Patients overwhelmed the hospital, stretching both its physical facilities and staff. At times, gurneys lined hospital corridors and filled five outdoor tents.
Batchlor was serving as chief medical officer for L.A. Care Health Plan — a public health plan covering underserved Los Angeles County residents — when she was tapped in 2012 to become chief executive of the hospital that was being set up to replace the shuttered Martin Luther King Jr. Hospital.
She spent the next three years laying the groundwork and stayed on to helm the Martin Luther King Jr. Community Hospital when it opened in 2015. Previously, she served as a vice president at the California Health Care Foundation, medical director for the Los Angeles County Office of Managed Care, chief medical officer for Prudential Health Care and clinical instructor at the UCLA School of Medicine.
The Business Journal sat down with Batchlor to discuss why the hospital was so hard hit by Covid, the steps she took to combat the surge and what the facility is focused on as the Covid crisis eases.
Martin Luther King Jr. Community Hospital was one of the hardest hit hospitals during the Covid-19 surge. How did you navigate the crisis?
Handling emergencies and crises is something that hospitals are well prepared for. Even so, it was a definite challenge. We were the epicenter of the epicenter of the Covid crisis. I really figured that out when I looked over a Health and Human Services agency report: We had more Covid patients in our small community hospital than hospitals four times our size. That said, we have a very talented, very nimble and resourceful staff. They found the resources that our patients needed.
How did you find those resources?
We reached out for help and got a lot of support from the community and the county and the state. As the pandemic’s first surge started in early 2020, we ordered traveler nurses and scheduled them to come in. When I reached out to Gov. (Gavin) Newsom’s office, the state stepped up with additional traveler nurses and respiratory therapists. We also called in nurses and doctors in outpatient locations. We also had five tents to house patients — before the pandemic, we had one tent.
Even before the pandemic you had a tent to house patients?
Yes. Given the community we are in, we had a high volume of emergency room visits. Our emergency department was designed for 45,000 visits per year; in 2019, we had 110,000 visits. And we were short some 1,200 physicians. So even before Covid hit, we had a public health crisis here.
This is really a reflection of the high rate of illness in our community that’s not being addressed — there’s not enough treatment on an outpatient basis. Take a disease like diabetes: We have over three times the rate of diabetes in South Los Angeles than the rest of the state, and our mortality rate is 70% higher. There is a need for health care funding, but also for other social determinants of health: access to healthy food, safe places to exercise, high-quality education and employment.
Why was the hospital unable to staff up to meet this?
Our community is very low-income. Most people are either uninsured or on Medicaid. That means we have lower reimbursement rates than other hospitals. That’s why we have the fewest hospital beds for every 100,000 people in the county. It’s also why we have a shortage of physicians and why we lack almost every other type of health care infrastructure. We’ve created a system of health care that is separate and unequal.
What has Covid-19 done to MLK Community Hospital’s finances?
A lot of other hospitals were impacted by the ban on elective surgeries — that’s where they get a lot of their income. But things are a little different at our hospital as we don’t do a lot of elective surgeries. Most of our surgeries have emergency conditions. So, we didn’t lose that much revenue there. But our emergency room volume did drop by half in the first few weeks. And we did have a lot of expenses — purchases of personal protective equipment, medications, ventilators and other supplies. We converted an entire medical floor into an ICU.That required a lot of new equipment.
Did the CARES Act dollars help the hospital get through the surges?
Some of the CARES Act funding helped. But that funding was not equitable. The first round was calculated using a formula based on the percentage of Medicare patients. But we don’t have a lot of Medicare patients: We have a high proportion of Medicaid patients. So that meant we got less in CARES Act dollars than other hospitals. We ended up getting somewhere around $18 million.
Did the hospital fare any better in subsequent funding rounds?
The next round was based on net patient revenue. But our lower reimbursement rates mean we don’t get much in the way of patient revenue. When the federal government finally got around to distribution for Medicaid patients, we didn’t qualify. Any hospital that had taken CARES Act dollars for Medicare patients — and we did take some — was not eligible.
How did you come up with the extra funding?
We had to raise funds from the community, and the community stepped up. Our supporters were generous with both money and in-kind donations. One of our partners was the International Medical Corps, which is headquartered right here in Los Angeles. They donated a field tent and ventilators.
Isn’t the International Medical Corps focused on providing aid to developing countries?
Yes, and it says something that an organization that is devoted to improving medical conditions in sub-Saharan Africa and other impoverished areas of the world had to focus right here in its own backyard. But we appreciated their support.
Did you have to make any cuts?
There wasn’t time for cuts. We were in a crisis and had to expand services. The only cuts were in outpatient visits. We converted to telemedicine as a substitute. But that wasn’t a cut in staff. The staff was brought back to the hospital to deal with the crisis here.
How are hospital finances now?
We have recovered financially. We finally did receive federal funding. Without that, we would still be in a money-losing situation. We also got an advance on Medicare payments that we had to pay back.
What happened to non-Covid care in the middle of all this?
Our community members were less comfortable going to hospitals for nonurgent care, especially during the Covid crisis. So, there is concern about pent-up demand for care that has been deferred. We’re concerned that chronic conditions among our community members, such as diabetes, may have gotten worse. And that means more expensive hospital care. For example, if diabetes treatment is neglected, then we have to do more limb amputations.
Now that we appear to be coming out of the Covid crisis, what are your goals for MLK Community Hospital?
For the rest of this year, our main goal is to help our community reach herd immunity. We’re investing a lot of resources in vaccinating people in our community. We have hot-spot maps that tell us where the highest concentrations of Covid have been in our community, and we’re going to those communities to vaccinate people.
And beyond the next few months? What are your priorities?
We’re going to be advocating for better funding for community-based care. Covid has given us a better look at the inequities in our community. I hope that we now have the will to invest more in our vulnerable underserved communities. That means more funding for diabetes management, treating pulmonary disease, obesity, substance abuse disorders, mental health conditions, etc. We’re also developing street medicine programs for homeless patients. It’s all about pushing more care into the community.
Anything else?
We have started a post-Covid multispecialty clinic. It includes physicians that cared for Covid patients, as well as the nurses and even spiritual advisers. The clinic follows Covid patients after their discharge from the hospital, helping them deal with lingering kidney or pulmonary problems, blood clots, behavioral issues and other mental challenges. Some of these people will be left with permanent disabilities or other effects of Covid. But some will be recoverable, and that’s what the clinic will be focused on.
How did you become interested in providing health care to underserved communities?
I’ve always been interested in public health and social justice and advocacy. I was raised by parents who were social activists. They went to the “I Have a Dream Speech” in Washington, and they took me to the Poor People’s March on Washington (in 1968). Much of my career was spent working to improve quality and access to health care for people in underserved communities.
What was it like getting MLK Community Hospital off the ground?
Getting the hospital established was the most challenging thing I’ve done in my career. … There was a lot of skepticism that it could be done, and there was the legacy of the old hospital that had to be overcome. But we did it.
Home Health Care LA500 Q&A: How Elaine Batchlor Steered Hard-Hit MLK Community Hospital Through the...
