|HARLINGEN, March 31 - The shortage of nurses, residency slots, Medicaid rates, Medicaid expansion, funding for physicians that see dual eligible patients and indigent healthcare were among the issues a South Texas hospital chief has brought to the attention of state lawmakers.
The hospital chief was Doug Matney, group vice president for South Texas Health System. Matney was on a healthcare panel at the Regional Academic Health Center in Harlingen that addressed an audience of state lawmakers during the Valley Legislators Tour. The tour was hosted 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.
Matney was one of three hospital executives on the healthcare panel. The others were Manny Vela, president and CEO of Valley Baptist Health System, and Israel Rocha, governmental affairs director at Doctors Hospital at Renaissance. All three hospital executives covered issues that have since become top healthcare issues at the state Capitol during the current legislative session.
Of all the issues Matney discussed, the one he stressed the most was the Disproportionate Share (DSH) program and what would happen to hospitals in the Rio Grande Valley if the program was eliminated or funding redistributed.
DSH stands for the Disproportionate Share Hospital program. The program provides additional help to those hospitals that serve a significantly disproportionate number of low-income and indigent patients.
Much of the DSH funding goes to large public hospitals in urban areas. This is true in Texas, where the funds have traditionally gone to eight large hospital districts. Under an agreement with the state, some of the DSH funding these hospital districts get is redirected to private hospitals for the treatment of low-income patients under an agreement with the State.
“One of the biggest things is finding a long term solution to the DSH funding,” Matney told lawmakers at the RAHC event. “That is a huge issue that for the longest time has been really the burden of eight transferring hospitals.”
Matney said the eight large public hospital districts in Texas want to “pull out” out of the DSH program. He said if this happens, “the program is going to collapse.” If that happens, he said, “it is going to hurt every hospital in the state and it is going to especially hurt hospitals in the Valley.”
Matney said his hospital and others in the Valley are “very dependent” on Disproportionate Share funding. If DSH goes away, Valley hospitals will have to find alternative sources of revenue through what are called Intergovernmental Transfers, he said. By transferring funds from a governmental body, such as a county, hospitals can leverage more federal funds for indigent healthcare through the (1115) Waiver program. However, Matney said, the Waiver program is built around the concept that some type of a large public hospital or hospital district is in operation. That is not the case in Hidalgo County, Matney pointed out.
“Our large public hospital is in Starr County. It is the only public hospital in our region. From our standpoint we do not have the public hospital. We are leaving millions of dollars in DISPRO funding on the table,” Matney said.
The same thing is happening in Laredo and Maverick County, Matney told the lawmakers. “They have no public hospital to serve as a funding source.”
In a question and answer session at the end of the panel discussion, Matney was asked what the top healthcare issue is that lawmakers can help with this session. He again focused on Disproportionate Share funding. “DSH is a statewide issue. It impacts every region. It is probably (facing) a 20 percent cutback right now, given the funding that is anticipated to occur. Beyond the coming year I am not sure there will be a DSH program. That is huge federal dollars left on the table because we cannot find the matching dollars,” Matney said.
Matney also discussed other top issues, including Medicaid rates. “Thank God you updated Medicaid rates the last time around,” Matney told the visiting lawmakers. “I think it had been over ten years since they had been updated. Slowly, over time, they have fallen further and further and further behind.”
Matney said Medicaid rates are important to hospitals and physicians alike. He said physicians who would like to take more Medicaid patients are finding it harder and harder to make ends meet. “I was talking to a physician the other day who said that for every Medicaid patient that comes to his office it costs him $18 to take care of the patient because the reimbursement for Medicaid is inadequate,” Matney said.
Another issue brought to the attention of lawmakers by Matney was the possible expansion of Medicaid. According to healthcare funding experts, two million Texans will become eligible for Medicaid should the Legislature choose to expand the state program. It would mean $7.7 billion in federal funds being injected into the state's economy over the next biennium. The benefits of expanding Medicaid would be especially notable in the Rio Grande Valley, supporters say. Cameron, Hidalgo, and Willacy counties could realize a combined $1.5 billion in federal funds from 2014-17 and over 80,000 additional Valley residents would be eligible for Medicaid if the program were expanded.
