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Healthcare Briefs
State & Local Healthcare News
PUBLISHED: September/October 2011
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STATE BRIEFS
UPL Programs to Expand
The Department of Health and Hospitals announced
a series of programs being implemented
or expanded this fiscal year that will help
local governments, hospitals, and other health
care providers maximize health care dollars and
preserve access to care for Medicaid patients
through a series of new programs being implemented
or expanded this fiscal year. House Bill
1, which was signed by Governor Bobby Jindal,
provides more than $102 million in expenditure
authority for DHH to pay local public hospitals
and ambulance services through the Upper Payment
Limit (UPL) programs.
In addition to the budget authority provided
for the UPL programs in HB1, Gov. Jindal
signed Senate Bill 176 by Sen. David Heitmeier
to authorize UPL programs and the payment
methodology for the Public Hospital UPL. The
Public Hospital UPL is expected to generate
about $72.8 million for non-rural, non-state
public hospitals throughout the state. In this
program, local dollars from hospital districts
are sent to the state and used as match to draw
down federal UPL payments. Non-state, nonrural
public hospitals that should benefit from
the UPL payment include:
• East Jefferson General Hospital
• Iberia Parish Hospital
• Lane Memorial Hospital
• North Oaks Medical Center
• North Oaks Rehab Center
• Opelousas General Hospital
• Slidell Memorial Hospital
• St. Tammany Parish Hospital
• Terrebonne General Hospital
• Thibodaux General
• West Calcasieu-Cameron Hospital
• West Jefferson Medical Center
DHH submitted a State Plan Amendment on
June 29 to the federal government outlining
the Public Hospital UPL plan and expects approval
by November with the first payments
going out as early as December.
The second program provided for in House
Bill 1 is the Hospital Based Physician UPL. Already
in place, DHH is planning to make $15
million this fiscal year in payments to participating
non-rural, non-state public hospitals for
hospital-based physician services. There are 43
hospitals in the state eligible for the program.
In this program, non-state, non-rural public
hospitals send local or state general fund dollars
to DHH to use as matching funds to access
UPL payments. Those UPL payments are
made back to the hospitals to ensure continued
access to physicians, physician assistants,
certified registered nurse practitioners, and
certified registered nurse anesthetists at the
hospitals for Medicaid recipients.
The final program is known as the Ambulance
UPL, and DHH anticipates making about
$14.5 million in payments to companies or
government entities that provide ambulance
services once the program is up and running
later this fiscal year. The Department submitted
a rule to the state Registrar in July outlining
the Ambulance UPL, which will be followed in
September by a State Plan Amendment to the
federal government. Once approved, ambulance
providers could see the additional dollars
by March 2012. While the exact payment methodology
is still being developed, it is expected
that this UPL program will allow local governments
(whether they run their own ambulance
service or contract that service out) to send
local dollars dedicated to emergency medical
services to the state. The state can then use
those dollars, which are currently unmatched,
as match to access federal UPL dollars to pay
to ambulance services to ensure continued access
for Medicaid recipients.
Children’s Hospital Telethon
Raises $1.74 Million
The 28th annual Children’s Hospital Telethon
raised a record amount of more than $1.74 million.
The final tote board at the two-day broadcast’s
conclusion showed $1,740,775; however,
Children’s Hospital received additional pledges
that had yet to be tallied, said Brian T. Landry,
the hospital’s vice president of marketing.
The 2011 Telethon exceeded last year’s total
by $160,000. Since 1984, the annual event has
brought in more than $20 million to Children’s
Hospital. Money raised through the annual event
is used to ensure the most advanced medical
and surgical equipment is always available.
Hospitals Recognized for
Targeting Birth Outcomes
Louisiana Department of Health and Hospitals
Secretary Bruce D. Greenstein, the Louisiana
Hospital Association (LHA), the Louisiana
State Medical Society (LSMS), the American
College of Obstetricians and Gynecologists
(ACOG ), and other Louisiana health care leaders
gathered recently at Woman’s Hospital to
celebrate the 20 Louisiana hospitals that have
demonstrated a commitment to healthier
moms and babies through their participation
in DHH’s 39-Week Initiative.
