HARLINGEN, February 24 - The recent Valley Legislators Tour provided a rare opportunity to see and hear three top south Texas hospital executives discuss health care issues on the same panel.

The three executives were Manny Vela, president and CEO of Valley Baptist Health System, Israel Rocha, governmental affairs director at Doctors Hospital at Renaissance, and Doug Matney, group vice president for South Texas Health System.

The panel discussion took place at the Regional Academic Health Center in Harlingen. The event was organized by the Rio Grande Valley Partnership. Many legislators in the audience told the Guardian afterwards that they appreciated hearing an in-depth discussion on a range of healthcare and hospital issues.

The Guardian is posting the thoughts of Vela, Rocha and Matney in a three-part series. The first part focuses on Vela’s remarks. Here they are:

Vela started by welcoming the visiting legislators and telling them that any dialogue on healthcare obviously needs to include the potential expansion of Medicaid under the Affordable Care Act.

“At a minimum, I believe that potential option is worthy of debate, as is any legitimate discussion that might deal with the resolution of finding a fix to create sustainability in the program,” Vela said. “What is at stake is nothing less than our ability to take care of so many tens of thousands, hundreds of thousands of folks in our great state.”

Vela said that as a health care provider and local business that acts as an economic driver for the local economy, Valley Baptist will ask “that you please consider the consequences of not finding a resolution to this incredibly vital issue.”

Vela also discussed the Medicaid transformation waiver, otherwise known as the 1115 Waiver. He pointed out that this waiver was approved as a replacement for Upper Payment Limit payments when managed care was brought into South Texas.

Vela pointed out that the waiver allows local public funds to be matched by the federal government, directed into two programs. One to compensate providers for uncompensated care and one to fund delivery system reform projects.

“The issue here relates to concerns that the public hospitals will be recipients of a majority of the funding under the Waiver even though they provide only about 16 percent of the Medicaid and uncompensated care in this state,” Vela said.

“We are asking that the legislature consider caps on waiver funding for public hospitals to ensure that funds are proportionately distributed to public and private providers based on actual percentage of Medicaid and uncompensated care in the state.”

Vela said this issue is critical to the border region. “You can well imagine, if you have seen our dynamics, and our demographics in this part of the state, up and down the river, we are those providers that fund those higher levels of Medicaid care and uncompensated care,” Vela said.

Vela also spoke of the importance of disproportionate share funding for hospitals with a high proportion of low-income patients. These hospitals are like Valley Baptist, Doctors Hospital at Renaissance and McAllen Medical Center that serve a significant and a disproportionate number of low income patients. DSH funds are an extremely important funding mechanism for such hospitals.

“The issue here is that the public hospitals that have traditionally funded this program through inter-governmental transfers, otherwise known as IGT transfers, are indicating that they do not intend to transfer funds to the DISH program after 2013,” Vela explained.

Vela said the stakes are high. “The problem with that is this could cause the entire DSH program to collapse in this state, which would have an incredible, serious financial impact on private hospitals such as Valley Baptist and others who provide these types of services, even to the point where it could cause private hospitals to scale back services to low income patients,” Vela said.

“What we should be trying to do is ensure services that allow us to catch patients before they become chronically or acutely ill. This would allow proper management care which would in turn reduce the public cost of providing care.”

Vela then spoke in more depth about inter-governmental transfer funding for Valley hospitals.

“The counties in the Rio Grande Valley have not historically generated significant tax dollars that could be used for IGT to support the 1115 Waiver program. Based upon numbers I have recently seen, of a total of $766 million allocated to our region, we will leave $440 million on the table because we do not have access to sufficient IGT dollars,” Vela said.

“The irony here is that the region that could use the funds the most, because of our payer mix, is the region most negatively impacted by not having sufficient IGT funds available.”

Vela said one option that deserves serious thought is the creation of a “public provider tax program” in all Valley counties. “We believe such a tax would create additional IGT dollars and will allow access to the funds previously referenced,” he said.

Vela concluded his remarks by discussing literacy in Texas. He said it could be the easiest issue to fix by utilizing the governor’s office, the secretary of state’s office and the offices of state legislators to promote literacy.

Vela said Texas is 47th in the nation for English literacy. He said 32.5 percent of the population in the 11 counties of South Texas have less than a ninth grade education. And, he said 43 percent of Valley residents lack basic prose literacy skills. He said this impacts the ability of patients to understand instructions given by care providers. Vela said it is always good when moral and economic arguments can be made at the same time. Improving literacy is a subject that allows this, he said. “We invest now to save later,” Vela said.

After the panel had concluded, state Rep. Senfronia Thompson, D-Houston, asked the panelists to give their top three legislative agenda items. Vela, Rocha and Matney all responded. This was Vela’s response:

“One of the top priorities has got to be finding ways of accessing the waiver dollars that we currently do not have access to. It pains us and it should pain everybody in this room that we are leaving so much money on the table because we just do not have the taxing entity necessary to access those funds.”

Parts two and three in this series will be posted in later editions. Part Two will feature the remarks of Israel Rocha, governmental affairs director at Doctors Hospital at Renaissance. Part Three will feature the remarks of Doug Matney, group vice president for South Texas Health System.