The Road to Wellville

by Jeremy Alford

Foundations and industry groups continue to throw support and cash to an aggressive, private health care study, while legislators ignore the effort.

Ponder the current condition of Louisiana health care long enough, and it'll give you an ulcer.

The state's notoriously shaky medical facilities and resources plunged into dire condition post-Katrina and Rita, raising serious issues about Louisiana's ability to care for its citizens ' especially individuals and families lacking the financial resources to purchase medication and insurance. The charity hospital system was upended by Katrina's decimation of New Orleans' flagship Charity Hospital; countless medical records were lost in the floods; post-traumatic stress disorder plagues thousands of Louisiana citizens; suicide rates have gone up alarmingly; and hospitals face a severe personnel shortage.

And like much of the rebuilding process, the private sector isn't waiting around for a magic elixir. A consortium of private groups is helping pour approximately $2 million over the next year into the Public Affairs Research Council to fund a comprehensive health care study and research position. Their work's already begun, with a lead gift of $200,000 from the Franciscan Missionaries enabling PAR to tap David Hood, former secretary of the Louisiana Department of Health and Hospitals, as the organization's senior health care policy analyst.

The first briefing from the long-term study was recently issued, and school associations, business lobbyists and industry groups are backing PAR's recommendations. Yet others seem hell-bent on ignoring the effort. The Legislature has yet to take an interest in the undertaking, says PAR President Jim Brandt, whose nonprofit agency monitors state government.

"We have had no response from lawmakers, which is unfortunate," Brandt says. "They aren't interested in talking about this. We thought we would have heard something by now."

Gov. Kathleen Blanco and other state officials hosted the Governor's Healthcare Summit two years ago to garner ideas, one of which was the formation of the Governor's Healthcare Forum. As a result, regional hearings have been held all over the state ' but tangible results are hard to find.

Meanwhile, PAR's initial findings reveal a dysfunctional structure ripe for reform. On a national level, Louisiana is a high-spending state, but in its study, PAR could not locate a single health care area where the money was being used efficiently. And more times than not, sacrifices were made on the backs of patients.

"Louisiana's health care system is organized to deliver inefficient institutional care at the expense of primary and preventive care," Brandt says. "Spending priorities in the health budget are focused on institutions and providers, rather than patients." The study concludes that Louisiana lacks the infrastructure to provide patients ' especially the uninsured population ' with basic health care services. To reverse that trend, PAR recommends the following immediate actions:

â?¢ Transfer certain emergency room visits to a doctor's office or clinic, saving around $300 per case. If one-half of all non-emergency ER visits were diverted in this fashion, the state would save $40 million annually.

â?¢ Establish an initial investment of $50 million in state or federal grant money to help develop new health centers and clinics around the state, specifically in the hurricane-ravaged areas.

â?¢ To assist with the extraordinary expenses related to treating Medicaid patients, the state should bankroll $36 million over three years to phase in a major Medicaid fee increase for primary care physicians and other doctors. The bottom-line result could be more people seeing more doctors.

â?¢ Restore medical care to rural parishes and other underserved areas by providing incentives for primary care physicians to practice in those locations. This would require an initial investment of $25 million in state or federal grant money.

â?¢ Relax practice requirements for non-physician clinicians or mid-level practitioners to enable them to practice independently in some cases.

â?¢ Provide no-interest loans to physicians in the Greater New Orleans region to assist them in re-establishing their medical practices.

They're lofty goals with a hefty price tag, but they've caught the attention of the Louisiana Association of Business and Industry, one of the state's most influential lobbying organizations. In particular, CEO Dan Juneau notes that the state's archaic Charity Hospital delivery system model was experiencing a steep decline in patients in the years leading up to the storms. At the same time, private hospitals were seeing a large influx of uninsured patients streaming into their emergency rooms for basic care.

"Our illogical system of government-focused healthcare has given strong indications of an impending disaster for a long time," Juneau says. "PAR makes a strong case that the time to act is now ' and the reforms needed are very apparent."

A recommendation to double the enrollment in school-based health centers also earned praise from the Louisiana Assembly on School-Based Health Care. The group recently urged the state to consider PAR's $10 million recommendation to develop more school-based health centers. "The PAR Report gets it exactly right in terms of school-based health," says Angie Ruiz, LASBHC president. "School-based health is a cost effective way to deliver quality health care to youth. They're a captured audience at a school, so they are more likely to actually get the physical or come in for the immunizations they need."

PAR's ongoing capital campaign will also fund other health care briefings in the coming year, addressing issues such as providing for the uninsured; long-term care for the elderly and disabled; and state Medicaid spending. The Baton Rouge Area Foundation, Community Foundation of Shreveport-Bossier, Ella West Freeman Foundation, Keller Family Foundation and the RosaMary Foundation have all contributed to PAR's campaign.

Another eight to 10 briefings are planned, with the second one arriving later this month. Brandt can't predict beyond that, as the effort is dependent on outside funding. But the results have already proven more beneficial than waiting on the results of another government forum.

"That's probably why we have been able to make an impact and bring something to the discussion immediately," he says.