DHH introduced the 39-Week Initiative as a
key component of the Birth Outcomes Project,
which was established to combat Louisiana’s
historically poor birth outcomes. The 39-Week
Initiative is a voluntary program in which hospitals
agree to establish policies to end the
practice of elective, non-medically necessary
deliveries prior to 39 weeks gestation. DHH officials
have been meeting with the state’s largest
birthing hospitals to teach them about the 39-
week Initiative, encouraging them to adopt the
initiative and providing support for its adoption.
Babies who are born premature have a
greater chance of newborn health complications,
such as breathing problems, and often
must spend time in the NICU receiving costly
specialized care. The National Center for
Health Statistics ranks Louisiana 49th in infant
mortality, preterm birth and in the percentage
of low birth weight and very low birth weight
babies. Additionally, Louisiana earned a failing
grade on the 2010 March of Dimes Prematurity
Report Card, and at 38 percent, has the second
highest C-section rate in the country.
The following hospitals have signed on to
implement the 39-Week Initiative:
• Baton Rouge General Medical Center,
Baton Rouge
• CHRISTUS St. Frances Cabrini Hospital,
Alexandria
• E. A. Conway Medical Center, Monroe
• East Jefferson General Hospital, Metairie
• Lake Charles Memorial Hospital, Lake
Charles
• Lakeview Regional Medical Center,
Mandeville
• Lafayette General Medical Center,
Lafayette
• LSU Health Sciences Center Shreveport,
Shreveport
• North Oaks Medical Center, Hammond
• Ochsner Foundation, New Orleans
• Ochsner Medical Center-West Bank, Gretna
• Rapides Regional Medical Center,
Alexandria
• Tulane-Lakeside Hospital, Metairie
• Touro Infirmary, New Orleans
• West Jefferson Medical Center, Marrero
• Willis-Knighton Pierremont Health Center,
Shreveport
• Willis-Knighton South & Center for
Women’s Health, Shreveport
• Woman’s Hospital, Baton Rouge
• Women & Children’s Hospital, Lake Charles
• Women’s & Children’s Hospital, Lafayette
Two hospitals that implemented the initiative
prior to the department launching the statewide
initiative have already seen the benefits firsthand.
From 2007 to 2010, East Jefferson General
Hospital reduced the number of elective inductions
prior to 39 weeks from 503 to 16. Since
implementing the initiative at Woman’s Hospital
in September 2007, neo-natal intensive care unit
(NICU) admissions dropped 20 percent.
As an added incentive, LAMMICO , a mutual
insurance company that provides malpractice
insurance for most Louisiana doctors, has partnered
with the Department to offer physicians
who participate in a “39 Week” training course
an hour of continuing medical education (CME)
credit. LAMMICO -insured physicians also will
receive an hour of credit toward the two-hour
credit needed for a 10 percent premium reduction
at the next renewal.
To learn more about the Birth Outcomes
Initiative, visit the DHH website.
Our Lady of Lourdes
Has a New Face
Our Lady of Lourdes Regional Medical Center
recently opened its brand new 396,000 square
foot hospital on Ambassador Caffery in Lafayette.
Strategic planning and preparation for the
move from the old St. Landry campus to the
new facility has been underway for over a year,
with several mock moves conducted to ensure
patient safety.
The new Our Lady of Lourdes facility was
built from the ground up at a cost of $211 Million
and features the most progressive medical
technology available in Acadiana. The 200
bed facility features larger patient rooms and
smaller nursing pods located closer to patient
rooms for more effective/efficient care. It also
features innovative design and organization for
better patient care, comfort, and privacy. The
hospital was designed to be energy efficient
and built with an eye for future expansion to a
potential 332 beds.
