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Health Care Quarterly
Inside This Issue • Organ Transplants • The ACA And Emergency Rooms • Improvements To Pediatric Services • News In Brief
An organ is delivered to an operating room where surgeons are to perform a lifechanging procedure on a recipient selected by matching blood type, the amount of time the patient has waited for the organ and the severity of illness, among other factors. More than 123,000 people are waiting for organ transplants across the United States. According to the nonprofit, OneLegacy, the federally designated organ procurement organization for Southern California, an average of 18 patients die every day waiting for organ transplants. (Photograph by Life Connection Of Ohio)
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HEALTH CARE QUARTERLY 2-B Long Beach Business Journal
August 19-September 1, 2014
With Long Organ Transplant Wait Times Statewide, Organizations Seek To Boost Donations ■ By SAMANTHA MEHLINGER Senior Writer ore than 123,000 people in the United States are waiting for organ transplants. Californians make up nearly a fifth of this figure, with almost 22,000 people on the national organ transplant waiting list as of August 8. With that list continually growing, doctors and nonprofit organ procurement organizations are working regionally and nationwide to increase organ donations and decrease deaths among patients who had to wait too long for transplants. Most patients on the national waiting list need kidney transplants, and more than 18,000 of those people are in California, where the wait time for kidneys is longer than in any other state, according to Tom Mone, CEO of OneLegacy, the nonprofit organ procurement organization selected by the federal government to oversee organ donations in the Southern California seven-county metropolitan region. The organization serves 19.5 million people – the largest donation service area in the country, Mone said. The wait time for kidneys in California is between five to 10 years, according to Mone. “One [reason] is that we have large urban areas, and large urban areas tend to have a lot of diseases that are related to lower incomes such as diabetes and dietary issues,” he said of the cause for the state’s long wait time. “The top causes of renal [kidney] disease are high blood pressure and diabetes, and as those become more common and as people are living longer, the need for transplants increases,” Dr. Raj Mittal, general and liver surgeon at Lakewood Medical Center, told the Business Journal. These diseases are often caused by lifestyle habits such as poor nutrition or overeating, he explained. Another cause for California’s long wait time for kidneys is simply that Californians live longer than people in other states, which means less opportunities for after-death organ donations, Mone said, citing data from the California Department of Health Services and the Center for Disease Control. “The death rate in California is about a third lower than the rest of the country,” he noted. Currently, about 75 percent of people who are eligible to donate at the time of
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their deaths do so, but even if 100 percent of people in California donated at death there still would not be enough organs to go around, Mone said. People who need kidney transplants are able to wait for longer periods of time for transplants than those who need other organs because renal disease may be treated with dialysis, a process through which a machine performs the function of kidneys by cleaning harmful waste from blood. Still, long wait times are detrimental for these patients. “You can imagine if you are waiting for eight years for a kidney
transplant; a lot can change in the course of that time,” Mittal said. “Sometimes people go on the wait list and they are no longer good candidates when the time comes to get an organ,” he explained. In the case of kidney transplants, “There is a high mortality of patients on dialysis on the waiting list for transplants,” he added. “The longer you wait the worse it is for your chances to survive until you get an organ,” Mone said. “When you have to wait five to 10 years, people are going to die while they are waiting.” Anne Stamm, a Long Beach resident and
Medical personnel transport donated organs to their respective recipients. Depending on organ type, the time between donation and surgery may be between four to 48 hours, according to Tom Mone, CEO of OneLegacy, the nonprofit organ procurement organization for the seven-county Southern California region. Organs are stored in coolers for preservation and are sometimes flushed with chemicals to keep them viable for as long as possible between the time of donation and transplant surgery. (Photograph provided by OneLegacy)
liver transplant recipient, is a living example not only of how organ donations can save lives, but of how long wait times for transplants put people at greater risk of death. Stamm waited nine years for a transplant after being diagnosed with a rare liver disease in 1992. “Slowly but surely I started developing all the symptoms of liver failure . . . I had severe jaundice,” she said. “A year prior to my transplant I was told I was not sick enough to go on the waiting list.” She reflected, “It was almost like, how sick do I have to be?” Stamm did not receive a transplant until she entered the hospital with liver failure so severe that her other organs began to fail, too. “When I received my transplant I would have had two weeks to live,” she said. Calling the organ donation she received “the gift of life,” she said it has been 12.5 years since her transplant and she continues to be healthy. Organ transplant recipients are determined by individual transplant centers where the surgeries are performed, Mone said. “Each transplant center evaluates patients who come to them with organ failure and determine whether they are good candidates based on that center’s medical criteria,” he explained. “[Transplant centers] make their own medical decisions based on what they are comfortable with from a medical standpoint.” He continued, “Some may for instance say, ‘We will only transplant liver patients with Hepatitis once and will not do a re-transplant.’ Others will re-transplant as many times as needed.” Mone said some transplant centers’ stringent requirements lead to wasted opportunities for organ transplants. “We waste some organs. We don’t transplant them because the transplant centers are held to outcome standards . . . that are probably too high,” he said. “There is a growing sense that we are a little arbitrary in what our outcome goals are . . . That is probably an area for a lot of research in the next five years.” The process for receiving a transplant varies by organ. For kidneys, a donor and recipient must have compatible blood types and antigens, proteins found on cells that may cause an organ to be rejected if it does not match the recipient’s proteins. Six antigens are measured for compatibility, and
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HEALTH CARE QUARTERLY August 19-September 1, 2014 drugs may be taken to prevent the body from rejecting kidneys with some mismatched antigens, Mone explained. If all six antigens between donors and recipients match, those recipients automatically get that organ regardless of where they are on the waitlist, he said. Size is another key factor for any organ donation. “If you are a child, you cannot have an adult organ in most cases,” and vice versa, Mone said. However, in some instances adult kidneys may be transplanted in children because the body adjusts to the larger organ over time. Similarly, children’s kidneys may be transplanted in adults because after transplantation the kidneys usually grow, he explained. Another factor is age. While there is no official age regulation, most transplant centers nationwide only accept organs from donors who are under 75 years old, Mone said, while in California the donation age cap is typically 70. “There are a lot of us in the organ procurement world who believe we are wasting opportunities to extend the lives of people who are older through what would be a successful transplant of an older organ, and there is probably some opportunity to improve there,” he said. In Europe, for example, organs from donors aged as
Long Beach Business Journal 3-B
Dr. James Leo, chair of Long Beach Memorial Medical Center’s organ donor council, raises a Donate Life flag on the hospital’s flagpole. The flag is raised every time an organ or tissue donation is made and flies for eight days, symbolizing how one organ donor may save up to eight lives. Donate Life California is a nonprofit organization overseeing the organ, eye and tissue donation registry statewide. (Photograph by the Business Journal’s Thomas McConville)
old as 90 have been placed in recipients who are similar in age, he pointed out. For kidneys, whoever has waited the longest typically receives a transplant first, although some other medical factors are
considered, Mittal said. The waiting list for livers differs in that the sickest patients get the organs first, he explained. Livers are the second most common organ transplants in the country, with about 15,778 people
currently on the national waiting list. The waiting list for lungs is also mostly needbased, while the waiting list for hearts favors patients who have waited longer. (Please Continue To Next Page)
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HEALTH CARE QUARTERLY 4-B Long Beach Business Journal
Living Donations Living donations have the most promise for reducing the kidney transplant wait list, Mone said. People have two kidneys yet only need one, so kidneys are the only whole-organ donation able to be given by live donors. For this reason, doctors and organ procurement organizations like OneLegacy encourage living donations. Donate Life America, a nonprofit alliance of national organizations aiming to encourage organ and tissue donations, recently started a website, www.livingdonationcalifornia.org, where people register to be living donors. “The website has a great deal of information on living donation and how it might work for you,” Mone said. “Living donations are becoming more and more common,” Mittal said, noting that in some of the country’s regions live donations make up 20 percent of kidney transplants. The surgery to remove kidneys is done through a minimally invasive technique that ensures a fairly speedy recovery time and minimal scarring. “In many centers we’re doing the surgery . . . through a keyhole incision and taking it out through a bikini incision very low on the abdomen so it doesn’t leave terrible scars,” he explained. Living donors earn the benefit of automatic placement at the top of the
August 19-September 1, 2014 organ donation waiting list should they ever need an organ themselves, he said. Mittal, who taught for several years at New York University before moving to California last month, said he taught a simple lesson to encourage his students to register as organ donors. “I asked how many people in the classroom would like to have an organ transplant if they needed it to save their lives, and pretty much everybody raised their hands. Then I asked everybody to raise their hands if they were registered donors, and usually just two or three hands went up,” he said. The exercise reflects the large disparity between the number of available organs and the number of people waiting for them, he said. Doctors and organ procurement organizations have encouraged living donations through kidney chains, which begin when an organ recipient has a willing donor who is not a compatible match. The organ procurement organization representing that patient’s region then looks for a similar situation where another patient has a donor who is not a match. The organization essentially swaps the respective donors to match up with the correct recipients. As many as 60 people may be involved in these organ donation swaps, Mone said. “The creation of these kidney chains has been the one most significant innovation that has gotten