“One of the things that I know will be hotly debated this session is acceptance of federal funds to expand the Medicaid program. Many other states have agreed to accept Medicaid funding,” Matney said. “It is something the legislature is going to have to wrestle with. There has to be some solution. We are leaving too much federal funding available on the table to ignore and walk away from.”
Another issue brought to the attention of lawmakers by Matney was funding to help train the next generation of doctors. He said more money has to be set aside to help hospitals with the residency slots they provide. He said the money has to go not only on new slots but also existing ones.
“We have an existing program now that has been around for almost 30 years. It is the longest family practice program in the Valley. Well over half of the physicians who have graduated from there have stayed in the Valley. There has to be increased funding to support these programs. The program that we have is struggling. It is a free standing program. It is not actually owned us, but by the UT System. There has to be support,” Matney said.
Another issue brought to the attention of lawmakers by Matney was funding for the treatment of dual eligible patients. These are patients who are poor enough to qualify for Medicaid and old enough to qualify for Medicare. Matney said that as a result of legislation passed last session, Medicaid funding for dual eligible patients has been cut. “In our community we have a lot of individuals who are dual eligible, meaning they are both elderly and they are also poor. Unfortunately, some of our physician practices in particular are heavily dependent, especially internal medicine and family practice. Their practices are full with people who are dual eligible. The effect of eliminating the payment of Medicaid has essentially meant a 20 percent cut for these practices,” Matney told the lawmakers.
Another issue brought to the attention of lawmakers by Matney was funding for nursing programs. “Our nursing population is aging, just like our physician population. While we have wonderful universities producing nurses for us, with the growth we see coming that is going to be inadequate,” Matney said.
Matney said his hospital is having a hard time recruiting nurses from other areas. “There has to be funding set aside, whether it is through UTPA or through the community colleges to allow them to grow and expand the nursing programs,” he said.
Matney also spoke about the unique challenges the South Texas border region faces. He cited high unemployment, low family incomes, low educational attainment levels, lack of primary care physicians, and a high undocumented population. This population has a difficult time accessing government programs, he said.
Matney also spoke with pride about South Texas Health System, which was named one of the nation’s ‘Top Performers on Key Quality Measures’ for 2011 by The Joint Commission, the leading accreditor of health care organizations in America. Its various hospitals have 850 beds, 650 physicians and over 300-plus volunteers, Matney said. STHS pays out about $130 million in salaries, invests an average of $9 million in capital improvements a year and pays $5 million in property taxes, he told lawmakers.
McAllen Medical Center is STHS’s flagship, Matney said, and has traditionally served as Hidalgo County’s county hospital. He said it has a stroke center and offers full surgical facilities, and women’s services. In addition, Matney said, McAllen Medical is the lead trauma center for the region and will soon reach Level 2 Trauma status. Additionally, it is the main kidney transplant center south of San Antonio. Because many Valley residents find it hard to travel to San Antonio, the hospital really is a life-saving facility, Matney said.
Matney also referenced the McAllen Heart Hospital which has twice been voted the No. 1 heart hospital in Texas. Other facilities in the System, he said, include Edinburg Medical Center, Edinburg Children’s Hospital, which wins awards for its asthma care, the 134-bed South Texas Behavioral Health Center, Edinburg Regional Rehab Center, and Cornerstone Regional Hospital.
Matney said probably the biggest benefit STHS provides is $258 million in uncompensated care. He said it is sometimes difficult to separate what is bad debt and what is charity. “When you think of health care it is indeed an economic driver in the community. It is one of the three largest employers in the community. We are not just an employer but an employer that pays very well,” he said.
Matney said STHS hospitals routinely see many Third World diseases that hospitals in other regions of Texas might see twice a year. He also said that the perception of violence makes it harder to recruit nurses and physicians.
Editor’s Note: This is the third of three stories coming out of the healthcare panel at the Regional Academic Health Center. Click here to read Part One, which focused on the comments of Manny Vela, president and CEO of Valley Baptist Health System. Click here to read Part Two, which focused on the comments of Israel Rocha, governmental affairs director at Doctors Hospital at Renaissance.