Below is the HillCo client report from the June 11 House County Affairs hearing.
The committee heard testimony from the medical schools and health science centers on the Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver.
Jeffery Levine, UTHSC Tyler
- Region with 28 counties
- Majority population is African American and half is rural
- 2012 data shows that they have poorer health outcomes than most of the state
- Project valuation of 166M
- Behavioral health integration
- ER diversion
- Self-management of chronic diseases
- Training medical residents to identify and manage depression
- Large number of residents remain in east Texas after graduation
- Community health worker training program
- Mobile asthma units to schools
- Want 4000 children served by the end of the waiver
- Physician recruitment is difficult for the region
Francisco Gonzalez-Scarano, UTHSC San Antonio
- Goal is to have a robust GME program
- 50 students per class, want to have 50 GME positions in the RGV
- Use practice plan funds as an IGT match
- Hidalgo County is anchor
- Coleman – this waiver is creating jobs
- Increased primary medicine slots in the school
- Epilepsy project in Laredo
- Implemented dental programs
- Reaching out to patients to address any mental health issues
- Coleman – encouraged by the dental programs because dental issues are a common reason for children to miss school
Thomas Murphy, UTHSC Houston
- Family physician in SE Harris County
- The wavier has been transformational for community and patients
- Serves 1100 Medicare patients
- Admission to hospitals is less than 50% for traditional Medicare patients
- Provide same day service
- Working to remove the mental health stigma
- Increased accessibility with extended hours
- 514 new patients in one month, scrambling for providers
- Coleman – is there still a huge influx of providers that want to come to Texas?
- Yes, but there is a high need all over the state
- San Antonio and Austin region is viewed as the most favorable area in the US
Andrew Casas, UT Physicians, Houston
- Using practice plan dollars for IGT
- Community health workers program
- Bayshore and 4 other regional clinics
- Waiver helped to fill the financial gaps and bring behavioral health specialists into the clinics
- Established a 24 hour nurse line where a nurse can access EMR in real time
- Gonzalez – the waiver is only 5 years, is there concern that CMS won’t extend it?
- It would be catastrophic
- GME slots in the valley would not be able to be continued
- Transformation will take more than 4-5 years
- Have had to reserve some dollars in the case of non-renewal and they are left on the hook for rent, equipment, etc.
Katrina Lambreck, UTMB Galveston
- 28 projects
- Transition of care plan
- Expansion of primary care
- Chronic illness management
- Increasing data reporting cap
- Believes it is an important piece of the waiver
- Increased recruitment of docs, NPs and PAs
- Working to increase enrollment in the school of nursing
- Care management registry
- Development of disease management registries
- IGT is 22M for UTMB and some external partners
- Project valuation is 200M
- Interested in increasing GME, but there are some logistical problems
Bruce Meyer, UT Southwestern
- Enrolled 160 primary care providers into an integrated health record that exchanges information with many institutions and programs
- Stickland – are patients notified?
- Structured program to educate the patients
- Kolkhorst – we passed HB 300 that has huge penalties for policy violations
- 43 sites NQCA certified
- Sickle cell facility with 24/7 hotline
- Depression screening and treatment program for all patients
- Reached the maximum number of students they can train
- Stickland – I feel like Tarrant County is being punished
- We are trying to fill gaps in the health care system not pick winners and losers
- Large GME program (3rd in the state)
- Grown 45% over the past 6 years
- Coleman – by laying out what the needs of the state it gives us the ability to help
MD Anderson, Louis Foxhall and Oliver Bogler
- Colorectal cancer screening project
- Reached out to FQHCs to identify individuals for the program
- Smoking cessation program
- Mobile mammography program
- Obesity program
- GME program – 1200 trained at MD Anderson
- Residency and fellows
- Try to match growth to the community need
- Nursing education program
- Nurses do clinical rotations
- Giving masters and PhDs to nurses
- Kolkhorst – of the foreign people that MD Anderson trains, do they stay?
