Hospital funding change sparks problems

State takes away money for surgery

The state suddenly yanked funding for surgery for uninsured women at Woman’s Hospital, leaving a health care access problem as services end at LSU Earl K. Long Medical Center.

“My great fear is women who need what they call ‘elective’ surgery, not getting it in a timely manner and some will die,” said state Rep. Regina Barrow, D-Baton Rouge. She said she knows of at least one case that became “life-threatening” before surgery could be arranged.

Barrow said explanations from LSU about what transpired and why, have not been very clear. “The funding was there for this and then the money was taken away from Woman’s and reallocated,” she said.

State Sen. Sharon Broome said women who had been receiving health care at the Earl K. Long facility were supposed to get the same access or better access to care with the transition to Woman’s Hospital.

“Now we are finding the opposite,” said Broome, D-Baton Rouge.

LSU System Executive Vice President Frank Opelka disagreed with the characterization of how the problem developed.

Under a public-private partnership, Our Lady of the Lake Regional Medical Center would become home to LSU patient care and medical education. But the Lake didn’t want to handle obstetrics and gynecological services, called OB-GYN, or prisoner care.

Woman’s agreed to take over OB-GYN services last April -—nearly 18 months ahead of the original late 2013 closure of the Earl K. Long facility. LSU recently pushed up the closure to mid-April

“It was a good faith attempt to respond to LSU’s needs. We agreed to take these patients sooner than expected based on there being bridge funding,” said Teri Fontenot, Woman’s Hospital chief executive officer.

“We were notified in late October the source of funding was being redirected,” Fontenot said. “That’s why we are not scheduling non-emergency surgeries ... If it was an emergency, we would be doing it. These are uninsured elective surgery cases through LSU residency.”

Broome said a lot of questions have gone unanswered surrounding the closure of the Earl K. Long facility, including access to health care, which have not been resolved.

“In the conversion process while we did not have everything in place there were some things we thought we had in place such as Woman’s taking over,” Broome said. “It becomes even more problematic if the things we had in place start unraveling. It causes alarm and concern.”

State Department of Health and Hospitals Secretary Bruce Greenstein said three-way discussions involving his agency, LSU and Woman’s began this week and are aimed at resolving the access problem.

“We are working on ways to finance it in a reasonable way,” said Greenstein. “We have some work to do to address this gap.”

“Every single case is extremely important and most of the time, time-sensitive,” Greenstein said. He said surgeries are non-emergency that must be scheduled such as hysterectomies for a variety of reasons.

Greenstein said the problem occurred as the state looked for new private sector partners to participate in the Low Income Needy Care Collaboration Agreement program, called LINCCA. Private hospitals sign agreements with state or local governmental entities to provide certain health care services.

“Instead of us not utilizing the capacity, I made the decision to take that extra capacity and bring it to Woman’s Hospital,” Greenstein said. “We had to move that back to where it needed to go, so that’s the reduction.”

Opelka said LSU has been working on individual cases as they crop up. He said he found out about the problems earlier this year as Broome and Barrow complained about the barrier to surgery their constituents have been running into.

“When it came to my attention I said ‘what’s going on?’” he said.

Opelka said Woman’s receives reimbursement for LSU programs under the major teaching hospital status, with OB-GYN residency programs located there. He said that translates into a higher Medicaid reimbursement for services. In addition, Opelka said there are LINCCA contracts under which Woman’s receive dollars to care for vulnerable patients.

Greenstein said there are women who are uninsured who have income above 200 percent of poverty and cannot qualify for Medicaid and for whatever reason have not taken advantage of insurance.

“Traditionally they went to Earl K. Long for access to care,” he said.

“We are now going to be working with them to get the right kind of financing for care and try to get women to get insurance,” Greenstein said.

In some cases, the women may qualify for Medicaid or premium assistance, he said.