In The News January

Lawmakers Question Jindal's Health Care Plan

BATON ROUGE — Louisiana lawmakers agree something has to be done to improve the state's health care delivery system.

But many say they're not ready to endorse Louisiana Health First until they get details of how the proposal by Health and Hospitals Secretary Alan Levine would be implemented.

In early December, representatives heard some of the pros and cons of the plan that could lead to low- and medium-income uninsured residents receiving coverage that would let them seek care from private providers instead of the state charity hospital system.

"This plan sets us on the road to work together to come up with a plan," Rep. Kay Katz, R-Monroe told the Shreveport Times. Said Katz, who chairs the House Health and Welfare Committee, "The needs are so great and the costs are so high, we have to do something."

Levine spent several hours laying the background for the need for switching from an expensive fee-for-service system that pays for random on-demand services to a managed-care system that coordinates health care plans for individuals.

Several lawmakers, including Rep. Rickey Hardy, D-Lafayette, say they can't determine whether the plan is good or bad for Medicaid recipients until Health and Hospitals fills in many of the holes in the proposal.

"The devil is in the details. But, hopefully, we'll find angels" when the plan is complete, Hardy said. "It's confusing because we don't know all the details."

How the plan is implemented depends a lot on whether the U.S. Health and Human Services Department approves shifting funds Louisiana owes the federal government because previous funding was misused, Levine said. A reimbursement of $771 million is expected, but he is trying to convince federal officials to allow the state to use some of that to finance a health care pilot program in the Lake Charles area.

The Lake Charles model would convert W.O. Moss Medical Center into an outpatient facility and supply insurance to families of four with up to $52,000 annual income if they have no health insurance coverage. The current Medicaid limit is $26,000.

Katz pointed out that even if the federal government approves the waiver, it would be 2010 before the Lake Charles model could begin.

Levine said the state ranks 51st, below Washington, D.C., in unnecessary hospitalizations and spends among the most to provide care to the uninsured.

Dr. Floyd Buras, of the Louisiana Medical Society, said the United States ranks last in preventive health care among 19 industrialized nations. Levine added that since Louisiana is the worst in the U.S., "what does that say about us? That we're the worst in the world."

The medical society is concerned about a proposal to turn health care over to managed-care insurers because "the whole focus is managed cost," Buras said. It would be better to have "a patient-centered medical home," he said.

Levine said a medical home system is required in a state law authored by Sen. Joe McPherson, D-Woodworth.

Rep. Jane Smith, R-Shreveport, said she wants to meet with Dr. John McDonald, chancellor and dean of LSU Health Sciences Center, before finalizing her opinion of the Health and Hospitals proposal.

"I want to do reform of Medicaid, but I don't want to do something that would affect the medical school. I'm appalled that we're spending so much on health care in this state and our return is so bad."

Dr. Fred Cerise, head of the LSU health system, said he "agrees with many of the concepts" of Levine's proposal but said many people still would be uninsured even if the Lake Charles plan is implemented. Charity hospitals would be needed as "a safety net," he said.

"What we spend on (current care programs) is far below what it would cost to provide insurance to all the uninsured."

Excerpted with permission from The Shreveport Times, Dec 2nd, 2008 by Mike Hasten.

Jefferson Parish Hospitals Hurting

Jefferson Parish's three largest hospitals are expected to lose a total of at least $50 million this year, according to a new report by the Jefferson Parish Economic Development Commission.

West Jefferson Medical Center, East Jefferson General Hospital and Ochsner Medical Center have been battered by post-Katrina problems including skyrocketing labor costs, a surge in uninsured patients and lagging Medicare reimbursements.

The financial health of the three hospitals is so dire that the huge losses actually represent an improvement over 2005, when they lost a combined $150 million.

Although the deficits have so far been covered by reserve funds, the hospitals can't afford to bleed cash much longer without cutting services. "We have been blessed with three exemplary hospitals that are facing some tough times financially," David Martin, vice chairman of JEDCO's board told the Times Picayune. "Our goal is to ensure that 10 years from now, those hospitals are as strong or stronger than they are today."