- Will get hard data but yes
- They are overproducing PhDs, so they are focusing on recruiting higher quality students
- There are fewer biomedical science jobs than PhDs being produced
- Trying to train PhDs to be suitable for other jobs outside of academia
Dr. Steven Burke, Texas Tech Health Science Center
- 23 DSRIP projects
- Primary care expansion
- Chronic illness management
- Want to produce more family practice physicians in the region
- Nationwide, less than 10% of docs choose family medicine
- Family Medicine Acceleration Program in Amarillo and Lubbock
- Permian Basin has increased family medicine residencies
- Expanded 2 community care clinics
- Expanded EMR database to identify individuals with potential for heart disease
- Patient navigators
- Breast cancer fellowship program
- Psych program for NPs and PAs
- IGT came from institutional funds
Dr. De La Rosa, Texas Tech El Paso
- Over a 12 year timeframe, separated from Texas Tech Lubbock
- 10 projects
- Increase primary care
- Recruiting 4 neurologists to El Paso (interventional neurologists)
- New training for gynecology surgery and breast cancer
- Increasing access to care
- Recruitment challenges
UTHSC Ft. Worth
- 6 projects focused on improving health care, patient experience and reducing costs
- Leveraging current practices but making them better in an innovative way
- Discharge planning for the elderly utilizing NPs and PAs
- Identifying individuals in the community to support physical health with medication adherence and disease management via mobile phone technology
- Project is in early stages
- Kolkhorst – sobering to thing about sustainability
- Stickland – the cell phone project sounds like a horrible idea
- 14.5M IGT from practice plan
- Project value is 77M-87M
- Stickland is concerned that his community is being disadvantaged
LeAnn Ran, A&M Health Science Center
- They do not have a teaching hospital
- Anchor of 2 RHPS, 8 (214M AF) and 17 (278M AF)
- 4 dental school projects
- Need additional in rural areas
- Coleman is concerned that dentistry will shrink and not grow bigger
- Expanded dental clinic hours
- School-based sealant project
- Opened 2 new dental clinics co-located with health care clinics
- Texas A&M Physicians have 7 projects
- Expanding primary care and preventative services
- Expanding clinic hours and hiring new providers for the uninsured
- Rural fellowship program for underserved areas
- Telepsychology project
- Kolkhorst – are you coordinating with the MHMRs?
- Yes
- Patient feedback is very positive
- Coleman believes that this will help a lot of people
- Patient centered medical homes
- Evidence based self-wellness program for the elderly
- Post discharge care coordination
- Home based palliative care before hospice is needed
Paul Ogden, A&M Health Science Center
- Geographically diverse
- In five years they have increased from 300 students to 800
- Top ranked dental, medical and pharmacy schools
- Using state grants and waiver funds to establish new residency programs
- 6 family medicine GME spots in Victoria in 2015
- New undergrad health program
- 309 pharmacists added to the workforce since 2010
- Trying to graduate nurses that can teach and train new students in the nursing school
- Forensic nursing program to address the shortage
Tim Lafrey, Seton – Trish Young, Central Health – Gregory Fenves, UT
- Have a partnership with Central Health and UT called the community care collaborative (CCC)
- Projects are 220M for 5 years
- Hired 200 additional providers
- Opened a psychiatric emergency department last month
- Have had 376 encounters with average time spent in the facility 14 hours
- Immediate home run and innovative idea that has great results
- Seton is building the new hospital on the land leased to Central Health from UT
- Coleman – does Seton have clinics?
- 90 outpatient, 3 primary care clinics for UC and Medicaid
- Coleman – Brackenridge will be closed?
- Will not see a decrease in charity care – forming partnerships to ensure that there is the supply for care
- Gonzalez asked about charity care
- Central Health has CommUnity Care in 24 FQHCs and they fun other safety net clinics like People’s Community Clinic
- CCC has 15 projects
- CCC allows for Central Health and Seton to jointly manage the patient population
- Coleman – this relationship is very different
- 1995 Brackenridge was owned by the city and entered into a partnership with Seton to run the hospital – Central Health inherited the long term lease
- Seton has the full financial risk to operate Brackenridge
- Kolkhorst – in the 1st pass did only Seton receive DSRIP money?
- Yes, but others got some in the second round
- UT partnered with Seton due to their 400 staff and residency slots
- Gonzalez – will I be able to get emergency contraception at the new hospital?
- Yes
- Dell Children’s and St. David’s are going to provide services Seton cannot provide regarding Women’s Health
- There are SANE nurses trained in sexual assault victim cases at St. David’s medical center – that is where victims are treated
- Coleman asked for all documentation of the arrangement
- Seton serves individuals up to 375% FPL, Central Health 200% FPL
- Gonzalez asked for a document regarding how students can (or cannot) access emergency contraception
- UT wants to train physicians not as individual practitioners but to work in integrative care teams