CLINICS LESSEN LOAD FELT AT COUNTY ERS; '95 FEDERAL BAILOUT HELPED L.A. CHANGE HEALTH CARE DELIVERY.Byline: Douglas Haberman Daily News Staff Writer Like other low-income San Fernando Valley San Fernando Valley Valley, southern California, U.S. Northwest of central Los Angeles, the valley is bounded by the San Gabriel, Santa Susana, and Santa Monica mountains and the Simi Hills. residents, Susan Williams Susan Rene Bartholomew-Williams (born June 17, 1969 in Long Beach, California) is a triathlete from the United States. She competed at the second Olympic triathlon at the 2004 Summer Olympics. She placed third with a total time of 2:05:08.92. got used to waits of four hours or longer in the crowded emergency room at Olive View-UCLA Medical Center Olive View-UCLA Medical Center is a hospital located in the Sylmar neighborhood of Los Angeles, California, USA. The hospital was founded on October 27, 1920, and is funded by Los Angeles County [1]. in Sylmar. The 51-year-old Pacoima woman who suffers from congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. , high blood pressure and diabetes had nowhere else to turn except the area's only public hospital. Now, Williams and thousands of patients can go to clinics and health centers spread across the Valley. It is part of a federal bail-out plan from 1995 that rescued the nation's second-largest health care system from near-bankruptcy. ``I feel good coming here,'' Williams said last week during a visit to a clinic. But what has been good for patients is far from solving the county's financial woes. A budget gap of more than $119 million is forecast for the health system. And now health officials say they believe that at least one clinic has intentionally in·ten·tion·al adj. 1. Done deliberately; intended: an intentional slight. See Synonyms at voluntary. 2. Having to do with intention. inflated numbers of visits, possibly to help meet goals under the federal bailout bailout The financial rescue of a faltering business or other organization. Government guarantees for loans made to Chrysler Corporation constituted a bailout. . An investigation is under way. An aide to Supervisor Gloria Molina Gloria Molina is a member of the Los Angeles County Board of Supervisors, and the current chairwoman of the Los Angeles County Metropolitan Transportation Authority.[1] Molina grew up as one of ten children in the Los Angeles suburb of Pico Rivera, California, U.S. said he believes the over-reporting of visits would not affect the deficit. ``The issue is that for 15 years there has been no reliable revenue stream to provide services for those who don't have medical insurance,'' said Molina's assistant chief deputy, Miguel Santana Miguel Santana (born February 9, 1965) is a former boxer from Puerto Rico. Santana was born in Canovanas. Boxing career Miguel Santana had an award winning amateur boxing career, training alongside a young Jose Antonio Rivera, who is a two division world champion himself. . ``So the burden has fallen on the county. It has nothing to do with monitoring or lack of monitoring in the clinics.'' The federal bailout was designed to give the county enough time and money to change the way it delivers health care. But despite the emphasis on outpatient care, officials with the county Department of Health Services Department of Health Services may refer to:
Rene Santiago, the department director in charge of the restructuring project, said the overhaul will save the county $173 million by 2000 instead of an earlier projection of $294 million - falling short by $121 million. Health department director Mark Finucane told the Board of Supervisors at a meeting last month that the original projection was too ambitious, and restructuring is proving more complex than anticipated. But this hasn't sat well with supervisors, who are still waiting for an explanation. ``I think our biggest frustration is we're trying to find out how far behind we are . . . and why we're behind,'' said Miguel Santana, an aide to Supervisor Gloria Molina. ``At this time we have more questions than answers.'' Patients, though, say the overhaul has made it easier for them to get care. And those going to the clinics no longer have to wait hours in emergency rooms to see a doctor. A proven success At Olive View and Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. County's four other public hospitals, nonurgent emergency room visits are down by 25 percent from three years ago. Overall use of emergency rooms has dropped by 13 percent, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the county Department of Health Services. Officials aren't yet ready to attribute this to their massive restructuring of the indigent indigent 1) n. a person so poor and needy that he/she cannot provide the necessities of life (food, clothing, decent shelter) for himself/herself. 2) n. one without sufficient income to afford a lawyer for defense in a criminal case. health care system, which now steers their nonurgent patients to a network of 149 walk-in clinics walk-in clinic Ambulatory clinic, see there . To pinpoint cause and effect, they would need to closely track how the patients, who are often highly transient, get medical care, Santiago said. But the numbers are showing a decline in some of the most expensive kinds of care - emergency room treatment and hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun) 1. the placing of a patient in a hospital for treatment. 2. the term of confinement in a hospital. . ``The key is reducing the inappropriate use of emergency rooms,'' Santiago said. Outpatient care costs less than hospital care and results in better treatment, officials said. Dr. Donald Thomas
Independent government commission charged by the legislature with setting and enforcing standards for specific industries in the private sector. The concept was invented by the U.S. for emergency rooms. In addition, patients who show up in emergency rooms typically are unknown to the medical staff and have no medical history on file there, ``so we have to test for everything,'' he said. But at outpatient clinics, the overhead is lower and, ideally, the patient has a medical record on file, Thomas said. The average clinic visit costs the county about $50, he said. New rules, better care The radical turnaround of the county system stems from the federal bailout more than three years ago. The federal government relaxed Medicaid rules so that Los Angeles County could increase access to medical care for people like Susan Williams who can't afford it but do not qualify for government insurance. The federal government is also pumping about $220 million a year into the county system, Santiago said. In return for the federal assistance, the county promised to shift medical treatment as much as possible from hospitals to clinics to slash costs. County officials fear they are likely to need an extension of the assistance, which is scheduled to end in 2000, Santana said. But the Board of Supervisors believes the Department of Health Services must demonstrate greater savings if the county is to return to the federal government with hat in hand, he said. One way to generate those savings is to stop people from using emergency rooms like a doctor's office, officials said. More doctors, better hours To that end, the county has increased the number of doctors treating adult patients in county health centers, like one in North Hollywood, that formerly treated only children and pregnant women. ``I've seen that we're able to provide better access for patients'' and reduce emergency room visits and hospitalizations, said Ernest Espinoza, assistant administrator for the county's Valley Care Health Centers. There are 2.7 million uninsured people in Los Angeles County - about a quarter of the county's population. The county health care system sees about 1 millIion people a year. The Department of Health Services has also created new partnerships with private clinics and physicians whom the county now pays to see uninsured patients. These public-private partnerships Public-private partnership (PPP) describes a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies. These schemes are sometimes referred to as PPP or P3. expanded the number of county walk-in sites from 45 to 149. The new sites get 400,000 visits a year, Santiago said. In addition to the decline in emergency room visits the county is experiencing, the average daily number of people in Department of Health Services hospitals has dropped by 28 percent, and the overall average length of hospital stays has decreased by half a day (a 7.8 percent decrease). The county has also increased the number of physicians and nurse practitioners nurse practitioner n. Abbr. NP A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician. in its system from 353 primary care and 950 specialists in 1997-98 to 500 primary care and 1,280 specialists in 1998-99. And it boosted the average number of hours of clinic operations by 15.5 percent, or about one hour a day Monday through Saturday. Daily News Staff Writer Philip Browne contributed to this story CAPTION(S): 2 photos PHOTO (1) Lilly Fernandez is a nurse at the county health center in North Hollywood, one of many health centers that has increased the number of doctors who treat adult patients. (2) Susan Williams gets her blood pressure checked at the county health center in North Hollywood. David R. Crane/Daily News |
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