By
JORDAN BLUM
The
LSU System is releasing its revised budget reduction and layoff plans today
now that the final budget reductions are in.
LSU
Chancellor Michael Martin said Wednesday that the flagship LSU campus is
proposing staff furloughs and close to 100 layoffs of staff and non-tenure
track faculty.
Ancillary
units such as the LSU museums, LSU Press and Center for Advanced
Microstructures and Devices also will be cut — significantly in some cases —
as they evolve into more self-sustaining entities, Martin said.
“Our
objective was to protect the academic core and the student experience,”
Martin said.
The
main LSU campus employs nearly 3,300 people.
The
LSU System is facing $56 million in cuts, which is reduced to about $52
million when extra line-item appropriations are factored in, such as $2
million to the LSU
Agricultural Center.
The
main LSU campus in Baton Rouge
is coping with a nearly $20 million cut, about a 9 percent decrease in state
funds.
The
final cuts are nearly 45 percent less than the original $219 million in Gov.
Bobby Jindal’s proposed reductions to all of higher
education statewide stemming from reduced state revenue.
The
budget slices do not factor in $55 million already cut from higher education
in January.
State
funding for public colleges was more than $1.4 billion and stands at about
$1.3 billion.
The
LSU System’s total budget to start the academic year was $1.58 billion, but
the state share was $690 million.
Jindal,
the House and the Senate worked out a last-minute compromise finalized June
25 to limit the cuts so colleges could downsize more slowly in anticipation
of additional budget reductions at least through 2012 because of declining
state revenue.
“It’s
not as bad as it could have been,” Martin said. “It’s still going to be
painful.”
LSU
System Vice President for Communication Charles Zewe said the system is
sending all of the LSU campuses’ budget plans to the LSU Board of Supervisors
today, then publicly releasing the plans.
The
LSU System includes five academic campuses, a law school, agricultural
center, biomedical research center and two medical schools.
The
University of New Orleans has scheduled a morning
news conference to announce its reorganization and budget-cutting plans.
At
the main campus, Martin was prepared to release his plans Wednesday.
LSU
System President John Lombardi requested he hold off until today so all the
plans could be released together.
Martin
said his proposed furloughs — mandatory time off without pay — would reduce
salaries on average by about 3 percent.
He
said higher-paid employees would receive larger furloughs. Such cutbacks
would allow “breathing room” to avoid larger faculty layoffs, he said.
Martin
said he is preparing to eliminate more academic programs in the future if
necessary.
Martin
also said he is looking into “incentive retirement plans” for older employees
to avoid more layoffs.
Academic
colleges are being cut about 3 percent each, Martin said, and he is slicing
about 5 percent from administrative and support units on campus.
LSU
campuses also are considering additional student fee increases, but no
decisions have been finalized.
LSU
is implementing 5 percent tuition increases.
The
tuition increase would generate more than $10 million for the LSU System,
including $7.1 million for the main campus.
http://www.2theadvocate.com/news/50318102.html?showAll=y&c=y
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The
LSU System will release its initial plan for cutting more than $50 million
from its operating budget today.
LSU
A&M in Baton Rouge
is facing $9 million in cuts after having to slash about $10 million in
January.
Going
into the legislative session two months ago, the University was expecting a
cut of about $45 million. Lawmakers managed to reduce cuts to higher
education in Louisiana
by more than 50 percent.
“It
could’ve been a lot worse and for that we are grateful,” said Chancellor
Michael Martin.
But
Martin said tough choices still have to be made, and the University’s
preliminary budget plan — submitted to the System on Wednesday — will affect
most departments on campus.
Martin
originally agreed to meet with members of the media on Wednesday to discuss
the budget, but System officials cancelled the meeting at the last minute —
saying they wanted to wait until today to release the information on all
System campuses at one time.
During
a phone interview Wednesday evening, Martin said the University’s budget plan
for the 2009-10 fiscal year reduces funding to all
academic units by an average of 3 percent and all non-academic units by about
5 percent.
Specifics
on the cuts won’t be available until each individual college decides where
best to make the cuts, Martin said. Academic program eliminations are not
likely, he said.
“Deans
are working diligently to put their cuts into their own context,” Martin
said.
Funding
for University programs like LSU Press and the Rural Life
Museum will also see a
significant loss of funding, Martin said. The University’s goal for those
programs — which are run partially on University funds — is for them to
become entirely self sufficient, he said.
“This
is, in any instance, a phase out,” Martin said.
While
the programs enhance the learning environment of the University, Martin said
they are not essential to what he calls the “academic core,” or the
“integrity” of the relationship between students and faculty.
Martin
said some layoffs are expected, and furloughs — unpaid time off — for civil
service and professional staff are being considered.
Because
faculty members can’t be furloughed without the University first declaring
financial exigency — or academic bankruptcy — Martin said he will voluntarily
take a furlough as well. He said employees at the lowest salary level will be
exempt from furloughs.
More
specific details on the University’s budget cut plans will be released today
and, after the System reviews them, will be finalized within the next couple
of weeks, Martin said.
http://www.lsureveille.com/news/budget-details-sent-to-lsu-system-1.1773002
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Gov. backs new rules for school dental clinics
(AP)
— BATON ROUGE, La. - New regulations will be
written to govern mobile dental clinics at Louisiana's public schools.
Gov.
Bobby Jindal has signed into law a bill requiring the Louisiana State Board
of Dentistry to come up with new regulations for the mobile units. The House
and Senate health care committees will be able to reject those regulations if
they find them insufficient or objectionable.
