La. Admin. Code tit. 48 § I-11105

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

Section I-11105 - Ambulatory Care

A. New Orleans/Bayou-River Health System Area

1. The New Orleans/Bayou-River area is predominantly urban, with a higher per capita income, more physicians and more hospital beds than elsewhere in the state. Yet the area has the highest mortality rate in the state. Mortality rates in the area which have particular significance for ambulatory care planning are those for heart disease, cancer and infants.

2. There is a shortage of primary care physicians in some of the rural sections of the area and in the poverty pockets of New Orleans. Dental services are also relatively inaccessible to some of the poorer residents of New Orleans.

3. Planning Objectives for Ambulatory Care in HSA I

a. ambulatory or mobile health care settings which provide low cost screening diagnosis and treatment or referral should be available and accessible to all residents of the area within 30 minutes travel time. Programs directed especially toward screening for heart disease, hypertension, cancer, tuberculosis, anemia, gonorrhea and syphilis are needed.

b. Primary care physician services should be available in Assumption Parish and in Northeastern St. Tammany Parish, Dulac, Desire/ Florida (N.O.), Teche and Lafitte by 1985.

c. Low-cost pre-natal care programs for the low-income population should be available within 30 minutes travel time for all residents of the area, with appropriate referral services for high risk patients.

d. Ambulatory or mobile dental services which provide low-cost screening and treatment should be available to all residents of the area within 30 minutes travel time, but especially in the poverty areas of New Orleans.

e. By 1987, 30 percent of all surgical procedures performed in the area should be performed on an ambulatory basis.

f. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for radiation therapy services.

g. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for computed tomography services.

h. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for end-stage renal disease services.

i. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for ambulatory surgical services.

j. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for preventive health services.

4. Recommended Actions

a. Primary care physicians, dentists and other ambulatory care providers should consider the cost-effectiveness of mobile or "no-frills" type services which can be offered at a lower consumer cost in underserved poverty areas.

b. The Medicaid Program should consider the feasibility of instituting coverage of adult dental services beyond the current denture program, with the possibility of implementing a "co-pay" coverage whereby the recipient would bear 50 percent of the costs.

c. Medicare, Medicaid and major health insurance companies should develop policies that promote the utilization of ambulatory surgical services when medically appropriate, such as patient rebate for same day discharge or cost incentives for hospitals for same day discharge.

d. Assistance from L. S. U. and Tulane Medical Schools and/or Louisiana State Board of Medical Examiners in locating primary care physicians willing to establish practice in the designated manpower shortage areas of the area.

B. Mid-Louisiana Health System Area

1. In Mid-Louisiana are several urban, economically sound areas with adequate physicians and other ambulatory health care. However, there is a significant number of rural sections in the area, some of which are relatively isolated, with ambulatory health care inaccessible to residents. Dental services are inaccessible to some of the poorer residents of Baton Rouge.

2. Mortality rates are high in Mid-Louisiana, as they are elsewhere in the state, but especially so in the 15-24 year old age group. Suicides and accidents are a major reason for the high mortality rate in this age group.

3. Planning Objectives for Ambulatory Care in HSA II

a. Ambulatory or mobile health care settings which provide low cost screening, diagnosis and treatment or referral should be available and accessible to all residents of the area within 30 minutes travel time. Programs directed toward screening for heart disease, hypertension, arteriosclerosis and cancer are especially needed.

b. Primary care physician services should be available in Ascension, Cameron, East and West Feliciana, Evangeline, Iberville, Jefferson Davis, Livingston, Pointe Coupee, St. Helena and West Baton Rouge Parishes; also in St. Martin, Eden Park (Baton Rouge), Merryville and North Lake Charles by 1985.

c. Ambulatory or mobile dental services which provide low-cost screening and treatment should be available to all residents of the area within 30 minutes travel time, with emphasis on providing services to residents of the Eden Park area in Baton Rouge.

d. A comprehensive effort to screen and refer young people with symptoms of mental health and/or chemical dependency problems should be initiated by ambulatory health care providers.

e. By 1987, 30 percent of all surgical procedures performed in the area should be performed on an ambulatory basis.

f. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for radiation therapy services.

g. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for computed tomography services.

h. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for end stage renal disease services.

i. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for ambulatory surgical services.

j. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for preventive health services.

