By Marsha Shuler
Capitol news bureau
September 05, 2012
The state health agency is running into trouble getting federal approval of a key element in the Jindal administration’s plan to close LSU’s Earl K. Long Medical Center in Baton Rouge.
At stake is future financing for the Earl K. Long outpatient clinics as the hospital closes and inpatient care and medical education move in 2014 to Our Lady of the Lake Regional Medical Center.
The four outpatient clinics operating as part of the LSU facility on Airline Highway are called provider-based clinics. As such, they are able to get federal reimbursement for uninsured care, including payment of physicians and physicians in training who deliver that care.
With the closure of the Earl K. Long medical center, the clinics would lose their provider base and with it operational funds.
The state months ago submitted a proposal to fix the problem under which LSU would continue to operate the Baton Rouge clinics, but under the auspices of LSU’s University Medical Center in Lafayette.
But federal Centers for Medicare and Medicaid Services, called CMS, reviewers recently advised officials that they will not approve the change, state Department of Health and Hospitals Undersecretary Jerry Phillips said.
Phillips said CMS had previously indicated that the plan would meet muster and the state Department of Health and Hospitals had expected approval by July 16. He said DHH argued that federal officials should look at the LSU system of hospitals as it looked at the clinic issue.
“They are LSU patients and part of the LSU System,” Phillips said. “It’s a discussion about integration of health services.”
But CMS is taking a more narrow approach, Phillips said. “They are saying the actual referral (of patients) has to be to primary the hospital proper,” he said. “Now CMS is changing the focus to where people are going to be (seen).” In the Baton Rouge case, it will be the Lake — not UMC in Lafayette, he said.
Phillips said a letter is being sent to the head of the federal CMS agency seeking guidance.
“CMS needs to give us a final answer on what is allowed here,” Phillips added. Then, he said, the state can adjust its planning accordingly. “What are the alternatives?” he asked. “We have to have these clinics.”
Earl K. Long-affiliated primary care clinics report nearly 200,000 outpatient encounters annually and more than 115,000 outpatient clinic visits.
An ultimate resolution between state and federal agency officials in the Baton Rouge hospital case also could have an effect on administration plans for private takeover of inpatient beds at other LSU hospitals. Those too would have to determine a funding stream for delivery of outpatient services.
“It’s a problem across the state as we pursue public-private partnerships,” LSU System President William Jenkins said. “This is a very important decision for us.
“What has to be worked out is the reimbursement,” Jenkins said.
On the immediate horizon is discussion with private hospitals to take over inpatient care currently delivered at W.O. Moss Regional Medical Center in Lake Charles. LSU would continue to operate outpatient clinics under the proposal.
The clinics, like the LSU Earl K. Long Regional Medical Center’s, are attached to the Lake Charles hospital, through which money flows for their operations.
Phillips said discussions have not yet begun with CMS on the Moss situation.
State Sen. Sharon Broome, D-Baton Rouge, said she is not surprised by the federal CMS rejection of the Earl K. Long clinic proposal.
“The time it has taken to get a response was an indicator that this is not the best route we need to take,” said Broome, in whose district the hospital sits. “It confirms some of my original concern about the whole (LSU-Lake) merger and the urgency of doing that merger without all the i’s dotted and t’s crossed.”
Broome said the clinics are a “very vital part of health care delivery ... If that is not assured and secured, then we have a major challenge. I don’t think we have any alternative but to try to find a way to work it out.”
LSU Earl K. Long outpatient facilities are the North Baton Rouge Clinic off Airline Highway, the Mid-City Clinic on North Foster Drive, the South Baton Rouge Clinic off Perkins Road and the Leo S. Butler Clinic on East Washington Street.
The clinic funding issue is one of three hurdles identified early on that had to be resolved as a result of the closure of the LSU Earl K. Long Regional Medical Center in north Baton Rouge.
Also remaining in limbo is who is going to provide the prisoner care currently delivered at the Earl K. Long facility. Prisoner care was not a part of the Lake deal.
LSU officials resolved the issue of obstetrics and gynecological care, which also was not included in the deal when the Lake reached an agreement with Woman’s Hospital in Baton Rouge.