Since Hurricane Katrina hit more than two years ago, the healthcare system in New Orleans has been in critical condition. Doctors and hospitals have absorbed patients, both insured and uninsured, who previously relied on the Charity system in the greater New Orleans area. The increased patient loads have challenged physicians and nurses and resulted in increases in emergency room visits and longer wait times for patients.
Not that everything in the healthcare arena was great before then.
Louisiana ranks 46th in overall health status, 51st in avoidable hospital usage and costs, 3rd in emergency room visits and 4th in prescription drug usage. Prior to Hurricanes Katrina and Rita, Louisiana had a higher proportion of uninsured adult residents than almost any other state. The traditional “safety net” system was expensive and inadequate before the hurricane; with the continued closure of CharityHospital in New Orleans, it is simply not functioning.
The hurricanes that caused so much destruction have given Louisiana the opportunity to fix a broken system. It’s time for a change.
A new group of experts has developed a plan to revamp healthcare delivery in the greater New Orleans area. The Coalition of Leaders for Louisiana Healthcare (COLLAH) represents all facets of healthcare in the state—from doctors, insurers and hospitals to consumers and businesses. It has a plan to cure the woes still facing the residents of New Orleans, one that can serve as a model for all of Louisiana.
COLLAH’s “Access to Coverage, Access to Care” plan is a voluntary program that would offer 80,000 uninsured adults living under 200 percent of the federal poverty level access to personalized care through a comprehensive coverage program (called RightCare) backstopped by ongoing funding for safety net care.
Patients who enroll in RightCare will receive comprehensive care, specialized and hospital-based treatment, coordinated by a primary care physician in a “medical home.” Health information technology will facilitate reporting of services and ensure that patients are receiving coordinated, quality care. When it is rebuilt, the Medical Center of Louisiana – New Orleans, along with community hospitals and private clinics, will compete for and be accessible by RightCare enrollees and any patients who remain dependent on a “safety net” of care. The emphasis on primary care will reduce avoidable hospitalization and utilization of emergency rooms, both of which are sadly more the rule than the exception in the state.
The roots of this group can be traced to the Louisiana Health Care Redesign Collaborative, the concepts of which were widely supported and endorsed by the governor, the Legislature, the Louisiana Department of Health and Hospitals (DHH), the U.S. Department of Health and Human Services (HHS), LSU and Tulane. Many members of COLLAH were key participants in the Collaborative. COLLAH’s plan picks up where the Collaborative’s study left off; state subsidies and federal matching dollars make “Access to Coverage, Access to Care” affordable.
So what’s next? The plan will require state and federal approval. There is no better time to push for reform than now. Governor-elect Jindal’s background with DHH and HHS give him the opportunity to be the “healthcare governor.”
The Legislature, even with (or perhaps because of) all the new faces, is primed for reform. Additionally, the passage of Senate Bill 1 in the past legislative session has set the stage for many of the ideas outlined by COLLAH.
During the recent elections, the words “reform” and “change” have been heard on the lips of candidates both old and new. It’s time for them to put their campaign promises into action and create a healthcare system that works for all Louisiana patients.
by Dan Juneau, President of Louisiana Business and Industry
One group Dan Juneau left out is the uninsured. The lack of representation in decisionmaking from the uninsured, coupled with the outrage use of Hurricane Katrina to keep Big Charity Hospital closed spells doom for the uninsured and working poor of Louisiana.
The Louisiana Healthcare Redesign Collaborative was for the most part another attempt to use the closure of Charity Hospital to privatize public healthcare. There was also a failure to look at the incredible cost and poor outcomes for medicare-eligible patients -- who mostly have received health care in Louisiana's private hospitals.
The two bright spots on the Louisiana Healthcare Redesign Collaborative are unfortunately largely being ignored: Medical homes and short-term priorities. Implementation of a "Medical Home" model for primary and preventive healthcare for the uninsured can only happen if a baseline commitment of coverage is guaranteed. One example is using the Charity Hospital system model of qualifying those with incomes up to 200% of the poverty line (even the much touted "Massachusetts Universal Healthcare Plan" grants free guaranteed healthcare for those with incomes up to 300% of the poverty line). Use of the emergency room for care currently is the only option for most uninsured patients because primary preventive care is priced out-of-reach for the working poor.
Louisiana State Representative Cheryl Gray ably chaired the Louisiana Healthcare Redesign Collaborative's "Short-term Priorities Committee". Their foremost demand is to restore health services to pre-Katrina levels. If LSU or the state will not reopen Charity Hospital, they say, then provide the full replacement for the servicess and facilities Big Charity provided. The failure of LSU and the state to do this is a major reason why the health crisis is GETTING WORSE TWO YEARS AFTER KATRINA. Unfortunately Rep. Gray and mental health professionals on the committee's pleas are being virtually ignored.
For the record we must also empathetically note that both Big Charity's medical staff and the US military had the first three floors of Big Charity ready to reopen less than one month after Hurricane Katrina. The basement was drained of floodwaters by engineers from Germany. The ruined electrical switched were bypassed to new ones placed on Big CHarity's third floor (showing that the state had actually prepared for such a disaster!) and reconnected. Sanitation and air conditioning were restored. Yet Charity workers were threatened with trespass if they continued to restore Big Charity for reopening -- forcing them and returning patients into outdoor "E-MED" tents in a dusty parking lot across from University Hospital. Big Charity's closure demands a thorough Louisiana and US Congressional investigation. The New Orleans City Council demanded as much May 17, 2007 in asking Attorney General Charles Foti, Jr. to issus a legal opinion on Act 906, 2003 Regular Louisiana Legislative Session, which mandates that LSU receive permission for the state legislature to close a hospital or an emergency room --something they have never received. Indeed, the Louisiana House and Senate passed HCR 89, 2006 Regular Session, which demanded Big Charity Hospital's reopening on an interim basis and an independent architectural and engineering inspection of the facility --never of which has happened.
Governor-elect Jindal, if he's truly interested in "ethics reform" must investigate the closure of Big Charity Hospital. It has been grossly unethical to keep shut an otherwise vital healthcare facility in the wake of America's worst urban health crisis in nearly a century.
-- K Brad Ott
Charity Hospital system outpatient
Member, Region 1 Health Care Consortium
Co-Chair, R1HCC's "Care for the Uninsured" subcommittee
Written by K. Brad Ott
on 11/11/2007
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The broken health care system is screaming for obvious help, especially post Katrina. Read the daily obits which have skyrocketed since the storm. Is it a coincidence that there seems to be more deaths though there are less residents?
Or is it a result of a severely ailing health care system that is overloaded or severe long term stress from Katrina or a combination thereof that produces such an abundant amount of deaths for 2 plus years and continuing? We need help! Ball park estimates using the daily obits shows a very rough estimate of about 16,000 deaths a year in the area. Kind of scary! Why doesn't anyone speak about the sky high death rates locally since the storm??? Written by Watchdog
on 11/9/2007
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