The report calls for a substantial cash infusion from the federal government, which has allocated billions of dollars for flood protection and housing but has yet to make a similar commitment to the recovery of the area's hospitals. Congress has allocated $600 million in social services block grants for areas affected by Katrina and subsequent hurricanes. The state hopes to secure a portion of that for New Orleans area hospitals, but the federal Department of Health and Hospitals has yet to determine how much each state will get.

LSU and Our Lady of the Lake Explore a Public–Private Partnership

BATON ROUGE — The LSU Health System and Our Lady of the Lake Regional Medical Center (OLOL) have been in discussions to explore a possible partnership aimed at supporting graduate medical education and improving access to care in the Baton Rouge area.

"Particularly post-Hurricane Katrina, Our Lady of the Lake has taken a more active role in graduate medical education to help meet Louisiana's ongoing need for physicians in the future. This has the potential to be a unique public-private partnership in the state at the same time aligning with our healthcare mission," says Scott Wester, OLOL President and Chief Executive Officer.

"The relocation of Baton Rouge-based graduate medical education to Our Lady of the Lake might offer the opportunity for LSU to deliver a new model of health care," said Dr. Fred Cerise, LSU System Vice President for Health Affairs and Medical Education. "And it can also offer the potential addition of facilities that can support LSU's academic and patient care mission."

OLOL and LSU Health System administrators have agreed to continue more detailed discussion for OLOL to become the teaching hospital site for LSU in Baton Rouge. If both parties reach an agreement, the change will likely occur in about two years.

New Medicaid Rules Allow States to Set Premiums and Higher Co-Payments

WASHINGTON — A new federal rule gives states sweeping authority to charge premiums and higher co-payments for doctors' services, hospital care and prescription drugs provided to low-income people under Medicaid.

The rule, published December 3rd in the Federal Register, is expected to save money for the federal government and the states. But public health experts and even some federal officials predicted that many low-income people would delay or forgo care because of the higher charges.

Under the rule, states can, in many cases, deny care or coverage to Medicaid beneficiaries who do not pay their premiums or their share of the cost for a particular item or service.

Governors have sought this kind of discretion for a long time, saying they wanted Medicaid to look more like private health insurance.

The rule, which is meant to carry out a law signed by President Bush in February 2006, represents a sea change in Medicaid.

"It's a tremendous break with the past in terms of what low-income people are expected to pay for their health care," Sara Rosenbaum, a professor of health law and policy at George Washington University told the New York Times.

Higher co-payments may be an attractive option for states struggling to rein in Medicaid costs in the current fiscal crisis, which has reduced state revenues even as the need for assistance grows. Rather than restricting eligibility, states can charge more.

"This flexibility will help protect the program from cutbacks in a time of tight state budgets," the administration said in a preamble to the final rule.

The administration acknowledged that "some individuals may choose to delay or forgo care rather than pay their cost-sharing obligations."

Public health experts said such delays could cause serious health problems, requiring more expensive care at a later date. Many Medicaid recipients have chronic illnesses, use numerous prescription drugs and frequently visit doctors, so the burden of even modest co-payments can become substantial.

But Jeff Nelligan, a spokesman for the federal Centers for Medicare and Medicaid Services, told the Times "States are in the best position to determine the appropriate levels of cost sharing. This rule gives states more tools to help slow spending growth, while maintaining needed coverage, which was the intent of Congress."

When the rule was proposed this year, it drew criticism from the American Academy of Pediatrics, the National Association for Home Care and AARP, among other groups. They said that higher co-payments would make it more difficult for low-income children, homebound people and older Americans to get care.

Diabetics Incur Increased Healthcare Costs

People diagnosed with diabetes spend over $4,100 more each year on medical costs than people who don't have diabetes, a gap that increases substantially each year following the initial diagnosis, according to a study published online in the journal Diabetes Care.

