Olive View worker Dwight Ravara, top, gets ready to admit Jose Molina, who… (Brian van der Brug/Los Angeles…)
It was a historic moment for the nation's healthcare system, but a routine one at Olive View-UCLA Medical Center's emergency department. Patients packed the waiting room suffering from chest pains, skin infections, stomach cramps and headaches — the least urgent cases waiting up to 12 hours to be seen.
Dr. Mark Richman, the county hospital's assistant medical director, was upbeat as he walked through the department Thursday. The Supreme Court had just upheld healthcare reform that guaranteed most of Olive View's poorest patients would be eligible for medical coverage.
The ruling was welcomed by public hospital managers statewide. But it also underscored their major, new challenge: competing with other healthcare providers for patients who for the first time will have medical insurance and can choose to use it elsewhere.
At Olive View, two-thirds of the patients are uninsured and rely mostly on emergency room visits for care. Now, thousands will have access to more traditional doctor's office care through an expansion of Medicaid, the federal insurance program for the elderly and disabled.
Olive View will have to upgrade its services or risk being left chiefly with indigent patients, including illegal immigrants, who won't qualify for the health plan.
"As a safety net hospital, we are going to have to transform," Richman said. "For the first time, we are going to have to compete in the marketplace. It's just the kind of stimulus we needed to provide better care."
People come from as far as the Antelope Valley to the Sylmar facility. In the last four years, the number of monthly emergency room visits has climbed about 30% to 4,383, something administrators attribute the economic downturn.
"The public system is really overwhelmed," said Richman, who has been an Olive View physician since 2006. "This reform will be great for our population. It will give people who are counting heavily on emergency services a chance to have their own primary care."
Changes can already be seen at the hospital. Officials have begun to implement Healthy Way L.A., the county program that serves as a bridge to healthcare reform. With nearly $1 billion in federal aid, the county is taking steps to increase access and improve care so that when the law is fully implemented in 2014, patients will be ready to make the transition.
Two clinics at the hospital are gearing up to work as "medical homes," or primary care centers, similar to those offered by private care providers like Kaiser Permanente.
Patients who visit the clinics will be given their own doctors and assigned case managers to refer them to specialists. Care managers will also be on hand for simpler tasks, such as taking blood pressure. Patient information will be kept electronically, making it easier to track medical issues.
"Our challenge is to improve access and to improve customer service and to improve the flexibility of our system so that people do choose to stay in it," said Azar Kattan, associate hospital administrator.
Countywide, about 200,000 patients have already enrolled in Healthy Way L.A. and about 7,000 have enrolled at Olive View. They are low-income patients who earn too much to qualify for Medi-Cal, but cannot afford to pay for their own insurance, even if it is subsidized.
Jose Molina, who was lying in a bed in the emergency room, had not heard about the Supreme Court ruling. When he learned that he may qualify for Healthy Way L.A., the 63-year-old, who suffers from heart problems, seemed relieved. "Hopefully, this new program will give me a hand so I don't keep coming back here," Molina said.
Enedina Pereyra, 58, who has already signed up for the program, hopes the hospital delivers on its promises. The North Hollywood resident often goes to the emergency room because it takes too long to get a doctor's appointment.
"I don't choose to be here and be ill," she said after Richman assured her that service would improve. "I come because I'm getting old and I have no choice."