more people transplants and is helping to reinvigorate living donation,” he said. The nonprofit Donate Life California, a division of Donate Life America, runs the state organ, eye and tissue donation registry and actively works with regional organ procurement organizations such as OneLegacy to increase organ donations. Donate Life started a program that enables people registering for driver’s licenses or state identification cards to register as organ donors at the same time. Their cards are then printed with a pink dot, identifying them as organ donors. Californians may also register as donors through www.donatelifecalifornia.org. Locally, Long Beach Memorial Medical Center, through its partnership with OneLegacy, was recently recognized for its organ donation efforts with a gold medal of honor from the U.S. Department of Health. Memorial was one of two hospitals in Los Angeles and Orange counties to receive the award, which is given to hospitals with organ donation rates that “greatly exceed national standards,” according to a statement from the hospital. “This recognition reflects the success of our OneLegacy partnership and the tremendous efforts of our hospital staff dedicated to saving and enhancing lives,” Diana Hendel, PharmD, CEO of Long Beach Memorial and its sister hospitals Community Hospital Long Beach and Miller Children’s
& Women’s Hospital, said in a statement. “At the end of the day our number one goal is to end deaths on the waiting list,” Mone said. “We’ll never end the waiting list; there will always be somebody who needs an organ. But if we could end deaths on the waiting list we would be very happy.”
Whole Body Donation Whole body donation for medical research is another option for those who want to improve others’ lives. Science Care, a national company with an office in Long Beach’s Douglas Park, specializes in whole body donation. “It is important to realize some people are not good candidates for organ donation or transplant. In that case, keep in mind that you can be a very good candidate for whole body donations for research. It is a different type of acceptance criteria,” Melinda Ellsworth, director of donor services at Science Care, told the Business Journal. “One of the main reasons people come to us is they are in the medical field themselves or they are suffering from an illness and they are interested in furthering medical research,” Ellsworth explained. Science Care partners with universities, medical research groups and even surgical implementation companies, where bodies are donated. If a donor wishes to contribute to a specific type of research, Science Care makes every effort to place the body in the proper hands, she said. Science Care’s donors have contributed to many medical causes and research studies. In one instance, surgeons used three bodies donated to Science Care to practice for a complicated procedure for a military veteran who needed half of her pelvis and an entire leg amputated. “The surgical team of three was able to practice for eight hours prior to surgery to ensure it was successful . . . It was very successful. [The veteran] is up and walking and is able to have children,” Ellsworth said. Some whole body donors may also be eligible for organ donation – it doesn’t necessarily have to be one or the other, Ellsworth said. But while the requirements for organ donation are fairly stringent, nearly everyone qualifies for whole body donation, she said. “The key rule-outs right now are contagious diseases at the time of passing such as Hepatitis B or C, HIV/AIDS, and maybe conditions like syphilis or active genital herpes. The other one would be extreme obesity, usually folks over 300 pounds,” she said of exclusionary factors for whole body donation. Science Care covers the cost of cremation, and remains are returned to families within three to five weeks, Ellsworth said. “If anyone is considering supporting medical research or even considering cremation, they should consider whole body donation with cremation. It is such an amazing way to give back.” ■
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HEALTH CARE QUARTERLY August 19-September 1, 2014
Long Beach Business Journal 5-B
After Affordable Care Act Implementation, Local Hospital Reps Reflect On ER Impacts ■ By SAMANTHA MEHLINGER Senior Writer earch “Affordable Care Act and emergency rooms” on Google, and you’ll come up with a few pages of articles dated from the implementation of the Affordable Care Act (ACA) in January to this past month, all with similar headlines: “Emergency Room Visits Spiking,” “Emergency Visits Seen Increasing With Health Law,” “Obamacare Likely to Increase Emergency Room Visits,” and so on. Early in August, the American College of Emergency Physicians released the results of a member survey corroborating these headlines. According to the organization, nearly half of survey respondents have already experienced more visitors in their emergency rooms (ER) since the ACA was implemented. A vast majority, 86 percent, of surveyed emergency physicians nationwide anticipated emergency room visits to increase in the next three years, and 51 percent believed hospitals would see a reduction in payments for emergency visits, according to the survey. Local hospital officials weighed in on how the ACA has impacted their emergency room activity. Representatives from two hospitals, Long Beach Memorial Medical Center and Lakewood Regional Medical