The
final version of the bill was very different from how it began. Slidell Rep.
Kevin Pearson initially proposed banning the mobile clinics outright, but he
couldn't gain passage for the idea.
The
mobile clinics have increased in recent years as the state raised
reimbursement rates for dental work through the Medicaid program for the
poor. House Bill 687 can be found at www.legis.state.la.us.
http://www.nola.com/newsflash/index.ssf?/base/national-33/1247134509106460.xml&storylist=louisiana
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By
Jan Moller
BATON
ROUGE -- A management shakeup in the Louisiana
State University
hospital system has left the state's public hospital in New Orleans without a permanent leader for
the third time in a year.
Dr.
Roxane Townsend, who has served as interim chief executive of the Interim LSU
Public Hospital
in New Orleans since January, has been named
head of LSU's Health Care Services Division in Baton Rouge. The division oversees the
seven state-run charity hospitals in South Louisiana.
She
replaces Dr. Michael Butler, who has run the hospitals' division since 2007. Butler will remain with
the LSU System, where he will focus on improving how the hospitals manage the
care of patients with chronic diseases such as asthma and diabetes.
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Dr.
Fred Cerise, LSU's vice president of health care, said the move is part of a
broader effort to restructure the management of LSU's health care operations,
which include 10 hospitals and medical schools in New
Orleans and Shreveport.
"We're
looking at the entire organization and seeing what functions make sense to
share among 10 hospitals," Cerise said.
It
also continues a string of management turnover at the New Orleans hospital that began last July,
when Dr. Dwayne Thomas was forced out as chief executive and replaced by the
hospital's medical director, Dr. Cathi Fontenot, who then gave way to
Townsend in January.
Although
Townsend's new duties will include oversight of the Interim LSU
Public Hospital,
the day-to-day operations of that facility will continue to be run by the
consulting firm of Alvarez & Marsal, which was
brought on in January to review the hospitals' operations and recommend
efficiencies.
According
to a report that the firm completed in March, the hospital could save up to
$72 million a year through improved management and other changes. Among other
things, the report found that the hospital is top-heavy with managers and has
per-patient costs that are far above national standards.
Cerise
said a search had been under way for a permanent chief executive in New Orleans, but that
it has been postponed indefinitely because of the continued uncertainty
surrounding the governance of the hospital and the 424-bed teaching hospital
that the state wants to build as a replacement.
LSU
and Tulane University officials are deadlocked
over how the new hospital should be run, with Tulane pushing for a board of
directors that is largely independent of either school, while LSU wants a
board where it has more influence. Tulane approved a state-brokered
compromise, but LSU refused.
"We
were having great difficulty trying to explain to (CEO) candidates who they
were going to be working for," Cerise said.
Time
is rapidly running out to resolve the situation, as the state's contract with
Alvarez & Marsal expires at the end of
September. Cerise said the state is evaluating whether to put the management
contract out to bid for a second time, which means either Alvarez & Marsal or another firm would continue running the hospital.
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/124703064428210.xml&coll=1
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By
Jessica Zigmond
Michael
Butler has been replaced as the CEO of the Louisiana State University Health
Care Services division by Roxane Townsend, the acting CEO of the LSU Interim
Hospital in New Orleans. The change, effective July 1,
is part of a larger restructuring effort at LSU, said Fred Cerise, vice
president for healthcare and medical education at the LSU system. Butler, 54, will
continue working at LSU as director of the system's disease-management
program.
Townsend
will continue in her role as acting CEO at LSU Interim
Hospital, which reduced
its workforce in April by about 300 people as a result of about $24 million
in budget cuts. According to Cerise, the LSU system contracts with
professional services firm Alvarez & Marsal to
manage the LSU Interim
Hospital, which is housed in the
system's former University
Hospital; it was
repaired after Hurricane Katrina. Butler
was named one of Modern Healthcare's Top 25 minority executives in 2008.
“Mike
has a very strong history of success in our disease-management programs and
we know that's going to be a more important piece for us going forward,” both
at the state and federal levels, Cerise said, adding that he views the change
as a “positive thing” to strengthen that segment for LSU.
In
a letter to LSU hospital administrators, medical directors and employees last
week, Cerise said the division has made great progress in terms of clinical
measurement and performance improvement, specifically related to
disease-management programs. “Our survival as an institution will depend on
exemplary results in this area,” Cerise said in the letter. “Because of
Mike's expertise, I have asked him to focus full time on these efforts.”
http://www.modernhealthcare.com/article/20090707/REG/307079973
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GONZALES
-- Chrissy Chauvin, 25, said she suffers from
painful earaches every three to six months and has had to wait hours in emergency
rooms to get the necessary antibiotics.
The
mother of a 5-month-old said she has been without health insurance for five
years and has been out of a job until recently to care for her infant.
Chauvin
said she could not afford the primary care offered at the doctor’s office and
had to go to the emergency room when the earaches became too painful.
But
Ascension Parish government and St.
Elizabeth Hospital
in Gonzales have joined to help the uninsured and underinsured in
predicaments similar to Chauvin’s.
After
more than two years of work, the hospital and parish government have opened
the St. Elizabeth Community Clinic, a health clinic inside the parish health
unit building in Gonzales, parish and hospital officials said.
The
clinic’s aim is to provide acute and chronic primary care to those in need,
alleviate pressure on St. Elizabeth’s emergency room and provide more
cost-effective care with better long-term outcomes for patients.
Chauvin
said she has been to the clinic three times already.
