LA Health Collaborative
Organizer’s Meeting 14 Minutes
LA Health Collaborative
Organizers’ Meeting 14 Minutes
December 15, 2005
Hospital Association of Southern California (HASC)
I. Welcome and Introductions
Yolanda Vera, Director of LA Health Action, welcomed everyone, asked them to introduce themselves and reviewed the agenda for the meeting.
II. Patient Dumping on Skid Row: What’s Happening?
The following documents were distributed to provide context for the discussion regarding patient dumping in the Skid Row Area of downtown L.A.:
· A November 17, 2005 memorandum from L.A. County Department of Public Social Services (DPSS), Department of Mental Health (DMH), LACDHS and Department of Children and Family Services (DCFS) to the Board of Supervisors providing recommendations to further enhance services to homeless adults on Skid Row (Attachment A);
· A November 28, 2005 LACDHS memorandum to the Board of Supervisors reporting on LACDHS’s actions in response to allegations that King/Drew Medical Center inappropriately discharges patients to Skid Row (Attachment B); and
· A LA Health Action document providing information on two Skid Row health care initiatives, the CCALAC-led Skid Row Homeless Health Care Collaborative and the Los Angeles Coalition to End Hunger and Homelessness’s efforts to develop discharge planning policies (Attachment C).
Dr. Michael Cousineau of USC Division of Community Health, Dr. Paul Gregerson of JWCH Institute, and Gloria Rodriguez and Debra Ward of CCALAC provided information about the Skid Row Homeless Health Care Collaborative. Established in January 2004 in response to a study by Dr. Michael Cousineau, the collaborative has been addressing issues of patient care and discharge policies, striving to develop responsive systems of care that close gaps including a coordinated approach among ERs, hospitals and community clinics. They have five pilot projects that attempt to address operations and policy issues, such as having a hospitalist to better manage patients at LAC/USC Medical Center, expediting specialty care referrals and expanding JWCH Institute’s recuperative care program based on a model program in Boston. The real problem is the transition from an inpatient setting to outpatient care, including case management, housing and access to a continuum of care especially specialty care.
Additional comments included providing services to outlying areas outside of the Skid Row, the recent appointment of Edmund Edelman to lead the City of Santa Monica’s charge to address homelessness and whether that will result in the attention and resources going to that area, and the Hilton Initiative to end homeless administered by the Corporation for Supportive Housing.
The Collaborative decided to convene a committee in January 2006 to determine how to best respond, with a sign-up sheet distributed for interested individuals.
III. Governance: Effective Governance of Public Safety Net Hospitals and Health Systems
Larry Gage, President of the National Association of Public Hospitals and Health Systems and Partner of Powell, Goldstein, Frazer and Murphy LLP, provided a presentation about effective governance of public safety net hospitals and health systems (Attachment D). The following questions were asked, with responses given below:
· Regarding if public health has always stayed in the public sector, Mr. Gage responded that it varied. In New York City and Boston, public health remained in the public sector, while the Denver Health and Hospitals Authority took public health. Some functions of public health are true government ones and do not transition well to a private entity. Usually, public health is subsidized by the public hospital system.
· Regarding what are the reimbursement implications of abandoning government and which models lend themselves to California, Mr. Gage replied that autonomy can be achieved without releasing governmental authority. However, because of constraints with taxing organizations, the Health Authority or Public Benefits Corporation is a preferred model for L.A. County.
· Regarding if any governance change has taken place when the governing body has been reluctant to give up authority, Mr. Gage replied that each situation has required substantial leadership from elected officials.
· Regarding issues that L.A. County faces as an area without an elected legislative branch, Mr. Gage replied that in theory that should make a governance change easier to achieve.
· Regarding what were tipping points for other governance changes occurring, Mr. Gage responded that new sources of revenue, new facilities and a fear of the future were important factors in some cases.
· Regarding if public benefits may transfer to a new entity, Mr. Gage responded that sometimes they can and are real, while in other instances it has not been possible.
· Regarding examples of when a change to a health authority was done well and when it was done poorly, Mr. Gage replied that when it worked, labor has had a seat at the table and has been given a role in the shift. When it did not occur in an ideal manner, labor and other stakeholders were excluded from the planning process.
In addition, the following documents were distributed:
· Supervisor's Knabe's motion from yesterday's Board of Supervisors discussion about the split of Public Health from LACDHS that passed with a 4 to 1 vote. Please note that this version does not reflect an amendment by Supervisor Antonovich to provide a specific report on how Antelope Valley Rehabilitation Services (drug and alcohol recovery) will be handled (Attachment E).