Center, observed an increase in ER visits since the ACA was enacted in January, while reps from St. Mary Medical Center reported a decrease. Opinions differ on what changes in ER activity local hospitals may experience in the long term. “The emergency department has seen about a 10 percent increase since the implementation of the ACA,” Judy Fix, RN, senior vice president of patient services for Long Beach Memorial and Miller Children’s & Women’s Hospital Long Beach, told the Business Journal. “We were expecting such an increase and our physicians, nurses and staff were prepared for this increase in patient visits,” she added. Chris Tomongin, emergency department director at Lakewood Regional, has observed an increase in visits to his department since March. “We have seen an increase in volume of emergency department visits as compared to a year ago,” he said. A lack of new primary care physicians for increased numbers of insured Americans may be causing the rise in vis-
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its, Tomongin suggested. “With what seems like millions more people now insured, there hasn’t been an increase in the number of primary care physicians taking care of these millions more people,” he said. According to the U.S. Department of Health and Human Services, the number of primary care physicians is expected to increase 8 percent by 2020, while demand for those physicians is projected to increase 14 percent by the same year. “From my experience in the emergency department, [it seems] now that these patients have insurance they are trying to see their designated providers; however, it sounds like their providers are inundated with so many patients that they can’t see them in a timely fashion, and so [patients] are now directed to go to the emergency department,” Tomongin observed. The American College of Emergency Physicians had a similar take on increasing ER visits. “When people can’t get appoint-
ments with physicians, they will seek care in emergency departments,” President Alex Rosenau said in a statement about his organization’s survey. He pointed to increased enrollment in Medicaid, the federal government’s low cost health insurance program, following the ACA’s expansion of the program’s coverage as another cause of increasing patient volumes in emergency rooms. “America has severe primary care physician shortages, and many physicians do not accept Medicaid patients because Medicaid pays so low,” he said. Some patients who are unable to find doctors who accept their insurance may then visit emergency rooms. Long Beach Memorial has had more patients with low-cost insurance visiting the
emergency room, according to Fix. “We have seen an increase in the number of insured patients, especially those who now have Medi-Cal, thanks to the expansion of eligibility and those who have been able to access lower-cost insurance from health insurance plans through the ACA,” she said. Medi-Cal is California’s Medicaid program. While more patients have visited Long Beach Memorial’s emergency department, (Please Continue To Next Page)
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HEALTH CARE QUARTERLY 6-B Long Beach Business Journal particularly among those with Medi-Cal, Fix believed the visits would eventually decrease due to the hospital’s efforts to match emergency room patients with primary care physicians. “We are very proud of a program we began years ago to help link emergency department patients without a primary care physician to a doctor who can provide continuing care, know the patient’s medical history and more quickly identify and treat medical conditions that may worsen because of the lack of access to care,” she said. “Our own data over the last year shows that of the 1,200 patients with whom we made appointments with physicians, those who continued with their new physician were more likely to schedule a doctor’s appointment for care rather than use the emergency department,” Fix said. “We believe that as more and more of the newly insured patients are linked with a primary care physician, they will more likely access their doctor or an urgent care center for minor health care needs rather than an emergency department.” Tomongin had a different point of view regarding long-term trends in emergency department patient visits. “Until there is an answer to the increase of patient volume and [we gain] an increased number of primary care physicians, I think unfortunately the emergency department is going to see a steady increase in patients,” he said. More insured patients and not enough primary care doctors may translate to longer wait times for patients to make appointments for care, which may then cause more emergency room visits, Tomongin explained. “If someone has a cough or a cold they need to have examined, they are not going to wait three months to see their primary doctor,” he said. If a push isn’t made to encourage more physicians to become primary care doctors rather than specialists, Tomongin said increased visits to emergency rooms might translate to increased waiting times for patients. Harold Way, CFO of St. Mary Medical Center, said his hospital’s emergency
August 19-September 1, 2014
Dr. Chris Tomongin, emergency department director at Lakewood Regional Medical Center, has observed an increase in patient volume in his department since the Affordable Care Act was implemented in January. Because the number of primary care physicians is not growing to meet the rising number of insured patients, those who are unable to find timely care from primary physicians are likely to continue visiting the emergency room for non-emergent issues, he explained. (Photograph by the Business Journal’s Thomas McConville)
