Demoting old hands needed to achieve deisrable change

With the departure of another high-level executive from Louisiana State University’s hospital and medical division, that indicates the necessary change in culture is occurring to improve system performance and to have it operate more efficiently.

While the old hands being replaced, first Fred Cerise by the Board of Supervisors and then with his replacement Frank Opelka informing Cerise’s immediate subordinate Roxanne Townsend that he was replacing her choices to head up some system hospitals triggering her resignation, unfortunately experience goes with them that might be useful as the system begins its long-overdue transformation from state-supported provider to quasi-public status and hopefully beyond. Former Gov. Kathleen Blanco indicated as such when she opined about Cerise’s departure that “I think they made a terrible mistake firing Fred Cerise, a man with so much integrity and so much knowledge on how to serve people”

No doubt – if you are invested in a government-run health care model for the indigent, as was Blanco and her allies and former appointees Cerise and Townsend. But that is a deviant model among the states, with no other state sharing the charity model foisted upon the state over 75 years ago, and for good reason, as it has produced low outcomes at high cost. And for that same reason it’s not the model that the Gov. Bobby Jindal Administration wishes to follow.

Decades of experience in the system are useful. Yet with fundamental system transformation in progress, that experience shaped by the old becomes less valuable as the old disappears. Indeed, having been immersed in the old makes one less able to be open to the new. And it becomes more trouble than it’s worth if those with that experience are not committed to the beneficial transformation. At some point, insufficient fervor over the new model on the part of Cerise and Townsend must have overridden whatever helpful contributions they could have made in their former positions (they remain in the system) or else they would have been retained.

One example of where the old retards the new is with the transition of indigent health care from the Earl K. Long facility in Baton Rouge scheduled to be closed in 2014. While most services have been contracted out upon closure, final disposition of prisoner care remains unresolved. Also and of greater impact, the four outpatient clinics governed by the closing facility under a recent federal government ruling will not be eligible for federal reimbursement under the proposed governance structure (which was under the auspices of the charity hospital in Lafayette, University Medical Center). Funding eligibility occurs when clinics are attached to a qualified hospital, and LSU wishes to keep the clinics under its umbrella.

Unlike in rural areas or in schools, for this kind of reimbursement the provider must be public or nonprofit. Thus LSU either must have the clinics taken over by area nonprofit providers, or a city/parish unit, or have them operate not at all. Any of these alternatives they are out of the system, which goes against the cultural grain of it, even as the evolving Bayou Health system provides a strong incentive for government to take the last option in its casting off the direct provision strategy entirely (except for medical education).

Change of a system where $7 billion passes through annually does not happen overnight, but trying to graft a hybrid in the interim will work only to slow unnecessarily. Here perhaps the demoted served too much as a brake in system evolution and, despite the assets they could bring to it, if focused on transition rather than transformation, they may better serve the system in other capacities.