UCLA Healthcare moves to local level

Wednesday, February 24, 1999

UCLA Healthcare moves to local level

CLINICS: Doctors treat patients, do research in many
communities

By Kiyoshi Tomono

Daily Bruin Contributor

In the monopolistic age of managed care, UCLA is taking a
‘little village’ approach.

Melding business with education, research and a public that is
demanding a more personal touch, UCLA has established a ring of 14
community offices in the greater Westwood area.

Typically, physicians who staff these offices are either medical
school residents or private practice physicians. The lure of an
academic setting, combined with research and teaching requirements,
keeps many physicians, especially residents, from seeking other
employment opportunities.

"The key reason why I joined was because I wanted the variety of
being both a clinical practitioner and clinical professor," said
Dr. Thuy Tran, an internist at the Manhattan Beach facility. "I get
to teach medical students, use my clinical skills and write
articles."

Other physicians cite problems with insurance reimbursement as
part of the reason they accepted UCLA’s offer. Dr. Bruce Landres
worked for 22 years in private practice with a group of five
physicians before deciding to join UCLA Healthcare in January
1998.

"Prior to January 1998, we were surviving," said Landres, who
works at the Brentwood Community Office. "But the patients were
paying out of pocket and the insurance companies were not
reimbursing us because we were not involved with any health
plan."

Despite advantages, both Tran and Landres indicate there are
drawbacks to working at the community offices.

"In a clinic, you are much less likely to bump into a specialist
that your patient might need," said Dr. Tran. "With that kind of
distance, now I have to call or e-mail somebody."

Alan Fogelman, executive chair of the UCLA Department of
Medicine, said the clinics are part of an overall system that
encompasses both Santa Monica and UCLA Medical Centers.

"The idea is that we will provide the highest quality of care at
the primary care level," said Dr. Fogelman. "When the patients need
to have something more sophisticated, they will be able to obtain
it at one of our two hospitals."

Landres pointed out similar problems in making administrative
decisions.

"UCLA is an institution and some responses are not as fast as
they could be if we could make them on our own," Landres said.

"If I wanted to buy an EKG machine in my private practice for
instance, it would take one call and it was done. Here, it could
take a couple of weeks," he continued.

The theory behind establishing community offices was threefold,
said Dr. Fogelman.

First, a shortage of primary care physicians in the late 1980s
prompted the governor to sign an agreement with the UC president in
order to train more primary care doctors.

Second, Fogelman indicated the offices are an experiment,
testing whether primary care is the best way to deliver medical
care and whether or not a medical system can provide better care
than a single practitioner.

Finally, community offices serve a small community of patients
that can be easily followed by physicians for education and
research purposes.

However, Dr. Aryeh Edelist – a practitioner with the Sherman
Oaks community office – has his own theories about why community
offices were established. Dr. Edelist joined the UCLA Healthcare
system three years ago from a private practice.

"As far as my patients were concerned, I basically turned them
over to UCLA," said Dr. Edelist. "At the time, UCLA realized that
there was a lot of competition for patients from managed care and
that if they wanted to stay in business, they had to stay in
competition."

But while Dr. Fogelman conceded there is some element of
business involved with the clinics, he gave other reasons for the
establishment of the network.

"The Regents do not subsidize these offices, and hence they must
be part of a healthcare system that makes economic sense," Fogelman
said.

"Unlike a true business, our goal is not to make profit but to
promote our teaching and research missions," he said.PATIL
ARMENIAN/Daily Bruin

Dr. Aryeh Edelist, formerly in private practice, is now
affiliated with the UCLA Medical Center as a member of its
community healthcare network.

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