success. You won't take on a new investment project or product range without a proper business plan, would you? The same principle applies to your fitness program. Set short, intermediate and long-term goals and make sure these goals are realistic and attainable. For example, your short term goal may be to climb an extra flight of stairs each day, while a long-term goal would be to lose a certain amount of weight or participate in a corporate fun run. It is important to remember that goals can change.

Get Organized. Many busy people get so caught up in meetings and deadlines that they forget to fit in any physical activity at all. Some even forget to eat! Why not schedule a daily appointment with yourself. Make notes in your diary a week in advance or ask your assistant to remind you take a 'fitness break' once or twice a day. You can also save time by placing your home exercise equipment in a corner of your office. Or leave it in a place at home where you have easy access to it. Hiding it in a dusty closet will not encourage you to use it. Also try to avoid going home before you go to the gym. Get in the habit of packing your workout gear the night before and take it with you to the office. Stopping at home to get dressed is too much of a temptation...

Surprise Yourself. Your fitness program does not have to be a highly organized, structured affair. Forget the rigid workout schedules. Do whatever you can whenever you can, as long as you do it on a regular basis. Short bits of exercise can be just as effective as long workouts. Traditional recommendations stated that people had to exercise continuously for at least 30 minutes at least three times a week to obtain health benefits. More recent recommendations state that short bouts of activity of at least 10 minutes each, several times a day, can be just as effective. Try to accumulate 30 minutes or more a day of moderately strenuous activities, such as walking, cycling, housework or gardening, on most days of the week. It all adds up in the end!

Don't Give Up. If you skipped a workout, because you had an urgent matter to attend to, don't give up. You can always make up for it tomorrow. Fitness should not be an all-or-nothing affair!

Have Some Fun. Enjoyment is a powerful stimulus to continue an activity. Bring some fun into your workouts. Exercise does not have to be dull and dreary. Ask a friend to join you or change your routine by using use different combinations of exercises. Why not make weekend exercise a family affair? A hike in the woods, a game in the pool, sharing gardening chores or an evening of dancing is not only a great way to exercise and reduce your stress levels, it also adds up to quality time with the people love.

Declan Moyet is a freelance writer and personal trainer.

New Measure May Help Prevent Patients From Being Sent Home

Hospitalized pneumonia patients who have abnormal vital signs, mental confusion, problems with eating or drinking in the 24 hours prior to discharge are more likely not to be able to resume normal activities, and face a greater chance of hospital readmission or death, according to a study funded by the Agency for Healthcare Research and Quality. The study was published in the Archives of Internal Medicine.

The research team, led by Ethan A. Halm, M.D., M.P.H., of the Mount Sinai School of Medicine, focused on the potential danger of releasing pneumonia patients from the hospital "quicker and sicker." They developed a simple measure of how sick patients with pneumonia are that can be used to judge whether it is safe for them to be discharged from the hospital. The measure uses information from the five basic vital signs that are checked several times a day in hospitalized patients (temperature; heart rate; blood pressure; respiratory rate; and oxygen levels in the blood), as well as an assessment of the patient's mental status and ability to eat and drink.

Dr. Halm and his colleagues found that patients who were medically unstable--defined as having problems with at least one of the seven factors in the measure--had a 30 percent increased chance of readmission or death and a 50 percent higher chance of not returning to their usual activities within 30 days. The researchers found that the risk of readmission or death was 5 times greater for the small proportion of patients who were discharged with two or more unstable factors. Using their instrument, Halm and his colleagues found that 1 in 5 of the patients they studied had been discharged "medically unstable."

The researchers believe that hospital and insurance plan guidelines that shorten the length of hospital stays should build in a safety check to measure clinical stability prior to discharge to make sure that patients are not sent home too soon. Halm also proposes that measuring stability before discharge can be used as an indicator of quality of care. This also can be used to compare provider and health plan performance or to stimulate quality improvement activities.

Information provided by the Agency for Healthcare Research and Quality.

Seniors can benefit from pet ownership.

Companion pets have become more common than children in U.S. households. Americans share their homes with 51 million dogs, 56 million cats, 45 million birds and 75 million small mammals, reptiles and fish. Current statistics confirm that more than half of all U.S. households have a companion pet.

While many seek pets for companionship and unconditional love, there are more than social benefits to pet ownership. According to the National Institutes of Health, pet owners visit the doctor less often, use less medication, have lower cholesterol levels and blood pressure, recover more quickly from illness and surgery, deal better with stress, and are less likely to suffer from loneliness.

Pet ownership has proven particularly beneficial for senior citizens. Pets may help elderly owners live longer, healthier and more enjoyable lives. Among the many benefits of a companion pet is that animals help seniors combat depression, one of the most common medical problems facing the senior population. Pets allow seniors to meet people more easily, keep seniors active and provide them with a sense of security.