Researchers calculated that a 50-year-old newly diagnosed with diabetes spends $4,174 more on medical care per year than a person the same age who doesn't have diabetes, while medical costs for the person with diabetes go up an additional $158 per year every year thereafter, over and above the amount they would increase due to aging-related increases in medical expenses. Most of the increase can be attributed to the cost of diabetes-related complications, such as heart and kidney disease, the researchers found. Once they controlled for complications, the remaining annual increase in medical costs was $75 per year - the bulk of which could be attributed to the increasing need for diabetes medications the longer a person lives with the disease.

Jack Khashou Joins North Oaks as Vice President of Clinics

HAMMOND — Jack Khashou of Covington has joined North Oaks Health System as Vice President of Clinics.

Khashou will lead the 12 facilities in Tangipahoa and Livingston Parishes that comprise the North Oaks Clinic network, as well as the Clinic Central Billing Office and the North Oaks-Livingston Parish Medical Complex in Satsuma, which is scheduled to open in the second quarter of 2010.

Khashou's prior experience includes 12 years of service with Kenner Regional Medical Center, where he quickly rose through the ranks to become Supervisor of the Health & Fitness Center and then Director of the Human Motion Center. He went on to serve as Director of Orthopedics and Geriatrics and then as Director of Business Development before becoming Chief Operating Officer. After Ochsner's purchase of Kenner Regional in 2007, he was promoted to Assistant Vice President of Business Development for the health system.

Khashou earned bachelor's and master's degrees in human performance and health promotion and a second master's degree in health care management from the University of New Orleans.

SURVEY: Doctors Report a Variety of Professional Discontents

In a survey conducted by the Physicians' Foundation, 11,950 primary care physicians and specialists responded.

The Physicians' Foundation, founded in 2003 through the settlement of a class-action lawsuit brought by doctors and medical associations against private insurers, says it seeks to "advance the work of practicing physicians and to improve the quality of health care for all Americans," reported the Wall Street Journal.

Its survey found that:

94 percent of respondents said the time they've devote to non-clinical paperwork in the past three years has increased, while 63 percent said the paperwork has meant they spend less time per patient.
82 percent said their practices would be "unsustainable" if proposed Medicare pay cuts were made.
78 percent believe there is a shortage of primary care physicians in the U.S.
49 percent said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.
60 percent would not recommend medicine as a career to young people.
42 percent said professional morale is either "poor" or "very low."
17 percent rated the financial position of their practices as "healthy and profitable."
6 percent described morale of their colleagues as "positive."

Financing in doubt for New Orleans Teaching hospital

Louisiana's efforts to finance a $1.2 billion teaching hospital in downtown New Orleans could be hamstrung by a constitutional cap on debt, which could force the project to be scaled back or reconfigured. Gov. Bobby Jindal's administration has long counted on borrowing about $400 million as part of the financing mix for the proposed 424-bed hospital. But bond underwriters in New York recently told a group of legislators that the borrowing would likely count against the state's debt limit, which would make it difficult to get approval from the State Bond Commission. [New Orleans Times-Picayune, December 12, 2008]

LHA Board Approves Statement on Healthcare Reform

BATON ROUGE — The Louisiana Hospital Association (LHA) Board of Trustees approved a statement that the LHA is "supportive of Gov. Jindal's efforts in healthcare reform and of the initial step of submitting the Medicaid waiver to CMS, which is a necessary first step before a more detailed plan may be developed that will reform our Medicaid system."

"The LHA supports implementing strategies to expand healthcare coverage, access and coordination; to provide adequate and sustainable funding for providers; to improve quality and outcomes; to protect and enhance graduate medical education; and to develop an academic medical center in New Orleans, all of which will be discussed and debated over the next several months," said John Matessino, LHA President and CEO.

In 2006, the LHA approved a board position on healthcare redesign in Louisiana that parallels many of the solutions being recommended by the governor's proposal.

"Now is the time for real reform, and hospitals and physicians want to be a part of the solution. We want all patients to have access to quality healthcare and for them to have the ability to be treated close to home in the communities where they live. Putting the patient first is what healthcare is all about," said Bill Holman, FACHE, LHA Board Chair.

