A September, 2006 report from the GAO entitled "HURRICANE KATRINA: Status of Hospital Inpatient and Emergency Departments in the Greater New Orleans Area" the GAO concludes that the stays, diversions and other parameters of emergency department use are disturbing in the New Orleans area but are in the range of similar parameters nationally. One is left to decide whether or not the New Orleans emergency department utilization rates and performance parameters are not of concern or, instead, whether or not this is even more telling confirmation of a national crisis in emergency care. Among the conclusions:
- The number of hospital beds in New Orleans is above national averages
- Personnel issues are major concern and may also explain an increased length of stay
- Legitimate differences exist in estimates of cost to address health care needs and especially reconstruction of Charity Hospital
- There are imbalances in bed availability - need is acute in psychiatry, med/surg, and adult critical care
- There is an acute problem in emergency departments, but that is a national issue.
- A number of difficult issues face the State in consultation with the federal government and other groups. Referring to psychiatric care, the report quotes that "in one case, workers made 39 telephone calls before locating a facility that would accept the patient. "
Why the GAO did the studyQuoting:
In the aftermath of Hurricane Katrina, questions remain concerning the availability of hospital inpatient care and emergency department services in the greater New Orleans area—which consists of Jefferson, Orleans, Plaquemines, and St. Bernard parishes. Because of broad-based congressional interest, GAO, under the Comptroller General’s statutory authority to conduct evaluations, assessed efforts to restore the area’s hospitals by the Department of Homeland Security’s (DHS) Federal Emergency Management Agency (FEMA); the Department of Health and Human Services (HHS); and the Louisiana State University (LSU) public hospital system, which operated Charity and University hospitals in New Orleans. GAO examined (1) the availability of hospital inpatient care and the demand for emergency department services, (2) steps taken to reopen Charity and University hospitals, and (3) the activities that HHS has undertaken to help hospitals recover. To fulfill these objectives, GAO reviewed documents and interviewed federal officials and hospital, state, and local officials in the greater New Orleans area. GAO also obtained information on the number of inpatient beds for April 2006, which was the most recent data available when GAO did its work. GAO’s work did not include other issues related to hospitals such as outpatient sevices or financial condition.
The availability of hospital inpatient care and the demand for emergency department servicesQuoting:
While New Orleans continues to face a range of health care challenges, hospital officials in the greater New Orleans area reported in April 2006 that a sufficient number of staffed inpatient beds existed for all services except for psychiatric care—some psychiatric patients had to be transferred out of the area because of a lack of beds. Overall, as of April 2006, the greater New Orleans area had about 3.2 staffed beds per 1,000 population, compared with the national average of 2.8 staffed beds per 1,000 population reported by the American Hospital Association. Hospital officials told us that they planned to open an additional 674 staffed beds by the end of 2006—390 of which would be at University Hospital—although they also reported that recruiting, hiring, and retaining nurses and support staff was a great challenge. With the addition of these beds, the population would have to increase from 588,000 in April 2006 to 913,000 by December 2006 before staffed beds would drop to the national average. For all types of care, eight of the nine hospitals we contacted provided us with an estimated overall occupancy rate for the 9-month period following the hurricane (through April 2006) and for the 12-month period before the hurricane. The hospitals’ occupancy rates for the 9-month period after the hurricane ranged from 45 percent to 100 percent, or an average of 77 percent, compared with a range from 33 percent to 85 percent, or an average of 70 percent, for the 12-month period before the hurricane. The American Hospital Association reported that the average monthly hospital occupancy rate nationwide was 67 percent in 2004. Eight of the nine hospitals that remained open after Hurricane Katrina also reported a high demand for services in their emergency departments, similar to the nationwide trend reported by the Institute of Medicine in June 2006 that emergency department crowding is a nationwide problem.
Steps taken to reopen Charity and University hospitalsThe report explains differing estimates of cost from LSU and from FEMA. It also describes the personnel concerns and other steps. Quoting:
Based on information provided by hospital officials, we believe a major challenge facing the greater New Orleans area is to attract sufficient nurses and support staff to operate the beds that are currently available. Since the number of staffed and available inpatient beds in the greater New Orleans area is above the national average, local and state officials are afforded time to deliberate the appropriate location and numbers of hospital facilities. Although LSU officials would prefer to construct a new hospital facility to replace Charity and University hospitals, decisions on the future of these hospitals and the overall provision of health care in New Orleans ultimately will be made at the highest levels of the state government. A number of federal, state, and local stakeholders will also have input into these final decisions. The decisions made will depend on a variety of factors. In addition to the major challenge of attracting and retaining hospital staff, other challenges will include the availability of funding, the health care needs of the population that returns to the city, and the state’s vision for the future of its health care system. Finally, as restoration of hospital inpatient care, emergency services, and hospital infrastructure proceeds, HHS’s efforts to conduct demonstrations and to waive certain program requirements will continue to be an important factor in addressing health care needs in the greater New Orleans area.
The activities that HHS has undertaken to help hospitals recoverQuoting:
HHS has been able to provide financial and technical assistance and has waived certain program requirements in order to help hospitals recover in the greater New Orleans area. HHS financial assistance included $221 million in hurricane relief funds designated for Louisiana through Social Services Block Grants (SSBG); some of these funds may be used to reconstruct health care facilities. As of June 13, 2006, HHS was considering four applications from the greater New Orleans area for a Medicare extraordinary circumstances exception, which allows hospitals serving Medicare patients to apply for long-term reimbursement for capital expenditures of greater than $5 million to repair hurricane-damaged facilities. Technical assistance to Louisiana is both ongoing and planned. Ongoing technical assistance has included providing consultation at Orleans Parish health planning committee meetings that addressed shortages of staff, hospital beds, and funding, and collaborating with survey agencies and hospitals to coordinate the application of accreditation standards for temporary hospital facilities or hurricane-damaged facilities. Planned technical assistance is part of a broader effort to help redesign Louisiana’s health care delivery system, including the restoration of inpatient care and emergency department services in the greater New Orleans area. HHS officials said that this could include assisting Louisiana in development of future requests for Medicare demonstrations and Medicaid waivers designed to make Louisiana’s health care system more effective and efficient. HHS has also waived certain Medicare billing and other requirements and accelerated Medicare payments to providers, including hospitals, in the hurricane-affected states such as Louisiana.
