New Orleans health commissioner says Landrieu administration ...

New Orleans officials are bracing for steep cuts to the LSU-run public hospital system, anticipating that that uninsured patients will experience reduced access to health care reminiscent of the years after Hurricane Katrina, the city's health commissioner said this week. "That is what I'm preparing for -- the amount of service reduction and the limits on access to care that we had after Katrina," said Dr. Karen DeSalvo in an interview.

After the storm, DeSalvo and others helped build a network of clinics to provide primary care to the uninsured and Medicaid patients, who had previously relied on the Charity Hospital in downtown New Orleans for much of their care. But despite the growth of primary care access in the metropolitan area in recent years, these patients still rely on the Interim LSU Public Hospital and associated clinics when they need to see specialists.

DeSalvo said Mayor Mitch Landrieu's administration has expressed its concerns to Gov. Bobby Jindal's staff, as well as leaders at the state Department of Health and Hospitals and LSU, which runs the 10 hospitals and their clinics.

Bruce Greenstein, the DHH secretary, said the comparison to after Katrina isn't fair or apt, in large part because of the primary care clinics, which the state helps support through a federal Medicaid waiver. While he acknowledged there will be "contraction in clinical operation and fewer beds" at the LSU hospital, he said efficiencies will result in better patient care.

Dr. Frank Opelka, who was recently selected by the LSU Board of Supervisors to run the system, said crafting LSU's cuts is the first step, but the next one will be taking the system in a new direction by partnering with local health care providers. He is scheduled to outline the latest round of cuts to legislative committees and the LSU Board on Thursday.

Opelka said leaders of each hospital are running a variety of scenarios for reductions. The cuts will be made to ensure that no hospital is closed and graduate medical education is preserved, to the maximum extent possible, he added.

In places where the budget cutbacks reduce or eliminate services, the system is looking to enter into partnerships with private health care providers to take over those services, Opelka said.

While the cuts are being made with such agreements in mind, the partnerships are all still in the discussion phase and won't be announced at the LSU Board meeting, he said. The description of the cuts for each hospital will be presented to the board as a "high level overview," he said.

Instead of reducing needed services, DeSalvo said Landrieu, a Democrat, wants the governor to find new revenue sources, such as a tobacco tax, to support the health care safety net.

Jindal, a Republican, has made clear in recent years that he is opposed to increasing taxes. "We are not interested in and will not be raising taxes," Greenstein said.

The latest budget slashing, which began this summer, was prompted by a reduction in the amount of federal Medicaid dollars Louisiana receives. The Jindal administration decided the LSU system would need to absorb most of the cut, amounting to more than $300 million. But Dr. Fred Cerise -- the former leader of the LSU Health system, who was replaced by Opelka -- staved off much of the immediate hit by finding one-time money to fill in the gaps.

When Opelka took the helm in early September, he announced the system would take a fresh look at cutting deeper in response to anticipated long-term funding shortages

In the last round of cuts, LSU officials prioritized preserving the training grounds for medical residents, which minimized the cuts at the Interim LSU Public Hospital in New Orleans compared to other public hospitals around the state. Still, LSU figures show the number of staffed beds at the facility dropped from 240 in October 2011 to 187 in June.

DeSalvo said she expects further reductions with the next round of cutbacks.

"I'm concerned about specialty access; I'm concerned about inpatient access for surgeries for people who need their gallbladder out and don't have insurance," DeSalvo said. "It's going to be hard to find an alternative place to go."

DeSalvo and others in New Orleans had expressed concerns about possible cuts to the number of psychiatric beds, which already shrank in March when LSU cut half of the emergency mental health beds, some inpatient beds and the chemical detox unit. While Opelka said some mental health reductions were originally contemplated, Greenstein said all psychiatric inpatient beds provided through LSU will be preserved.

DeSalvo, who has taught at the Tulane University School of Medicine, said bed cutbacks could pose a problem for accreditation of the two graduate medical programs in New Orleans, which traditionally have relied on public hospitals for training residents.

Last month, Opelka said the Tulane and LSU medical schools will need to refocus training to community-based and other outpatient programs, an increasingly common practice in medical education. While DeSalvo, a primary care advocate, agreed that shifting focus to outpatient training makes sense over the long term, she said residency programs are accredited and financed based on hospital beds.

Both Opelka and Greenstein said they expect that LSU will continue to shift residency programs to private community hospitals, something that has been under way for years.

Source: http://www.nola.com/health/index.ssf/2012/10/new_orleans_health_commissione.html

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