“It’s
really nice to have a place to go,” said Chauvin, who lives in Livingston but now works in Ascension Parish as a
restaurant hostess.
The
new clinic opened April 29 without broad public notice and has served about
350 people, said Kristin Martin, one of two nurse practitioners at the
clinic.
The
clinic handles many of the acute and chronic care needs for which someone
would go to the doctor’s office — colds and coughs, or diabetes and high
blood pressure checkups, Martin said.
On
Tuesday evening, parish government, city of Gonzales and hospital officials witnessed
the blessing and dedication of the new clinic by Father Gary Belsome, pastor of St. Theresa of Avila Catholic Church
in Gonzales.
“People
really don’t realize how many unfortunate families that we do have in this
parish,” Parish President Tommy Martinez told the gathering.
“You
ride around here. You see all the growth. You see all the big buildings, the
new buildings coming up, but we do have certain percentage of our population
that needs something like this,” he said.
In
the last quarter of 2008, 15.7 percent of Ascension Parish adults were
uninsured, according to an estimate from the LSU Public Policy Research Lab.
Overall,
11,442 parish children and adults were uninsured in the fourth quarter of
2008, the lab estimates.
Jon
Hirsch, St. Elizabeth Hospital
spokesman, said uncompensated care from emergency room visits cost the
hospital more than $1 million last year.
The
Franciscan Missionaries of Our Lady Health System gave the 95-bed St. Elizabeth
Hospital a two-year grant to start up
and operate the new clinic, Hirsch said.
In
exchange, parish government is providing space in its health unit for two
exam rooms, an office and a shared lab, said Kenny Matassa,
parish health unit director.
Hirsch
would not disclose the grant’s value but said the hospital plans to work with
parish grant writers to find funding for the long term.
The
not-for-profit health system is a Baton Rouge-based network of hospitals,
clinics and physicians that includes Our Lady of the Lake Regional
Medical Center
and St. Elizabeth, the system Web site says.
The
health system grant is paying the salaries of the two nurse practitioners, a
registered nurse and two patient account representatives, Hirsch said.
Dr.
James D’Antoni is the clinic medical director but
is not on-site, Hirsch said. D’Antoni will review
patient charts through a new, all-electronic records system.
Hirsch
said staff at the clinic will be able handle to the vast majority of patient
needs but D’Antoni can follow up if needed.
Patients,
who must be 10 years old or older, pay on a sliding scale based on income
ranging from nothing to $25, Martin said. Patients must bring picture
identification and proof of income, Martin said.
Clinic
hours are 9 a.m. to 4 p.m. Mondays, Tuesdays, Thursdays and Fridays and 10
a.m. to 4 p.m. Thursdays. The address is 1024 S.E. Ascension Complex Blvd.,
Gonzales.
http://www.2theadvocate.com/news/50186702.html
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La. official seeks help on Medicaid fund loss
Louisiana’s health chief heads
to Washington, D.C., today to work on a congressional
solution to the potential loss of $1 billion in annual federal support for
the state’s health-care program for the poor.
“This
is the single biggest threat to us right now,” state Department of Health and
Hospitals Secretary Alan Levin said in a pre-departure interview Tuesday
If
the state is unsuccessful in achieving the relief, Levine said, “Our Medicaid
program might as well close up shop. We cannot sustain a $1 billion drop.”
The
billion dollars is about one-sixth of the Medicaid budget.
Because
all who qualify for Medicaid must be served, the extra cash commitment would
become the state’s obligation, Levine said.
Levine
called the just-ended health-care budget battles “a walk in the park”
compared to what would be in the state’s future.
The
problem involves a U.S. Health and Human Services formula used to determine
the level of federal support for state Medicaid programs.
Medicaid
is the government health insurance program for the poor.
In
Louisiana,
it mainly covers services for children, the elderly and developmentally
disabled.
The
Medicaid budget for the fiscal year that began July 1 is $6.75 billion
including state and federal funds.
The
funding formula considers per-capita income over a three-year period to
determine the state’s participation rate.
The
formula is flawed, Levine said.
It
penalizes states, such as Louisiana,
that have temporary economic increases because of an influx of federal
hurricane recovery dollars, he said.
The
formula set to kick in next year would drop the federal share from 80 percent
to 63 percent.
Louisiana’s Medicaid program
would be facing a $400 million to $500 million loss in federal funds in the
state’s next budget year when the initial change kicks in, Levine said.
In
the following state budget year with full implementation, Levine said the
number would exceed $1 billion, he said.
Levine
said he is working with the state’s congressional delegation on legislation
that would essentially freeze the match at 72 percent federal and 28 percent
state that had been in effect.
“We
are arguing that when you have a disaster and your per capita income spikes
up there should be a certain threshold that Health and Human Services should
use to negate the formula,” Levine said.
For
instance, if a state’s per capita income goes up 5 percent or more that would
be the trigger to freeze the current rate, Levine said.
The
idea would be to keep the pre-disaster match rate for three years to allow
time for the economic situation to settle down, Levine said.
That
would mean Louisiana,
for instance, would pay 28 percent instead of 37 percent that would be
required under the formula, he said.
“The
entire delegation wants to be involved,” Levine said.
Levine
said he is also trying to build a coalition of states to support the
legislation.
He
said he has already discussed the potential legislation with health chiefs in
Florida, Texas
and Alabama.
He
said he also wants to get Mississippi and Iowa involved because
of the presidentially declared disasters that have spawned similar Medicaid
funding problems in those states.
