health care and education

…always seem to get the axe

if this happens, and without a long-overdue-Charity-Hospital built, this town will be devastated.

Health clinics depend on federal grant set to expire in September
By Bill Barrow, The Times-Picayune
March 03, 2010, 6:21PM
Ted Jackson/The Times-Picayune

Primary-care health clinics have proliferated across the New Orleans region since Hurricane Katrina, in no small part due to a $100 million, three-year federal grant that will run out in September.

Leaders of the network, which calls itself Greater New Orleans Community Organizations, have been mobilized for months lobbying politicians who control public purse strings to identify a new stream of cash. But it’s nearing crunch time as the group awaits state and possibly congressional action on the most likely source: leftover federal block grants.

Gov. Bobby Jindal’s proposed state budget for the fiscal year that begins July 1 calls for $58 million in block grant money to be steered to the clinics over two years, but that requires Louisiana Recovery Authority and federal approval to redirect the grants from their originally approved destinations, from roads and schools to the Road Home program for homeowners. With an otherwise tight budget amid falling tax revenues, there is no state-originated money earmarked directly for the clinics.

“I’m very nervous,” Dr. Karen DeSalvo said while preparing next year’s budget for Tulane University’s community clinics. “At this point, I’m planning not to have that money.”

What that means will vary among the 90-plus facilities included in the original Primary Care Access and Stabilization Grant, as different organizations derive varying percentages of their operating budgets from the federal aid.

DeSalvo, other clinic chiefs and state Health Secretary Alan Levine credit the expanded services with reaching more than 100,000 patients in Orleans, Jefferson, St. Bernard and Plaquemines parishes, a benchmark that suggests the facilities have met the original federal mandate to re-establish primary care after Katrina, particularly for the uninsured and the under-insured.

Without that financing stream, the Louisiana Public Health Institute, which manages the grant, estimates the system’s total patient capacity would drop by 30 percent to 40 percent.

“We cannot lose these clinics,” Levine said in a recent interview.

At the Lower 9th Ward Clinic, registered nurse and executive director Alice Craft-Kerney credits the clinics with fundamentally altering the old paradigm in which Charity Hospital’s emergency room was the primary destination for many southeast Louisiana residents seeking medical attention. The idea, she and other providers say, is to help patients manage chronic illnesses, particularly diabetes, high cholesterol and high blood pressure. That prevents or at least delays complications and catastrophic events such as stroke, heart attacks, amputations and organ failures that lead to hospitalization.

“We have definitely declogged and decluttered the emergency rooms,” Craft-Kerney said. “When our patients come back, we always ask every visit: ‘Have you been to the emergency room since your last visit?’ People say no, unless they actually had a real emergency.”

DeSalvo said Tulane’s flagship clinic at Covenant House, which eventually will move to the former Ruth’s Chris Steakhouse on North Broad Street, is more insulated from potential cuts because it has so many other sources of support. But Tulane’s mobile clinic, which provides services throughout the city, and the Tulane community clinic in eastern New Orleans would take a serious hit.

Craft-Kerney said she the primary-care grant comprises more than half of her budget.

The system includes adult and pediatric primary care, obstetrics, dental care, mental health services and school clinics. Half of the system’s patients are uninsured and about a quarter are on Medicaid, almost all of those being minors. The rest have Medicare or carry private insurance.

Nearly all of the clinics require payment from the uninsured, with fees typically ranging from $5 to $25 depending on income, though Craft-Kerney said she won’t turn anyone away. Clinics are paid on a per-patient basis, with the clinic’s overall payer mix and level of risk among the patients weighting the payments. The Public Health Institute also developed incentive programs that give bonuses to clinics that get national certification for using best-practices.

More than a third of the clinics have been recognized by the National Committee for Quality Assurance for meeting the minimum standards as “medical homes,” a best-practices model that concentrates on individual patient-physician relationships, with effective follow-ups, referrals and record keeping. Additionally, the NCQA on March 23 will present the network with one of its five 2010 Health Quality Awards. “Their success is an important and inspiring model for the rest of the country of what community-based health care can do,” NCQA President Margaret O’Kane said.

DeSalvo originally asked the LRA for $150 million, enough for operations through 2015, and she said she will continue to lobby federal appropriators for a long-term taxpayer commitment. For now, though, the aim is to avoid a cliff in September.

LRA spokeswoman Christina Stephens said her agency’s board members are “enthusiastic” about helping the clinics, but still weighing their options for how to proceed on redirecting portions of three separate congressional appropriations of Community Development Block Grant money. Any portion from Louisiana’s first two congressional appropriations would have to be approved by the U.S. Department of Housing and Urban Development. Congress earmarked the third and final aid package for Road Home, and Congress would have to approve any changes.

DeSalvo said she and her colleagues have gotten a “good reception” in Washington, D.C. But, she said, “Everything seems to be revolving around health-care reform. It’s hard to get much attention for anything else.”

Rob Sawicki, press secretary to U.S. Sen. Mary Landrieu, who is expected to take the lead on the issue, said, “Sen. Landrieu is supportive of extending the PCASG program. … She remains committed to working with the rest of the delegation to find the most effective way to fund the program beyond September.”

He did not say how Landrieu might try to accomplish that. Republican senators and conservative commentators excoriated Landrieu last fall when she won an amendment to the Senate’s health care insurance overhaul that would increase Louisiana’s federal Medicaid support in future years. Jindal sought the fix but still lambastes the overall bill.

This time, Levine said, “We don’t really care how they do it; we just need it.”


~ by maringouin on Wednesday, March 3, 2010.

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