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Thursday, Mar 28, 2024

Doctor in the House?

Community clinics who care for the Valley’s poor and uninsured, are finding themselves in a curious predicament these days. Thanks to health care reform, they suddenly have more money to take on new patients and expand their services. At the same time, they are constrained by the lack of primary care clinicians. After being forced to turn away patients, North Hollywood’s Valley Community Clinic, which saw nearly 17,000 patients last year, expects to be able to add 5,000 new patients this year, a whopping 30 percent increase, thanks to the newly revamped Healthy Way LA. A program of the County Department of Health Services, Healthy Way LA makes new federal and county dollars available to assign uninsured patients to medical homes, which in many cases will be the clinics. The program is meant to pave the way for health care reform in 2014, when the currently uninsured will be brought into the federal Medicaid program. Though the federal health care reform law may yet be challenged, county health officials say they want many of the uninsured to have a medical home by the time the program is scheduled to go into full effect in 2014. The county has earmarked some $300 million to the program — half of which is from the federal government — with a goal of assigning some 550,000 uninsured patients to 100 clinics throughout Los Angeles, said Shari Doi-Hatcher, director of patient experience for the county health department. By 2014, the program will be fully funded by the federal government. So far, about 115,000 patients have been assigned to clinics, she said. But even with that new bucket of money, clinics are struggling to meet the need and are facing a tough time enrolling new patients. Northeast Valley Health Corp., which saw 63,000 patients last year, does not expect to be able to take on any more, said Kimberly Wyard, president and CEO. “We closed to new patients in July because we are at capacity in adult medicine,” she said. “We are enrolling our existing patients in the new program but we can’t add more. We are running full tilt.” She said the lack of primary care physicians and space is problematic. “We need more exam rooms and physicians, and right now, we don’t have either.” Even those who have the ability to take on more patients, like Valley Community, are facing a huge administrative burden to enroll so many new patients, qualify them for new programs under health care reform and educate them about ways to navigate the new system of care under which the clinics will become a medical home to the region’s poor. The challenges speak to the difficulties that are likely to greet health care providers on a much larger scale as they ramp up to provide care for the country’s 40 million uninsured under the Patient Protection and Affordable Care Act in 2014. “It’s a daunting task,” said Olga Duran, director of patient services at Valley Community Clinic. She hired six new staffers in recent months to help enroll more than 1,000 new patients since July and walk them through a 45-minute intake procedure. Valley Community Clinic decided earlier this year that it will expand its services with the inflow of new money. Right now, about half of its $10.5 million budget is from government sources, including the county, while the rest comes from donations, foundations and fees, which is used to treat the uninsured and often, the undocumented. Under the Healthy Way LA program, the clinic expects to get a significant new funding source, roughly $125 per patient visit, and there’s no cap on the number of patients or visits, said Judi Rose, vice president of development and government affairs. It’s an opportunity to serve more people, said Dr. Roger Peeks, chief medical officer. “There are people who call us every day and we have had to turn many away,” he said. “This helps us take care of more people.” At the same time, the clinic is down to 11 full-time clinicians, who are already stretched taking care of existing patients. Without more staff, the clinic will be hard-pressed to serve the 5,000 new patients, he added. Finding more primary care doctors who are prepared to serve the county’s poorest residents at a salary that’s 20 to 30 percent less than what they can earn across the street at Kaiser Permanente is no small task, he said. Dr. Peeks says he has some creative ideas, including calling on area hospitals to have their doctors donate some of their time at the clinic. “Some of the same patients who could come to us wind up in the emergency room, which costs those hospitals a ton of money,” he said. “They could instead send us some doctors and we could keep those patients out of the ER at a huge savings to the hospital. It’s a win-win.” As Dr. Peeks explores such possibilities, he is also preparing his staff to go live on March 15 with a new electronic medical record system, which will also help his staff cope with the influx of patients. With the EMR — a $1 million investment funded with money from the 2007 federal stimulus program — the clinic can more easily and efficiently care for its new patients, providing them coordinated care in a medical home, similar to what they would receive with private insurance. “It’s a lot of work getting ready, but the potential for growth is really exciting,” he said.

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