DHH Narrows Field for
Coordinated Care Networks
In August, the Louisiana Department of Health
and Hospitals tentatively selected five entities to
administer Coordinated Care Networks (CCNs)
in the state’s Making Medicaid Better initiative.
The initial selection drew appeals from some of
the entities that were not chosen, with calls for
complete disclosure of the winning proposals
and how they were selected.
The department chose from 12 submitted
proposals for both prepaid and shared savings
networks, which would be implemented within
three Geographic Service Areas (GSA). Entities
were allowed to propose networks for a specific
GSA, or multiple areas. All of the CCN s being
recommended by the evaluation teams would
serve all GSAs. The recommended CCN s are:
CCN-Prepaid
• Louisiana Healthcare Connections, Inc.
(whose parent company is Centene)
• Amerihealth Mercy of Louisiana, Inc.
• AmeriGROUP Louisiana, Inc.
CCN-Shared Savings
• UnitedHealthcare of Louisiana, Inc.
• Community Health Solutions of America, Inc.
Under the prepaid model, CCN s will receive
a monthly fee for each enrollee covered to
provide core benefits and services, with prior
authorizations and claims payment handled directly
through the CCN. These networks also are
responsible for establishing a robust provider
network of primary care physicians, specialists,
hospitals, and other providers. The CCN -Shared
Savings is a managed fee-for-service model
that is responsible for coordinating the care of
its members. The entity shares in the savings
generated by improving health outcomes and
reducing costs. In this model, providers will continue
being paid on a fee-for-service basis by the
state Medicaid program.
Several steps remain before CCN contracts
are fi nal a nd t he n etworks a re r eady t o b egin
operations. The Division of Administration must
approve the evaluation process and the final
contracts. Additionally, CCN s will undergo a
thorough readiness review before any network
can begin providing services to Medicaid recipients.
To ensure network adequacy, each CCN
must demonstrate it has a robust network of primary
care providers (and specialists, hospitals,
and other provider types in the case of the prepaid
CCNs) in place to treat patients, sufficient
support staff to handle administrative processes
and provider relations, and the ability to meet all
the deliverables specified in its proposals. The
Centers for Medicare and Medicaid Services will
review each CCN’s contract and network adequacy,
and must approve these before recipient
services can begin. Any CCN that cannot meet
these rigorous readiness review requirements
will not be allowed to operate in Louisiana.
For more information on Coordinated Care Networks,
go to www.MakingMedicaidBetter.com.
Senate Honors Lemoine
John E. Lemoine, MD, a family physician from
Bunkie, Louisiana, and a current member of the
LAMMICO Board of Directors, was honored by
the State Senate during the recent Legislative
Session in Baton Rouge. The recognition came
in the form of Senate Concurrent Resolution
No. 83, sponsored by State Senator Eric LaFleur
(D - Ville Platte). The resolution commends
Dr. Lemoine “for his dedication in serving the
healthcare needs of many patients, and as a
tireless advocate for just and fair physician liability
laws in the state.”
Dr. Lemoine has been associated with LAMMICO
since shortly after the company’s founding
in 1981. After serving as the Senior Vice
President of LAMMICO ’s Underwriting Committee,
Dr. Lemoine joined the Board of Directors
in 1985 and became Chairman of the Board in
1996. From January 1, 2000 until December 31,
2007, Dr. Lemoine led LAMMICO as its Chairman
of the Board/CEO/President. From January
1, 2008 until 2010, he remained on LAMMICO
’s Board of Directors as Chairman.
Increased Scrutiny
Delays Payments
Due to a change in policy announced in July,
Louisiana healthcare providers will now be paid
later for Medicaid claims. The change comes as
a result of an increase in review time for claims
now being implemented by the Louisiana Department
of Health and Hospitals. The goal of
the increased scrutiny is to help root out fraud,
waste, and abuse in the system. It is estimated
that nationally as much as 10 percent of Medicaid
and Medicare expenses are diverted by
wasteful, fraudulent, and abusive activities.
