By: Elise Kalfayan
As the New Year begins, the nation’s healthcare organizations are looking ahead to 2014 implementation of the federal Patient Protection and Affordable Care Act. Although many details remain to be sorted out, it is clear that healthcare reform is going forward. How are the hospitals of the San Fernando/San Gabriel Valley region preparing for expanded coverage, changes in physician groups, and incentives for provision of care?
Providence Saint Joseph Medical Center, Burbank
We are already prepared for an influx of patients, as we’ve had experience in the past with events such as very difficult flu seasons. Some of our hospital areas can be enlarged for expanded patient care, such as a seldom-used ICU in the older part of the building.
The Affordable Care Act is going to increase the number of patients that need primary care. Our emergency room will always be available for them, until they find a primary care physician. We are working with Providence Medical Institute and the Facey Medical Foundation to identify more primary care physicians who are interested either in employment or in contracting with these foundations. They represent several hundred physicians, and are meeting with our hospitals to find ways to reduce costs, and to become more productive and efficient in delivering quality care.
We are also exploring pilot programs such as “Bundled Pay” – one payment for the doctor and hospital to share while providing high-quality patient care. The more physician groups can work with hospitals to reduce costs, the better things will be for patients and for providers.
To improve provision of care, we have to start specializing. Here at St. Joseph’s in Burbank, we have a wonderful neurology program; Tarzana is a great pediatrics resource. Every hospital can’t afford to specialize in all treatment areas. If someone is very sick, they can be transferred to the facility that can do the very sophisticated expensive procedures. The more you do, the better you get, so we are focused on how we can create centers of excellence.
To sum it all up: health care reform is a great thing for patients in the San Fernando Valley. It is going to incentivize providers to partner with physicians to provide great outcomes and reduce costs.
City of Hope, Duarte
City of Hope has long met the high expectations of our cancer patients and their families by providing the highest-quality care possible -- in other words, care that makes a difference. We do this, and will continue to do this, by combining the best conventional treatments with the most promising research.
Now we are providing even greater patient access by expanding our presence in communities such as South Pasadena and Lancaster in the Antelope Valley, working with local healthcare providers to deliver more and better care in convenient outpatient settings at a lower cost. At the same time, we understand that insurance companies and other federal and private payers expect superior outcomes for their members. We also have successfully incorporated physician leadership into our enterprise over the past several years through the creation of our Medical Foundation, allowing us to become even more successful at recruiting physicians who understand the value of participation at a high-quality institution. This integrated and aligned leadership works to ensure that our increasingly efficient provision of care puts patients first.
Glendale Adventist Medical Center
Kevin A. Roberts
President and CEO
The degree of change facing Southern California hospitals as a result of healthcare payment reform and other industry structural shifts is more than any government-mandated changes that we've seen before. It touches all aspects of hospital operations.
GAMC has spent many years re-investing in the infrastructure of our facilities to prepare for additional patient volumes. In just 5 years, we have grown to become the largest hospital in the San Fernando Valley.
Size is only one aspect of our growth. Inside the walls at GAMC, our newest patient care tower offers the latest medical advances to provide the safest and best medicine at the most efficient cost for our community.
Safe, high quality patient care only comes in cooperation with our physicians. GAMC has spent much time aligning processes and strategies with physicians and health plans to promote effective and efficient health care delivery systems. Earlier this year, we announced the launch of Adventist Health Physicians Network (AHPN). AHPN allows better integration of care between physician practices/urgent care sites and the hospital, which provides a much broader, community-based way to care for our patients, and this community.
All of these efforts create a broad strategy that includes new processes and initiatives to meet the implications of federal payment reforms. The driving force of our strategies is a continual focus on quality improvement. This is publicly demonstrated through third party surveyors like The Joint Commission who gave Glendale Adventist a 98.6 % composite score in its most recent Core Measures report acknowledging GAMC's 'desired performance' in providing care for patients with heart attack, heart failure, pneumonia and stroke conditions.
Safe, high quality patient care is and always will be the top priority at GAMC.
Huntington Memorial Hospital, Pasadena
Stephen A. Ralph
President and CEO
California is building a state-run health insurance exchange that will launch January 1, 2014. This will create an online, one-stop shopping mall where employers and consumers can view health plans side by side, comparing benefits, costs, provider networks and other features. This transparency and accessibility is designed to help consumers select coverage that best meets their needs and budget.
California’s Medi-Cal program will see significantly more participants, meaning the majority of the current 2 million uninsured in Los Angeles County will now qualify for state insurance. While expanding coverage is good, the government pays providers like Huntington Hospital only a portion of what our costs are for caring for this population. Increasing our patient activity in this area while maintaining the highest possible levels of quality and patient experience will require sound financial stewardship on our part and, most likely, new ways of providing care outside of the hospital environment.
There will also be changes in how hospitals get paid. Historically hospitals have been paid through a contracted arrangement where payment is received commensurate with each service rendered to diagnose and/or treat disease. For the most part there has been little or no incentive for providers to help keep people healthy and the current model provides no direct correlation to the quality and efficacy of care. Going forward this payment will be replaced by new methods that seek to incentivize hospitals and physicians to coordinate care, manage the health of individuals, and ensure that care is provided as early as identifiable and in the most cost-efficient setting. Huntington supports this movement and is investing significant dollars to broaden our focus beyond the walls of the hospital. This includes the development of new relationships with physicians and others so we can meet this challenge in a proactive and meaningful way.
In this environment of change, Huntington will continue to focus, as we always have, on high-quality, cost-effective patient care. That remains our reason for being, the core of our mission, and the bridge to our not-for-profit heritage.