Access to medical care for the indigent has improved under Los Angeles County’s 1995 plan to shift poor and uninsured patients from hospital emergency rooms to privately run clinics, county health officials say.
Under the plan, the county called in non-profit clinic organizations to take over eight of its clinics. Although the plan was implemented because of a crisis the county could no longer afford to run the clinics it had the side benefit of increasing the number of sites where the poor can be treated.
As a result of taking over those eight facilities and signing contracts with additional clinics the number of clinics treating poor and uninsured patients has risen from 39 to 117, health officials say.
In addition, the county has nearly fulfilled another goal increasing patient visits to clinics by 50 percent.
“We have met the goals of increasing the access points as set out in the restructuring, and we’re now seeing an increase in the number of patients they’re seeing,” said Nancy Rubin, chief of staff for Mark Finucane who is the director of the county Department of Health Services. “The access points are a mosaic of private providers, many of whom have never worked with each other or the county.”
But the jury is still out on whether this translates to better care, according to patient advocacy groups.
“There are a lot more access points, yes, but it’s too early to tell if the quality of care is maintained or has been improved,” said Lark Galloway, executive director of the Community Health Council, a non-profit group. “Any time you have such a horrendous restructuring and rapid growth of clinics, something is going to take a hit.”
Among the problems: Untangling the web of plans that are used by uninsured and under-insured patients, such as county aid, Medi-Cal and partnership services for the indigent.
“We need to smooth out confusion over how patients are charged so that it is not interrupted unnecessarily,” said Margaret Leerector of the Public-Private Partnership program.
“We also need guidelines and protocol for how to refer patients for specialized care between the clinics, both in terms of need and geography,” she said.
Mandy Johnson, executive director of the Community Clinic Association of Los Angeles, sees the challenges for the new system in minutiae illustrated by the way the various organizations share patient files.
“There are lots of issues that have to be worked out in terms of how to handle and transfer information about a patient who has to move between public and private facilities,” Johnson said.
Increasing available primary care at clinics has two main benefits: It saves visits to county emergency rooms and gives patients a better chance to receive attention for a problem before it actually becomes an emergency.
“We don’t have any hard data yet for how much this is reducing the number of visits to the E.R.s that data won’t really be available for another year and a half,” said Margaret Lee, director of the Public-Private Partnership program, the county body charged with finding ways to increase the availability of primary care for the poor.
Also unclear is whether the county will save money on running the clinics with the help of private entities, though Lee noted that private operators are not tied by the same wage and working conditions in force for county employees.
The partnership program is part of the Medicaid Demonstration Project for Los Angeles, a county, state and federal plan devised to address a fiscal crisis which in 1995 threatened to shut down county hospitals.
Not unexpectedly, spreading the word has taken time.
“At first when we took over our two sites (the Canoga Park Health Center and the Valencia Health Center), the numbers of patients coming into Canoga were a little low,” said Helen Arriola, director of governmental and public policy for the North Hollywood-based Northeast Valley Health Corp. “The word got around for some reason that the county clinic was closing or being turned into something else.”
But Arriola said the same word of mouth circles slowly have been increasing the numbers.
The Paramount Health Center is the most recent privately-managed county facility to come on-line, and does not seem to have had problems with low awareness. The facility was taken over by the Metrosouth Provider Network.
“The clinic is seeing about 500 people a month, which is many more than when the county ran it,” said Jeffrie Miller, CEO of Metrosouth and the associate dean for family practice at Charles R. Drew University of Medicine and Science in Inglewood, with which Metrosouth is affiliated.
Lee said there has been an overall increase in the numbers of indigent patients making appointments at the partnership sites, and that there are fewer no-shows these days, all of which bodes well for the goal of lessening the burden on the county hospitals. The drop in no-shows is due to patients developing relationships with their clinic doctors and feeling encouraged to keep their commitments.
The clinics, which sign yearly contracts with the partnership program, receive 90 percent of what Medi-Cal would pay for medical services.
“So far we’ve only had one clinic drop out. They said the reimbursement rates were too low and that they didn’t have the infrastructure to treat a lot of things they needed to,” Lee said.
For the fiscal year 1996-1997, the partnership program is operating on a budget of $14 million, and $22 million is slated for the program for 1997-1998. The increase reflects the fact that a large number of clinics have been added in the past year or will be this year.
Lee said the county has been soliciting offers from other private health clinics interested in contracting with the county to become expansion sites.
Bob Holt, director of physician advocacy for the Los Angeles Medical Association, agreed that the partnership program has done well to accomplish its initial goals of increasing the availability of localized primary medical care for the indigent.
“I think we have seen a lot of progress with the program in terms of the expansion of access points for care,” Holt said. “What remains to be seen is whether it will further expand, or re-expand into some of the county clinics which were closed.”