At
the same time, Levine said an administrative solution through the federal
health agency is being worked on.
But
the federal agency insists a law change is needed to alter the Medicaid
funding formula, he said.
“We
are talking about a lot of money that’s going to disappear,” Levine said.
“All
the discussion about (health-care) reform is fine. We have a state that
cannot afford to make up $1 billion.”
Medicaid
is an entitlement program so the state must cover costs, Levine said.
“If
we cannot get this done and we have to plug this hole, it must come from
other areas of the budget. … This could have a direct impact on higher
education” which is unprotected from the budget ax, he said.
http://www.2theadvocate.com/news/50186757.html?index=1&c=y
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There’s
a happy ending to an unhappy story in The New York Times. Larry Yurdin, a computer specialist in Texas, has full medical care because he’s
just turned 65 and is eligible for Medicare.
The
bad news? He had to file for bankruptcy for unpaid medical bills, even though
he was insured when he had several heart surgeries in the past couple of
years.
The
examination of the Texas
man’s case in the Times is inspired by hearings in Congress about the
failures of today’s employer-provided insurance plans to protect the insured
financially as well as physically.
In
Yurdin’s case, his employer offered a “limited
benefit” plan that appeared to him to cover hospitalization. Turns out, it
did not cover most of the medical procedures that one has in a hospital, and
certainly not expensive surgeries. His insurer, Aetna,
while regretting the circumstances, said limited benefit plans are not
appropriate for a man in his 60s with an irregular heartbeat.
But
is a busy worker trying to earn a living able to understand the fine print in
his insurance policy? In fact, does anyone outside an insurance company?
The
Yurdin story underlines a concern that opponents of
President Barack Obama’s health-care plans seem not to understand: the
pervasive fear among Americans that insurance isn’t going to be there for
them.
Louisiana’s
three members of Congress who are physicians — Charles Boustany
of Lafayette, Bill Cassidy of Baton Rouge, John Fleming of Minden — are all
Republicans who oppose Obama’s plans. They’re right to note that there’s a
lot about Obama’s plans that is unexplained and might be rushed through by
the Democratic majority without regard to unintended consequences.
All
too often, they glide over the issue of under-insurance by saying most
Americans are happy with their private insurance.
We
wonder if, in a recession in which millions are losing their jobs and thus
their health insurance, the Republicans’ view that things are fine for most
everyone is realistic. If the GOP does not grapple with this problem, we doubt
there will be a political coalition possible to stop any proposal the
president wishes to make.
In
the Times, a health economist for the New America Foundation think tank, Len
Nichols, put the problem bluntly: “Conceptually, insurance means normal people
should not go bankrupt from serious medical conditions.”
If
Republicans don’t get that concept, their opposition to Obama will be not
only unsuccessful this year, but potentially ruinous for an already-damaged
party’s prospects.
http://www.2theadvocate.com/opinion/50184292.html
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By
Ricardo Alonso-Azldivar
WASHINGTON
--- The nation's hospitals will give up $155 billion in future Medicare and
Medicaid payments to help defray the cost of President Barack Obama's health
care plan, a concession the White House hopes will boost an overhaul effort
that's hit a roadblock in Congress.
Vice
President Joe Biden announced the deal at the White House on Wednesday, with
administration officials and hospital administrators at his side.
"Reform
is coming. It is on track; it is coming. We have tried for decades to fix a
broken system, and we have never, in my entire tenure in public life, been
this close," Biden said. And in a firm message to lawmakers, Biden
added, "We must -- and we will -- enact reform by the end of
August."
Obama
has set an ambitious timetable for legislation, with the hope of signing a
comprehensive bill in October. But lawmakers returned Tuesday from their July
4 break with lots of questions about the complex legislation and deep
misgivings about key elements under discussion.
Democratic
senators in particular are having second thoughts about a proposed new tax on
generous health insurance benefits provided by some employers. Without the
tax -- Republicans favor it as a brake on cost increases -- the prospects for
a bipartisan deal in the Senate appear to be in jeopardy.
Timing
is critical because lawmakers might be reluctant to vote on such a charged
issue as health care next year, when all House members and one-third of
senators face elections.
"We're
not there yet," said Sen. Max Baucus, D-Mont., who, as chairman of the
Senate Finance Committee, has spent countless hours seeking a compromise with
Republican colleagues. "I'm trying the best I can to get there
soon."
Another
senator deeply involved in the bipartisan negotiations said the proposed new
tax on the costliest employer-paid insurance benefits is quickly losing favor
with Democrats.
"It's
clearly a very difficult issue," said Sen. Kent Conrad, D-N.D., citing
recent polls. "You go to the public to ask them what they think and they
don't like it."
A
compilation of surveys reviewed by senators showed at least 59 percent of the
public opposed to taxing health care benefits to "pay for reform."
As
a result, Conrad said, "we're looking at other options" to help
finance a bill whose price tag is expected to reach $1 trillion or slightly
more. Those other options may be hard to sell to Republicans whose support
Baucus has been cultivating.
Baucus
has long championed a tax on health benefits as the best way to pay for
health care while simultaneously restraining the growth of the cost of
coverage in the future. But the idea has drawn strong opposition from
organized labor, a core Democratic constituency. House Democrats have been
highly resistant, too, and Obama campaigned hard against it in last year's
run for the White House.
The
deal with the hospitals -- the one bright spot right now for Obama -- may
also be on shaky ground. Officials said it's pegged to the Senate Finance
Committee legislation that Baucus is negotiating, and whose prospects are
uncertain. It would follow concessions from drug companies, and an announcement by Wal-Mart last week that it would support an
employer requirement to help pay for health care.
