The Gov. Bobby
Jindal Administration continues to make lemonade out of lemons, as the hit
the state takes from Congress
deciding to stop favoring it on Medicaid reimbursement provides another
opportunity for the governor to push along the needed revamp of care to the
indigent, and even finally wean the state off its inefficient model that makes
government the primary provider of health care.
As head of the Department of Health and Hospitals 15 years ago, Jindal
saw firsthand the tremendous inefficiency of a health care system based upon
primary care provided large institutions – the country’s only such system where
a number of state-owned hospitals provided this for those on Medicaid. Then as
now dealing with a budgetary imperative, he began to wrench efficiency into the
system, the process of which would continue under the oversight of others when
he left the job, although very slowly if at all under the appointees of his predecessor
to him as governor.
The pace picked up again when he became governor. Although he could
created more efficiencies by making it smaller, the replacement for the
state’s hospital in New Orleans, ravaged by Hurricane Katrina, at least was
downsized from earlier versions in some recognition of the smaller role the
state should play in direct provision of indigent care beyond that needed for
its use as a teaching hospital. He also got the Legislature, which must approve
of closures, to go along with closing
the aging hospital in Baton Rouge, having its service performed by private
providers contracted to the state.
While he seemed hesitant at times to abandon the money-goes-to-the-institution
model, perhaps this was because of the politics involved of legislative
involvement, particularly the populist uses of these facilities by some
legislators who see them more as opportunities to claim they brought jobs to
their districts than as part of a holistic health care strategy. After securing
reelection, the reform pace quickened with the introduction of the Bayou Health
initiative, where money follows the patient, still being rolled out that makes
Medicaid more like an insurance service where private providers are expected to
become increasingly the providers of choice for clients.
Some cuts came to these facilities earlier this year because of a
mid-year budget correction. And now more and larger ones will as a result of
the surprise
action by Congress to strip extra and accidental funding the state had
received from the federal government for Medicaid. (In fact, because of the
complexity of the fiscal aspect of the program stemming from using the charity
system for primary care, the state actually had
the same basic thing happen, overcompensation, some years earlier but
rather than not getting funds, it had to pay some back last year.)
To cope, the brunt of the reductions this time will come from the
charity system, although some will come from other programmatic areas, even
from Bayou Health plan administrators themselves. Notably, little relatively
comes from private sector providers of Medicaid waiver services and, outside of
government, mainly from the declining,
over-capacity nursing home industry that already gets subsidized for empty beds,
and non-state hospitals.
While the details are left to the governing agency of the hospitals,
the Louisiana State University System, as state Sen. Dan Claitor deduced, the
opportunity has presented itself perhaps to break the back of populist
resistance to dismantling the charity regime. Cuts in services, some of low
priority, others addressing more necessity but which will be curtailed in
availability, will encourage the indigent to visit the more efficient providers
outside of the government sector. This will make, with their existing
infrastructures, the charity hospitals even less efficient in care provision
than they have been. Eventually, this could lead to the shared recognition even
among the big government holdouts in the Legislature that the proper number of
state hospitals should be the pair primary designed for teaching, in New
Orleans and Shreveport and the state could sell or lease the remainder.
As long as DHH takes care to make sure the additional flow of Medicaid
clients through Bayou Health to non-government facilities is handled smoothly,
there shouldn’t be much drop off in care. And in the long run, this should
prove an excellent preemptive move to offset declining federal reimbursements
to the state courtesy of the Pres. Barack Obama-inspired
increased federal government involvement in health care, where state-run
hospitals would absorb a disproportionate impact.
No comments:
Post a Comment