Because of the additional review time automated
payments in July hit bank accounts a day
later than usual. In subsequent months, the payments
will continue to be pushed out further in
a similar manner until there is a full additional 14-
day window for claims reviews. “We know this is
going to be a transition for our health care community,
so we are phasing in the additional time
throughout the fiscal year to ensure they have
time to adjust their businesses appropriately,”
DHH Undersecretary Jerry Phillips said.
LOCAL BRIEFS
Rushing to Lead Medicare
Quality Improvement Contract
eQHealth Solutions’ Vice President and Chief
Operating Officer Edie Castello announced
that Debra Rushing has been named the Executive
Director for the company’s Medicare
quality improvement contract in Louisiana.
She takes over for Scott Flowers, who recently
accepted a vice-president position with
Thibodaux Regional Medical Center.
Since joining eQHealth in 2009, Rushing has
served as a Quality Improvement Director on the
Louisiana Medicare contract. She received her
nursing degree from Southeastern Louisiana,
and her MBA from the University of Phoenix.
Pennington Hosts
Obesity Conference
On September 14, 2011, the Pennington Biomedical
Research Center will host its fourth
annual childhood obesity and public health
conference, Reducing Childhood Obesity in
Louisiana: Charting the Course for 2020. The
conference is designed for professionals engaged
in public health efforts, including: physicians,
nutritionists, physical activity specialists,
registered dietitians, nurses, health educators,
psychologists, and counselors, healthcare policy
makers, researchers, media, business and
civic leaders, parks and recreation personnel,
and early childhood and school-age educators
and decision-makers. Participants in this conference
will be able to:
• Comprehend the extent of the problem of
childhood obesity in both the nation and in
Louisiana
• Identify national public health objectives as
detailed in Healthy People 2020
• Suggest public health goals for childhood
obesity for the State of Louisiana
• Identify strategies to achieve demonstrable
improvements in obesity-related behaviors.
Among the featured presentations are an introduction
by Bruce D. Greenstein, Secretary,
Louisiana Dept. of Health & Hospitals; a presentation
on National Goals for Improving Diet
& Health by Deborah Galuska, MPH, PhD, U.S.
Centers for Disease Control and Prevention;
a discussion of The National Physical Activity
Plan by James R. Whitehead, American College
of Sports Medicine; and Lessons Learned from
Physical Activity Promotion in Brazil, a presentation
by Pedro Hallal, PhD, Federal University
of Pelotas, Brazil.
The free conference will take place from 9
a.m. to 3:30 p.m. on September 14th. You can
register at www.pbrc.edu.
Dupuy Named Outstanding
Nursing Instructor
Keeley Dupuy, MSN, RN, Assistant Professor of
Nursing at Our Lady of the Lake College, was
recognized by Our Lady of the Lake Regional
Medical Center as the Outstanding Nursing
Instructor of the Year. The award nomination
describes Dupuy as caring and compassionate
with her students, yet holding them to a high
standard.
Dupuy contributes in significant ways to
academic development at Our Lady of the Lake
College, where she has worked for over six years.
She currently serves as chair of the College’s curriculum
committee, leading the development of
a groundbreaking foundational BSN curriculum.
Not only has she championed an interdisciplinary
approach to curriculum, but she has involved
faculty across the campus in the development of
case studies for campus-wide use.
Dupuy is currently on the Board of Directors
for the Louisiana State Nurses Association
and Chair of the Membership Committee for
the Baton Rouge District Nurses Association.
She is also a member of the American Nurses
Association, Sigma Theta Tau International
Honor Society of Nursing, and the Phi Kappa
Phi Honor Society.
HHS Invests in Local
Health Centers
The Department of Health and Human Services
recently announced awards of $95 million to
278 school-based health center programs
across the country. Among them was Baton
Rouge’s own Health Care Centers in Schools
along with 13 other entities across the state.
Provided by the Affordable Care Act, the
awards will help clinics expand and provide more
health care services at schools nationwide. HHS
estimates an additional 440,000 patients will be
served thanks to the new funds awarded. The
awardees are currently serving approximately
790,000 patients.