Of
the $155 billion in projected savings from hospitals, about $40 billion to
$50 billion would come from reducing federal payments hospitals receive for
providing care to uninsured and low-income patients, according to lobbyists.
Those payments are now made through the Medicare and Medicaid programs. The
Medicaid cuts would be apportioned by state, as 10 percent annual reductions
beginning around 2015.
Officials
of public hospitals say they have concerns such reductions could also squeeze
funding for trauma centers and burn units, which receive Medicare and
Medicaid money. But they wanted to see the fine print.
Other
savings of about $100 billion would come from slowing increases in planned
Medicare payments to hospitals. A small amount of savings would come from
trimming the money hospitals get for preventing patients from being
readmitted for additional care.
Hospitals
would also get something out of the deal. They won an agreement that if the
Finance Committee's legislation includes a public health insurance plan, it would reimburse hospitals at above the rates
Medicare and Medicaid pay, which hospitals have long complained are
insufficient.
The
issue of a government insurance plan to compete against private companies
continued to inflame sentiments on both sides of the political aisle.
Republicans remain solidly opposed. Democrats, citing polls that show the
public is open to the idea, are talking about a showdown on the issue.
Biden
was joined at the White House by Rich Umbdenstock,
president of the American Hospital Association, Richard Bracken, president of
Hospital Corporation of America,
Wayne Smith, president of Community Health Systems, and Sister Carol Keehan, president of Catholic Health Association of the United States.
"We
know how urgently reform is needed, both for moral and economic
purposes," said Keehan, who represents
Catholic hospitals.
House
Republican Leader John Boehner of Ohio
criticized the hospital deal, saying it was negotiated out of public view.
"The administration and congressional Democrats are literally bullying
health care groups into cutting backroom deals to fund a government takeover
of health care," Boehner said in a statement.
http://www.google.com/hostednews/ap/article/ALeqM5jlMpJGn28kqCcgU-aGcYE_ZHW-ywD99AFHI01
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WASHINGTON
(AP) -- House Democrats at work on health legislation are narrowing in on an
income tax surcharge on the highest-paid wage earners to help pay the cost of
subsidizing insurance for the 50 million who lack it.
Pushing
to complete a comprehensive health care bill by Friday and bring it up for
committee votes next week, House Democrats abandoned earlier money-raising
proposals, including a payroll tax. They planned to meet behind closed doors
Thursday to fine-tune the details.
The
action in the House stood in contrast to the Senate, where Democrats edged
away from their goal of passing health care legislation by early August amid
heightening partisan controversy over tax increases and a proposed new
government role in providing insurance to consumers.
As
discussed in the tax-writing House
Ways and Means Committee, the surtax would apply
to individuals with adjusted gross income of more than $200,000 and couples
over $250,000, according to officials involved in the discussion. Most spoke
on condition of anonymity because the talks were private.
In
addition, key lawmakers are expected to call for a tax or fee equal to a
percentage of a worker's salary on employers who do not offer health
benefits.
Ways
and Means Chairman Charles Rangel, D-N.Y., has said his committee needs to
come up with $600 billion in new taxes to deliver on President Barack Obama's
goal of sweeping changes to the nation's health care system to bring down
costs and cover the 50 million uninsured. Hundreds of billions of dollars
more would come from cuts to Medicare and Medicaid to pay for legislation
expected to cost around $1 trillion over 10 years.
Top
administration officials, including White House chief of staff Rahm Emanuel, conferred with Rangel's committee Democrats
on Wednesday as they met throughout the day.
"They
know what I'm thinking about and I have no reason to believe I'll have any
problems with them on that part of the bill," Rangel said of the tax
proposals.
Rep.
Shelley Berkley, D-Nev., a member of the panel,
said the proposed surtax on high-income taxpayers appealed to her and others
as a way to avoid a "nickel-and-dime" approach involving numerous
smaller tax increases.
Lawmakers
cautioned that no final decisions have been made, either by the tax-writing
committee or by the Democratic leadership, which hopes to have legislation
drafted by the end of the week and through the House by month's end.
Smaller
tax options remained possibilities, depending on the overall cost of the
legislation, including a tax on sugared soft drinks and ending a tax break
that drug companies receive for advertising.
In
the Senate, New York Democrat Chuck Schumer told The Associated Press that he
believes the "ultimate goal" is to have a bill by the end of the
year that is signed into law by the president.
Separately,
Republicans who met with Senate Majority Leader Harry Reid, D-Nev., said he expressed flexibility on the timetable,
indicating that he was willing to allow more time before legislation is
brought to the floor.
Any
failure to meet the August goal would be a setback -- but not necessarily a
fatal one -- for Obama's attempt to achieve comprehensive health care
legislation this year. A group of Democratic and Republican senators led by
Finance Committee Chairman Max Baucus, D-Mont., is still working toward a
bipartisan deal, but that effort appeared set back by concerns Reid and other
leading Democrats expressed this week over a tax on health care benefits that
Baucus was considering to pay for it.
The
White House expressed its support Wednesday for the emerging House
legislation, noting that the Congressional Budget Office had said planned
changes to Medicare would save more than $500 billion over 10 years. A
significant part of that money would come from the steep reduction in
subsidies paid to insurance companies that offer private Medicare coverage.
