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House County Affairs

Chairman Garnet Coleman Thursday, February 19, 2015

Teaching Hospitals of Texas Maureen Milligan, President & CEO

THOT Members

AUSTIN

Central Health

Seton Healthcare Family

CORPUS CHRISTI

CHRISTUS Spohn Health System

Nueces County Hospital District

DALLAS

Children’s Medical Center

Parkland Health & Hospital

System

The University of Texas

Southwestern Medical Center

EL PASO

University Medical Center

of El Paso

FORT WORTH

JPS Health Network

GALVESTON

The University of Texas

Medical Branch

THOT Members

AUSTIN

Central Health

Seton Healthcare Family

CORPUS CHRISTI

CHRISTUS Spohn Health System

Nueces County Hospital District

DALLAS

Children’s Medical Center

Parkland Health & Hospital

System

The University of Texas

Southwestern Medical Center

EL PASO

University Medical Center

of El Paso

FORT WORTH

JPS Health Network

GALVESTON

The University of Texas

Medical Branch

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• Supporting access to care for all in our communities with a

special focus on vulnerable populations;

• Providing and coordinating essential community health systems, such as trauma and disaster management;

• Preparing for the future by training tomorrow’s healthcare providers and supporting health research and healthcare transformation.

THOT: One Shared Mission Based on Three Shared Commitments

• Medicaid financing & uninsured care: County property taxes are supporting Medicaid hospital payment system.

• Uninsured Texans: Counties pay for care while losing economic and coverage benefits

• Unmet Behavioral Health Needs: Counties bear the burden of unmet behavioral health needs – in Emergency Departments, Jails, Courts and Criminal Justice Systems.

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Shared Challenges

Counties supporting Medicaid & Uninsured Care

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• State sets Texas Medicaid Rates

• For Texas hospitals, the state’s Medicaid rates pay hospitals only about – 50% of Inpatient Costs

– 70% of Hospital Outpatient Costs

• Some counties stepped up to get access to additional Medicaid funds for all Texas hospitals

• In lieu of General Revenue; county property taxes from 11 counties were used to help all hospitals in Texas.

Evolution of Medicaid Financing

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Illustrative Depiction of Medicaid Financing

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Medicaid Trends: Reduced GR, More Pressure on IGT

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Current System is Unsustainable

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• Only six counties provide the bulk of match funding for the entire Medicaid system – Bexar, Dallas, El Paso, Harris, Tarrant and Travis

– Down from 11 participating counties

– 41% increase in IGT contributions over the past 10 years

• Medicaid hospital costs will exceed rates by $3.5 Billion/year in 2016 & 2017

• Uninsured Care Needs and Costs increasing

• Additional impacts: – Federal reductions in Medicare rates, in DSH to offset Medicaid

expansion

Long-Term Solution

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• Texas needs a long-term, sustainable solution including:

– Medicaid rate increase

– GR support for DSH

– Coverage options to effectively address uninsured

– Authority to pursue equitable funding options

Coverage Options: Tarrant County

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• 141,200 - people who could gain coverage under Coverage Option

• 29,000 – people in coverage gap: Not Medicaid & Not Exchange

• $324,000,000/year – new federal healthcare funds available

• $38, 928,035 - new local tax revenues

Coverage Options – Impact Tarrant County

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• 24,893 – yearly average new jobs created

• $1,373,000,000 – yearly average growth in income for county residents yearly average

• $595,740,391 – yearly average growth in retail sales in the county Business, economic, health, and county-level impacts

http://tools.forabettertexas.org/healthwealth/

• Behavioral Health (BH) – if Medicaid or state funding doesn’t provide BH for uninsured Texans – who does pay?

• local hospital emergency department (ED) use, criminal justice system resources and jail time.

• Jails are often criminal justice equivalent of Emergency Departments: the provider of last resort.

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Counties Pay for Unmet Behavioral Healthcare Needs

BH and Correctional System Health Care

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• Harris County Correctional System Health Services Budget: $51 Million

• Largest behavioral healthcare provider in the state

• 400 + healthcare personnel

• 24/7/365 medical physicians and psychiatrists

• On-site pharmacy, x-ray, dietary dental, specialty care

• 100-bed medical infirmary

• 108 bed mental health infirmary

A Behavioral Health Waiver Project

Deputies, Jail & Return Deputy, ED, Jail & return

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System Redesign

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System Improvements

Reduced jail; stabilize; right care Reduced jail/ED, with right care

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The Solution- Costs

• County: Law enforcement personnel time to respond and transfer to crisis stabilization unit. No incarceration costs.

• Healthcare Delivery System: BH assessment ($500 - $1500), transition to LMHA/provider for ongoing support or intensive outpatient treatment program ($4800 for 17 months). [Compare to one ED visit at $7,000.]

• Most Importantly: Patient receives the right care, at the right time, in the right setting.

THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER 17

Going Forward

• Waiver renewal is critical

• Likely need political support in White House & Congress – Support for HHSC during renewal discussions

– Sharing the story of transformation and success

• Key Dates:

– September 2016- waiver expires

– March 2015 – Transition Plan

– September 2015 – Proposal Due

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TRAUMA FUNDS

• THOT Members operate 10 of the state’s 16 Level I regional trauma centers

• Funding from the Driver Responsibility Program (DRP),

trauma funds: – Enabled expansion of licensed trauma facilities throughout

Texas; and – Continues to play a vital role in their sustained trauma care

to support critical care when and where Texans need it most

• Need continued, dedicated, recurring funding to support Trauma Care.

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TRAUMA FUNDS

– Continue dedicated funding for trauma now funded through Driver Responsibility Program

– Fully allocate 5111 Trauma Facility and EMS GR

Account Funds – Work with stakeholders to identify improvements to

the program

THOT engaging in constructive dialogue and continuation of vital and essential dedicated trauma funding

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THOT – What we do

Hospitals All Pt. Days Medicare Days Medicaid Days Outpt Visits Unfunded Care

Series1 5 16 11 23 30 36

0

5

10

15

20

25

30

35

40

THO

T %

of

Tota

l

THOT % of All Hospital Activity Key Areas

• Trauma care - 10 of the state’s 16 highest level, regional trauma centers (Level 1).

• Waiver support - 11 of the state’s 20 anchors for the 1115 Transformation Waiver – Our members also provide the bulk of the funding needed to access federal

transformation funds under the waiver.

• GME: About 63 percent of Texas hospital systems’ Graduate Medical Education (GME) residency positions; – Representing about 61 percent of Texas hospital residency direct costs. – Net unreimbursed average hospital direct GME costs of between $67,000 - $102,000

per resident per year

• THOT members provide a significant amount of outpatient care

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THOT – What we do

Outpatient care at the heart of local healthcare

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Contact Information

Maureen Milligan

President and CEO

maureen@thotoneline.org

512.476.1497

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