Lake After Hours Locates
to Coursey
Lake After Hours has opened a new location
at 13702 Coursey Boulevard. The clinic is open
seven days a week from 9 a.m. to 6 p.m. A
nearby location on O’Neal will maintain evening
and night hours so the Coursey clinic with
day-time hours will provide greater access to
those who may not be able to make a same day
appointment with their primary care physician,
or travel across town to see their physician.
Sellars Named to UCAOA
Board of Directors
Steven P. Sellars, CEO of Convenient Care,
LLC, which owns Lake After Hours and Total
Occupational Medicine, has been named to the
Urgent Care Association of America (UCAOA )
Board of Directors. Sellars serves as a board
member for a multi-site rehabilitation company
and the Baton Rouge Primary Care Collaborative,
is an active member of UCAOA ’s Certification
Committee, and is a member of the
Medical Group Management Association.
UCAOA provides educational programs in
clinical care and practice management, sponsors
urgent care Fellowship Programs, funds
groundbreaking industry research, has a monthly
Journal of Urgent Care Medicine and maintains
an active website and online forum for daily
exchange of best practices. UCAOA provides
leadership, education and resources for the successful
practice of urgent care for its members.
Two Medical Equipment
Suppliers Sentenced
Two local business owners have been sentenced
for defrauding the federal government
with claims relating to their durable medical
equipment supply companies. In the first case,
Samuel B. Johnson of Baton Rouge was sentenced
by the U.S. District Court to serve 60
months in federal prison for his role in a multiyear
health care fraud scheme that he perpetrated
in the Baton Rouge area. Johnson was
also ordered to pay $878,280 in restitution,
and ordered to forfeit an additional $928,280
in proceeds from his crimes. Following his release
from imprisonment, he will be required
to serve a 2-year term of supervised release.
Johnson was one of the owners of a company
known as Medical Supplies of Baton
Rouge, Inc., which was engaged in the business
of providing power wheelchairs, orthotics and
other durable medical equipment to Medicare
beneficiaries. In connection with his guilty plea,
Johnson admitted that from November 2005
through about June 2009, he conspired to use
the company to defraud the Medicare Program
and commit health care fraud. Specifically,
Johnson and his co-conspirators routinely submitted
claims to Medicare seeking reimbursement
for a set of expensive braces (including
a back brace, knee braces, and other items),
knowing that the braces were not medically
necessary and had not been prescribed for the
beneficiaries by their physicians.
In the second case, Veronica Ann Lewis
Green, of Gonzales, was sentenced to thirty
months in prison, restitution of $1,128,308, and
two years supervised release after imprisonment.
Green was also ordered to pay restitution
to Medicare, Blue Cross, and the Social Security
Administration. From April 2006 through
August 2009, Green submitted false and
fraudulent claims to Medicare. The false claims
led to Medicare and Blue Cross of Louisiana
issuing payments to her medical supply business,
AYS Medical Supplies, in Gonzales. Green
defrauded Medicare by submitting claims for
durable medical equipment which was neither
medically necessary nor actually provided to
Medicare beneficiaries. In the course of investigating
the false claims to Medicare and Blue
Cross, investigators also discovered that Green
submitted false information to the Social Security
Administration.
DOE: OLOL College Among
Most Affordable
Our Lady of the Lake College in Baton Rouge
is among four-year, private, non-profit institutions
providing undergraduate education at
the lowest net price according to a Department
of Education report released in June. Each
year, the Department of Education compiles
College Affordability and Transparency Lists
which name institutions at the extremes of tuition
rates in a variety of categories. Our Lady
of the Lake College is among 121 institutions
in its class recognized as charging the lowest
total cost of attendance.
Each year, all institutions of higher education
are required to submit data to the U.S.
Department of Education, National Center for
Education Statistics, Integrated Postsecondary
Education Data System (IPEDS). The average
net price is calculated using this IPEDS data
by subtracting the average amount of federal,
state/local, government or institutional grant
or scholarship aid from the total cost of attendance.