department has experienced “less volume overall” in patient visits. “What we have seen is kind of counter to what I have read since the Medi-Cal expansion,” he said. “We have seen about a 5 percent decrease in volume.” Gail Daly, COO and chief nursing officer at St. Mary, also noted postACA trends at St. Mary’s emergency department may differ from other hospitals. “We have heard within our own system that there has been a significant increase in volume,” she said of emergency room visits within the Dignity Health system of medical centers. Perhaps there has been a decrease in patient visits to St. Mary’s ER because many physicians serving the medical center already accepted lower paying insurance plans, such as Medi-Cal, prior to ACA implementation, Way theorized. “We have historically seen a lot of Medi-
Cal patients,” he said. “I think the doctors will just absorb the Medi-Cal patients and we won’t see them in the emergency department. At least that is what we have seen in the short term,” he added. For St. Mary, having more patients with MediCal simply means more visits are going to be reimbursed to physicians and the hospital, he explained. Way and Daly believed the current postACA implementation trends of lower patient volumes should continue in the years to come. Adding more facilities to service the growing number of insured
patients may also help reduce emergency room visits. “We have some plans to expand our outpatient clinic footprint both on campus and potentially offsite that would help give [outpatient] access to patients,” Way said. Lakewood Regional may also expand its resources to accommodate the growing number of insured patients, Tomongin said. “There have been talks about expanding the emergency department. The hospital is looking towards continually enhancing its facilities and possibly improving patient care that way,” he said. ■
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Christine Eusoof-Alviz, RN, is director of emergency services at St. Mary Medical Center in Downtown Long Beach. The hospital’s emergency department, shown behind her, has experienced a decline in patient volume since the Affordable Care Act was implemented in January, according to St. Mary COO Gail Daly and CFO Harold Way. (Photograph by the Business Journal’s Thomas McConville)
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HEALTH CARE QUARTERLY August 19-September 1, 2014
Long Beach Business Journal 7-B
Local Pediatric Patients Benefit From Better Access To, And Quality Of Care From, Advanced Technologies ■ By SAMANTHA MEHLINGER Senior Writer ediatric patients in Long Beach, South Bay and Orange County are now receiving more advanced and specialized medical treatment as well as more accessible and convenient care thanks to recent innovations and partnerships between local hospitals. The nonprofit MemorialCare Health System has been working to provide better access to and coordination of care for pediatric patients in the region, through hospital partnerships, new technology and surgical techniques, improved hospital procedures and expanded facilities.
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Hospital Partnerships Expand Access To Care One way MemorialCare has improved access to pediatric medical care is through partnerships among its regional hospitals. In late July, the health care system announced a partnership in which inpatients at Torrance Memorial Medical Center – a hospital much smaller than the threehospital system in Long Beach, which includes Miller Children’s & Women’s Hospital Long Beach, Community Hospital Long Beach and Long Beach Memorial Medical Center – have access to pediatric specialists at Miller Children’s. “In the South Bay they have a lot of general pediatricians and . . . they don’t have enough pediatric specialists,” Dr. Divya Joshi, chief medical officer at Miller Children’s, told the Business Journal. “Here we have maybe 90-plus pediatric specialty physicians,” she said. “What this new link means is that there is now a formal agreement that, if children hospitalized at Torrance Memorial need a pediatric specialist, there is a direct link to the pediatric specialty group here at Miller’s that will provide those services pretty much instantaneously,” she explained. “What it would mean for children in the South Bay is, if they are hospitalized in Torrance and need a pediatric pulmonologist, they won’t have to come all the way here.” Craig Leach, president and CEO of Torrance Memorial, said in a statement that Miller Children’s has had a strong role in caring for pediatric patients in Torrance over the years. “The physicians at Miller Children’s are highly skilled in their subspecialties and care for some of the most complex pediatric care cases,” he stated. “This partnership is the perfect way to
ensure that care not only continues, but expands during a particularly challenging time in health care.” Beginning this September, Miller Children’s is also partnering with Orange Coast Memorial Medical Center, a
MemorialCare hospital located in Fountain Valley, to provide better access to pediatric care for Orange County residents. In this partnership, children who visit the emergency room at Orange Coast are going to have access to pediatric
physicians at Miller Children’s through telemedicine – live video feed between the hospitals, Joshi said. Orange Coast lacks pediatric physicians in its emergency department, Joshi said. (Please Continue To Next Page)
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HEALTH CARE QUARTERLY 8-B Long Beach Business Journal Starting in September, if a pediatric patient comes through the emergency room at Orange Coast, a physician there may call Miller Children’s and a pediatrician will appear on a screen. The pediatrician would
August 19-September 1, 2014 be able to see the patient and converse with Orange Coast staff and the patient’s family, Joshi explained. The technology may also come in handy in Miller Children’s partnership with Torrance Memorial, she added.
