CMS and HRSA Assistance to Sustain Primary Care Gains in the Greater New Orleans Area
GAO-10-773R: Published: Jun 30, 2010. Publicly Released: Jul 12, 2010.
More than 4 years after Hurricane Katrina made landfall, the greater New Orleans area continues to face challenges restoring health care services disrupted by the storm and flooding that followed. In July 2007, the U.S. Department of Health and Human Services (HHS) awarded the $100-million Primary Care Access and Stabilization Grant (PCASG) to the Louisiana Department of Health and Hospitals (LDHH). The PCASG was intended to restore and expand access to primary care services in the greater New Orleans area without regard to a patient's ability to pay. The PCASG was designed to provide a temporary funding source--from July 23, 2007, through September 30, 2010. Despite the various types of assistance offered, concerns remain about whether the primary care gains made will be sustainable after the PCASG funding ends. Given the federal investment in providing and sustaining health care in the greater New Orleans area, Congreess asked GAO to describe what steps CMS and the Health Resources and Services Administration (HRSA) have taken to help the PCASG-funded organizations--LDHH, LPHI, and the PCASG-funded providers--sustain the primary care gains made in the greater New Orleans area.
During the 3 years since the PCASG grant was awarded, CMS and HRSA have offered five types of assistance to the PCASG-funded organizations to help them sustain the primary care gains made--funding, training, information sharing, technical assistance, and workforce support. From October 2007 through May 2010, HRSA provided about $27.6 million in Health Center Program grant funding to five PCASG-funded providers. HRSA is considering a revised evaluation process for awarding some of this funding which would put greater emphasis on need that, if made, may improve the competitiveness of PCASG-funded providers, increasing the likelihood that they would receive funding. CMS is also considering an extension of the PCASG, which would allow unspent funds to be redistributed by LPHI to PCASG-funded providers who (1) spend all PCASG funds already received and (2) continue to meet all PCASG program requirements through September 30, 2010. Those PCASG-funded providers would then have 12 months to expend the redistributed funds. HRSA has offered various trainings to PCASG-funded providers to explain and provide guidance on how to meet Health Center Program requirements and how to develop effective applications to participate in the program. CMS has shared information with PCASG-funded organizations to help them sustain the primary care gains made in the greater New Orleans area; for example, how they might be able to redistribute Medicaid funding traditionally given to hospitals that serve a disproportionate share of low-income or uninsured patients to outpatient primary care providers that serve those patients and information about potential sources of additional funding. CMS provided technical assistance, including how to become a Medicare provider, so that they could begin billing for Medicare patients. LPCA offered technical assistance on operational and quality improvement issues to PCASG-funded providers receiving Health Center Program grants including focusing on areas such as fiscal and operational issues and recruitment and retention of clinicians. In addition, LPCA provided two PCASG-funded providers with assistance developing an agreement on how to share Health Center Program grant funding that had been awarded based on the combined patient volume of both providers. CMS and HRSA offered workforce support assistance to PCASG-funded providers by funding programs that provide incentives for clinicians to work in the greater New Orleans area. Despite the various types of assistance offered, all of the officials we spoke with, including CMS and HRSA officials, were concerned that the primary care gains made in the greater New Orleans area may not be sustainable after PCASG funding ends.