Louisiana?s public hospital safety net will have to cut back dramatically the services it offers to uninsured patients across the state under a plan approved Thursday by the LSU Board of Supervisors. (Photo by Times-Picayune archive)
Louisiana?s public hospital safety net will have to cut back dramatically the services it offers to uninsured patients across the state under a plan approved Thursday by the LSU Board of Supervisors. In New Orleans, a $49 million reduction at the Interim LSU Public Hospital will mean that 432 workers lose their jobs, while the number of patient beds will shrink from 201 to 155. Some clinics associated with the hospital will close, while others will reduce their hours.
Dr. Frank Opelka, the new head of the seven LSU system hospitals in south Louisiana, told the board and legislators later in the day that the current model of delivering safety net care through the state hospitals is ?unsustainable? over the long term.
"This is a very difficult time for us, all of us," Opelka told the board. "These are the most vulnerable patients in the most difficult circumstances requiring some of the most complex treatment."
The board approved a plan to reduce state financing to the seven hospitals in south Louisiana by $85 million, although combined with a loss of federal funding the reductions total $152 million. The cuts represent a 19 percent hit out of the system?s $802 million budget.
Overall, 1,487 jobs out of the 6,140 positions in the system?s budget will be cut.
The reductions were brought on by a decrease in federal Medicaid funding for Louisiana this summer. The initial budget slashing began months ago, but when Opelka took over leadership of the system in September, he re-evaluated the existing plan and said he would need to cut deeper.
here access to health care for uninsured patients is reduced or eliminated, Opelka said the solution will be finding private hospitals to offer those services. Those partnerships will help fill the gaps, Opelka told the LSU Board and, later in the day, a joint meeting of the Legislature?s health committees.
But Opelka mostly did not specify what those partnerships will look like, although he noted that Mary Bird Perkins Cancer Center will treat patients previously cared for by LSU oncology clinics in Baton Rouge and Independence. In addition, an existing agreement for Our Lady of the Lake in Baton Rouge to begin providing many of the services currently provided by Earl K. Long will be accelerated.
Speaking with reporters, Opelka said he is working with Louisiana Department of Health and Hospitals Secretary Bruce Greenstein on the details of the new partnerships, including how such private hospitals would be paid for treating the uninsured. In New Orleans, Opelka said, officials are negotiating with various private hospitals in the metropolitan area.
The vast majority of patients at LSU hospitals are either uninsured or on Medicaid. Asked whether uninsured patients will have access to non-emergency treatment when the cutbacks take effect, Opelka said he is ?trying to achieve the highest level of confidence we can? that access will be available.
Clinics associated with the interim hospital will reduce hours and staffing. Several clinics at the New Orleans hospital -- women's health, pain management, endocrine, and sickle cell clinics -- will close. The hospital will also close two operating rooms and reduce hours for non-emergency surgeries, likely creating longer waits for such operations.
Other hospitals will also see cuts in beds, including the hospital in Lafayette dropping to 10 staffed beds, a reduction that already occurred this summer at Lallie A. Kemp Regional Medical in Independence and Walter O. Moss Regional Medical Center in Lake Charles. In Lafayette, the system is in talks with Lafayette General to take over services.
Members of the Board of Supervisors said they were pleased with Opelka's plan, saying it would transform the way health care and medical training is delivered in Louisiana. They approved the plan unanimously, giving Opelka and LSU System Interim President William Jenkins leeway to tweak plans as they move forward.
Several board members praised Opelka, saying the blueprint will take the system in a new direction and provide medical residents the opportunity to train in more modern environments.
While half the medical residents in Louisiana currently train in public hospitals, that number will decrease to 25 percent in the redesign for graduate medical education. Opelka emphasized that the cuts were made with the intent of preserving medical training programs.
Several legislators expressed concern that LSU was rolling out the cuts without plans in place for private entities to take over the care.
?It is a question of who dies and who lives. Where are these people going to go?? asked Sen. Ben Nevers, D-Bogalusa. ?I am asking you who is going to provide the services? Until you tell me that, I am not going to be able to.?
Opelka told legislators that in some cases where private partners are established, uninsured patients might have better options for medical treatment. But he conceded that if no private hospitals step up, there could be ?difficulty in getting access to care.?
After looking at the final cuts for the Interim LSU Public Hospital, Dr. Karen DeSalvo, the New Orleans health commissioner, said she remained concerned about whether patients in the city will have access to specialty medical care and surgeries.
?I?m pleased they have preserved the psychiatric facilities and beds,? DeSalvo said.
But she added that the reductions will certainly be felt by the uninsured. ?It is a major cut and will be hard for that not to be felt in our community,? she said.
While many uninsured and Medicaid patients in the New Orleans area receive primary care in community clinics outside the LSU system, the interim hospital?s clinic provides most of the specialty care for those clinics. The interim hospital is the region?s public hospital until the 400-bed University Medical Center under construction in Mid-City is complete.
Opelka told legislators that some of the cuts will go into effect soon, although because of civil service rules the layoffs won?t occur until January. System employees laid off after an initial round of cuts this summer will be leaving their jobs later this month.
During the meeting, several legislators complained of being shut out of LSU?s budget-cutting process. Though there was much talk of ?partnerships,? Rep. Chris Broadwater, R-Hammond, said that ?there is an absence in partnership between you and us in solving these problems.?
During his presentation, Opelka told legislators that he valued their input and used it when seeking partnerships with private entities.
Source: http://www.nola.com/health/index.ssf/2012/10/deep_cuts_to_louisianas_public.html
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