Seven months after Hurricane Katrina, government auditors report that the number of hospital beds in New Orleans has dropped by about 80%, and the region's already-troubled healthcare system continues to look bleak.
A status report from the Government Accountability Office last week said the number of staffed beds in New Orleans in February was 1,984, compared with 4,083 before the storm hit. "Residents are expected to return to the area slowly, and their return will be affected by the availability of housing and other services," the report said.
While several hospitals have remained closed, three facilities -- Ochsner Clinic Foundation, East Jefferson General Hospital and West Jefferson Medical Center -- have remained open the entire time and have shouldered much of the state's healthcare burden, including treatment for a large amount of the population's uninsured. On March 24, HHS announced it would allocate an initial $1.5 billion in aid for 32 states that established Medicaid programs and uncompensated-care funds or provided medical care to evacuees from Aug. 24, 2005 -- when residents first began to evacuate -- until Jan. 31. Congress has set aside a total of $2 billion for this purpose, and the remainder will be used for future costs.
Of the $1.5 billion, $383 million has been earmarked for Louisiana, according to the Louisiana Department of Health and Hospitals. Some local hospital officials expressed serious concern that the funds, though appreciated, are simply not enough to begin addressing the region's critical healthcare problems. In addition, the state will reimburse all claims for uninsured patients at 70% of the Medicaid reimbursement rate for a given procedure, according to Bob Johannessen, a spokesman for the health department. "If there is money left over after those initial reimbursements, we will try to make good on the full amount," Johannessen said.
Paul Salles, vice president of healthcare reimbursement policy at the Louisiana Hospital Association, said the state's Medicaid payments are already low, and the funds do not solve problems past Jan. 31. In addition, the plan is getting a chilly reception from physicians in Louisiana (See story below).
"I think part of it is the old adage: `Something is better than nothing,' " said Mark Peters, chief executive officer at 439-bed East Jefferson General Hospital in Metairie, La. "And without complaining, the facts speak for themselves. When the uninsured percentage was 3%, you can manage that process. When it becomes a 9% level, it changes things significantly."
John Matessino, president and CEO at the Louisiana Hospital Association in Baton Rouge, said most discussions about Katrina center around economic growth, and that the healthcare industry is a major player in that expansion.
"Everyone talks about economic development, and we remind them constantly that before Katrina, healthcare was the No. 1 employer in the state of Louisiana for payroll expenditures, and hospitals made up 48% of that," Matessino said. "We are a major employer and major structure of economic development," he said. "This is not about trying to get our hospitals a lot of money to put bucks on the bottom line. This is about getting our hospitals money to provide care."
Despite what Matessino called "Katrina fatigue" among many in the area and in Washington, he and other healthcare officials see the disaster as a catalyst for effecting change.
"Having a bird's eye view of how this catastrophe evolved has been a fascinating study," said Patrick Quinlan, CEO at Ochsner, which has its main campus located just outside the center of the city. "One recurring theme (is that) we have an opportunity to design from the beginning a healthcare system that is more effective."
While Quinlan said the HHS funding is a "great start," he said Ochsner, with 484 staffed beds by the GAO's count, is treating more patients who are underfunded now than before because people are returning the area. The HHS money will not help cover those costs because the allotment is for the time period between late August and late January. Quinlan said Ochsner's charity cases have more than tripled from about 3% before the storm to between 9% and 11% today, and about 25% of the people who visit the hospital's emergency room cannot pay for service.
"We have to be more selective in who we can take," Quinlan said, adding that Ochsner has spent $280 million rebuilding its facilities. "Our capacity to help is going to be more limited in the absence of state and federal help."
Peters, who said it is important to consider both short-term and long-term solutions to fixing the state's healthcare system, said he is concerned about the possibility of another "exodus" of residents as summer approaches.
"The current healthcare infrastructure in our area is at risk," Peters said. "It can be stabilized. ... But it needs to happen soon."