But
in a letter to Rangel and other committee chairmen, budget director Peter Orszag urged additional cuts in projected Medicare and
Medicaid spending, as well as consideration of a plan to give an independent
commission a greater role in setting future payments rates for Medicare
health care providers -- something that could weaken Congress' involvement.
http://www.nola.com/news/index.ssf/2009/07/house_democrats_look_at_taxing.html
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BATON
ROUGE — The Department of Health and Hospitals’ Bureau of Primary Care and
Rural Health is offering grants to medically underserved, rural and urban
areas to expand access to primary care services, according to a news release
from DHH.
Application
guidelines for the Community-Based and Rural Health Program Grant are
available to download at www.pcrh.dhh.louisiana.gov.
Individual
awards of up to $75,000 are available to public and non-profit groups located
in rural areas, health professional shortage areas or areas identified in Act
162 from the 2002 First Extraordinary Session of the Louisiana Legislature.
Act 162 is a bill aimed at impacting health care in Louisiana’s rural and urban underserved
communities, and outlines a strategic plan for increasing access to and the
quality of care in these areas.
Proposed
projects should expand, enhance or strengthen access to quality primary care
services or school-based health centers with priority given to projects that
demonstrate components of the medical home system of care.
This
includes:
#
evidence-based, patient-centered care,
#
coordination of care across multiple providers
#
disease management
#
quality improvement initiatives
#
health information technology.
A
maximum of $30,000 is available for capital improvements, equipment and
technology regardless of the project’s focus.
“Each
year, the Community-Based and Rural Health program grant is updated to
reflect current priorities and initiatives of the department,” said Gerrelda Davis, director of the Bureau of Primary Care
and Rural Health. “This year, one of our top priorities is investing in
projects that increase access to primary care services that are truly viable
and sustainable.”
Letters
of intent are due by close of business on July 17, and the application
deadline is 5 p.m. on July 31.
Applications
can be mailed to P.O. Box 3118,
Baton Rouge, La, 70821.
Applications can also be submitted electronically in a Word or PDF file to
sheree.taillion@la.gov with “CBRH Application” in the subject line.
Applications
will be reviewed by a committee. Funding decisions will be based on
recommendations from the committee’s evaluation and scoring of the
applications.
http://www.thetowntalk.com/article/20090708/NEWS01/90708017
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Cash-strapped Jefferson Parish hospitals to work together to cut
costs
The
Jefferson Parish Council created a 10-member board this morning to oversee
joint cost-saving efforts between the parish's two publicly owned hospitals,
which have lost a combined $170 million since 2005.
The
council unanimously approved a parish-wide hospital service district to
increase collaboration between West Jefferson Medical
Center in Marrero and East Jefferson
General Hospital
in Metairie.
Parish
officials said the board will use the hospitals' combined bargaining power to
negotiate higher reimbursement rates from insurance companies and lower
prices on everything from pharmaceuticals to cleaning supplies.
The
hospitals will remain independent and retain their existing boards.
"The
community will not see any changes," said Nancy Cassagne,
West Jefferson's chief executive officer.
"This will all be about increased efficiency in back-office
functions."
Pinched
by skyrocketing labor costs and a surge in uninsured patients, the two
hospitals, like all large hospitals in the New Orleans area, have been bleeding cash
since Hurricane Katrina.
Since
2005, East Jefferson has lost $104 million, while West
Jefferson has lost $66 million, according to a report by the
federal Government Accountability Office.
Although
the deficits have so far been covered by reserve funds, hospital
administrators have said they can't afford to operate in the red much longer
without cutting services.
Unlike
the east bank and West Bank hospital service districts that oversee the two
public hospitals, the parish-wide hospital board is not authorized to levy
taxes or issue bonds.
The
board will be comprised of the chief executive officers and medical staff
chiefs at both hospitals as well as the chairperson,
vice chairperson and treasurer on both of the existing hospital boards.
http://www.nola.com/news/index.ssf/2009/07/cashstrapped_jefferson_parish.html
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HealthLeaders
| 07.08.09
Cheryl
Clark, for HealthLeaders Media, July 8, 2009
America's emergency room
doctors have been feeling slighted.
For
starters, they were left out of an influential White House health reform
summit in March, leaving them grumbling that their new President didn't
appreciate their crucial role in saving lives.
Second,
they have been arguing for more respect from their hospital CEOs, who they
say often turn a blind eye to gridlocked emergency
rooms with loaded hallway gurneys. Several emergency room doctors this week
complained that while the ED "boards" patients with respiratory
illness and injuries waiting for an upstairs bed to clear, empty beds sit for
hours on the units labeled "reserved," awaiting well-insured
patients scheduled for elective surgery.
And
third, they say they were insulted by Kathleen Sebelius,
who no sooner than assuming the role of U.S. Health and Human Services
secretary this spring, suggested most patients who end up in the emergency
room don't really need to be there. In doing so, they say, she
"perpetuated myths" and trivialized the very dangerous problem of
overcrowding, even as hospitals everywhere prepare for a very different
influenza season.
She
was so mistaken, says Nick Jouriles, MD, president
of the American
College of Emergency
Physicians, who pointed to a Centers for Disease Control and Prevention
report that says only 12% of emergency room patients have non-urgent medical
needs. More than half of patients who seek emergent care are admitted, so how
can their medical needs not be serious?
And
fourth, emergency teams are stretched as never before. The number of visits
to the emergency room has increased from 90.3 million patient
in 1996 to 119.2 million in 2006 just as the number of hospital emergency
rooms has decreased, from 4,019 to 3,833. And the percentage of the
population that visited an emergency department increased 18%.