4. Recommended Actions

c. Primary care physicians and other providers of ambulatory health care should devote attention to the screening and referral of persons in the 15-24 age group who may have symptoms of mental health and/ or chemical dependency problems.

d. Medicare, Medicaid and major health insurance companies should develop policies that promote the utilization of ambulatory surgical services when medically appropriate, such as patient rebate for same day discharge or cost incentives for hospitals for same day discharge.

e. Assistance from L. S. U. and Tulane Medical Schools and/or Louisiana State Board of Medical Examiners in locating primary care physicians willing to establish practice in the designated manpower shortage areas of the area.

C. North Louisiana Health System Area

1. North Louisiana is a predominantly rural area of the state, with a larger geographic area and a smaller population than the other areas of the state. There is a higher level of poverty in the area, especially concentrated in the Cenla and Northeast districts. This type of setting portends a shortage of ambulatory care, accessible within 30 minutes travel time, just as is found in the area. Creative planning and implementation activities are needed to improve the accessibility and availability of ambulatory care in the rural sections of North Louisiana.

2. There are designated primary care physician shortages in Bienville, Bossier, Caldwell, Catahoula, DeSoto, Grant, Jackson, Madison, Tensas, Vernon, Webster, West Carroll and Winn Parishes, and in Zwolle, West Union and a poverty area of Shreveport. There is also a designated shortage of primary care physicians for the state-operated hospital in Ouachita Parish, E.A. Conway Memorial Hospital.

3. There are designated dental manpower shortages in Bienville, Caldwell, Catahoula, Concordia, DeSoto, East and West Carroll, Franklin, Grant, Jackson, Lincoln, Madison, Morehouse, Natchitoches, Red River, Tensas, Union, and Vernon Parishes.

4. Despite the general lack of accessible primary care, the mortality rate in North Louisiana is lower than in other parts of the state except for motor vehicular accidents, cerebrovascular disease and infant mortality, which are the highest in the state. The area also has the highest rate of illegitimate births and the highest fertility rates for females age 10-19, who are at high risk for complicated pregnancy and neonatal illness.

5. The North Louisiana area has a very high percentage of persons over the age of 65 years (11.8 percent), making ambulatory care for the chronic diseases of the aged important, especially in light of the area's high utilization among the + 65 population of nursing home services.

6. Planning Objectives for Ambulatory Care in HSA III

a. Ambulatory or mobile health care settings which provide low cost screening, diagnosis and treatment or referral should be available and accessible to all residents of the area within 30 minutes travel time. Programs directed toward screening for cerebrovascular and heart disease and screening and treatment of chronic diseases of the aged (such as diabetes, respiratory disease, vision problems and eye disease) are especially needed.

b. Primary care physician services should be available in designated shortage areas by 1987, if not through permanent location, through mobile units or special placement of interns and residents.

d. Increased visibility, availability and accessibility of health education and family planning services directed toward low-income females in the 10-19 year age group, especially in the Northeast district, should be implemented by 1985.

e. Low-cost pre-natal care programs for the low-income population should be available within 30 minutes travel time for all residents of the area, with appropriate referral services for high risk patients.

f. By 1987, 30 percent of all surgical procedures performed in the area should be performed on an ambulatory basis.

g. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for radiation therapy services.

h. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for computed tomography services.

i. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for end-stage renal disease services.

j. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for ambulatory surgical services.

k. By 1987, there should be conformity to goals and standards established in the 1982-87 State Health Plan for preventive health services.

7. Recommended Actions

a. Primary care physicians, dentists and other ambulatory care providers should consider the cost-effectiveness of mobile or "no-frills" type services which can be offered at lower consumer cost, especially in under-served, rural poverty areas.

c. Rural hospitals with occupancy rates less than 60 percent should research the feasibility of converting underutilized capacity to outpatient clinics and obtaining the services at least on a part-time basis of primary care physicians. Especially needed are prenatal services and care for the chronic diseases of the aged directed toward low-income groups.

d. The Office of Health Services and Environmental Quality should implement more effective outreach and delivery of family planning services in the North Louisiana area, especially in the Northeast district among the 10-19 age group.

e. Medicare, Medicaid and major health insurance companies should develop policies that promote the utilization of ambulatory surgical services when medically appropriate, such as patient rebate for same day discharge or cost incentives for hospitals for same day discharge.

f. Assistance from L. S.U. and Tulane Medical Schools and/or Louisiana State Board of Medical Examiners in locating primary care physicians willing to establish practice in the designated manpower shortage areas of the area.

La. Admin. Code tit. 48, § I-11105

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).