East and West Jefferson community hospitals saw a significant spike in indigent patients right after Hurricane Katrina, and since then, both institutions have continued to provide higher levels of "uncompensated care." The higher number of uninsured and Medicaid patients has cost both hospitals millions of dollars each year because of gaps in state and federal reimbursement programs.
State Sen. David Heitmeier, D-Algiers, is pushing Senate Bill 235 as a partial solution to the problem. Heitmeier, an optometrist who has taken on health care financing as his top legislative issue, has devised a plan to use existing state and local dollars to leverage higher Medicaid payments to the state while also generating higher reimbursement rates for Louisiana's community hospitals.
"The present reimbursement plan actually encourages the state not to adequately reimburse community hospitals like [East Jefferson General Hospital and West Jefferson General Hospital]," Heitmeier says. "The plan we want to put into effect will allow the state to pay a higher rate of reimbursement to hospitals for doctors' services at those hospitals — called physicians' UPL, or upper payment limit.
"At present, about a dozen community hospitals across the state have a combined net deficit of more than $65 million in uncompensated care every year," Heitmeier continued. "They get back maybe 10 percent of that. Under the new plan, we can add another $8 million to that, and if national health care reform adds more people to the Medicaid rolls, the payments will increase."
Heitmeier says the new plan, if approved by the feds, will also increase the total amount the state can leverage in Medicaid funds, thereby reducing the state's incentive not to fully reimburse community hospitals. "Pennsylvania is already using a similar plan," Heitmeier says, "so we're optimistic about our plan getting approved."
The Heitmeier bill has cleared the Senate and is pending in the House Health and Welfare Committee. — Clancy DuBos