With
an underlying sense of umbrage, Jouriles and the
College this week reemphasized the critical importance of emergency room
teams, and turned up the volume in its call for attention.
In
a scary 16-page National Strategic Plan for Emergency Department Management
of Outbreaks of Novel H1N1 Influenza, they painted a potentially chaotic
scenario this fall when and if the next wave of H1N1 influenza strikes,
coming down hardest on America's emergency rooms first.
Some
of the most thoughtful scientists are suggesting that H1N1 might return with
a vengeance, striking younger people, the ones in the hospital system's
workforce, first. Yet not all hospitals are doing what they should to get
ready, Jouriles says.
The
report contained 27 plan topics, underscored with 93 suggested action items,
which the College thinks hospitals wishing to make a serious effort at
preparedness should be doing now.
Make
sure support personnel have enough resources, check that all appropriate
hospital staff are properly certified and trained and set aside time to
rehearse with disaster drills—not for a flood or an explosion scenario—but a
real live H1N1 pandemic.
For
even the largest hospitals, it's a daunting "to do" list. And
smaller and medium-sized hospitals, might not get around to completing a lot
of what might be required, says Stephen Cantrill,
MD, a member of ACEP's H1N1 Task Force.
Cantrill says these are three areas where
hospitals are most vulnerable in the event of a pandemic attack:
Number
one, Cantrill says, "is staffing. In a
disaster like Katrina, you had people from around the country willing to come
in and help out. But if the next outbreak is broadly population based, you
will lose not only many members of your own staff, but the vast majority of
your volunteers."
Hospitals
need to start now to mobilize teams of nurses and physicians, even if it
means recruiting those retired but who kept their licenses active.
Number
two is supplies. Far too many hospitals are using "just-in-time"
purchasing policies that will leave them scrambling for masks, gloves, gowns
and ventilators, not to mention antibiotics and IV equipment, if a 1918-level
flu season strikes.
"If
you do the numbers of what would be required for a sustained pandemic, it
just strikes fear in the heart of anyone who has looked carefully at this
problem," say Cantrill, an emergency room
physician at Denver Health Medical
Center in Colorado.
"There
would be a disruption in our supply chain." And hospitals that normally
compete with each other will not be willing to help out if they themselves
are running short too, he says.
Number
three is communication. Hospitals and public health officials must have a
routine, constant communication stream, a conduit he
says has historically been a weak link. But the involvement of public health
officials is essential to reassuring the public and the media, notifying
patients when to go to the hospital, and when to stay away.
At
his hospital last April, "the number of patients in our emergency
department with respiratory complaints increased by a factor of three. It was
overwhelming and debilitating and public health officials need to know about
that, and do what they can to offload on other facilities," Cantrill explains.
Lastly,
he says, is to imagine the worst. Hospital officials at all levels of care
need to dust off their protocol books and spend some time thinking about how
such a scenario would really play out when resources are stretched thin.
It's
tough to think about, he says, but each hospital needs to have a plan, and a
chain of command, for deciding how to triage patients for life-saving care.
Who gets a ventilator and who doesn't when there aren't enough to go around?
"We
only have 105,000 ventilator in the U.S. and we
would need six times that if we had a true pandemic," Cantrill says. "Hospitals are going to have to look
at way to prioritize when we have limited supplies."
"These
are tough ethical questions," no one can dispute, he says. And while
some states and regions of the country have "really taken the bull by
the horns," others have not.
The
emergency room doctors have turned up the volume of their message. Maybe it's
time to listen up.
http://www.healthleadersmedia.com/content/235617/topic/WS_HLM2_COM/ER-Docs-Will-See-H1N1-FirstmdashDont-Ignore-Their-Warnings.html
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By
GARDINER HARRIS
President
Obama on Wednesday nominated Dr. Francis S. Collins, a pioneering geneticist
who led the government’s successful effort to sequence the human genome, as
head of the National Institutes of Health.
Dr.
Collins’s selection, which had been rumored for weeks, was praised by top
scientists and research advocacy organizations for whom
the health institute is a crucial patron.
Based
in Bethesda, Md.,
the N.I.H. is the most important source of research money in the world; over
the next 14 months it will dole out about $37 billion in research grants and
spend $4 billion on research programs at its Maryland campus.
“Francis
Collins is an extraordinary scientist and one of the nicest guys you could
ever meet,” said Dr. Otis W. Brawley, chief medical officer of the American
Cancer Society.
But
praise for Dr. Collins, 59, was not universal or entirely enthusiastic. Dr.
Georges C. Benjamin, executive director of the American Public Health
Association, called Dr. Collins’s selection a “reasonable choice.” Others
privately expressed unease.
There
are two basic objections to Dr. Collins. The first is his very public embrace
of religion. He wrote a book called “The Language of God,” and he has given
many talks and interviews in which he described his conversion to
Christianity as a 27-year-old medical student. Religion and genetic research
have long had a fraught relationship, and some in the field complain about
what they see as Dr. Collins’s evangelism.
The
other objection stems from his leadership of the Human Genome Project, which
is part of the N.I.H. Although Dr. Collins was widely praised in 2003 when
the effort succeeded, the hopes that this discovery would yield an array of
promising medical interventions have greatly dimmed, discouraging many.
Dr.
Collins cannot be blamed for the unexpected scientific hurdles facing genetic
research, but he played an important role in raising expectations impossibly
high. In interviews, he called the effort “the most important and the most
significant project that humankind has ever mounted” and predicted it would
quickly allow everyone to know the genetic risks for many diseases.