Seventeen-year-old Brennan Korshavn is assisted by Carol Iannessa, a physical therapist, at the pediatric rehabilitation center within Miller Children’s & Women’s Hospital. Korshavn is being familiarized with the Bioness L-300 Foot Drop System, a functional electronic stimulation device that sends electrical impulses signaling the muscles in his leg to lift his feet, helping him walk. Sensors inside his shoes alert the stimulation device on his legs to send the impulse when his heels lift off the ground. (Photograph by the Business Journal’s Thomas McConville)
New Medical Technology And Techniques Advance Pediatric Care Miller Children’s & Women’s Hospital has begun implementing new treatments for its pediatric patients through recently developed technology, medical treatments and surgical techniques. One of the newest technologies available through Miller Children’s is helping children with debilitating conditions to walk and move more easily, according to Joshi. Manufactured by medical device company Bioness, the L-300 Pediatric Foot Drop System is a lightweight functional electronic stimulation device that attaches to a patient’s foot and leg, sending electrical impulses into abnormally functioning muscles to help them function more normally, according to Bioness Director of Rehabilitation Technology Joel Behnke. Miller Children’s began offering the technology in January to patients with conditions such as spinal cord injuries and cerebral palsy, a movement disorder of the nervous system. “Cerebral palsy patients have an inability to lift their foot up while walking, which causes them to trip and fall,” Behnke said. A gait sensor, easily affixed to any part of a child’s foot, detects when a patient’s heel lifts off the ground and sends a signal to a cuff attached to the patient’s leg, stimulating the muscles and lifting the foot off the ground, he explained. A pocket-sized control unit allows patients to adjust the intensity of the impulses. The system, approved by the U.S. Food and Drug Administration in 2012, was the first functional electronic stimulation system to be approved for pediatric use, Behnke said. “It is absolutely mind-boggling,” Joshi said of the technology’s successful results in pediatric patients. “They can go to school, get on a school bus, go play with their friends, walk the dog and even do chores,” she said. “Social interaction and participation is a huge component of adolescence and pre-teen development, and the idea of using technology in order to fully experience that is something we really stress,” Behnke said. Other new treatments have been implemented at Miller Children’s in the past year, including a new technique available at the Pediatric Food Allergy Clinic, which is able to completely eradicate food allergies in some children, according to Joshi. She compared the technique to a psychological treatment for patients with phobias, in which patients are exposed to their fears incrementally to help them recover entirely, or at least learn to live with their phobias. “Imagine you are afraid of spiders . . . You might see a film of a spider, and then there would be a spider at the end of the room and then at the end of the treatment you sleep with the spider,” Joshi said. “We do the same thing with food. You figure out
somebody has an allergy to peanuts, so you take the chemical that is responsible for the allergic reaction and you give it to the person in microscopic amounts. If they handle that well, you give it to them more and more. Over the course of time, the body kind of gets used to it and doesn’t have an allergic response anymore,” she explained. Thanks to this treatment, “50 percent of the children seen here for food allergies actually leave our center not allergic anymore,” she said. The allergy treatment has only been available for a year at the hospital and already the waiting time for the program is three months, Joshi said. Soon, the hospital is going to double its resources for the treatment to reduce the waiting period, she noted. In addition to implementing new treatments and technologies, Miller Children’s is also “at the cutting edge” in terms of surgical procedures, according to Dr. Fombe Ndiforchu, medical director of general pediatric surgery at the hospital. While minimally invasive surgery – which involves three or four 0.25- to 1.5-centimeter incisions – has been available as a traditional surgery alternative for about 15 to 20 years, hospital surgeons are now practicing single-incision procedures in pediatric patients for abdominal surgeries such as appendectomies, Ndiforchu said. Rather than making three or four incisions to insert surgical instruments and a camera, in a single-incision procedure all these instruments are inserted through one cut, Ndiforchu explained. “The instruments are fairly small and have different lengths,” enabling dexterous surgeons to maneuver multiple instruments without them colliding. The patient’s abdomen is inflated with carbon dioxide so the surgeons may see their work more easily, since the abdomen remains closed except for one small incision, he noted. “The patients are able to recover faster. They require less pain medication and their gastrointestinal functions return faster,” Ndiforchu said of single-incision surgeries. Less anesthesia is needed for these surgeries in comparison to traditional open surgeries, and an added benefit is minimal scarring, he said. All this equates to shorter hospital stays, he added.
