	PCASG Fund Recipients Used PCASG Funds to Support Primary Care Services by Hiring Health Care Providers and Other Staff and Adding Services and Sites

PCASG fund recipients that responded to our October 2008 survey  reported that they used PCASG funds to hire or retain health care  providers and other staff, add primary care services, and open new sites. Recipients also said that the PCASG funds helped them  improve service delivery and access to care for the patients they served. These patients had over 1 million encounters  with a health care provider, two-thirds of which were for medical and  dental care and one-third of which were for mental health care. 1.) Of the 23 recipients that responded to our survey, 17 reported they used  PCASG funds to retain health care providers, and 15 of these reported that  they also used grant funds to retain other staff. In addition, PCASG fund recipients also reported using grant  funds to add or expand specialty care or ancillary services. In addition, they reported that the PCASG funds helped  them improve access to health care services for residents of the greater  New Orleans area. Other Federal Hurricane Relief Funds Helped PCASG Fund Recipients to Pay Staff, Purchase Equipment, and Expand Mental Health Services to Help Restore Primary Care

PCASG fund recipients also used other federal hurricane relief funds to  help support the restoration of primary care services. According to LDHH  data, as of August 2008, 11 PCASG fund recipients expended $12.9 million  of the SSBG supplemental funds that were awarded to Louisiana and that  the state designated for primary care. The two PCASG fund  recipients that received a total of almost $12 million in SSBG supplemental  funds designated for mental health care used those funds to provide crisis  intervention, substance abuse, and other mental health services, mostly  through contracts to other organizations and providers. The majority of  funds were expended on the categories LDHH identified as “substance  abuse treatment and prevention services,” “immediate intervention and  crisis response services,” and “behavioral health services for children and  adolescents.”
As of August 2008, most of the 25 PCASG fund recipients had retained or  hired a health care provider who had received a Professional Workforce  Supply Grant incentive payment to continue or begin working in the  greater New Orleans area. PCASG Fund Recipients Face Multiple Challenges and Have Various Plans for Sustainability

PCASG fund recipients face significant challenges in hiring and retaining  staff, as well as in referring patients outside of their organizations, and  these challenges have grown since Hurricane Katrina. In addition, 16 of the 23 recipients reported that  retaining health care providers was a great or moderate challenge. Among  those, about three-quarters also reported that this challenge had grown  since Hurricane Katrina. Specifically, HRSA designated  all of Orleans, Plaquemines, and St. Bernard parishes, and much of  Jefferson Parish, as HPSAs for primary care. Beyond challenges in hiring and retaining  their own providers and other staff, PCASG fund recipients that responded  to our survey reported significant challenges in referring their patients to  other organizations for mental health, dental, and specialty care services. PCASG Fund Recipients Are Taking Actions to Address the Challenge of Sustainability, but Are Concerned About What Will Happen When PCASG Funds Are No Longer Available

In our July 2009 report on the PCASG, we found that an additional  challenge that the PCASG fund recipients face is to be sustainable after  PCASG funds are no longer available in September 2010. LPHI  officials told us that they expect that some PCASG fund recipients might  have to close, and others could be forced to scale back their current  capacity by as much as 30 or 40 percent. LPHI and a PCASG fund recipient have identified additional potential  approaches for securing revenues to decrease what LPHI estimated would  be a $30 million gap in the PCASG fund recipients’ annual revenues when  PCASG funds are no longer available. Although PCASG fund recipients have completed or planned actions to  increase their ability to be sustainable and have received guidance from  LPHI, it is unclear which recipients’ sustainability strategies will be  successful and how many patients recipients will be able to continue to  serve. With the availability of PCASG funds scheduled to end in less than  10 months, preventing disruption in the delivery of primary care services  could depend on quickly identifying and implementing workable  sustainability strategies.
Why GAO Did This Study

The greater New Orleans area--Jefferson, Orleans, Plaquemines, and St. Bernard parishes--continues to face challenges in restoring health care services disrupted by Hurricane Katrina which made landfall in August 2005. In 2007, the Department of Health and Human Services (HHS) awarded the $100 million Primary Care Access and Stabilization Grant (PCASG) to Louisiana to help restore primary care services to the low-income population. Louisiana gave PCASG funds to 25 outpatient provider organizations in the greater New Orleans area. GAO was asked to testify on (1) how PCASG fund recipients used the PCASG funds, (2) how recipients used and benefited from other federal hurricane relief funds, and (3) challenges recipients faced and recipients' plans for sustaining services after PCASG funds are no longer available. This statement is based on a recent GAO report, Hurricane Katrina: Federal Grants Have Helped Health Care Organizations Provide Primary Care, but Challenges Remain (GAO-09-588), other GAO work, and updated information on services, funding, and sustainability plans, which we shared with HHS officials. For the report, GAO analyzed responses to an October 2008 survey sent to all 25 PCASG fund recipients, to which 23 responded, and analyzed information related to other federal funds received by PCASG fund recipients. GAO also interviewed HHS and Louisiana Department of Health and Hospitals officials and other experts.

What GAO Found

PCASG fund recipients reported in 2008 that they used PCASG funds to hire or retain health care providers and other staff, add primary care services, and open new sites. For example, 20 of the 23 recipients that responded to the GAO survey reported using PCASG funds to hire health care providers, and 17 reported using PCASG funds to retain health care providers. In addition, most of the recipients reported that they used PCASG funds to add primary care services and to add or renovate sites. Recipients also reported that the grant requirements and funding helped them improve service delivery and expand access to care in underserved neighborhoods. As of September 2009, recipients used PCASG funds to support services for almost 252,000 patients, who had over 1 million interactions with a health care provider. Other federal hurricane relief funds helped PCASG fund recipients pay staff, purchase equipment, and expand mental health services to help restore primary care. According to data from the Louisiana Department of Health and Hospitals, 11 recipients received HHS Social Services Block Grant (SSBG) supplemental funds designated by Louisiana for primary care, and 2 received SSBG supplemental funds designated by Louisiana specifically for mental health care. The funds designated for primary care were used to pay staff and purchase equipment, and the funds designated for mental health care were used to provide a range of services including crisis intervention and substance abuse prevention and treatment. Most of the PCASG fund recipients benefited from the Professional Workforce Supply Grant incentives. These recipients hired or retained 69 health care providers who received incentives totaling over $4 million to work in the greater New Orleans area. PCASG fund recipients face multiple challenges and have various plans for sustainability. Recipients face significant challenges in hiring and retaining staff, as well as in referring patients outside of their organizations, and these challenges have grown since Hurricane Katrina. For example, 20 of 23 recipients that responded to the 2008 GAO survey reported hiring health care providers was a great or moderate challenge, and over three-quarters of these 20 recipients reported that this challenge had grown since Hurricane Katrina. PCASG fund recipients also reported challenges in referring patients outside their organization for mental health, dental, and specialty care services. Although all PCASG fund recipients have completed or planned actions to increase their ability to be sustainable, recipients are concerned about what will happen when PCASG funds are no longer available. Officials of the Louisiana Public Health Institute, which administers the PCASG locally, expect that some recipients might have to close and others could be forced to scale back capacity by as much as 30 or 40 percent. They have suggested strategies to decrease what they estimate would be a $30 million gap in annual revenues when PCASG funds are no longer available. With the availability of PCASG funds scheduled to end in less than 10 months, preventing disruptions in the delivery of primary care services could depend on quickly identifying and implementing workable sustainability strategies.