Goal #4: Transition Louisiana’s Charity Hospitals to Public-Private Partnerships
The Problem
In 2010, Louisiana was rated 49th on America’s Health Rankings,71 and roughly 880,000 individuals have no health insurance.72 Louisiana maintains a unique
health care model, caring for the uninsured in 10 centralized, state-run hospitals—a tradition described by national experts as “at best antiquated.”73 Numerous
non-governmental organizations and research institutions have been advocating for changes to the “two-tiered” system of care for years, citing inefficiencies and
ineffectiveness in this system.74
HEA
LTH
C
SMA
R
CRI T ON
ME
ARE
Implementation of the Patient Protection and Affordable Care Act will force this decision to the forefront. Medicaid and the Louisiana Children’s
Insurance Program (LaCHIP) already provide coverage for 1.2 million people.75 At full implementation, federal health care reform will extend coverage
to an additional 645,000 people—some who are uninsured today and others who will switch from existing plans.76 While this will significantly reduce the
numbers of uninsured in Louisiana, it will come at considerable cost to the federal and state government. Early estimates indicate an additional $4 billion
annually.77
Louisiana currently relies on federal Disproportionate Share Hospital (DSH) dollars to fund charity
hospitals at a rate more than three times the national average.78 However, these funds will decrease as
Medicaid enrollment dramatically increases in 2014 under federal health care reform. As DSH funding
began to diminish in recent years, Louisiana has back-stopped charity hospitals with unmatched State
General Fund—$100 million in Fiscal Year 2011 and another $36 million in Fiscal Year 2012.79 When even
the federal government is dis-incentivizing this “antiquated” model in favor of insuring patients and providing
them with a choice, Louisiana simply can’t afford not to change.
It’s going to be Darwinism at its
most abrupt.
– Congressman Bill Cassidy, physician at
Earl K. Long, referencing the impact of
federal health care reform on Louisiana’s
charity hospital system in The New York
Times, December 2009
The Solution
Significant progress away from state-run institutions has been achieved in recent years, namely the network of primary care clinics in New Orleans and the new
relationship in Baton Rouge between Our Lady of the Lake Regional Medical Center and Earl K. Long Hospital. These types of initiatives should be applauded as
in-state best-practice models. The state should now take the lead to encourage other regional partnerships based on this success.
Page 15 of 23
SUPERVISING ARCHITECTS: THE CITIZENS OF LOUISIANA
FOR ADDITIONAL SPECS: BLUEPRINTLOUISIANA.ORG
225-408-1965 . Toll Free 1-866-483-3920
Blueprint Louisiana is a citizen-driven effort to identify and
implement essential changes to fundamentally improve Louisiana.
The Blueprint for Action
1 • Create and expand public-private partnerships in sites with low-inpatient admissions near private facilities with capacity. This effort should begin with
Dr. Walter O. Moss Regional Medical Center in Lake Charles and Huey P. Long Medical Center in Alexandria. Similar to the Baton Rouge model, access to care
should be prioritized in urgent care and out-patient clinics, while specialized and emergency care transitions to private facilities. Both of these institutions have a high rate of empty beds, cited by experts as a cost of health care borne by the community.80 Both hospitals also rank highest
among the 10 Louisiana State University (LSU) hospitals with regard to their reliance on State General Fund for operating revenues.81 And both have private
hospitals nearby with hundreds of licensed beds to treat additional patients.82
At the same time, the state should continue to maintain and improve teaching hospitals at medical school sites in New Orleans and Shreveport. LSU holds a dual
mission to run the state’s charity hospital system and to educate and train Louisiana’s health-care workforce. By increasing private partnerships and exploring
local governance options in other areas of the state, LSU’s mandate can be more focused on providing medical education, conducting research, and offering
specialized patient care. This includes a well-planned and financed facility in New Orleans,
which is critical both to the mission of graduating highly-qualified doctors that will stay in
Comparison of Revenue Sources:
Louisiana and to expanding patient mix to include private insurance and Medicare patients.
LSU Shreveport with Huey P. Long and
W.O. Moss Medical Centers83
100
90
80
Other
In Percentages
70
State General Fund Direct
Self-Generated
60
Medicare Claims
50
Medicaid Claims
Medicaid UCC
40
30
20
10
0
SUPERVISING ARCHITECTS: THE CITIZENS OF LOUISIANA
FOR ADDITIONAL SPECS: BLUEPRINTLOUISIANA.ORG
225-408-1965 . Toll Free 1-866-483-3920
LSU
Huey P. Long
Shreveport
Moss
Blueprint Louisiana is a citizen-driven effort to identify and
implement essential changes to fundamentally improve Louisiana.
Page 16 of 23