FACILITY TARGETED FOR CUTS TO BUDGET\Some care slated for clinic network.

Byline: Karen Maeshiro Daily News Staff Writer

Up to 75 beds at county-run High Desert Hospital could be eliminated in the next five years under a cost-cutting plan to shift care away from hospitals to a network of clinics, officials said.

The changes are in part related to changes in health care where there is less need for inpatient beds and more focus on providing care on an outpatient basis, officials said.

They also stem from the county seeking a waiver in Medicaid rules that would allow the county to shift much of its routine health care away from hospitals to lower-cost health centers, officials said.

"In that waiver, the county system is looking at a one-third reduction in the beds it operates across the entire system," said Jonathan Freedman of the Los Angeles County Health Services Department. "High Desert at this point is targeted for 75 beds."

Cutting beds at county hospitals is part of a county plan to reach a five-year goal of cutting 876 of 2,595 hospital beds. This year, the county already has eliminated 307 beds throughout its six-hospital system.

Licensed for 170 beds, High Desert now uses 75 to 80 beds for mostly skilled nursing and rehabilitation, officials said.

"It's a little bit early to say whether the beds will disappear," High Desert administrator Mel Grussing said. "It's an ongoing decision-making process depending on how the budget looks. There's no question we are going to have a decrease in county beds and that includes High Desert as well."

Grussing said it is difficult to say what form, if any, High Desert Hospital will take in five years and whether inpatient services will continue to be offered at all or on a reduced scale.

The hope is that High Desert will benefit from the formation of "public-private partnerships" to fund operations, rather than depend on county subsidies.

"If we utilize partnerships, it's not costing the county. It's funding from other sources other than taxpayer coffers," Grussing said.

Ideas being pursued are partnerships in areas of skilled nursing and rehabilitation or possibly establishing a comprehensive center for ambulatory care, Grussing said.

"If we do business with partners in skilled nursing and rehabilitation, they might want to work with us in funding an inpatient setting," Grussing said.

The hospital was threatened with and then spared from closure last year but suffered about $14 million in cuts that took effect in October, including a 30 percent reduction in skilled nursing care and elimination of an eye clinic and nine other outpatient services.

Freedman said the idea is to make the hospital "revenue-supporting" on its own.

"The facility can stay open by bringing in revenue and having alternative operations. We are looking at private-public partnerships," Freedman said.

The county wants the flexibility to pay for expanding its clinic system as it downsizes its hospitals to deal with a budget shortfall, officials said.

To help do that, it is seeking the Medicaid waiver to relax rules so that the county could spend its government grants in clinics, not just in hospitals.

Approval of the waiver would mean that the county would be sent $364 million in federal dollars to care for the poor this year, officials said last week.

The county is proposing to boost the amount of primary care it provides to patients through the expanded clinic network, county health officials said.