Total cost of attendance is the sum
of published tuition and required fees, books
and supplies and the weighted average for
room and board and other expenses. Based
on IPEDS data, the net price at Our Lady of
the Lake College is $9,125. The national average
for similar type institutions is $19,009.
Elliott wins NRHA’s
Outstanding Researcher Award
The National Rural Health Association (NRHA)
named Robert Elliott, MD, PhD, the 2011 recipient
for the Outstanding Researcher Award
during NRHA’s 34th Annual Rural Health Conference
in Austin, Texas. The premise for the
NRHA Outstanding Researcher Award lies in
the notion that health services research and
basic scientific inquiry specific to rural health
needs have the potential to make long-lasting
contributions by guiding public policy and
health care planning toward a rural focus. Dr.
Elliott was chosen for the honor based on more
than 20 years of research and contributions in
advancing treatment of breast cancer.
In addition to his work with breast cancer,
Elliott has made tremendous strides in other
types of cancer as well. When the U.S. Navy
Cancer Vaccine Program was established to
develop a new prostate cancer vaccine, the Department
of Defense built the program around
Elliott’s pioneering cancer research.
OLOL College Makes
Honor Roll
The Corporation for National and Community
Service (CNCS) recently honored Our Lady
of the Lake College as a leader among institutions
of higher education for their support
of volunteering, service-learning, and civic engagement.
OLOL College was admitted to the
2010 President’s Higher Education Community
Service Honor Roll for engaging its students,
faculty, and staff in meaningful service that
achieves measurable results in the community.
OLOL College has been named to the President’s
Higher Education Community Service
Honor Roll for the years 2006, 2008, 2009
and 2010. The Corporation for National and
Community Service, which has administered
the Honor Roll since 2006, chooses institutions
for recognition based on a series of selection
factors including the scope and innovation of
service projects, percentage of student participation
in service activities, incentives for service,
and the extent to which the school offers
academic service-learning courses. A full list
of Honor Roll recipients can be found at www.nationalservice.gov.
PBRC Study Suggests
Sedentary Work Contributing
to Obesity
In a new study conducted at the Pennington
Biomedical Research Center, scientists have
found that the decrease in workplace physical
activity over the past fifty years is a significant
contributor to the obesity epidemic. The study
suggests that changes in caloric intake cannot
solely account for observed trends in weight
gain increases for men and women in the United
States. The study, entitled “Trends Over 5
Decades in U.S. Occupation-Related Physical
Activity and their Associations with Obesity,”
was published by the Public Library of Science
(PLoS), an international peer-reviewed journal
in science and medicine.
In the 1960s, more than one half of jobs included
moderate physical activity in contrast
to today’s less than 20 percent, according to
the new study. “In the last fifty years, we estimate
that daily occupation-related energy
expenditure has decreased by more than 100
calories per day, and this reduction accounts
for a significant portion of the increase in mean
U.S. body weights for women and men,” said
lead study Pennington Biomedical scientist
Timothy Church, MD, MPH, PhD.
The study examined the trends in occupational
physical activities over the past five decades,
comparing how the trends compare to concurrent
changes in body weight in men and women
in the United States. In 2008, federal physical
activity recommendations were released suggesting
150 minutes per week of moderate intensity
or 75 minutes of vigorous intensity physical
activity per week. However, only 1 in 20 Americans
are meeting these guidelines. If men and
women were meeting these recommendations,
this would make up for the decreased activity
levels in the labor work force.
In addition to Dr. Church, six of the study’s
authors are from the Pennington Biomedical
Research Center: Catrine Tudor-Locke, PhD,
Peter T. Katzmarzyk, PhD, Conrad P. Earnest,
PhD, Ruben Rodarte, MS, Corby K. Martin, PhD,
and Claude Bouchard, PhD. Other authors are
Diana M. Thomas, PhD, of Montclair State University,
and Steven N. Blair, PED, of the University
of South Carolina.
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