This morning, the Louisiana Department of Health (DHH) notified the federal Centers for Medicare and Medicaid Services (CMS) that all parties had signed the revised public-private partnership agreements that now govern the operation of five former LSU hospitals and affiliated clinics across Louisiana. Copies of the agreements were provided to the federal agency as part of LDH's official response to CMS's earlier inquiry.
Earlier this year, LDH submitted to CMS a revised state plan amendment (SPA) in response to an earlier denial by CMS of pending SPAs that governed payments to the public-private partnerships. LDH worked diligently to craft a new reimbursement methodology that addressed concerns raised by the federal agency.
The revised SPA, transmittal number 14-25, amends Medicaid state plan provisions governing Disproportionate Share Hospital (DSH) payments in order to establish payments to a new category of hospitals, called Louisiana Low-Income Academic Hospitals. On August 19, 2014, CMS provided the state with a request for additional information (RAI), which formally halted the 90-day review clock. In response to questions raised in that RAI, the State has revised its agreements with the partner entities. Specifically, the revised agreements include those with:
- Louisiana Children's Medical Center (partner) and University Medical Center Management Corporation (operating subsidiary)
- Biomedical Research Foundation of Northwest Louisiana (partner) and BRF Hospital Holdings, L.L.C. (operating subsidiary)
- Lafayette General Health System (partner) and University Hospital and Clinics (operating subsidiary)
- Our Lady of the Angels Hospital, Inc. (partner)
- Southwest Louisiana Hospital Association d/b/a Lake Charles Memorial Hospital (partner)
The revised agreements address concerns raised by CMS regarding funding provisions in the CEAs. Payments to hospital partners will now be governed entirely by the Louisiana Low-Income Academic Hospitals methodology in the Medicaid state plan, rather than funding provisions of the CEA. LDH provided executed copies of the amended agreements to CMS as part of its official response to the August 19, 2014 RAI. This action officially restarts the 90-day review clock, though LDH anticipates a faster decision as the department earlier provided CMS with copies of the amended but unsigned agreements.
"These changes directly address concerns raised by CMS, and early feedback we havereceived from our federal partners strongly favors a speedy review and approval," said LDH Secretary Kathy Kliebert. "The evidence that these partnerships are improving quality and access to care has never been greater, and we are excited to be moving forward on strong footing into this new era of health care in Louisiana."
For a copy of the response to CMS, including copies of the revised agreements, click here.
It is clear that the public-private partnerships are transforming the delivery of care to residents by increasing access to primary and specialty care as well as emergency and urgent care. Some of the most recent achievements include:
- In Baton Rouge, Our Lady of the Lake's clinics have already had more than 126,000 patient clinic visits, including over 30,000 patient visits at the new 24-hour urgent care center that was opened in North Baton Rouge. OLOL is also on track to become a Level I trauma center. Over 15,000 patients have been seen at the Perkins Surgery Center.
- Additionally, in Baton Rouge approximately 80,000 prescriptions have been filled since the partnership took effect in 2013, and the wait time for filing prescriptions has been reduced significantly from 10 days to 1 day in most instances.
- In Lafayette, private partner Lafayette General has reopened clinic and hospital capacity that had previously been shuttered or scaled back due to budget cuts, including its reopening of a pediatric clinic, a twelve bed medical detox, and returning its orthopedics unit to full-time status.
- In New Orleans, Louisiana Children's Medical Center took over the operations of the Interim LSU hospital. Since completing the partnership, the hospital has increased the emergency department capacity and reopened several medical/surgical inpatient beds and nine inpatient psychiatric beds.
- Under its partnership with Lake Charles Memorial Health System, W.O. Moss in Lake Charles has established a new urgent care clinic, which means that more patients are able to see a physician outside of expensive and ineffective emergency room settings. Physicians are now averaging 28-30 patients per day versus 10 in 2012.
- The partnership in Lake Charles has also led to the introduction of several new specialty care clinics, including an orthopedic clinic and a breast health clinic. Patients who were previously referred out of town for these critical services can now receive them in their home community. Additionally, all previous backlog for receiving an MRI, pulmonology services, or GI scopes has been reduced.
- In Houma, the partnership between Terrebonne General Medical Center and Ochsner has resulted in improvements to patient care with the hiring of new physicians, including a new cardiologist, urologist and family health physician. Two new digital mammogram units have been installed at the hospital and it has instituted a same-day walk-in screening process leading to a 16 percent increase per month in mammograms.
- The Houma partnership has also resulted in expanded urology services - a 41 percent increase in monthly visits. Additionally, it has resulted in an 83 percent increase in urological surgical procedures and a 12 percent increase overall in patient clinic visits. Ochsner has also decreased the wait time for admit screening for diabetes care from 1 hour to 5 minutes and has increased colonoscopy screening by 54 percent.
- In Shreveport and Monroe, University Health has dramatically decreased wait times, for example, reducing MRI appointment times from more than 60 days to 1-2 days and CT appointment times from 14 to 2 days. They have also reduced the clinic appointment backlog from more than 12,000 to less than 1,800 patients.
The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about LDH, visit www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow LDH's Twitter account and Facebook.