County moves ahead with $2.2 billion overhaul of health system.

Most of the plans for the $2.2 billion overhaul of Los Angeles County's public health care facilities have been completed, and construction is already under way on some of the projects comprising the massive "health maintenance organization" that will serve the county's needy residents.

The proposed $672 million facility to replace the Los Angeles County+USC Medical Center represents much of the long-overdue capital improvement plan to upgrade the county's aging health care facilities. Additionally, the county's Health Facilities Replacement and Improvement Plan, as the plan is formally known, includes the $300 million renovation/new construction program under way at Rancho Los Amigos Medical Center in Downey, a new High Desert Hospital facility in Lancaster and an "efficiency plan" that calls for consolidating the county's 46 pre-existing medical clinics into 30 facilities.

Plans for the county's revamped public health care system -- which emphasizes prevention and early treatment to reduce the need for emergency services and "inpatient" care -- have been in the works for years, explained Vicki Romigh, a partner with Romigh Roger Rusk, the consultant firm helping the county's Department of Health Services coordinate the massive overhaul.

Under Senate Bill 1732, passed in the late 1980s, the county should be reimbursed through the state's Medi-Cal program for 40 to 50 percent of capital expenditures on improving inpatient facilities, Romigh explained.

The state is not required to issue those reimbursements, however, until after the projects are completed. The state Legislature funds this program each year, so DHS is also supporting National Association of Public Hospitals' efforts to secure federal funding "in case the state funds aren't there," said Larry Colvin, director of DHS's facilities implementation team. The County+USC replacement project would be "the No. 1 priority" if financial shortfalls erode the replacement-and-improvement plan's budget, Colvin added.

Planners remain hopeful that county general obligation bonds, the proceeds of which would be used to "take out" (repay) the short-term "bond anticipation notes" now funding construction programs, will also pay off construction debts, Romigh noted. But if voters don't approve this funding structure by a two-thirds majority -- voters are typically reluctant to do so during a recession -- DHS may instead seek to fund the projects through more expensive county-backed "certificate of participation" bonds paid off by facility revenues, Colvin explained.

Economies stemming from the more-efficient facilities and management programs will also help DHS apply already-allocated county funds to retiring the construction debt, Romigh added.

The massive overhaul also ties into the revised state public health care plan adopted early this year, said Colvin.

Under this state plan, about 5 million low-income Medi-Cal patients in 13 counties would receive health care from either the "managed care" systems -- including hospitals and community clinics -- developed by counties, or competing private health maintenance organizations that win bids for the contracts.

Medi-Cal is shifting from a service through which the state reimburses providers for each service rendered, to one in which all care is provided -- by the county program or the private "mainstream plan" competitor -- for a flat monthly fee paid by Medi-Cal for each recipient. The new managed care system is scheduled to be phased in statewide by 1995.

DHS has "already been building in the direction that managed care will take us," Colvin noted. Hence, the county improvement program stresses "flexibility" in terms of where patients receive services, as well as prevention and early care to eliminate the need for emergency services and inpatient care, he added.

Ellerbe Becket Architecture, the lead design firm on the team planning the countywide facilities overhaul, recently submitted the "master plan" for consolidating the county's 46 health care clinics to the Los Angeles County Board of Supervisors. The Ellerbe Becket team recommended that the proposed 30 surviving -- and upgraded -- facilities offer full clinical services six days a week, with the county's six major hospitals offering "urgent care" every day, explained Bob Prendergast, vice president/manager of programming and planning.

According to the plan, the 16 facilities closed through the consolidation would be sold, and DHS's administrative offices would be centralized into a single facility to be designated soon, he added.

"I think it's a very forward-looking program that's ahead of anyone else in country," he added. "It's likely to be the direction the country as a whole takes" in response to recommendations of the federal task force headed by First Lady Hillary Rodham Clinton, Prendergast suggested.

Major components of the county plan include the following:

* Thought to be the biggest medical construction project planned in the entire U.S., the Los Angeles County+USC Medical Center near downtown L.A. is scheduled to be replaced with a new 946-bed acute care hospital, a comprehensive outpatient department and a full-service trauma center.

When completed on the eastern portion of County+USC's existing campus and an additional 15 acres the county is acquiring, the project's gross building area will cover nearly 2 million square feet at an estimated cost of $672 million.

Construction on the first phase is scheduled to begin in February 1994, with completion of the entire campus expected by 2002.

* The 1.34 million-square-foot renovation and new construction already under way at Rancho Los Amigos Medical Center in Downey is projected to cost an estimated $300 million. This project entails consolidation of the existing hospital and development of several buildings, including two inpatient units, an ambulatory care building, patient support facilities, additional parking, a warehouse and a central plant. Completion is slated for 2002.

* The High Desert Hospital facility in Lancaster is scheduled to be replaced with a new full-service, 199-bed acute care medical center and ambulatory care complex about three miles east of the existing hospital. This campus-like project is scheduled to be developed in two phases beginning early next year. The first phase is to be a $28 million, 90,000-square-foot perinatal center scheduled to be completed by July 1995.

The 440,000-square-foot, $134 million second phase includes a diagnostic and treatment block, two inpatient towers, an ambulatory care center, an administration and conference center and the central power plant. Construction on this phase is scheduled to begin in November 1995 and finish up in January 1999.

* Two major projects are planned for the Harbor/UCLA Medical Center in Torrance. The first, which is scheduled to get under way this July and open 24 months later, is designed as a three-level, 47,000-square-foot primary care and diagnostic center. Planners estimate that this project will cost about $10 million.

The second project here, expected to cost $90.7 million, is to include a new 210,000-square-foot ambulatory care/surgery/emergency room facility, along with a renovation of the existing emergency, surgery and central supply services -- including a new nine-story elevator tower. Construction is expected to commence in September 1995, with completion scheduled for November 1998.

* Olive View/UCLA Medical Center in Sylmar is scheduled to see a $44 million, 198,000-square-foot perinatal/emergency room services facility housed in a four-story structure to be developed north of the existing hospital. Construction is set to begin in July 1995 and finish in December 1997.

* Two projects are also in the works at Martin Luther King Jr./Drew Medical Center in south L.A. The first is an 8,000-square-foot, $2.57 million addition to the pediatric acute care and child care center. Construction on that began in February 1992 and is scheduled to be finished in November 1994.

Construction on a proposed five-story, 182,000-square-foot addition to the facility's trauma center is to commence this July. This $35 million project is slated to take 24 months to complete.

Three additional construction projects are planned at county clinics that provide public health programs and services. Those plans include:

* A $13.9 million, 46,300-square-foot addition that would house adult medicine, pediatrics/adolescent medicine, women's services, walk-in primary care, dental and urgent care at the Pomona Comprehensive Health Center. Construction is scheduled to run from September 1995 through December 1997.

* A $21.2 million, 126,300-square-foot addition including space for adult medicine, pediatrics/adolescent medicine, women's services, expanded surgery capacity and urgent care, at the El Monte Comprehensive Health Center. Construction here is set for a June 1995 start and a December 1997 finish.

* A $2.2 million renovation, including seismic upgrade and new building systems, at the Alhambra Health Center. Construction is scheduled to run from May 1994 through August 1995.