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LADHS Primary Care Capacity Update

One of LADHS’ key accomplishments in 2011 was empanelling nearly 240,000 insured and uninsured patients into a medical home.   For the first time, these patients had an assigned primary care provider.  LADHS Ambulatory Care Network staff presented on the department’s primary care capacity set against a backdrop of future expansions.

LADHS empanelled 236,499 patients as of March 1 in the department’s health centers, comprehensive health centers, and hospital-based ambulatory care.  Having 140 FTE providers and using a panel size of 2,000 patients per physician and 1,500 per nurse practitioner, LADHS may serve up to 250,800 patients presently.  Estimated growth in demand for 2012 includes SPD beneficiaries (5,000) and Medi-Cal managed care assignments (27,000) through the relationship with L.A. Care Health Plan with 8% disenrollment rate (-2,560), which totals to 29,440 new patients.  However, the exact number of GR recipients that will convent to the local LIHP (Healthy Way LA Matched) is unknown, with this population having differing utilization patterns.  LADHS plans to begin auto-enrolling 82,000 GR beneficiaries into Healthy Way LA Matched starting in June with approval granted from State DHCS and DRA verification to be completed.  LADHS plans to expand current primary capacity by achieving systems efficiencies, implementing an in-house registry, and recruiting 10 new primary care providers by the end of the year, which will result in an additional capacity of 14,861 patients.  Therefore, LADHS will be close to meeting the projected increase in demand, with the exception of GR recipients.  Regional capacity differences exist among the ACN facilities, with empanelment ranging from 99% of overall capacity in the Antelope Valley’s High Desert MACC/health centers, 71% capacity in the MLK MACC/Humphrey Comprehensive Health Center, and 78% capacity in Roybal/Hudson/El Monte Comprehensive Heath Centers.

However, two significant barriers to hiring exist.  A shortage of primary care physicians nationally and statewide persists that results in a small pool of candidates.  LADHS loses many qualified candidates to Kaiser Permanente, which offers substantially higher salaries and an incentive bonus for additional language capacity.  With an acute need for bilingual Spanish-speaking physicians, LADHS’ planned strategies include providing a more competitive compensation package along with loan repayment, enhancing recruiting methods by effective advertising, and streamlining the application and hiring process.  While the numbers of patients assigned to a provider panel are typical of a managed care setting, LADHS’ panel size may require readjustment based on patient acuity and demand.  The panel size used by teaching hospitals and the VA is 1,500 patients per physician and 1,200 per nurse practitioner.  It is important to note that Community Partner clinic capacity is not factored in, although the billing and payment issues faced with Healthy Way LA Matched may preclude many CPs from hiring new staff and increase capacity.  Primary care residents training in programs specializing and located in underserved communities tend to select the public health care system and FQHCs as a place to work upon graduation.  The question regarding what will primary care look like in two years when full ACA implementation takes place is one with which LADHS and many other providers are grappling currently.

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