· LACDHS Organizational Chart (Attachment F).
· LA Health Action’s policy brief about the split (Attachment G).
IV. State of the County
Dr. Thomas Garthwaite, Director and Chief Medical Officer of LACDHS, provided a year-in-review report and his thoughts looking forward. LACDHS has been able to recruit an extremely strong management team, including Dr. Bruce Chernof, John Cochran, Paula Packwood and Vivian Branchick as Director of Nursing Affairs. KDMC is doing dramatically better with Dr. Thomas Yoshikawa leading Drew University and Antoinette Smith-Epps as KDMC’s new CEO. Dr. Bruce Chernof will be stepping into the role of Acting Director effective Monday December 19, while Dr. Garthwaite will be assisting with staffing issues at KDMC. Specifically, a dramatic improvement has taken place with resident supervision, and the affiliation agreement with Drew University has been significantly strengthened, with improved trust between the Board of Supervisors and the university. LACDHS’s performance measurement system has 2.5 years of data showing improvements, such as decreasing hospitalizations and complications for asthmatic children. The LACDHS budget outlook is poor due to lack of a stable funding source for the uninsured (Attachment H). Regarding changing LACDHS’s governance structure, Dr. Garthwaite supports the creation of Health Authority, as the Board of Supervisors face the challenge of having other priorities interfere with running the public health care system.
The following questions were asked, with responses given below:
· Regarding what Christmas gift he would give to Dr. Chernof, Dr. Garthwaite replied that he would address LACDHS’s structural problems through a health authority. Even though LACDHS has a budget of $3.5 billion, it does not have its own attorneys and relies on County Counsel. The centralized County Human Resources has a different mentality and pressures compared to LACDHS. There are ways to arrange it to work more effectively.
· Regarding if private hospitals are contributing with respect to the uninsured, Dr. Garthwaite said he did not have good data, unlike in Sacramento where an analysis was conducted of the benefit of nonprofit status and providing care to the uninsured.
· Regarding Dr. Chernof’s top three areas of focus for 2006, he said:
§ Support the outstanding work of new CEO Antoinette Smith-Epps and her staff in transforming KDMC. The upcoming CMS survey is one hurdle, but until KDMC has passed two cycles of JCAHO and ACGME, it will not be out of scrutiny. If it goes poorly, LACDHS feels strongly that the SPA 6 community needs a hospital.
§ Open a new hospital at LAC/USC. When it first opened, 160,000 people lived in L.A. County. It will be reengineered to accommodate work processes and must balance being a community hospital for every uninsured individual versus a quaternary hospital for LACDHS.
§ Start a dialogue about the LACDHS budget deficit, projected to be $126.7 million in FY 2006-07, while ensuring that LACDHS is a leading provider of clinical care.
V. Activities and Priorities for the Collaborative
Ms. Vera mentioned that she will be contacting individual members to discuss priorities for the Collaborative in 2006.
VI. Activity and Workgroup Updates
A. Health-e-LA
Mark Windisch, Senior Advisor of L.A. Care Health Plan, reported on the progress of Health-e-LA, a coalition established in 2004 to develop an infrastructure for multi-organizational electronic exchange of clinical health care information throughout the greater Los Angeles region (Attachment I). As the coalition does not have dedicated staffing and resources, it engaged First Consulting Group to develop a strategic focus, with a session held last Friday. The next phase is to prepare proposed alternatives, to raise additional funds and to educate others about the importance of electronic medical records.
B. LA Health Action Web Site Introduction
Neelam Gupta, Assistant Director of LA Health Action, reported that the full web site launched last month and is available at www.lahealthaction.org. It was announced via the electronic and hard copy newsletter, which also featured the recent publications. From the vision of the Collaborative’s Data Committee to create a health policy and planning web-based resource for L.A. County, the web site features:
· Updates on timely health care issues, such as the recently approved hospital financing waiver and county governance;
· A comprehensive library of reports and other documents on major health topics such as county health care financing, public insurance and coverage programs, and delivery systems;
· A Committees section with archived meeting information for the LA Health Collaborative;
· Links to Internet resources, including public health databases, policy-related tools and consumer guides; and
· An Events section for local health care-related events.
If you have any reports for posting in web site’s library, please feel free to forward them to .
VII. Adjournment
The meeting was adjourned at approximately 3:00 p.m. Happy holidays!
4