Mission Community Hospital is taking its long defunct San Fernando campus and turning it into a community clinic, which will operate as a medical home to the area’s poor and medically underserved. What’s more, Mission is planning not just one, but two new clinics and down the road, perhaps more, according to the hospital. But the move, which requires an initial investment of $1.5 million to $2 million, raises some interesting questions about how a struggling hospital like MCH will be able to care for potentially more uninsured patients, the most likely customers of the new clinic. Others who already provide services to the area’s underserved, such as Northeast Valley Healthcare Corp., point out that there is already ample available care for those with Medicare and Medi-Cal, especially children, parents below the poverty line, and the elderly. Admittedly, there isn’t enough care for the Valley’s vast legions of uninsured and undocumented workers. But how exactly would Mission Community Hospital plan to recoup its investment? After all, just a few years ago the hospital was so troubled that the Attorney General approved for-profit hospital operator Deanco Healthcare’s buyout of the institution. Certainly on the face of it, it would seem like a daunting challenge, and not one that a hospital would want to undertake so willingly. But where others see a challenge, Mission Community President Jack Lahidjani is sensing an opportunity. There are many reasons why serving San Fernando’s poor — and even its uninsured — makes good business sense. One obvious reason is that Mission Community is getting ready for the Accountable Care Act, despite the mostly negative comments from the Supreme Court Justices who heard arguments both in favor and against the legislation the last week in March. Perhaps like many others, Lahidjani trusts that “Obamacare” will pass the challenge against it in the Supreme Court. Should that happen, an estimated 80 percent of the Valley’s roughly 405,000 uninsured are expected to qualify for some kind of insurance. And under that scenario, Mission’s new San Fernando Community Health Centers will be able to seek reimbursement for its services. Audrey Simons, who will oversee the new clinics, acknowledged that the hospital is hoping that health care reform passes and allows the new centers to care for the newly insured — and get paid for it. Less obvious is the fact that, even if the legislation fails, there are sound reasons for the community hospital to create a medical home for the area’s poor and uninsured. One reason is the new 30-day rule under which hospitals that readmit a patient within 30 days of discharge are no longer paid for that readmission. Research and experience has taught hospitals that without a continuum of care —without good follow-up — many patients wind up right back in the hospital. If hospitals such as Mission Community don’t want to bear the cost of that readmission, it makes sense to discharge that patient to a medical home, rather than just ad-hoc care, which in all likelihood contributed to that patient’s illness and hospitalization in the first place. Another reason Mission Community would want to treat the uninsured in a medical home is to control admissions to its emergency room. Like all hospitals serving the poor, Mission has a high number of uncompensated cases. The hospital has been struggling with uncompensated ER admissions for years, according to sources. Mission has a responsibility to care for them, regardless of their ability to pay. But if Mission can somehow keep the population surrounding its hospital just a bit healthier through preventative care, then admissions to its ER — along with its uncompensated care burden— should drop. “It’s a very good cost control measure to reduce uncompensated care,” said Bill Gil, CEO of the Facey Medical Foundation, whose medical group operates a facility in nearby Mission Hills. In fact, he said, his medical clinics are being approached by multiple hospitals looking to make Facey a partner in efforts to reduce uncompensated care. “Several hospitals have approached us,” Gil said. “The idea would be for us to be the medical home to patients for preventative care and for those being discharged. We would become that step-down unit, if you will.” The challenge in striking such a partnership for Facey: who would pay the group to become that medical home for the uninsured? “That’s the $64,000 question,” he said. It makes sense for hospitals to pay Facey because they save money in the long run, but their reimbursements are being cut and their budgets are tight. For Mission Community, the ownership structure between the hospital and the clinics opens an opportunity to care for the uninsured in a way that would benefit the hospital, as well. Simons said reducing ER admissions to Mission Community is a significant reason for the move to open the San Fernando clinic, and eventually, a clinic adjacent the ER at the Panorama City hospital. “The ER tends to become the first access point to care for the uninsured,” Simons said. “What we’re creating here is a continuum of care, a circle of care. We are giving the patients a place where they can be followed up. And the next time they have a need, they go to the clinic instead of the ER.” “It makes good business sense,” she added, “as it alleviates the inappropriate use of ER services and allows that room to be more appropriately used for those who really need the emergency intervention.” The new 8,400-square-foot facility will be able to accommodate as many as 150 to 200 patients a day. The clinic is recruiting family practice doctors and internists. It will have a total of 4 to 5 primary care doctors, 4 to 5 specialists, 5 to 10 nurses and physician assistants, and some 20 to 40 additional support staff. Simons said plans for a second clinic adjacent to the hospital are still in the discussion phase but the hospital has available space. Reporter Judy Temes can be reached at (818) 316-3123 or [email protected].
New Clinics to Bring Care to the Valley’s Underserved