While such organizations as Pets on Wheels and Therapy Dogs International have been providing opportunities for seniors to visit with animals on a regular basis, there is a growing trend towards incorporating pets into daily activities of seniors. More recently, resident homes for seniors have begun allowing animals to live full time in their homes. Sunrise Assisted Living of West Hills, an assisted living community on Topanga Canyon Blvd., is an example of a community that allows pets in the home. Not only can residents bring their pets with them when they move into a Sunrise residence, the home itself has resident pets to support those who don't have the love and companionship of their own furry friends

Entering a long-term care environment in the past often meant giving up familiar surroundings. Sunrise Assisted Living strives to provide quality care that does not alter its resident's lifestyle.

According to Ronda Wilkin, executive director of Sunrise of West Hills, "We understand how attached people grow to their pets and understand the benefits, both mental and physical, of having companion animals around. We want to provide a homelike environment, including cats and dogs, that will keep our residents happy and healthy. The most-loved residents in our home are Blossom, our 4-year-old Golden Retriever/Australian Shepard mix and gray retired show biz cat named Mars. The companionship these animals provide brings real joy and comfort to our residents, Some families have even expressed an interest in knowing when Blossom is at the groomers. Why? Because visiting with Blossom is almost as important as spending time with their loved one. The warm-fuzzies from Blossom makes their day!"

The motto of the Sunrise of West Hills Team is a quote by Will Rogers:

"If you want to be successful it's this simple: Know what you're doing. Love what you're doing. Believe in what you're doing."

This article was provided by Sunrise Assisted living, Inc.

A cornerstone for patient care

It seems you can't open a newspaper without seeing a headline about how California's healthcare industry is suffering. In fact, recent reports indicate that two-thirds of the state's acute care hospitals operated in the red last year. The nursing shortage, decreased reimbursement, and the dwindling state budget have put California hospitals is serious peril. The enactment of Senate Bill 1953, which requires California hospitals to be compliant with the state's seismic codes by 2008, has added an additional financial burden to the healthcare industry. Valley Presbyterian Hospital, while not immune to these issues, has continued to thrive due to continued support from its Board of Directors and the community as a whole.

With a focus in mind to continually help improve the level of health care in the community - including making sure that patients are cared for in a safe environment, Valley Presbyterian Hospital has embarked on an ambitious mission to build a new patient care facility and to upgrade existing facilities. The replacement and enhancement project ensures that Valley Presbyterian Hospital continues to meet the seismic standards as mandated in Senate Bill 1953 while also allowing the organization to better meet the needs of their diverse clientele of patients and to respond to emerging changes in health care delivery.

The facility replacement and enhancement project involves two phases. Phase I includes the construction of a six-story patient tower. Phase II of the project, which calls for the renovation or modification of existing inpatient structures, will commence shortly after the completion of the new patient tower, which should be completed by the end of 2003.

The facility replacement and enhancement project is evidence of a remarkable partnership between Valley Presbyterian Hospital and the community, federal agencies and the benefactors who will help the hospital build what promises to be a model of exceptional patient care, now and well into the future.

This article was provided by Valley Presbyterian Hospital.

Breast Cancer Survivors 'Pose' to Help Others.

Lyea Chu

A unique collaboration of women -- including a group of breast cancer survivors, their surgeon, and a portrait photographer -- have joined forces to make a difference in the lives of women faced with the terrifying diagnosis of breast cancer. The result of their collaboration, "Reconstructing Aphrodite," is a new book of photography and commentary focusing on women who have survived breast cancer and who have opted to have breast reconstruction via an innovative surgical technique -- "single stage" reconstruction.

Responding to a Need

Many don't realize just how many women are affected by breast cancer. Indeed, one out of every nine women in diagnosed with the disease in her lifetime. For most of these women, mastectomy -- a mind and body altering process -- follows the frightening diagnosis. Each woman faced with a mastectomy. In an attempt to "return to normal" or "become whole again," some women today opt for breast reconstruction -- and a growing number of those women are now turning to the new "single stage" option.

Plastic surgeon, Dr. Loren Eskenazi, who was trained as an artist as well as a clinician, is a vocal advocate for the patient-friendly, aesthetically realistic method referred to as single stage reconstruction. Working with several of her courageous patients and photographer Terry Lorant on the "Reconstructing Aphrodite" project, she is now able to educate and share with women around the country some of the life-affirming possibilities that are now available to survivors of breast cancer. The book is currently available at Amazoncom or via www.reconstructingaphrodite.com.

Each of the women photographed in "Reconstructing Aphrodite" posed nude for photographer Terry Lorant, and their striking portraits are accompanied by each survivor's story - told in the first person.

