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THE HEALTH CARE ISSUES
& PROFESSIONALS TO WATCH IN 2015
How will Mid City fare without an emergency room? Will Baton Rouge get its own medical school? How bad can the physician shortage get? And why are two competing hospitals suddenly collaborating? These are just a few of the issues at the top of the Capital Region’s health care agenda in the year to come. We detail eight ongoing stories to watch, along with six professionals who are making a difference.
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1. End of an era of emergency care.
Baton Rouge General Hospital’s Mid City emergency room on Florida Boulevard shut down after 65 years in operation. Hospital officials announced the closure in early February, explaining the institution is losing upwards of $2 million a month treating thousands of uninsured patients in its ER. What will it mean the future of Baton Rouge General? For patients in Mid City? For other hospitals forced to pick up the slack? That should become evident in the coming months. At the hospital, the average daily census is estimated to drop from 120 pre-ER closure to between 30 and 80. For now, other services at Mid City will remain available—radiation oncology, hyperbarics, imaging and rehab among them. The burn center remains at the Mid City campus for now, though it may eventually migrate to the Bluebonnet campus. Meanwhile, other providers and state health care officials are scrambling to make sure the four remaining ERs in East Baton Rouge Parish can pick up the slack. Long term there is talk of building a community clinic in Mid City to provide primary and urgent-care services, not the level of services typically offered by an ER. About $500,000 is included in the 2015-2016 state budget bill to begin planning for such a facility. But that funding may not materialize and the planning process would take years. Construction costs would be in the millions and a source for that hasn’t been identified. For now, community leaders are focusing on beefing up existing urgent-care clinics. They’ve expanded the capacity at clinics on north Foster Drive and on Airline Highway. No one knows whether the people of Mid City, accustomed to using the Baton Rouge General ER, will turn to the clinics or seek out emergency rooms at other hospitals.
QUOTE TO THE SIDE:
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“Mid City has had financial problems for 10 years.”
KATHY KLIEBERT, secretary, Louisiana Department of Health & Hospitals, in an interview with the Chicago Tribune
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2. Affordable Care Act: The paperwork.
Companies with 100 or more full-time equivalent employees must begin complying with the Affordable Care Act coverage requirements in 2015, although they will have two years to phase up to the requirement that they cover 95% of their workers. Companies with 50 to 99 full-time equivalent employees will have another year—until 2016—to start complying. Smaller businesses are exempt. Under tax code sections 6055 and 6056, employers must compile monthly and report annually numerous data points to the IRS and their own employees. This data will be used to verify the individual and employer mandates under the law. Although required reporting won’t occur until January 2016 to employees and March 2016 to the IRS, the report is based on what happened during 2015. So the time to start gathering all that data is now.
QUOTE TO THE SIDE:
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“[Companies] feel this economic boom coming, they see the expansion coming, and they are ready to put that capital to work. This is a tripwire for them, and they just don’t know what to do.”
STEPHEN WAGUESPACK, president and CEO, Louisiana Association of Business and Industry
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3. The technology race.
Linx. iRound. The breath-hold technique. The robotic Whipple procedure. Fluidized positioning devices. Advanced 3D mammography. The da Vinci XI surgical robot. Those are just some of the new technological advances to arrive in Capital Region medical facilities in the past year or two. Look for even more in 2015, as hospitals and specialty clinics compete to distinguish their services to patients by declaring themselves the “first and only” to offer the latest and greatest.
QUOTE TO THE SIDE:
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“We have broadened our surgical capabilities and put the most advanced equipment in the hands of world-class surgeons.”
TERRIE STERLING, chief operating officer, Our Lady of the Lake Regional Medical Center, on the introduction of the da Vinci XI robot for minimally invasive procedures
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4. A medical school for Baton Rouge?
Work on a Baton Rouge Medical District is chugging along. As first laid out in broad strokes in FuturEBR, the city-parish master plan, officials hope to leverage the Bluebonnet/Perkins/Essen medical corridor as an economic driver and an important part of the city’s brand. It will be broadly patterned after medical districts in other major urban areas, like the Texas Medical Center in Houston or the Memphis Medical Center. So where does it stand? Four key potential projects have been identified: a potential medical school campus, a Baton Rouge Diabetes and Obesity Center, a post-acute care integration program and a clinical trials consortium. John Spain, executive vice president of the Baton Rouge Area Foundation, says key stakeholders—hospitals, research institutions and other health-care providers—have directed consultants to develop business plans for the initiatives. While a medical school likely will take years to come to fruition, Spain says, the other three initiatives could materialize as early as three to five years after a business plan is developed.
QUOTE TO THE SIDE:
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“It’s time for a third full-blown medical school here, but not at the expense of New Orleans and Shreveport. This is not just a four-year medical school we’re talking about here. It’s so much more.”
JOHN SPAIN, executive vice president, Baton Rouge Area Foundation
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5. From competitors to collaborators.
