La. Admin. Code tit. 48 § I-11103

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-11103 - Acute Care

A. New Orleans/Bayou-River Health System Area

1. There are 34 general (non-federal) hospital facilities located in the New Orleans/Bayou-River area. Current patient bed to population ratio is 5.6/1,000 general population. The ratio in planning district I (New Orleans) is 6.26/1,000, while in planning district III (Bayou-River) is 2.90/ 1,000. Although there is a relatively large use of hospital beds in the New Orleans district by persons from outside the service area, only 5 of the 26 facilities in the district had occupancy rates during 1980 which reached 80 percent. No facility in the Bayou-River district reached 80 percent occupancy; 6 of the 9 facilities in that district had occupancy rates below 60 percent during 1980. Most of the facilities in the Bayou-River area are small hospitals which provide acute care accessibility to rural residents and cannot reasonably be expected to achieve 80 percent occupancy.

2. Three new general hospital facilities have been approved for construction in HSA I and 714 additional beds have been approved for existing facilities.

3. Planning objectives for acute care in HSA I:

a. by 1985 the ratio of non-federal short-term general hospitals beds to population should not exceed 5.0 beds per 1000 population in the five-parish New Orleans area;

b. by 1985 non-federal medical-surgical beds located within the New Orleans Standard Metropolitan Statistical Area should reflect an annual unit occupancy rate of at least 80 percent;

c. by 1985 medical-surgical beds located in the non-metropolitan parishes of Assumption, Lafourche, Plaquemines, St. Charles, St. James, St. John the Baptist and Terrebonne should reflect an annual unit occupancy rate of at least 70 percent except where the number of beds is less than 50 and where accessibility would otherwise be jeopardized;

d. by 1985 non-federal short-term obstetric beds and neo-natal beds located within the New Orleans SMSA should reflect an annual unit occupancy rate of at least 75 percent and should conform to other standards and goals established in the 1982-87 State Health Plan;

e. by 1984 non-federal short-term pediatric beds located within the New Orleans SMSA should reflect an annual unit occupancy rate of at least 70 percent and should conform to other standards and goals established in the 1982-87 State Health Plan.

4. Recommended actions:

a. local consumer groups, business leaders, and labor unions should assume an active role in increasing the public's understanding of the need to restrain rising hospital costs through local action;

b. District VI of the Louisiana Hospital Association, the Metropolitan Hospital Council of New Orleans, and individual hospital administrators in the New Orleans SMSA should institute coordinative agreements which will lead to voluntary reduction of excess hospital capacity through mergers, relocations and conversions of existing hospital services;

c. short-term general hospitals located in the New Orleans SMSA which have annual medical-surgical occupancy rates of less than 70 percent should convert underutilized capacity to new services such as, but not limited to: comprehensive primary care services; mental health services; immunization programs;

d. prenatal care programs, particularly aimed at high risk mothers; screening for early detection of cancer; habilitation and rehabilitation services; services for the developmentally disabled; and alternative maintenance services;

e. short-term general hospitals located in non-metropolitan parishes which have an annual medical-surgical occupancy rate of less than 70 percent should assess the feasibility of closure or conversion to alternative services, such as ambulatory care centers or skilled nursing facilities, except where such action would jeopardize accessibility to a rural population group;

f. obstetric units in the New Orleans SMSA which have fewer than 400 deliveries per year should be consolidated or closed;

g. pediatric units in Orleans Parish with fewer than 20 beds should be consolidated or closed.

B. Mid-Louisiana Health System Area

1. There are 57 general (non-federal) hospital facilities located in the Mid-Louisiana area. Current bed to population ratio is 3.9/1,000 general population. The ratio in planning district II (Capital) is 3.58/1,000; in planning district IV (Acadiana), it is 4.19/1,000; and in planning district 5 (Southwest), it is 4.36/1,000. Only 4 of the 21 facilities in the Capital district had occupancy rates during 1980 which reached 80 percent; only 3 of the 24 facilities in Acadiana district reached 80 percent occupancy during 1980; none of the 12 facilities in the Southwest district reached 80 percent occupancy. The need to provide accessibility for rural population groups is a factor which applies to many of the area's hospitals and keeps occupancy below 80 percent; however, 26 of the 57 facilities had annual occupancy rates which fell below 60 percent in 1980.

2. Two new general hospital facilities have been approved for construction in HSA II and 561 additional beds have been approved for existing facilities.

