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North Baton Rouge’s residents and politicians have made needing an emergency room their battle cry in recent months, saying the lack of one simply jeopardizes lives.

Local politicians have deemed it a crisis, and nudged City Hall to prepare a tome of incentives for hospitals to build in the area. Gov. John Bel Edwards said this week that he wants to explore reopening Baton Rouge General Medical Center’s Mid City emergency room, which closed its doors one year ago.

But local hospital leaders say nothing has convinced them yet that north Baton Rouge truly needs an emergency room, saying the existing ERs in the southern part of the parish are serving the entire population well. Any talk about incentives or building out health care in the economically struggling north part of the parish should focus on other priorities, such as expanded availability of primary care, they said.

Baton Rouge General President and CEO Mark Slyter said he has no plans to reopen the Mid City emergency room, despite the governor’s statement. The hospital reported that its Mid City campus lost $23.8 million in 2014, before the ER closed.

Our Lady of the Lake CEO Scott Wester goes as far as saying that it is a myth that north Baton Rouge needs an emergency room. Data from Our Lady of the Lake Regional Medical Center, which took over providing indigent hospital care in Baton Rouge in 2013 after the state closed the north Baton Rouge-based Earl K. Long Medical Center, shows decreases in emergency room visits throughout the market between January 2015 and 2016, with more people instead getting treated at urgent care facilities they run in north Baton Rouge and Mid City.

Lane Regional Medical Center CEO Randall Olson said the politicians are not listening to the hospitals and understanding why there is too much economic risk in building out in a part of the city with a higher percentage of uninsured patients or those on Medicaid, the federal government’s health insurance for low-income families.

“At this point, I don’t see any way for a private (hospital), whether for-profit or not-for-profit, they just cannot afford to open up in a low-paying area,” said Walter Lane, a health care economics expert and professor at the University of New Orleans who also sits on the board of Slidell Memorial Hospital.

“Most hospitals are struggling to keep their head above water in an even patient area,” Lane said, referencing areas where more privately-insured patients live rather than a majority of people on either Medicaid or Medicare, which provides insurance for senior citizens.

Still, north Baton Rouge residents and political leaders alike are skeptical that their part of town can thrive without the security and economic investment of a hospital. Metro Councilwoman Donna Collins-Lewis has her sights set on immediate fixes to health care access in north Baton Rouge for now, but she said a full-service hospital must be the eventual goal.

“There needs to be some medical facility beyond a standalone clinic or ER — there needs to be a hospital,” Collins-Lewis said.

One possible solution that’s already been raised by Together Baton Rouge, a coalition of community and faith organizations, is a hospital service district, which can tax the people who live in their boundaries to build facilities. Like hospital officials, Together Baton Rouge leaders aren’t convinced about the feasibility of a full hospital, saying they also are exploring a stand-alone ER among other possibilities as a cheaper alternative.

But the group’s leaders also labeled attempts from hospitals to say that north Baton Rouge doesn’t need an emergency room as “public relations.” Their plan is to build a health district in the area that could include a number of services that the community wants, like a stand-alone ER, HIV clinics, expanded primary care, healthy food and exercise options.

“People die earlier because they don’t have this access,” said Claude Tellis, a retired Baton Rouge pulmonologist working with the group.

Meanwhile, those in north Baton Rouge who are insistent on a hospital are looking 70 miles away, to New Orleans, where the city, state, federal government and a private partner came together to open the New Orleans East hospital in 2014. But the people behind it warn that building the hospital — which had to be rebuilt after it was flooded following Hurricane Katrina — was the easy part, and operating it over the past two years has been much more difficult.

Medical needs

After a recent deep dive into East Baton Rouge health care statistics, Together Baton Rouge leaders say the need in some of the city’s less prosperous neighborhoods is clear. They found that north Baton Rouge and Mid City are served by the fewest primary care physicians and health providers despite the area having the highest rates in the city of preventable illness and premature death.

About 22 percent of people who live in north Baton Rouge and Mid City lack health insurance, according to national statistics compiled by the group. The number drops to 12 percent in the other parts of the city-parish.

Baton Rouge General leaders point out that, taken as a whole, the health statistics for Baton Rouge are positive when compared with the rest of the state. Citing the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute’s 2016 health rankings, Slyter noted that Baton Rouge came out on top for clinical care measures, including the number of primary care physicians, preventable hospital stays, uninsured rate and more.

But Slyter also acknowledges that there are challenges in the market, as Baton Rouge General points to them when explaining the decision to close the Mid City ER last year.

With the closure of Earl K. Long in 2013, the state entered into a partnership with Our Lady of the Lake to treat the region’s poor and uninsured patients. But many of those patients from north Baton Rouge went to the closer Baton Rouge General Mid City emergency room instead.

Just 13 percent of patients going to Baton Rouge General’s Mid City emergency room had commercial insurance, coveted by hospitals for higher reimbursement rates. Thirty-six percent of the patients who visited the ER had no insurance, leaving the hospital to absorb the costs.

It simply was economically unfeasible, Slyter says. And he recently insisted it will remain so even when Louisiana expands Medicaid coverage to more uninsured people later this year.

