Legislature, LSU system should listen to Regents

Another, not inconsiderable, factor has entered into the debate about Louisiana health care redesign – the state Board of Regents, significant because it governs budgets and academic affairs concerning the LSU system which runs the charity hospital system in the state. Yet another waits to be heard from.

As the state is being nudged, somewhat forcefully, by the federal government to restructure its archaic, inefficient, institution-heavy system of health care for the indigent, the LSU Board of Supervisors has fought the idea of eliminating the charity system. In most of the hospitals, care is below comparable community standards, programs are fragmented, and patients are forced to travel long distances to access care. The federal government wishes the state to move to a model where money follows the patient, meaning any hospital can provide indigent care at adequate reimbursement rates but which likely would mean the state government exiting ownership and operation of a majority of those public facilities.

But the Supervisors don’t want to follow this sensible path, despite a recommendation from the Regents that they do so because trying to run an indigent health care system the Regents claim dilutes LSU’s ability to pursue its primary function regarding these hospitals, medical education. In response, the Supervisors say the Regents have no authority over the hospitals and they are doing a good job running things. However, the Regents are correct – anything administrative that distracts from medical education cannot be a good thing, and the Regents do have the right to oversee that. (This dispute wouldn’t exist if Louisiana didn’t have such a convoluted system governing higher education – just like with the charity system, no other state in the union does things this way.)

That answer masks the real reason the LSU system wishes to keep as many of the hospitals as it can: money, in the form of reimbursements for indigent care – although if you asked some of the individual facilities, they might wish to free of the system, because typically surpluses a hospital makes from reimbursements exceeding costs get redirected back into the system. The more charity business the system can do, the more potentially it could redirect funds.

Of course, two could play this game if the Supervisors defy the Regents on this. For budgeting, the Regents could start cutting funds going to medical education, denying the system the extra funding, in essence, since these funds would have to be spent on medical education at that institution. But, ultimately, the single biggest factor, the state Legislature, would be the one that will have set policy and budgets for higher education as well as indigent care.

Which is why the following needs to be done by the Legislature, acknowledging that the Regents are correct on this issue:

Keep LSU Medical Center Shreveport, E.A. Conway (Monroe), Medical Center of Louisiana New Orleans (better known as “Big Charity”), University Medical Center (Lafayette), and W.O. Moss (Lake Charles) in a system run by LSU

Divest the state of all others (including cancelling any plans to build a new facility in Baton Rouge to replace the aged Earl K. Long facility)

Realign medical education so that each advanced program is taught at just one of these five institutions

Rebuild Big Charity but on a smaller scale than currently envisioned, to take into account the reality of a much smaller population base to be served

After this realignment, immediately start redirecting health care dollars for the indigent to the patients themselves, usable at any private or public facility that meets the records management criterion of the health care redesign panel

Naturally, this obviously more efficient means of providing indigent health care requires political will focused on better care for fewer dollars, not in sharing the wealth – a quality Louisiana government historically has had in short supply.