3. Planning objectives for acute care in HSA II:

a. Medical-Surgical Services. Through 1985, the total supply of all hospital beds in Mid-Louisiana should not exceed 4.0 licensed beds per 1000 Mid-Louisiana residents.

b. By 1985 medical surgical beds located in the non-metropolitan parishes of the area should reflect an occupancy rate of at least 70 percent annually except where the number of beds is less than 50 and accessibility would otherwise be jeopardized.

c. Obstetrical Services. Through 1985, the total supply of obstetrical beds should not exceed 354-370 beds and should conform to other standards and goals established in the 1982-87 State Health Plan.

d. Neo-natal services should conform to goals and standards established in the 1982-87 State Health Plan.

e. Pediatrics. Through 1985, the total supply of pediatric beds should not exceed 383-441 beds and should conform to other standards and goals established in the 1982-87 State Health Plan.

f. Cardiac care services should conform to goals and standards established in the 1982-87 State Health Plan.

4. Recommended Actions. Short-term general hospitals located in non-metropolitan parishes which have an annual medical-surgical occupancy rate of less than 70 percent should assess the feasibility of closure or conversion to alternative services, such as ambulatory care centers, except where such action would jeopardize accessibility to a rural population group.

C. North Louisiana Health System Area

1. There are 50 general (non-federal) hospitals located in the North Louisiana area. Current patient bed to population ratio is 5.06/1,000 general population. The resource goal in North Louisiana is 4.26/1,000, adjusted upward as necessary for small institutions needed in rural areas to accomodate accessibility.

2. The current patient bed to population ratio in the Cenla district is is 4.03/1,000; bed need goal adjusted for percentage of population 65 + is 4.11/1,000. The current patient bed to population ratio in the Northwest district is 6.06/1,000 and in the Northeast district is 4.56/1,000. In both the Northwest and Northeast district the age-adjusted bed need goal is 4.30.

3. Occupancy rates in the North Louisiana area are generally low. In Cenla district, 2 of 13 facilities had occupancy rates in 1980 which reached 80 percent. In the Northwest district, 3 of 20 facilities reached 80 percent occupancy. In the Northwest district, none of the 17 facilities in that district reached 80 percent occupancy. Although small rural hospitals account for a significant proportion (66 percent) of the hospitals in the North Louisiana area, occupancy rates were below 60 percent in 1980 at 24 of the 50 facilities in the area. The Northwest and Northeast districts account for 10 facilities each in the below 60 percent category; the Cenla district had four facilities with occupancy rates below 60 percent.

4. Two new general hospital facilities have been approved for construction in HSA III. 530 additional patient beds have been approved for existing facilities.

5. Planning objectives for acute care in HSA III:

a. by 1985, the ratio of non-federal short-term general hospital beds to population should not exceed 5.0/1,000 in the Northwest district;

b. by 1985, the ratio of non-federal short-term general hospital beds to population should not exceed 4.3/1,000 in the Northeast district;

c. by 1985, medical-surgical beds located in the non-metropolitan parishes (outside Caddo, Bossier and Ouachita parishes) should reflect an annual unit occupancy rate of at least 70 percent, except where the number of beds is less than 50 and where accessibility would otherwise be jeopardized;

d. by 1985, medical-surgical beds located in the metropolitan parishes of Caddo, Bossier and Ouachita should reflect an annual unit occupancy rate of at least 80 percent;

e. obstetrical, neo-natal and pediatric services should conform to standards and goals established in the 1982-87 State Health Plan;

f. cardiac care services should conform to standards and goals established in the 1982-87 State Health Plan.

6. Recommended Actions

a. Local consumer groups, business leaders, and labor unions should assume an active role in increasing the public's understanding of the need to restrain rising hospital costs through local action.

b. The Louisiana Hospital Association and individual hospital administrators in the Northwest and Northeast districts should institute coordinative agreements which will lead to voluntary reduction of excess hospital capacity through mergers, relocations and conversions of existing hospital services.

c. Underutilized medical-surgical bed capacity should be converted to needed new services, such as comprehensive primary care services, mental health services, chemical dependency units, family planning and prenatal care programs; habilitation and rehabilitation services; services for the developmentally disabled; alternative maintenance services; and ambulatory surgical beds.

La. Admin. Code tit. 48, § I-11103

Promulgated by the Department of Health and Human Resources, Office of Management and Finance, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P. L. 96-79, and R. S. 36:256(b).