Acut in federal support for Louisiana’s Medicaid health insurance program for the poor put the state budget out of balance by nearly $860 million. Gov. Bobby Jindal’s administration announced budget cuts of about $500 million to start closing the hole — 60 percent of them impacting LSU’s 10 hospital system.

The public hospitals, located in every area of the state, provide care for the poor and uninsured and serve as the training ground for the state’s future physicians.

The cut prompted LSU to consider multiple scenarios, including hospital closures.

One plan would have resulted in across-the-board cuts of 34.5 percent — one-half of a percent below the amount that would trigger the need for legislative approval. All the hospitals would have stayed open, but some with as few as 10 beds remaining and certain medical services gone.

While patient care would have suffered, the plan also would have adversely impacted LSU’s graduate medical education programs.

Some 280 residents out of LSU’s School of Medicine in New Orleans would have no longer had the hospital- and clinic-based settings required for training, said Dr. Charles Hilton, associate dean of academic affairs for the school. That’s out of 800-plus residents, who train in one of LSU’s hospitals in south Louisiana.

Accredited programs require certain types and numbers of patients, as well as medical experiences, Hilton said. With hospital cutbacks those standards were jeopardized, he said.

“What we are concerned about is a sudden change in the size of the hospitals or patient volume or type of services provided at that facility,” said Dr. Steve Nelson, dean of the medical school. “How will that impact our residency training programs?”

Nelson said a majority of those physicians in training end up staying in Louisiana.

“Things that could jeopardize this program will clearly have an impact on health care in this state,” Nelson said. “Once the administration understood the impact on that training they designed a plan to salvage these programs.”

LSU came up with a stop-gap plan to eliminate all but 20 percent of the cuts, using one-time state funds to attract federal dollars. The idea is to give some breathing room while LSU System officials investigate — at Jindal’s behest — potential public-private partnerships and potential sale or lease of some facilities.

“We have no opposition to public-private partnerships as long as we fulfill the training mission of the school of medicine,” Nelson said. “It just takes time. It’s not just a light switch.”

He pointed to the public-private partnership between LSU’s Earl K. Long Medical Center and Our Lady of the Lake Regional Medical Center in Baton Rouge as an example.

“But those take time to work through and make sure everybody is working together so at the end of the day we will have a (medical education) program that will be accredited,” said Nelson. Hilton said initial discussions on residency programs at the Lake started in 2006.

The medical school administrators said it’s important to have programs that keep graduates in Louisiana for their on-the-job training.

“Our job is to provide doctors for this state,” said Nelson. Without a good place for training, medical students will go elsewhere and then only 30 percent will return to practice medicine in Louisiana, he said.

“Everyone forecasts a shortage of primary care and other specialties . Anything that could adversely affect us would adversely affect health care in Louisiana,” Nelson said.

Nelson and Hilton urge caution and care as officials proceed. There’s a lot at stake for the future of health care in Louisiana.

Marsha Shuler covers health policy for The Advocate’s of the Capitol news bureau. Her email address is mshuler@theadvocate.com.