Katie Hebert has run University Hospital & Clinics for three years and has worked within Lafayette General Health's system for more than a decade. She oversees a facility that includes a traditional hospital licensed for 116 beds with an emergency department, along with 11 clinics, including primary care and a variety of specialties.
Lafayette General took over UHC in 2013 when Gov. Bobby Jindal decided to transfer management of our state's charity hospital system to a variety of health care organizations through public-private partnerships. While there have been cuts in funding to these partnership agreements in the past, this latest legislative session is the closest these deals have come to falling apart completely both in Lafayette at UHC and at other facilities across the state.
This week Hebert and her team were mandated by law to send out "warn" letters to their 800 employees that they might be fired if the state doesn't live up to its financial commitments. At the same time, they've started a grassroots campaign called Save UHC to drum up support to prevent that from happening.
There's some skepticism that this is more than a political threat. Gov. John Bel Edwards has said for the record that he won't sign the budget bill currently working its way through the state Legislature. Should a budget deal not be reached, Edwards suggested that whatever reduced health funding remains would go to charity hospitals in New Orleans and Shreveport, potentially orphaning UHC.
Meanwhile, Lafayette General Health CEO David Callecod says UHC needs funding restored by June 30. If the state doesn't come through with the funding it's contractually obligated to provide by that date, Lafayette General will walk away from its deal, and UHC may have to shut its doors.
Such a move would deal a devastating blow not only to Lafayette's economy, but also, as Hebert explains, to the region's poorest population.
Describe the types of patients who seek help at UHC.
When you talk about payer mix, about 56 percent are Medicaid patients. When the state of Louisiana expanded Medicaid back in 2016, many people got insured by Medicaid, but that didn't guarantee them a physician. A lot of physicians are in private practice, and they either don't accept Medicaid at all or they accept very little percentage of their practice because reimbursement is so poor. So most of those patients seek their care here. The other patients who seek their care here are those who come to use it in times of need when they didn't have insurance or Medicaid, and they've either gotten older and got on Medicare or have improved their lot in life and have commercial insurance but have developed a relationship with us and are very comfortable in wanting to stay here. Overall, a lot of the patients who come to us are very sick. Our physicians say we have a lot of pathology at UHC. Many of our patients have multiple issues that we're caring for.
What's changed since UHC since LGH took it over?
Right before we took over, they really had limited services here. UHC had gone down to 15 in-patient beds, had closed clinics, had closed the pediatric clinic, and the state had to lay those folks off. So many services here were closed. We now staff 52 in-patient beds. We've brought back orthopedics services. We've brought back pediatrics. We've expanded oncology and opened a very nice infusion center to manage our oncology patients' chemotherapy. When we took over, the ED [emergency department] was a 10-bed crammed ED, but now we have 20 beds. So we've really done everything that we could in order to expand services. Over the course of the last five years, Lafayette General has invested about $11.5 million in this facility.
Lafayette General seems rich. Why can't it afford to run UHC without state support?
Let's never forget that Lafayette General is a not-for-profit. So every dollar we make we put back into our hospitals in the way of equipment like MRIs and CT scans and additional services. Also, the hospitals that we have throughout Acadiana are management agreements because we want our smaller hospitals that surround Lafayette to stay open. Because in today's healthcare environment, unless a small hospital is connected to a system, their chances for survival are really really slim because of the way we're reimbursed and all the challenges that we have within healthcare today. Yet as important as UHC is to Acadiana, Lafayette General can't afford to risk the financial stability of the whole health system without the financial support of the state to keep UHC open.
If we don't have healthy citizens, we really have nothing. It starts with good health. If we continue to limit healthcare, continue to limit the education of those that provide healthcare, how can we talk about economic growth?
What will happen to patients if UHC closes? Can't they just find care elsewhere?
We probably service the most patients in Acadiana for primary care. As I mentioned earlier, our patients have health issues. They have comorbid conditions like diabetes, high blood pressure and heart disease. Most of those types of patients can be treated very effectively with medication, but they need to see their doctor regularly.
If we close, I don't know where they'd seek healthcare because, as I said earlier, most physicians take very little Medicaid or Medicare. If you haven't been with a physician in private practice, generally, as you turn 65 they don't take new Medicare patients, or very few of them. So these patients would struggle to find a physician to treat them. If we close, how will they get their prescriptions filled?
Now we have a patient with high blood pressure who hasn't taken their medicine for a few days. They're going to show up at the doorstep of an ED somewhere in Acadiana. And our EDs, if you've checked any of them lately, they're full. And so it's going to put stress on the infrastructure of all the emergency departments within all of Acadiana. That was one of the things we looked at as we talked about what ifs back in 2013. We knew that if we just stepped out of the consideration of being a partner, if the hospital closed, we knew it wouldn't just be devastating to UHC but all the hospitals in Lafayette and all of Acadiana. Because it's going to impact everybody. If we close today, the same statement is true. If you take the 150 people we see every day at our ED, they're going to go to Lourdes or Lafayette General, and it would be a huge impact. And those are going to be patients who probably don't have insurance or who are on Medicaid. And for hospitals like Lourdes and Lafayette General, it's going to affect them financially.
