EMS and Global Healthcare Issues Los Angeles County Robert G. Splawn, MD, MPH, FACEP Chair, EMS Commission, LA County Director, HealthCare Partners Institute

Hospital Closures in LA County 2002-2006 2002 St. Lukes Medical Center 2003 Granada Hills Community Hospital 2004 Santa Teresita Hospital Century City Hospital(reopened in 4/06) Community Hospital of Gardena ED Northridge Hospital-Sherman Way Robert F. Kennedy Medical Center

Hospital Closures LA County 2002-2006 2005 Suburban Medical Center 2006 Centinela Freeman Regional Medical Center, Freeman Campus

Issues Large number of uninsured Increased ED demand Longer wait times Increase in ambulance diversion Increase in LWBS Boarding admitted patients in ED’s Regional variations in disease states, access, and healthcare services

Issues IT infrastructure Malpractice Reimbursement Quality

Action Plans Work with local jurisdictions to seek a reduction in City/County business tax for physician providers who work in medically underserved areas. Examine the efficiency and efficacy of service areas in the County of Los Angeles to better manage volume surges. Work with the State Legislature, CHA, and other key stakeholders to address the negative financial impact of the County’s “lateral transfer” policy on the private sector and seek financial solutions

Action Plans Seek passage of Prop 86 Develop/Implement solutions to improve operational efficiencies of hospitals and ED’s Develop a web-based community health care resource directory Seek increased funding for providers to work in medically underserved areas

Action Plans Develop a state-wide task force of key stakeholders to develop potential solutions to improving health access in medically underserved communities within the State and to ensure that these solutions are enacted. These solutions include, but are not limited to:

Developing medical enterprise zones Institute a developers fee for healthcare services as we do for schools, sewage, public works, and other essential services State funding for healthcare providers who commit to working in medically underserved communities Address the Medi-Cal reimbursement disparity rate

Develop a mechanism of oversight to review hospitals financial performance on a periodic basis to better monitor hospitals that may be in financial trouble and to better develop a plan of action before closure is warranted Improve planning efforts between the public and private sector when “rightsizing” healthcare services for a geographic community