Lott's Notebook

California's emergency rooms are becoming increasingly crowded with mentally ill and often disruptive patients, partly the result of inadequate mental health care and sometimes injudiciously written "5150 holds." Acute care facilities lacking psychiatric beds sometimes have to hold these patients for days, at significant expense. Medi-Cal reimbursement for psychiatric patients is inadequate; compensation for uninsured patients is all but non-existent.

We were asked to measure the impact of the closure of King-Harbor Hospital on the distribution of uninsured patients admitted to other public and private hospitals. Accordingly, to help answer this question we engaged the National Health Foundation (NHF) to analyze hospital discharge data reported by hospitals to the Office of Statewide Health Planning and Development (OSHPD) and available to the public.

We concluded from NHF's analysis that much of the change to hospital inpatient utilization experienced by the hospitals directly impacted by the closure of King-Harbor Hospital took place over a year before King-Harbor closed.  Moreover, when King-Harbor closed in the second quarter of 2007, the hospital was operating with a downsized emergency room and approximately 42 staffed beds.  Accordingly, we doubt that the eventual closure directly affected utilization at other hospitals significantly.  Rather, a confluence of factors account for the changes in hospital utilization throughout the region. They include the following:
                      

1. Changes in service delivery and capacity at King-Harbor Hospital over time,

2. The closure of five private hospitals in or around the King-Harbor service area during the analysis period,

3. Sizable reductions in admissions at LAC+USC Medical Center and low-to-moderate reductions at Harbor-UCLA Medical Center,

4. Changes in the County's patient transfer policy, and

5. An overall increase in demand for hospital inpatient services by the residents of Los Angeles County.

Since the 1980s California hospitals have been facing the increasingly difficult challenge of finding appropriate shelter settings for increasing numbers of homeless patients who are discharged from acute-care settings. Hospitals have worked and will continue to work diligently in their communities to solve this vexing problem. AB 2745, signed into law in late 2006, mandated that the regional hospital associations invite key stakeholders to planning meetings to improve the post hospital transition of homeless patients and then compile the recommendations in a document by January 2008. This document fulfills the mandate of AB 2745.

It is a rich document, which can be helped further by the support of the California legislature, and work will be ongoing.

Executive Summary

• Los Angeles County Report
• Orange County Report
• Riverside & San Bernardino Reports
• Ventura & Santa Barbara Reports

Government payers and commercial insurers are paying less for hospital emergency room visits.

We surveyed registered voters who are likely to vote regarding their opinions about health care and hospitals in the six counties served by the hospitals in Hospital Association of Southern California.  This documents summarizes the results of that poll.