ER alternatives

Hospital leaders say critics aren’t looking at the successes in north Baton Rouge since Earl K. Long closed, particularly the expansion of services provided at clinics run by Our Lady of the Lake. These clinics, which not only have primary care doctors, but also some key specialities, like treatment for cancer patients, have truly expanded options in the area, said Wester with Our Lady of the Lake.

Wester said the clinics — called the LSU Health Baton Rouge Urgent Care clinic and located on Airline Highway and North Foster Drive — are filling the gaps.

Total emergency room visits across Baton Rouge have dropped by 41 visits a day within a nine-month period in 2014 and 2015 compared with 2015 and 2016, according to data compiled by Our Lady of the Lake. At the same time, visits to the LSU Health clinics have increased by about 49 visitors a day over the same period.

Wester said those statistics show the system is working.

“We’ve done such a good job of starting to have people think about using alternative access points, urgent care, or primary care, but then at the same time, what you’re hearing from the outside is emergency room, emergency, emergency room, we need another emergency room,” Wester said.

Slyter said overuse was another one of the contributing factors of Baton Rouge General’s Mid City Emergency Room’s closure. Four out of five patients visiting the emergency room, which saw 45,000 patients in 2014, could have been treated with urgent care or primary care instead.

Other solutions

Two options for building health care in north Baton Rouge have taken hold with many residents and political leaders: hospital services districts and stand-alone emergency rooms.

The only hospital service district in the city-parish is Lane Regional Medical Center in Zachary, which opened in 1960 after using tax money to build the hospital. It has not collected taxes from the people in the district for decades and pays its bills using mostly patient revenue.

Doing so is a constant challenge for a small hospital, especially as many patients rely on Medicare and Medicaid, which don’t pay as much as private insurers, said Lane’s leader, Olson.

The size of Lane’s hospital district has led some to question whether they could expand it to build an emergency room or another hospital in north Baton Rouge. The district’s southern border dips down to slightly north of the Baton Rouge Metropolitan Airport and follows Hooper Road going northeast.

“We don’t see our mission moving father south,” Olson said. “We cannot take the added financial burden of a freestanding emergency room or something that doesn’t pay for itself.”

Our Lady of the Lake was the first hospital in the state to jump into the stand-alone emergency room trend.

They opened Our Lady of the Lake Livingston in 2012, which is a freestanding emergency room but also has extra spaces for physician offices and a pharmacy.

Dean Williams, vice president of operations for Our Lady of the Lake, said the organization tried to identify areas with medical service shortages in 2006. They recognized then that Livingston lacked an emergency room and primary care, and that Our Lady of the Lake’s campus on Essen saw 8,000 patients a year from the Livingston area.

“It was really to fill the gap in the Interstate 12 corridor for an emergency room,” Williams said.

But Williams said the gap of ER services in north Baton Rouge is not comparable to Livingston. He said north Baton Rouge is still part of East Baton Rouge Parish, where multiple emergency rooms exist on the south side.

Still, Williams acknowledged that having such a close-by emergency room gives people a better sense of security, and he said it has improved the community as a whole.

The Livingston emergency room is still not all-things-to-all-patients. Trauma victims — those in car crashes, people who have been shot — still are mostly brought to Our Lady of the Lake’s trauma center on Essen Lane. And 6 percent of the patients who visit the Livingston ER are later transferred to the Essen campus.

New Orleans hope?

Bucking the long-term trend of smaller hospitals closing, the New Orleans East Hospital opened in 2014 to great fanfare from residents who pushed for a hospital for years. New Orleans East saw Methodist Hospital flood after Hurricane Katrina, leaving the sprawling area without an emergency room for nine years.

New Orleans Mayor Mitch Landrieu prioritized building the $130 million facility, which got its funding from a combination of local, state, and federal dollars, plus a partnership with LCMC Health, a growing hospital nonprofit group.

“In New Orleans East, the 9th Ward and Gentilly, nearly 80,000 residents are up to 30 minutes away from an emergency room,” Landrieu wrote in 2011 in the Louisiana Weekly. “This is not only shameful — it is a matter of life or death.”

Many of the neighborhoods in north Baton Rouge are at least 30-minute drives to emergency rooms in south Baton Rouge and a good distance from Zachary, unless people are transported by ambulance.

Building a hospital in New Orleans East was meant to bring both health care and an economic spark, said New Orleans Health Director Charlotte Parent and the chairman of the hospital’s district, Ronald Burns, Sr. They said people might not have moved back to New Orleans East without it.

But the New Orleans East hospital had advantages that a north Baton Rouge hospital does not. The biggest is the post-Katrina infusion of money. Federal block grants gave the city $49.8 million to buy Methodist Hospital.

It also has struggled since it opened to break back into the market. The city of New Orleans budgeted $4 million to give the hospital this year to help it make ends meet.

Parent said people’s habits changed when they went so long without health care in their neighborhood.

They are now trying to convince them to stay in their own community for health services. Burns said the hospital is just now getting all of the insurance providers on board, which will help them to attract more people.

They agreed that building the hospital was the easiest part. Making sure it has enough patients coming to it and ensuring that the hospital can pay its bills has been much harder. Though the New Orleans East Hospital is part of a hospital services district, they do not collect tax money.

“This is a long-term project for us, not to be taken lightly by any community,” Parent said. “As Baton Rouge moves forward with this, they need to go in with eyes wide open on what makes sense.”