Better Coordination Of Care In addition to implementing new technology and treatments, the MemorialCare Health System hospitals in Long Beach are working to improve hospital procedures and expand facilities to better coordinate pediatric patient care. One simple way the hospital is now improving communication among families, patients and hospital staff is by installing white boards in every inpatient room. “On the board is the name of the doctor and the nurse, the time for [the doctor’s patient] rounds, the plan for the day and what exactly needs to happen for the child to be
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HEALTH CARE QUARTERLY August 19-September 1, 2014 able to go home,” Joshi said. “I think that has made a huge difference because it empowers the family to really participate in care,” she added. The hospital also recently began requiring physicians to commit to specific time frames for patient rounds, Joshi said. “The way rounds used to work is that at random times the doctor would come into your room and would tell you the plan and then leave again. Then a nurse would come in and might say something, and then another doctor might come in and have no idea what the first doctor said . . . It was just a mess,” she recalled. “It has taken some time to convince physicians to commit to a time for rounds because the universe doesn’t revolve around them, it revolves around the patient and they need to be somewhat flexible in their time,” she said, adding that so far the new procedure for rounds has been working out well. The hospital is also working to improve coordination of care by expanding its facilities. A new facility combining the pediatric neurology and nephrology departments is opening in January of 2015, Joshi said. These fields, which deal in neurological and kidney issues, are often interrelated, so having a center where the two departments are combined should ensure better coordination of care between a patient’s physicians since they are going to
Long Beach Business Journal 9-B
Dr. Divya Joshi, chief medical officer at Miller Children’s & Women’s Hospital Long Beach, interacts with two of the hospital’s pediatric cancer patients, seven-year-old Ava Valdez (right) and three-yearold Jacob Delacruz. According to Joshi, the hospital has access to some of the most recent pediatric oncology treatment protocols through a partnership with the National Children’s Oncology Group. The hospital sends the group research data about the treatment of its pediatric patients to help advance cancer research, she said. (Photograph by the Business Journal’s Thomas McConville)
be steps from one another rather than in separate buildings, she explained. Miller Children’s sister hospital, Community Hospital Long Beach, is also soon to be home to a new facility benefit-
ing pediatric patients, Joshi noted. “We will have in the very near future at Community Hospital an inpatient adolescent psych unit,” she said. Although one in five children has a mental condition, find-
ing mental health care for children is often difficult, she said. As a result, “What we have found is we get children into our emergency department who are out of control; sometimes they threaten to kill themselves or their parents,” she explained. The children’s hospital is to work directly with the inpatient psychiatry facility at Community Hospital to ensure that whichever doctor attends to a patient initially in emergency is the same doctor who cares for that patient both for inpatient and followup outpatient care, Joshi said. She estimated the facility would be open within a year. Also in the works is a new pediatric campus where many outpatient pediatric physicians and specialists are to be housed in one location to better coordinate care among multiple doctors and to make treatment more convenient for patients and their families, according to Joshi. The idea, in the works for about two-and-a-half years, was sparked because many patients at Miller’s see three to five physicians, all with differing specialties, on a regular basis, she explained. “The idea is to have all those specialists and all those services in one building so that the family only comes once,” she said. MemorialCare is still searching for a location for the facility, although Joshi said, “we are hopefully close to clinching the deal on one of the locations.” ■
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HEALTH CARE QUARTERLY 10-B Long Beach Business Journal
August 19-September 1, 2014
Los Alamitos Medical Center Getting New Facilities; Clayton Named CEO
Kent Clayton, pictured at right, was recently named CEO of Los Alamitos Medical Center (LAMC), replacing former CEO Michele Finney, who departed to join Tenet Healthcare’s Abrazo Health System in Arizona. Prior to taking on his new role at LAMC, Clayton served as CEO of Placentia-Linda Hospital in Placentia, California, for 10 years. There, he oversaw the development of new clinical programs, five new outpatient centers, expansion of the emergency room and other projects. Clayton comes to LAMC at a time when it is undergoing facility expansions. A new three-story, 70,000-square-foot medical office building (pictured) for physician practices is opening in the fall on Katella Avenue next to LAMC’s Total Care Pavilion. A new catheterization laboratory is also under construction at the hospital. When completed, the state-of-theart facility will enable physicians to perform electrophysiology procedures to diagnose issues in the heart and neuro-interventional procedures for diagnosing and treating vascular disorders, according to Todd Silver, catheterization lab supervisor, pictured at left. (Photographs by the Business Journal’s Thomas McConville)
