USC researchers create model to help develop sustainable healthcare delivery and primary care resident training

LOS ANGELES — As the Affordable Care Act plays out, numerous challenges have cropped up — from how to serve the millions of newly insured expected to crowd into doctors’ offices, community clinics and hospitals, to the perilous shortage of primary care doctors to serve them.

Researchers at the University of Southern California believe they may have a solution to some of those challenges, which they recently put into practice through a merger of the Family Practice and Family Medicine Residency involving the Keck School of Medicine of USC, the California Hospital Medical Center and the Eisner Pediatric and Family Medical Center.

The merger transformed a downtown Los Angeles family practice previously owned and operated by USC into a federally qualified health center (FQHC) that is now eligible for federal grants and higher Medi-Cal reimbursements.  The center is now owned by the Eisner Center, while USC faculty physicians continue to run the residency and see patients.  Patient volumes have increased and the new center is not only in the black after one year, but it has for the first time filled all eight of its residency slots.

“This model is a true partnership between a university, a hospital and clinic and a model for how to expand community-based medical training,” said Michael Cousineau, principal investigator on the paper and associate professor of preventive medicine at the Keck School of Medicine of USC. “Trying to align leadership was tough. Leadership and commitment were the keys.”

Lessons learned were detailed in a paper published by Academic Medicine, a journal of the Association of American Medical Colleges. Titled “Transforming a family medicine center and residency program into a federally qualified health center,” the paper is a kind of template that the researchers and participants hope will help others set realistic expectations when attempting to accomplish similar goals.

“We were surprised at the complexity of the project,” Cousineau said. “I’ve helped in merging organizations, but I didn’t imagine all the obstacles. The smallest things could have undermined us at any time.”

The most important lessons, as noted in the paper, include:
• Getting a commitment from all partners to the final goal, which helped usher through approvals and eliminate communications problems
• Hiring a project director to keep the project on track and facilitate the grant process (including a $600,000 operational grant from the Health Resources and Services Administration)
• Leveraging opportunities for federal and local grant funding
• Obtaining funding from a foundation (in this case, UniHealth) with the means to support critical goals such as building infrastructure and securing legal counsel

Although Cousineau said the partners “went in with our eyes open,” the administrative and legal hurdles were considerable. For one, the staff of about 20 had to leave USC employment to become Eisner Center employees, which led to some staff attrition.

As the clinic was moved from USC to Eisner, the partners found they had to replace all of the equipment—even exam tables—which were officially owned by USC. Another challenge was switching the patient management system from USC to Eisner, which involved developing new electronic medical records and patient scheduling system.

The merger also created a sustainable alternative to hospital-based family medicine residencies for medical residents, Cousineau said. With hospital-based family medicine residencies becoming more rare, community health centers like Eisner are well positioned within the healthcare safety net, making them more attractive to residents.

“The students interview and see our clinic’s affiliation with USC and the fact that it’s an FQHC, and they’re interested. They have a sense that they’re part of something,” said Cousineau, adding that medical students have already established a student-run Saturday clinic.

The residents are still able to fulfill hospital-based residency training requirements including labor and delivery, which they perform at California Hospital, he said.

Now that the clinic has been up and running for a year, Cousineau said leadership is meeting soon to learn more about outcomes to help determine future plans.

Article cited:
Cousineau, M., Flores, H., Cheng, S., Gates, J., Douglas, J., Clute, G., Coan, C.E. Transforming a family medicine center and residency program into a federally qualified health center. Academic Medicine, Vol. 88, No. 5, Published May 2013

Contact: Leslie Ridgeway at (323) 442-2823 or lridgewa@usc.edu