“Filling a Gap in Emergency Care”

By Ed Martinez – December 7, 2008


In 2006, the County of San Diego commissioned a study to evaluate the strengths and weaknesses of San Diego South Bay’s healthcare safety net that consists of three acute care hospitals and several community clinics. Results of the study indicated that several issues threatened the ongoing sustainability of the health care safety net. The two major concerns reported included (1) an increasing number of uninsured patients relying on hospital emergency departments (EDs) for minor illness and injuries, and (2) a decreasing number of primary care providers willing to provide services to low-income and uninsured patients.


As a result of this study, Supervisor Greg Cox spearheaded the formation of the South Region Safety Net Work Group that solicited strategies for improving safety net service.


Even as the Work Group has moved forward, community clinics have experienced additional challenges. The first challenge relates to the state’s budget impasse that withheld Medi-Cal payments to safety net providers for several months and threatened closure of community clinics throughout the state. The second challenge relates to the spate of many South Bay residents losing their health insurance due to increasing unemployment caused by the dire economic environment. To most safety net providers, it’s clear that the increase in uninsured populations will further exacerbate the stressful work environment of local EDs as they attempt to treat a growing number of patients presenting with minor illnesses and injuries.


The latest news from Sacramento indicates damage to our community’s health care safety could become even more acute.


 California’s budgetary crisis continues and the likelihood of another impasse seems imminent. With San Diego’s community clinic safety net still recovering from the shortfall of funding only a few months ago, another freeze on Medi­Cal reimbursements represents a significant public health issue for our community. This assessment is based on the fact that San Diego’s community clinics treat more than 500,000 low-income and uninsured patients on an annual basis.


In San Diego, hospital emergency departments have experienced a growing trend of inappropriate use (for minor illnesses and injuries) for many years. A 2004 assessment of San Diego’s safety net by George Washington University reported that approximately 40 percent of the ED visits at one of San Diego’s largest, mid-city hospitals were for non-emergency care that easily could have been managed within the setting of a primary care medical home or urgent care clinic.


South Region hospitals have reported similar misuse of ED services. For example, in 2007, Scripps Mercy Chula Vista Hospital’s ED discharged nearly 3,000 patients with nonemergency conditions. The presence of these patients in the hospital’s ED has dramatically increased patient wait time and, ultimately, the cost of health care for all taxpayers.


In the area of health policy,  broad based answers such as Universal Health Coverage come slowly after extended debate. Meanwhile, communities experience significant barriers to essential health services. I believe that health care safety net providers such as community clinics and  mission driven hospitals must become increasing proactive to meet the needs of their communities. This means expansion of community and business partnerships, working closely with government officials and finding community-based solutions to resolving access-to-care barriers.


In direct response to this, San Ysidro Health Center, in partnership with Scripps Mercy Chula Vista Hospital, La Maestra Family Health Centers, Imperial Beach Community Clinics and Operation Samahan, through a San Diego County grant, have launched a new urgent care clinic for children and adults with common non-life threatening illnesses and physical injuries such as minor cuts and burns, sprains, strains and simple fractures. The San Ysidro Health Center’s new Urgent Care Clinic in Chula Vista will also provide immunizations and serve as a medical home for patients.


SYHC and our safety net collaborators anticipate that the new Urgent Care Clinic will decrease demand for ED services in the South Bay due to (a) the new clinic’s proximity to Scripps Mercy Chula Vista Hospital, and (b) the ease of accessing health/medical care services after regular business hours.


Having already treated more than 2,000 South Bay residents since starting the urgent care service on an interim basis in mid-August, it is obvious that SYHC’s new urgent care clinic has filled a long-standing gap between overcrowded EDs and difficult-to-access primary care offices within the South Bay community.


Clearly, SYHC and its safety net partners collectively have demonstrated success in addressing the priority concerns of the South Bay’s health care safety net.


Ed Martinez is a resident of El Cajon and  former CEO/President of San Ysidro  Health Center

The San Diego Union-Tribune – Sunday, December 7, 2008

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