"After the waiver is approved, there are many important issues relating to reform that need serious consideration and input from stakeholders, including hospitals, physicians and the legislature. Some of these issues include funding; minimum benefit plan design; new regulatory requirements; payment floors for providers; and administrative requirements, such as prompt-pay, network adequacy, and medical necessity review. These are the types of issues that will need to be debated and deliberated to create a healthcare reform system that is beneficial to the patient," said Paul Salles, CEO of the Metropolitan Hospital Council of New Orleans.

The LHA will continue to work with Gov. Jindal's Administration and the Louisiana Legislature on details to improve our healthcare delivery system over the coming months.

St. Elizabeth Hospital President and CEO, Dee LeJeune, Honored by Our Lady of the Lake College

BATON ROUGE — Dee LeJeune, President and CEO of St. Elizabeth Hospital in Gonzales, was honored with the 2008 Distinguished Alumni Award by Our Lady of the Lake College. Our Lady of the Lake College President, Sandra Harper, Ph.D., presented LeJeune with this inaugural award at a banquet held at De La Ronde Hall in Baton Rouge.

LeJeune has remained very active with Our Lady of the Lake College since graduating from the School of Nursing. Most recently LeJeune sat on the Leadership Team of the Southern Association of Colleges and Schools, assisting the college in its Compliance Report preparations.

Our Lady of the Lake College Celebrates 85 years of Excellence

BATON ROUGE - — Our Lady of the Lake College recently celebrated its 85th anniversary as an institution of higher learning with a mass at St. Josephís Cathedral and dinner at De la Ronde Hall on November 15, 2008. In addition, Mayor Kip Holden declared November 15, 2008 "Our Lady of the Lake College Day."

The OLOL College has grown from its modest beginning in 1923, as a small nursing college with only nine students to a student-centered academic community with nearly 2,000 students. Today, OLOL College is a four year college offering students masters, bachelors, associate degrees and certificates in nursing and various healthcare professions, the liberal arts and the humanities. It is the only Catholic college in Baton Rouge.

During the anniversary celebration and dinner, three annual awards were presented:

2008 Franciscan Impact Award was awarded to Charlotte Placide, Superintendent for the East Baton Rouge Parish School System. Her efforts impact thousands of children each school year, as she strives to provide a strong education base for our community leaders of tomorrow.
2008 Distinguished Alumni Award was presented to Dolores "Dee" LeJeune, President and CEO of St. Elizabeth's Hospital in Gonzales, Louisiana. Under her leadership, St. Elizabeth's has been recognized nationally for its outstanding work environment and has been awarded a Louisiana Performance Excellence Award Level III.
2008 Distinguished Young Alumni Award was given to Christine Blanchard who graduated from Our Lady of the Lake College in 2007 with an ASN in Nursing.

LHA Board Celebrates Opening Of New Conference Center

BATON ROUGE — The Louisiana Hospital Association (LHA) held a ribbon-cutting ceremony yesterday for its new, state-of-the-art conference center. The LHA Conference Center will be used for educational programs, board meetings and various other hospital events.

Established in 1926, the Louisiana Hospital Association is a non-profit organization representing more than 180 hospitals and healthcare provider groups across the state. The mission of the LHA is to support its members through advocacy, education and services.

Lafayette General Medical Center Recognized As A Heart & Stroke Champion

LAFAYETTE — The American Heart Association recognized Lafayette General Medical Center's commitment to heart health in Louisiana with the annual Heart & Stroke Champion Award. The American Heart Association presented the award to David Callecod, CEO of LGMC and Kristi Abshire, Director of Cardiovascular Services at Lafayette General Medical Center on December 2, 2008.

Each year, the American Heart Association recognizes those supporters who go above and beyond to champion the organization's mission in their communities. Lafayette General Medical Center served as the signature supporter for the Go Red for Women Luncheon and truly made a difference in the way of education to women in Acadiana of their risk of heart disease.