Some
scientists and advocates for people suffering from diseases criticized the
extraordinary amount of money and attention the sequencing effort garnered,
saying it distracted from more fruitful areas of research.
Fran
Visco, president of the National Breast Cancer
Coalition, raised questions about the appointment. “The N.I.H. needs
visionary leadership willing to challenge the present stagnation at the
institute,” Ms. Visco said. “It may be difficult
for Francis, since he has been a part of the system.”
“We
look forward to working with him,” she added, “to help him move beyond a
focus on technology and to push N.I.H. to foster innovation and regain the
sense of urgency to save lives.”
Dr.
Collins’s confirmation by the Senate is all but certain. He has long
cultivated good relations on Capitol Hill. And since the administration
finalized rules for broader use of stem cells in federal research before
nominating him, anti-abortion forces will have a harder time using that issue
to stop his confirmation.
Dr.
Collins, who resigned last year as director of the National Human Genome
Research Institute, would succeed Raynard Kington, who has been acting director at the N.I.H. since
last fall.
Dr.
Collins earned a Ph.D. in physical chemistry from Yale
University and a medical degree from
the University
of North Carolina. He
likes to sing and play a guitar decorated with a double helix, the shape of
genetic code.
He
was part of a team at the University
of Michigan that in
1989 discovered the gene for cystic fibrosis. At the time, many predicted
that the discovery would lead to a quick cure. But like so much in genetic
research, that hope is still a long way off.
As
the leader of the Human Genome Project, Dr. Collins engaged in a fierce
public battle with Dr. J. Craig Venter of Celera to finish the sequence first
and make it broadly available. The success of Dr. Collins’s project torpedoed
much of Celera’s business model. But in a speech last month, Dr. Collins said
the N.I.H. needed to form more partnerships with the pharmaceutical industry
to create new drugs.
Dr.
Alan I. Leshner, chief executive of the American
Association for the Advancement of Science, said it was “an excellent idea to
have a very credible geneticist heading N.I.H. at a time when we are pursuing
so vigorously the promise of personalized medicine based on genomics."
http://nytimes.twi.bz/Yb
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By
Karen Tumulty
Should
government-subsidized health coverage pay for abortion procedures? For more
than three decades, that question had seemed pretty much settled. The Hyde
Amendment, passed by the House on Sept., 30, 1976, forbade Medicaid — a
program for poor people, jointly administered by Washington and the states,
which had, up till then, paid for about 300,000 abortions a year — from using
any federal money to pay for the procedure. All but 17 states followed suit,
banning use of their own funds as well; with a few modifications, the ban has
stood up ever since.
The
prospect of sweeping health reform, however, has reopened the issue. While
current versions of the legislation do not address the abortion issue at all,
late last month, 19 antiabortion Democrats in the House sent a letter to
Speaker Nancy Pelosi, warning that they "cannot support any
health-care-reform proposal unless it explicitly excludes abortion from the
scope of any government-defined or subsidized health-insurance plan."
Among those who signed the letter were two members of the House Energy and
Commerce Committee (one of the three panels with principal jurisdiction in
the health-reform effort): Bart Stupak of Michigan
and Charlie Melancon of Louisiana. (See more about abortion.)
"The
health-care-reform package produced by Congress will be landmark," the
Democratic lawmakers wrote, "and with legislation as important as this,
abortion must be addressed clearly in the bill text." Pelosi's office is
negotiating with the lawmakers to find some way to accommodate their
concerns, but thus far, they haven't found one.
Indeed,
the abortion question is just one of a myriad of tricky questions that will
emerge from the fine print as the health debate moves forward. Democratic
leaders say, for example, that they are already prepared to accede to
Republican demands that illegal immigrants be excluded from the plan. But
other issues, such as abortion, are going to be far more difficult to
navigate. (Read "Understanding America's Shift on
Abortion.")
If
an explicit ban on abortion coverage were imposed, say sources involved in
writing the legislation on Capitol Hill, it could have much further-reaching
implications than the Hyde Amendment ever did. It could, in fact, have the
effect of denying abortion coverage to women who now receive it under their
private insurance plans. Nearly 90% of insurers cover abortion procedures,
according to a 2002 survey by the Guttmacher
Institute, a nonprofit organization whose statistics are relied upon by both
sides of the abortion debate.
Under
the legislation being worked on by three committees in the House, Americans
earning up to 400% of the poverty level — $43,000 for an individual; $88,000
for a family of four — would be eligible for government subsidies to help
them purchase coverage. But if the antiabortion legislators get their way, those
subsidies would have a big string attached; they could not be used to
purchase a policy that has abortion coverage. For many women, that would mean
giving up a benefit they now have under their private insurance policies. And
it would raise all sorts of other questions if insurers were allowed to
discriminate among their customers based on whether or not they are using
federal dollars to pay for their policies.
Abortion-rights
advocacy groups are pushing back. On July 6, the National Women's Law Center (NWLC)
released a poll of 1,000 likely voters conducted by the Mellman
Group indicating that 71% favor including reproductive services such as birth
control and abortion as part of health reform. The poll also found that 75%
believe an independent commission should determine what medical services are
covered among the basic benefits offered under health reform. (Congress is
also considering giving that power to the Health and Human Services
Secretary.) Said NWLC vice president Judy Waxman: "Congress should refrain
from practicing medicine and instead let medical professionals determine what
health-care services will be included in a benefits package."
http://www.time.com/time/politics/article/0,8599,1909178,00.html
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