Ahead of federal healthcare overhaul, local hospitals look to primary care

As the new year begins, local healthcare providers are preparing for a potential flood of patients who previously didn’t have access to insurance, but who will now be covered as the federal Affordable Care Act takes effect.

More primary care physicians and their assistants will be needed, according to healthcare officials. And everyone from primary care doctors to hospitals are beginning to look at increased preventive care, more outpatient procedures and home healthcare services to reduce costs.

In Los Angeles County, about 1.7 million uninsured residents will gain access to coverage, according to the county’s Department of Health Services.

To offer primary care services, Glendale Adventist Medical Center acquired two urgent care centers and a multi-specialty medical practice last summer — all owned by Dr. Ara Tavitian.

At about the same time, Providence Health & Services, Southern California — which owns Providence St. Joseph Medical Center in Burbank — acquired Facey Medical Group with locations throughout the San Fernando Valley to provide primary care services.

Kevin Roberts, president and chief executive of Glendale Adventist, said the hospital made the purchase because administrators were “very interested in affiliating with doctors who already have a passion to serve the people of Glendale.”

There is a shortage of primary care physicians, but Roberts said he feels supply and demand will hopefully bring more graduating medical students into primary practice because they are the gatekeepers to healthcare and come in direct contact with the most patients.

“I’m pretty bullish for the primary care community,” Roberts said, adding that primary physicians will have the greatest incentives under the new federal healthcare act because of the volume of patients they will be seeing.

David Mauss, vice president of business development at Glendale Memorial Hospital, said one hurdle in cultivating more primary care physicians is the choices made by medical students when they graduate. Often financially strapped with enormous student loan debt, more of them are opting to go into specialties such as pulmonology, cardiology or gastro-intestinal procedures because they can make more money and have more manageable hours.

A primary care physician will earn between $150,000 and $175,000 annually, compared to a specialist, who can make up to $500,000 a year — and that’s after a slight downward pay trend in recent years, Mauss said.

Michael Rembis, chief executive of Providence St. Joseph, said some of the initial rush experienced by healthcare providers will be due to the number of people who have put off taking care of their healthcare needs.

“[They] don’t have physicians now and may not be taking care of their medical conditions,” he said, adding that emergency rooms may see a patient increase because the newly insured may not have selected a physician if a medical problem arises in early 2014.

That swell, though, is expected to subside, Rembis said.

Hospitals will also probably see more outpatient procedures performed, Rembis said, further driving down hospital costs.

That switch has already been occurring over the past several years because of technological advancements, such as laparoscopic, minimally-invasive surgery.

Mauss said the rate of outpatient procedures will likely continue to climb, but not solely because of technology. It’s also tied to the fact that insurance companies and Medicare are telling physicians more and more that they won’t pay as much for a procedure performed in a hospital — if at all.

Patient satisfaction and readmissions within 30 days will also become important, said Len LaBella, president and chief executive of Verdugo Hills Hospital.

“Medicare and other insurers are treating healthcare as a commodity, and paying accordingly, so that patient satisfaction scores and clinical warranties become part of the reimbursement equation,” he said.

In terms of increased staffing tied to healthcare reform, the Verdugo Jobs Center is gearing up by training students who want to work in the medical field, though the most hiring may be in specialized areas, such as billing or physician assistants, said Don Nakamoto, executive director of the Verdugo Workforce Investment Board, which oversees the center.

While an influx of students graduated from nursing training a few years ago as they sought new careers during the recession, several of them couldn’t find jobs.

“There was suddenly this bottleneck of all these graduates who were coming into the system and they couldn’t find work,” Nakamoto said.

Lori Kudoghlian, in-house health specialist with the investment board, said many hospitals were looking for nurses who were experienced or had special training.

Nakamoto said, however, that more of those graduates are landing positions because the economy is improving and portions of healthcare reform are already taking effect.

Roberts acknowledged that down the road the new healthcare legislation will put a lot of pressure on healthcare providers, particularly primary care physicians.

“We’ll be challenged, but it will be worth it,” he said.

-- Mark Kellam, Times Community News

Follow Mark Kellam on Twitter: @LAMarkKellam

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