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Molina Names New Chief Medical Officer – Dr. Keith Wilson, M.D., has been named chief medical officer for Long Beach-based Molina Healthcare, Inc., a health plan provider offering plans through Medicaid, Medicare and state insurance marketplaces. He has served as the company’s vice president of clinical services for Molina Medical Group and American Family Care since 2013. “Dr. Wilson’s track record in leading physician practices and caring for sicker patients, in addition to his managed care experience, will be invaluable,” Terry Bayer, COO of Molina Healthcare, said in a statement. Wilson previously served as president and CEO of Talbert Medical Group before the group merged with HealthCare Partners, after which he became HealthCare’s regional medical director. He studied chemistry and chemical engineering as an undergraduate at the University of Southern California and earned his M.D. at Howard University College of Medicine in Washington, D.C. His medical residency was at King-Drew Medical Center in Los Angeles. Currently, he is a boardmember of the Financial Solvency Standards Board for the California Department of Managed Care, a fellow of the American College of Obstetrics and Gynecology, a committee member of the California Association of Physician Groups and a member of the American Medical Association, National Medical Association and Orange County Medical Association. (Photograph provided by Molina Healthcare)
Readmission Innovator – Debbie Rivet, case management director at Los Alamitos Medical Center (LAMC), has earned a Readmission Innovator award from the National Readmission Prevention Collaborative, a volunteer organization formed to share best practice case studies among health care industry leaders. “This prestigious award was earned by Debbie’s tenacious efforts to decrease patient readmissions by working with skilled nursing facilities, home health providers and other local agencies,” Karen Games, LAMC collaborative care director, said in a statement. In 2011, Rivet formed the regional Preventing Readmissions Collaborative for Southeast Los Angeles County and North Orange County professionals. The group’s membership has since tripled. The collaborative focuses on education of health care workers, reducing hospital readmissions and improving the quality of patient care. In a statement, Rivet said earning the Readmission Innovator award “shows that we are making a difference in our community.” (Photograph provided by Los Alamitos Medical Center) LBUSD Alumni Earn Nursing Certificates Through Goodwill SOLAC – A Goodwill Serving the People of Southern Los Angeles County (SOLAC) program that trains low-income students to earn certified nurse assistance certificates is graduating its first class on August 22. The class of 10 students is made up of for(Continue To Top Of Next Page)
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HEALTH CARE QUARTERLY August 19-September 1, 2014 mer Cabrillo, Jordan and Polytechnic High School students who participated in health care academies at their schools, which qualified them for the program. The Long Beach Unified School District began the academies last year to encourage low-income students “who did not necessarily have college plans but demonstrated an interest in working in the health care field” to pursue their goals, according to a statement from
Long Beach Business Journal 11-B Goodwill SOLAC. The students participate in the certified nurse assistant training program free of charge. “Once our students become certified nurse assistants, they are eligible to get training as a licensed vocational nurse,” Susan Gavel, director and instructor for the program said in a statement. The graduation ceremony on August 22 takes place at 10 a.m. at Goodwill SOLAC’s Long Beach headquarters, 800 W. Pacific Coast Hwy. ■
Local Orthodontist Mark Garlington Rated Among Top 1 Percent Of Invisalign Providers Worldwide Long Beach-based orthodontist Dr. Mark A. Garlington, D.D.S., has been identified as one of the top 1 percent of Invisalign providers worldwide by the manufacturer of the product, a clear mouthpiece used as an alternative to traditional braces. The ranking was based on Garlington’s experience, knowledge and the number of cases he has successfully treated, according to Invisalign. “He averages more than 200 Invisalign patients a year, meaning he’s got the experience and expertise patients can trust,” John Ramko, Invisalign regional development manager, said in a statement. “Achieving elite top 1 percent worldwide means that I am in the upper echelon of orthodontics providing Invisalign, and that achievement validates my commitment and passion for orthodontics,” Garlington stated. Garlington has 28 years of experience as an orthodontist, and has been using Invisalign in his practice since 2000. He earned a bachelor’s degree from the UCLA and his D.D.S. from USC. His Long Beach office is located at 5479 E. Abbeyfield St., Suite 1, where he may be reached at 562/439-4553. (Photographs by the Business Journal’s Thomas McConville) ®
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Molina Healthcare Opens Senior Resource Center On August 20 at 2 p.m., Molina Healthcare is hosting a free community grand opening for its new Senior Resource Center at College Medical Center, 2776 Pacific Ave. Molina Healthcare provides health plans through Medicaid, Medicare and other state insurance marketplaces. A week before the center opened, Dr. Jennifer Zweig, family medicine residency director and clinic director at College Medical Center (left), and Dr. Martha Bernadett-Molina, executive vice president of Molina HealthCare, paid a visit to the Senior Resource Center’s gardening area, one of several free resources available there. In addition to gardening, the center provides local seniors with free access to health education and exercise classes, painting, a library of books and DVDs, television and a computer lab. The goal of the center is to help seniors “take an active role in maintaining their health and wellbeing,” according to Molina Healthcare. (Photograph by the Business Journal’s Thomas McConville)
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