Care, from the heart

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Pacifica Hospital of the Valley delivers best-in-class public health care

In good times and bad, safety net hospitals are the beating heart of this nation’s healthcare system. Whether by mission, mandate, or default, they are the last line of hope, help, and healing for underserved patients. They often provide crucial services other hospitals don’t, such as inpatient behavioral health, subacute care, intensive care, and ambulatory care. With large geographic areas to serve and limited funds, they perform death-defying feats of operational survival on a daily basis.

In the San Fernando Valley of Los Angeles, the 231-bed Pacifica Hospital of the Valley is creating a roadmap for the future of hospitals that care for a disproportionate share of uninsured and vulnerable patients. Accredited by the Joint Commission on Healthcare, Pacifica provides state-of-the-art 24/7 emergency services, acute/intensive care, outpatient surgery, subacute care services, rehabilitation, inpatient behavioral health and more, serving residents of over 14 zip codes in the greater Los Angeles area.

Pacifica’s CEO Precious Mayes, believes every patient deserves impeccable care, and she is on a quest to make it happen. “To be a safe haven for the community and to deliver a higher standard of care, my mission is to make sure that we deliver high-quality care like Mayo Clinic, Stanford, or Cedars-Sinai in an inner-city setting. There's no reason that our most vulnerable population cannot have the same standards of care,” she said.

In 2018, Mayes became President and CEO, tasked with leading a transformation in the public hospital space. In 2019, her teams delivered the best financial audit in the hospital’s 30-year history. “When you go into a safety net, disproportionate share hospital (DSH), it is a leadership challenge for most operators on how to find the balance of service lines needed by the community with relatively minimal resources and funding to actually pivot and make it profitable,” she explained.

One of the key strategies was to assemble an experienced leadership team whose passion is to serve for the health of the community. “With passion and commitment, and leading with a clear vision, there are no boundaries to what can be accomplished to create a positive culture, quality level of care, and patient satisfaction that result in financial viability.”

Another critical step forward was a re-evaluation of service offerings and optimizing bench strength on the team to implement changes to support new lines of services. “We did not want to change the stripes of who we are,” Mayes said. They made the stripes broader and bolder, adding service lines that normally wouldn't be offered in a safety net setting. “We developed new partnerships with IPAs and Managed Care Organizations and established new models of care such as Medicare, capitation, and targeted service lines. For example, to meet the needs of our new partnerships, we added an outpatient program for physical, occupational, and speech therapy services as well as a new orthopedic OR group. With these new service lines, this will promote growth to offset our limited reimbursement from the state,” she said.

“It’s about being very selective, choosing the right physicians who have the right heart, compassion, and commitment to the community. Financially, it’s also making sure that you're looking at everything from your contractual arrangements to your costs, and then giving back to the hospital wherever it’s needed. Sometimes you have to spend money to make money, and sometimes the best business you do is the business that you don’t do. That's something that I actually have used in my leadership style for many years,” she noted. “You don't have to have every managed care contract out there; you just need the right managed care partner to negotiate a profitable rate. That’s just one example of how you get to that financial responsibility, and how safety net hospitals can deliver a fantastic audit just as we did.”

Some of the early decisions provoked curiosity in the community, but as with everything Mayes and her team undertakes, they were rooted in creativity and practicality. In the first six months of her tenure, she closed the hospital’s labor and delivery unit. “Adding birthing rooms would cost millions of dollars, so instead we partnered with another hospital and sent our services there. We made it affordable from a contractual standpoint because we have capitation contracts and they were giving us the best of both worlds.” Pacifica also converted available space to long-term and sub-acute care, creating a ventilator and trach patient unit.

With capitation contracts, the primary payer, which in Pacifica’s case is the state of California, pays the hospital or healthcare system directly. Contracts are tough to negotiate and hard-won. “To be able to get capitation contracts in a year and a half when they're not awarding capitation contracts to anybody is a tremendous feat,” Mayes stressed. “I rolled up my sleeves and worked with constituents, assembly members, congress, senators, and family members in the communities to look at what we need to serve the community, how we could get out there and push more services—and also get them to push the community to come and actually be served by our hospital.”

Safety net DSH hospitals in general provide services other hospitals can’t or won’t, and that includes caring for people with mental and behavioral health crises. Pacifica has a locked behavioral unit, a necessity for urban areas that is often overlooked.

“This pandemic has really created breaks in our mental health and well-being that nobody would have ever anticipated,” Mayes said. “People are hurting. They need support; they need hotlines, they need somebody to talk to, they need to know where they can go and get help for their loved ones, and I don't think we've done enough of that.” On the flip side, patients in the hospital’s long-term ventilator and trach unit face unprecedented isolation. To support the residents, the hospital provided tablets so they can keep in touch with their loved ones. “This one offering to enable a personal connection between the residents and their families was so important to their overall well-being and minimizing feelings of isolation due to the pandemic,” she said.

“Pacifica Hospital is very near and dear to my heart. I love my patients, residents, and staff. The longevity of my nurses, some of whom have been here 30-plus years, reflects the dedication and loyalty to our hospital,” she said. “For example, our team of housekeepers are on the front lines 24/7, following infection control protocols to keep our hospital clean and safe, especially during this pandemic. We are grateful for all individuals doing their part to contribute to the quality and standards at Pacifica Hospital. Pacifica is a gem of a Cinderella story. Safety net hospitals provide marvelous care with effective leadership. Our mantra at Pacifica Hospital is ‘giving heart to what you do every day.’”