By Robert Fulton
When Ema Rowe found out that she was pregnant with her third child, her physician at Cedars-Sinai Medical Center referred the South Los Angeles resident to Eisner Pediatric & Family Medical Center.
Rowe soon entered Eisner’s centering pregnancy program at the clinic’s main location in downtown Los Angeles. A nurse called her after noticing she had been a little depressed at a recent centering pregnancy class.
“I appreciated that call,” said Rowe, who receives Medi-Cal. “She didn’t have to. She’s not my friend.”
The connections to community members are a big part of what makes the clinic tick — and are at the heart of a clinic expansion and collaboration made possible with funding from the Affordable Care Act. But even with the new funding, the clinic expects substantial challenges once demand for care increases after health care reforms take effect in 2014.
Founded in 1920 and located in the southern reaches of downtown Los Angeles, Eisner offers a number of services, including primary care, prenatal and gynecological care, dental care, mental health services, pediatrics and school-based teen clinics.
Kerin Asher-Galloway is a Registered Nurse/Certified Nurse Midwife who runs Eisner’s centering pregnancy program, which is a series of group sessions where expectant mothers “become integral in their own prenatal care.” Asher-Galloway teaches self care, where the women learn skills such as taking their own blood pressure.
The group setting also facilitates supportive relationships among the soon-to-be mothers.
The program aims to take the mystery out of pregnancy. “It gives them a really good foundation for everything,” Asher-Galloway said. “For their birth, delivery, postpartum and beyond. It creates community, which is really important to us.”
The federally qualified health center had $1 million in revenue and 17,000 annual visits in 1990, according to Eisner President and CEO Carl Coan. Now the center has $23 million in revenue and 115,000 visits spread across 10 sites, including school satellite clinics, a portable dental clinic and a Women, Infants and Children clinic.
Grants made possible by the Affordable Care Act have further bolstered the services offered by the clinic, including and expansion of their dental clinic, doubling the size of their pediatric services and enlarge their pharmacy.
The grants also included money to develop a primary care clinic staffed by medical residents. The clinic is a collaboration between the University of Southern California’s Keck School of Medicine, Eisner and California Hospital Medical Center, which is two blocks away from the clinic in downtown Los Angeles.
The goal of the partnership is to stabilize the residency program at the hospital, expose practitioners to community clinics and improve primary care.
“We really felt that there was good data out there [showing] that linking primary care residencies to community health centers both increases the quality of the residents who choose the residency, as well as the likelihood that they will then go out and practice in a community-based setting,” said Dr. Deborah Lerner, Chief Medical Officer at Eisner Pediatric.
Eisner serves mostly Latino working-class patients in the immediate community, though some travel from outside the area.
Norma Orihuela has been visiting Eisner for almost 15 years, first for prenatal care, now for comprehensive services. She lives in Pico Rivera, about 12 miles southeast and 45 to 50 minutes away by bus. She said through an interpreter that she appreciates staff such as Dr. Luis Lopez.
“Right away I could tell I could do much more for the patient than I could in a private setting,” said Lopez, Eisner’s Director of Pediatric Services. He has worked at the clinic for almost 22 years. “Certainly you can’t take it to the bank, but it’s for the soul and just makes me feel like I’ve chosen the right profession and I’m in the right place.”
Despite the capital improvements, increased services and transition to electronic medical records, Eisner still faces challenges with the pending Medi-Cal expansion.
Lerner boiled these challenges down to the simple science of the demand for available resources overwhelming supply.
“There are sooooo many challenges,” Lerner said, elongating the word “so” beyond a single syllable. She cited the national crisis in recruiting primary care providers to serve expanding Medi-Cal rolls and finding the space to house the physicians they do recruit. The recent capital improvements at Eisner, she said, are like expanding a Los Angeles freeway: it may relieve congestion temporarily, but drivers ultimately fill the new lanes.
“The challenges that we face are really all community clinics are facing in one way or another,” Lerner said. “We’re all facing this impending influx of patients. At bottom, no matter how you look at it, the biggest challenge is the mismatch of supply and demand.”
Coan pointed out that in addition to physician recruitment, he’s concerned about lowered Medi-Cal reimbursements and yearly increases not keeping pace with Eisner’s needs.
“We run a business. A mission driven business, but it’s still a business,” Coan said. “I think those are challenges people sometimes don’t think about. They see us out there and they see the Affordable Care Act and they think there’s going to be all this money coming down rolling toward the health industry.”
“It may be rolling towards some parts of the health industry, but believe me, this is going to be tough for clinics because we’re still faced with the uninsured that we have to take care of,” he added. “There’s still folks out there who are not going to be covered. There’s going to be a mismatch and it’s going to be interesting to see how that plays out. This is not an end to the crisis by any means.”