Patients overwhelmed the hospital, stretching both its physical facilities and its staff. Sometimes gurneys lined the hospital corridors and filled five outer tents.
Batchlor was the chief medical officer of the LA Care Health Plan – a public health plan covering underserved Los Angeles County residents – when she was asked in 2012 to become CEO of the hospital that was being created for replace the Martin Luther King Jr.. Hospital.
She spent the next three years laying the groundwork and remained as the head of the Martin Luther King Jr. Community Hospital when it opened in 2015. Previously, she was Vice President of the California Health Care Foundation, Medical Director from Los Angeles County. Office of Managed Care, Chief Medical Officer of Prudential Health Care and Clinical Instructor at UCLA School of Medicine.
The Business Journal spoke with Batchlor to discuss why the hospital has been hit so hard by Covid, the steps it has taken to tackle the outbreak and what the facility is focusing on as the crisis of Covid is easing.
Martin Luther King Jr. Community Hospital has been one of the hospitals hardest hit by the Covid-19 outbreak. How did you get through the crisis?
Managing emergencies and crises is something hospitals are well prepared for. Even so, it was a definite challenge. We were the epicenter of the epicenter of the Covid crisis. I really understood this from looking at a report from a health and social services agency: We had more Covid patients in our small community hospital than hospitals four times our size. Having said that, we have a very talented, very agile and resourceful staff. They found the resources our patients needed.
How did you find these resources?
We asked for help and got a lot of support from the community, county and state. As the first wave of the pandemic began in early 2020, we ordered the traveling nurses and scheduled them to arrive. We also used nurses and doctors on an outpatient basis. We also had five tents to house patients – before the pandemic we had one tent.
Even before the pandemic, did you have a tent to house patients?
Yes. Considering the community we are in, we have had a large number of emergency room visits. Our emergency service was designed for 45,000 visits per year; in 2019, we had 110,000 visits. And we were missing 1,200 doctors. So even before Covid hit, we had a public health crisis here.
It really is a reflection of the high rate of disease in our community that goes untreated – there is not enough outpatient treatment. Take a disease like diabetes: we have more than three times the rate of diabetes in South Los Angeles than the rest of the state, and our death rate is 70% higher. There is a need for funding not only health care, but also other social determinants of health: access to healthy food, safe places to exercise, quality education and employment.
Why has the hospital not been able to provide staff to respond to this?
Our community is very low income. Most people are uninsured or on Medicaid. This means that we have lower reimbursement rates than other hospitals. That’s why we have the fewest hospital beds per 100,000 people in the county. It is also the reason why we are short of doctors and why we lack almost all other types of health care infrastructure. We have created a separate and unequal health care system.
What has Covid-19 done to the finances of the MLK Community Hospital?
Many other hospitals have been affected by the ban on elective surgeries – this is where they derive a large chunk of their income. But things are a little different in our hospital because we don’t do a lot of elective surgeries. Most of our surgeries have emergency conditions. So we haven’t lost that much income there. But our emergency room volume dropped by half in the first few weeks. And we had a lot of expenses – purchases of personal protective equipment, drugs, ventilators and other supplies. We converted an entire medical floor into an intensive care unit, which required a lot of new equipment.
Did the CARES Act money help the hospital overcome the surges?
Some of the funding from the CARES Act helped. But this funding was not fair. The first round was calculated using a formula based on the percentage of Medicare patients. But we don’t have a lot of Medicare patients: we have a high proportion of Medicaid patients. So that meant we got less dollars from the CARES Act than other hospitals. We ended up getting about $ 18 million.
Did the hospital fare better in subsequent funding rounds?
The next cycle was based on the patients’ net income. But our lower reimbursement rates mean we’re not getting a lot of income for patients. When the federal government finally came to distribution for Medicaid patients, we did not qualify. Any hospital that had taken CARES Act dollars for Medicare patients – and we took some – was not eligible.
How did you find the additional funding?
We had to raise funds from the community and the community mobilized. Our supporters have been generous with cash and in-kind donations. One of our partners was the International Medical Corps, headquartered right here in Los Angeles. They donated a campaign tent and fans.
Isn’t the International Medical Corps focused on helping developing countries?
Yes, and that says something that an organization dedicated to improving medical conditions in sub-Saharan Africa and other poor parts of the world has had to focus here, in its own backyard. But we appreciated their support.
Did you have to make any cuts?
There was no time for cuts. We were in crisis and had to expand our services. The only reductions were for outpatient visits. We have converted to telemedicine as a substitute. But it was not a reduction in staff. Staff have been brought back to the hospital to deal with the crisis here.
How are the finances of the hospital now?
We have recovered financially. We finally received federal funding. Without it, we would still be in a loss of money situation. We also got an advance on Medicare payments that we had to repay.
What happened to non-Covid care in the midst of it all?
Members of our community were less comfortable going to hospitals for elective care, especially during the Covid crisis. We are therefore concerned about the pent-up demand for care that has been postponed. We are concerned that chronic illnesses among members of our community, such as diabetes, have worsened. And that means more expensive hospital care. For example, if the treatment of diabetes is neglected, we have to do more limb amputations.
Now that we seem to be emerging from the Covid crisis, what are your goals for the MLK Community Hospital?
For the remainder of this year, our main focus is to help our community achieve collective immunity. We invest a lot of resources in immunizing people in our community. We have hot spot maps that tell us where the highest concentrations of Covid are in our community, and we go to those communities to vaccinate people.
And beyond the next few months? What are your priorities?
We will advocate for better funding for community care. Covid has given us a better insight into the inequalities in our community. I hope we now have the will to invest more in our vulnerable and underserved communities. This means more funding for the management of diabetes, treatment of lung disease, obesity, substance abuse disorders, mental health issues, etc. We are also developing street medicine programs for homeless patients. It’s about pushing more care in the community.
We have opened a post-Covid multi-specialty clinic. It includes doctors who have treated Covid patients, as well as nurses and even spiritual advisers. The clinic follows Covid patients after discharge from hospital, helping them cope with persistent kidney or lung problems, blood clots, behavioral issues and other mental issues. Some of these people will be left with permanent disabilities or other effects of Covid. But some will be recoverable, and that’s what the clinic will focus on.
How did you become interested in providing health care to underserved communities?
I have always been interested in public health, social justice and advocacy. I was brought up by parents who were social activists. They went to the “I Have a Dream Speech” in Washington, and they took me to the March of the Poor in Washington (1968). Much of my career has been devoted to improving the quality and access to health care for people living in underserved communities.
What was it like getting the MLK Community Hospital off the ground?
The most difficult thing I have done in my career has been to start the hospital. … There was a lot of skepticism about the possibility of doing this, and there was the legacy of the old hospital that had to be overcome. But we did.
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