Woman’s Hospital and Our Lady of the Lake Regional Medical Center are new best friends. The two hospitals have signed up for not one, but two medical partnerships. The first involves critical care: Last fall, critical care specialists at OLOL began monitoring and providing assistance to ICU patients at Woman’s using real-time, virtual technology. Though Woman’s only has four adult ICU beds, finding enough critical care physicians to care for ICU patients is a challenge due to a nationwide shortage of providers in that specialty area. Woman’s is paying OLOL a per diem to monitor any patients it has in its adult ICU. “This will not replace the doctors in charge of patient care at Woman’s,” says Patrician Johnson, Woman’s chief nursing officer. “But it will provide an additional group of clinical experts to closely watch and review the vital signs of our most critical patients.” It was the first time Our Lady of the Lake provided the service to another hospital in this market. Then came word last month of another partnership initiative between Mary Bird Perkins-Our Lady of the Lake Cancer Center and Woman’s in the fight against breast and gynecologic cancer. A new facility called the Center for Breast and GYN Cancer is planned for the Woman’s campus on Airline Highway. The free-standing facility is on schedule to be completed by late next year. Possible services include physician offices, diagnostics, outpatient surgery, chemotherapy and radiation therapy. Cancer patients will also have the choice to access any of the services at MBP-OLOL Cancer Center’s main campus on Essen Lane. As the medical district concept gains traction and a doctor shortage continues in some specialties, the Capital Region could see more collaborations.
QUOTE TO THE SIDE:
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“This will be a union of our technology, individual clinical expertise and specialized cancer resources to uniquely deliver the most advanced, personalized cancer care for women in the Gulf South.”
TERI FONTENOT, president and CEO, Our Lady of the Lake Regional Medical Center
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6. The privatization model.
It’s been two years since the deal with Our Lady of the Lake Regional Medical Center to take over delivery of local health care services for the region’s poor and become a primary teaching hospital for the LSU medical school. Much substantial progress has been made, although the full impact on the state’s public health care system is still unfolding. The collaboration began in April 2013, when Earl K. Long closed its services and medical education functions shifted to OLOL. The hospital has taken over management of multiple clinics, rebranded under the name LSU Health Baton Rouge. Enhancements include establishing an urgent care center in north Baton Rouge, an area previously lacking in primary care services. Reports indicate that the physician training program has given students a more diverse educational experience, as well as access to a $19 million medical education center on the OLOL campus. But relocating charity care to OLOL left a geographical void in Mid City, diverting thousands of Medicaid and uninsured patients from the low-income, inner city to Baton Rouge General’s Mid City campus, which was given no state funding to treat them. Last month, the hospital closed its emergency room. All eyes are now on the state and the Lake to see how this setback will be rectified.
QUOTE ON THE SIDE:
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“We went from a place that had, when we left, 30 to 40 beds, to a facility that has more than 700 beds, so from a graduate medical education perspective, that was a big bonus.”
DR. KEVIN REED, associate dean, LSU Health Sciences Center
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7. The doctor will see you when he or she can.
There’s a national philosophical debate raging over whether the U.S. is truly experiencing a doctor shortage. The media has widely reported allegations that the Affordable Care Act’s insuring of 11 million new people last year could lead to a shortage of as many as 45,000 physicians by 2020. But a report by the Institute of Medicine found “no credible evidence” to support such a claim, suggesting it is based on “questionable doctor-patient ratios,” a lack of consideration for geographic differences in physician supplies and a failure to recognize the role of new technology and alternate health providers. But there’s no doubt the Capital Region is experiencing a shortage of some degree, whatever the cause. In announcing it would begin monitoring and assisting ICU patients using real-time, virtual technology at Woman’s Hospital, Our Lady of the Lake Regional Medical Center pointed a finger directly at scarcity. “The move was prompted by the need to alleviate a shortage of critical care physicians—or intensivists—that specialize in the treatment of critically ill patients,” says Lauren Davidson, an OLOL spokesperson.
QUOTE ON THE SIDE:
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“This is a nationwide shortage that has hit close to home, making it difficult for facilities like Woman’s to recruit the physicians they need to care for patients in the ICU.”
LAUREN DAVIDSON, spokesperson, Our Lady of the Lake Regional Medical Center
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8. Tackling mental illness.
There’s a discussion taking place in a variety of quarters around the community: What can be done to boost care for the mentally ill in the Capital Region? Central to the discussion is the lack of long-term psychiatric care facilities, a void resulting in part by the recent closures of several state mental hospitals. It comes on the heels of Mayor Kip Holden’s failed public safety tax proposal that included funding to build a mental health facility that offered 24-hour crisis assessment, evaluation, stabilization and intervention; a sobering unit; a detox unit; a minor medical center; an outpatient mental health clinic; recovery counseling and support; and inpatient psychiatric services. A separate tax proposal also would have paid operational costs. City/parish officials and the Baton Rouge Area Foundation are searching for alternatives.
QUOTE TO THE SIDE:
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“We’ve got to get these people out of the penal system. It’s immoral. It’s just not right.”
RYAN HECK, Metro Councilman