Lafayette General has lots of vacancies. Won't you just hire everyone you have to let go from UHC if you have to close?
We're going to do our best because we don't want our people to be jobless, but the reality is we don't have 800 positions available within Lafayette General. So there will be people without jobs. And obviously there are a lot of nursing jobs open but less than half of UHC's 800 employees are nurses, so not everyone's going to fit in the right positions. The real crime for me is that I really feel like for the employees who work here, it's a calling. They want to be here. For many of them, is there another job out there for them? Yes, but we don't want to be anywhere else.
How does federal funding figure into all of this?
For every dollar the state garners from the public-private partners, the feds match from $1.75 to $2.75. That's pretty significant. That's an extra tens of millions of dollars that our community will lose if UHC closes.
If I don't use UHC, why should I care if it closes?
It's not only about healthcare; it's about the economy. If 800 jobs are lost, the unemployment rate in Lafayette goes up. Also, when the 54,000 patients that come to UHC bombard other emergency rooms, these patients are going to be sicker than they are today because they haven't received care. That's going to affect the bottom line at other hospitals. In short order, other hospitals in our area are going to be having financial difficulties. That's also going to affect people who say this doesn't affect me. When a hospital or a whole health system has more patients coming to them that are no pay at all or Medicaid, sooner or later we have to compensate for that. So what usually happens is our managed care rates go up. So now the Blue Cross for a person who has insurance, the next time they negotiate a rate their costs go up, as it has a domino effect. We can imagine that in the next year or so we'd see increases in insurance rates as well if UHC were to close.
If UHC closes, that also means Lafayette doesn't just lose its hospital of last resort, we also lose our teaching hospital. What would that mean for our community?
At UHC we have two main programs: our family medicine residency and internal medicine. Our residents stay for three years. In addition to that we have residents who come from New Orleans in rotation. They get about 40% of their required service numbers through us. If we close, that would be devastating to the state of Louisiana. It would put the programs not only here at risk but the programs in New Orleans too. We're not the only hospital public-private partner threatening to walk away either. If the worst were to happen and we were to all walk away, I don't see how LSU could have a medical school because there'd be no hospitals to rotate through. We know, statistically, usually a great percentage of residents stay where they train. So it's always been a great recruiting tool to have a residency program here because those are the future physicians who will be in our community. If we didn't have a medical school residency program in the state, it could lead to a huge shortage of physicians both in Lafayette and across the state.
What are you all doing to convince our state government to keep UHC open?
[April 30] was a big day, as we issued warn notices of possible layoffs. In conjunction with that, we also began a grassroots campaign. We have our employees at every entrance to the hospital telling our story and soliciting help from our patients and anyone else who feels passionate about UHC and the care and service we deliver here. We're asking them to write letters, to reach out to their delegation via traditional mail, [and] we have tablets for people to do email. We just think it's really important that those folks in Baton Rouge really understand what's happening here.
What are the next big steps in government to get this funding issue resolved?
This year is an even year, so government can't raise revenue in a regular session. So any consideration to increase revenue to fund healthcare has to happen in a special session. In February we had a special session that wasn't very successful. The governor would like the regular session we're currently in to end early to start another special session. This could be anywhere from May 15 to May 18. We're hoping that our legislators see fit to approve additional revenue. The thing a lot of people don't really understand is, a lot of the sales tax that we're talking about we're paying today. This is a renewal of taxes that are going to expire in June. What we've been told by others who have done the analysis is that if we approve of half of one of the pennies that is expiring, it will totally fund everything we need that people are paying a whole penny for today.
What would you say to legislators directly who are still on the fence on this issue?
Healthcare is such an integral part of a community, of the whole state. If we don't have healthy citizens, we really have nothing. It starts with good health. If we continue to limit healthcare, continue to limit the education of those that provide healthcare, how can we talk about economic growth? It can't happen. To me when you look at growing our economy, it starts with healthy citizens. For healthcare not to be protected in the state budget doesn't make any sense to me. The two things that aren't protected in our state budget are healthcare and higher education. To me those are two of the most important things.
LSU used to run the charity hospitals. So there is a potential outcome where the state doesn't fund the public-private partnerships and LSU picks these up again. Are they gearing up to do that?
LSU has said that they don't have a plan because they think everything's going to work out. But if the funding of the public-private partnerships doesn't come through then it would be the state, i.e., LSU, it would be their responsibility to begin running the hospital. As far as I know they haven't begun creating an infrastructure to do that or started figuring out how that would happen. Hopefully that doesn't happen, as if UHC closes even for a couple of days it would put the residency caps in jeopardy. So LSU would have to keep it open in some fashion. It would be catastrophic when you look at the chain of events that would happen if the state doesn't fund these partnerships. It blows my mind. We're better than that. We as Louisianans are better than that, and we need to fix it.