Health clinic network wins praise from Government Accountability Office
Published: Wednesday, July 14, 2010
Bill Barrow, The Times-Picayune
Supporting oft-made statements from Louisiana officials, a new federal government assessment hails the region’s burgeoning network of primary-care clinics and warns that an impending loss of federal taxpayer support will limit the newfound medical care for the working poor and uninsured.
The Government Accountability Office report, conducted for the House Committee on Oversight and Government Reform, does not recommend any source of new financing for 90-plus clinics that have received almost $100 million from a grant that Congress approved for Gulf Coast states after the 2005 hurricane season.
But parts of the document suggest hope for state and local authorities’ developing plans to redirect some of Louisiana’s other federal health care money from hospitals to the primary-care network.
The primary-care grant expires Sept. 30, affecting clinics in Orleans, Jefferson, St. Bernard and Plaquemines parishes. Officials say some financing stream is needed to sustain the clinics from now until 2014, when the federal health care overhaul will expand Medicaid and private insurance pools to the uninsured patients the network now targets.
State Department of Health and Hospitals Secretary Alan Levine already has made a preliminary request that federal Medicaid authorities allow the state to tap a portion of Louisiana’s disproportionate-share hospital money, federal Medicaid financing that usually helps cover hospital care for the uninsured. Levine, the Louisiana Public Health Institute and the leaders of the 25 provider organizations that run the clinics are working to submit a formal request by Aug. 15.
The GAO report notes that the Centers for Medicare and Medicaid Services, the agency that must approve the state’s waiver application, has been active in working with the state on that financing possibility. And in its written response to the report, the federal Health and Human Services Department said the GAO draft “accurately reflects the department’s concern about the sustainability of the primary-care gains in the greater New Orleans area” if the clinics cannot find a new stream of money.
Both of those details suggest that federal officials will be receptive to Louisiana’s proposal.
The network, which serves about 100,000 patients, 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 one-fourth are on Medicaid, almost all of those being minors. The rest have Medicare or carry private insurance.
Nearly all of the clinics require some payment from the uninsured, with fees typically ranging from $5 to $25 depending on income. 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.”
Levine has said the state will propose in its waiver application requiring all the clinics that receive disproportionate share hospital financing to attain the national certification.
The current program also uses a per-patient payment model to distribute the grant money, meaning clinics get a set amount for a patient rather than being paid a fee per service, the model used in most components of the American health care system.
Dr. Karen DeSalvo, a Tulane physician who is one of the network’s leading organizers and advocates, said the extended program would continue the per-patient payment model, rather than revert to fee-per-service billing.
DeSalvo said the network is also trying to develop a program to move patients from the grant pool to the expanded Medicaid rolls or private insurance exchanges that are coming online as part of the new federal law.
Centers for Medicare and MedicaidServices officials, DeSalvo said, have been “flexible” in their preliminary conversations with the Louisiana officials. She said she hopes federal authorities will fast track their review of the state’s waiver request so clinics can start getting the disproportionate share hospital money by Oct. 1.
According to the GAO report, the clinics had received $92.5 million from the grant by December 2009. The grant makes up varying portions of the providers’ total clinic budgets. For the period of Aug. 1, 2008 through July 31, 2009, only five of the 25 providers reported their primary care grant money as less than a third of their total clinic budgets during that span; nine providers reported that the grant accounted for at least half of their total financing.
DeSalvo said some of the clinics, particularly those that are school-based, will have a cash-flow problem even if federal officials give swift approval to a waiver.
Bill Barrow can be reached at firstname.lastname@example.org or 504.826.3452