Eskenazi explained that an objective of the project was to help people understand that there are a number of alternatives to the traditional radical mastectomy. Most don't realize that typical breast reconstructions consist of multiple surgeries. Single stage reconstruction, the technique utilized by Eskenazi and a growing number of surgeons around the country, involves placing an expandable implant that can be adjusted in size for up to six months after surgery for the best possible aesthetic results. This means women may only have to endure one surgery and general anesthetic to reconstruct their breasts, instead of two or more.

"Reconstructing Aphrodite" captures the life-affirming vision that modem surgery has made possible. It is a celebration of the health and reconstruction of 20 breast cancer survivors and an artistic collaboration between a breathtakingly honest photographer, healers, patients and the loved ones who have borne witness. The book's rich black and white photographs by Lorant are by turns powerful and beautiful -- often capturing the stark reality of emotions expressed by each of the women.

Art, Education and Options

"Our primary goal with this project was to help and to educate," said Lorant. "When my beloved friend Jo (one of the women who appears in the book) was diagnosed with breast cancer and faced with a double mastectomy, there was so much anguish surrounding the uncertainties and lack of information pertaining to her options. Having immediate breast reconstruction at the time of her mastectomies was a huge help for Jo in so many ways."

"It was Jo who lamented to me there really was nothing to look at when trying to make the decision about mastectomies and reconstruction," said Lorant. 'With my background as a portrait photographer, one thing led to another and, through working closely with Jo, her surgeon, Dr. Eskenazi, and the other women you see in the book, we believe we've accomplished something that really can provide women with a clear picture of what's possible during a very scary time."

"It's most rewarding to be able to do what I do -- photography -- and utilize my work to help people. The comments we've been receiving from women around the country have solidified that reward."

Lorant describes the entire process as "pure collaboration." "Especially with this sensitive subject matter," she recalled," it was very important to me that all the women participating in the project be comfortable and proud of what they were doing."

"With a condition as widespread as breast cancer, education is essential," said Betsy Mullen, Founder and President of Women's Information Network Against Breast Cancer ('A/IN ABC), a national nonprofit organization. "One of our primary missions at WIN ABC is to equip breast cancer patients with the knowledge and tools necessary to facilitate confident and informed decisions regarding their treatment options. 'Reconstructing Aphrodite' is a wonderful, artful new element for the toolbox -- visually informing women of some of their options."

During the book's creation, Lorant set up a flexible system which involved meetings with each of the women and discussions about poses and settings. "With every woman, there was a powerful story to be told," said Lorant. "Not only with words, but with their bodies and the expressions of triumph on their faces. Fighting cancer is a heroic endeavor, and these women have taken that heroism to the next level -- sharing the possibilities of what can be with other women who are struggling--often unaware of their options."

Learn more about these courageous women and their book at www.reconstructingaphrodite.com.

New Imaging Technology Comes to the Valley

Thanks to a joint venture of Tower Imaging Medical Group and Mission Community Hospital, a groundbreaking alternative to MRI technology is now available in the Valley.

The Hitachi Airis II open MRI machine is considered by many medical experts to be the best MRI equipment on the market. If you have ever had an MR scan, you know that they can be stressful and intimidating. In fact, most traditional MR technology is unable to perform an MRI on approximately 10 percent of patients because of obesity or claustrophobia, while the majority of the other 90 percent find the procedure extremely uncomfortable.

The Airis II features a wide-open air design, not a closed tube, which allows claustrophobic and larger patients up to 500 pounds to be scanned. Another bonus feature is that the usual loud knocking sound of the magnet has been softened to a faint tapping.

The Airis II also uses specialized surface coils, which are devices that fit around a specific body part such as a shoulder or knee to generate better pictures. Describing this powerful piece of new equipment in his treatment arsenal, Mission Community Hospital MRI Medical Director Dr. Matthew Charms enthusiastically explained that, "We have all the new surface coils for specific body parts: Spinal, cervical/thoracidlumbar; shoulder, large and small extremity, and extra large quadrature spine/body. These coils provide high quality images were until recently not possible on an open MR machine."

Beyond the new technology, Tower Imaging and the Hospital formed Mission Community Hospital with the goal in mind to offer local residents Tower's 30 radiologists, most of them fellowship trained, offering subspecialty expertise in nuclear, pediatric, mammography, musculoskeletal, nuero, and orthopedic. Dr. Charms notes, "We have all of radiology covered. This is a new concept for the Valley--it's new territory -most other radiology groups are general radiologists, but radiology has become more complex."

Another innovation for the region is the unique network that links Tower's offices in West Los Angeles to the San Fernando Valley, or "Teleradiology." Tower developed the system 10 years ago so that every scan taken at all Tower locations are instantaneously available to all 30-subspecialists via a network over the internet. Dr. Charms explains, "For example, if I get a difficult neck MRI here that I want someone to look at, it's available to any one of my 29 partners at the same time that I'm looking at it on the screen. So we get on the phone and we consult with each other. It's an instant consultation with a subspecialist. That's why we've been so successful."

This article was provided by Mission Community Hospital.