|HARLINGEN, September 2 - Top level discussions are underway in Cameron County on the creation of a hospital district to help boost funding for indigent healthcare and ensure the long-term success of the UT-RGV medical school.
Manny Vela, president and CEO of Valley Baptist Health System, says his hospital group is doing “due diligence” on the issue. If the results are favorable, Vela said, Valley Baptist will throw its support behind a hospital taxing district for Cameron County.
“To move in the direction of a hospital district will take a coalition of folks from throughout the entire county, including the hospital providers,” Vela told the Guardian in an exclusive interview. “Currently, we are still doing our due diligence. We want to make sure we understand the interplay between a hospital district and our current waiver programs. We are assuming they will be able to coexist. If so, we are going to back it (the creation of a hospital district) to the hilt. That is the assumption right now.”
Under the 1115 Waiver program, hospital providers can draw down additional Medicaid dollars with the help of counties.
Vela said that about five weeks ago Cameron County leaders started serious discussions about the possibility of putting the hospital district on the ballot in November. “The conclusion was that it did not give us enough time to coalesce as a county group to develop a campaign for a hospital district in the county,” he said.
Vela said it will take support from more than just the hospital providers to get a hospital district created. “We have to have all the information together so that when people ask us, what the tax rate will be and how the dollars are going to be spent, that we are ready. That is what UT is working on, a budget related to that.”
In Hidalgo County, moves are already afoot to create a hospital taxing district. At the request of over 100 prominent citizens who signed a petition, Hidalgo County Commissioners Court will put the issue before voters in November. If there is a “yes” vote and the Legislature revamps enabling legislation authored by state Sen. Juan Hinojosa, D-McAllen, the hospital district will be created. The initial tax rate will be set at eight cents per $100 property valuation.
The need for a hospital district in Hidalgo County is deemed more urgent than in Cameron County because the first two years of education at the UT-RGV medical school will take place in Hidalgo County. The state of Texas currently pays for third and fourth year education at the Regional Academic Health Center in Harlingen and this is expected to continue when the RAHC is transferred to the UT-RGV medical school.
Nolan Perez, a Harlingen-based physician, says Cameron County residents should not be concerned about Hidalgo County forging ahead with a hospital district and their county falling behind.
“I think the UT System and UT-RGV are hugely committed to making this university regional and the medical school regional. No one is going to steal the medical school from us. I have spoken to the folks at Doctors Hospital at Renaissance and the leaders in Hidalgo County and McAllen. There is no conspiracy from anyone to steal this from us,” Perez told the Guardian.
“In fact, we can learn from how Hidalgo County does it. We can then synergize our efforts. I hope they are successful. Kudos to Hidalgo County.”
Perez believes the people who should be taking the lead on creating a hospital district in Cameron County are the hospitals that provide uncompensated care.
“In my opinion, what should drive this in Cameron County is the hospital systems that will have all the indigent health covered by the health district. I look at Manny Vela and Valley Baptist Health System. He has been instrumental in promoting graduate medical education. We need graduate medical education. It is a critical part of the medical school process. It is not just under-graduate. We need residency programs so Valley Baptist, under the leadership of Manny Vela, has been very important in expanding medical education opportunities. There is a cost to that, just as there is a cost to indigent care. So, let’s let Valley Baptist do their due diligence and if it makes sense for them, which I think it will, if it is timely now for them, let’s let them drive this process.”
Perez also believes support for a hospital district will have to be built up across Cameron County and particularly in Brownsville.
“Most of the votes are in Brownsville. You cannot win anything without Brownsville. So, the hospital district should be a regional initiative, led by Brownsville to a large extent. It has got to be across the region, if Cameron County is to take on this initiative. It would be a mistake to have a Harlingen-centered operation. It has to be all of us in it together but I think a huge, critical, component is Manny Vela and Tenet and the whole Valley Baptist Health System saying, you know what, this makes sense, let’s do it.”
Dallas-based Tenet Healthcare Corporation owns Valley Baptist Health System.
Valley Baptist Health System’s Vela pointed out that the UT System and the State of Texas will, at some point, expect Cameron County to contribute financially to the success of the UT-RGV medical school in much the same way the City of Harlingen has contributed to the success of the RAHC.
“We are looking at this in a deliberative manner. We are doing our due diligence, and, when the time is right, we expect fully to get behind an effort to establish a hospital district. We recognize it from a funding perspective. We have been told, like everybody else, that UT and the State will expect the community to participate. We are not going to be left behind in that regard at all. For us it is just a matter of timing,” Vela said.
Asked if he felt confident that the 1115 Waiver funds Valley Baptist gets for the uncompensated care it provides can be protected if a hospital district is set up, Vela said: “We just had a visit with Senator Hinojosa’s office last week. Jennifer Saenz did some research in that regard and she feels very comfortable that we can. She shared that research with us. We have shared that with our internal folks and my hope is and certainly my expectation is that we draw the same conclusion, sooner rather than later because we do not want to allow too much time to lapse.”
Jennifer Saenz is Sen. Hinojosa’s healthcare policy specialist and public affairs director.
“The expectation is that if the hospital district is created there will be more IGT (inter-governmental transfer) tax dollars created through the hospital district than are currently funded by the county. That sounds good because that means there is more of a match coming back to take care of the indigent population,” Vela said.
“The initial analysis certainly has the hospital district creating more IGT, thereby creating more federal dollars coming down, which looks favorable. We just want to make sure that does not interfere with our provider fund, the funding mechanism which was created by Senate Bill 1623, which Senator Hinojosa sponsored and got passed for us. That has been incredibly helpful in shoring up our infrastructure and making sure our network and our safety net is completely intact to take care of the people down here.”
SB 1623, authored by Hinojosa, only came about after managed care was introduced into Cameron, Hidalgo and Webb counties. For the best part of the decade these three counties had been carved out of managed care. The legislation allows the three border counties to work with local hospital providers to draw down additional Medicaid funds. The hospitals, essentially, tax themselves and pass the monies to the counties. The counties in turn leverage those dollars to draw down additional funding from the federal government. The funds are then passed on to the hospital providers to offset the cost of uncompensated care.
Asked if, like Hidalgo County, Cameron County would need legislation in order to set up a hospital district, Vela said: “We have determined that there is a law in place that allows counties to exercise their prerogative so the county would actually have to put the referendum on the ballot and we would not have to seek the same type of legislative action that Hidalgo County took, even though that is another pathway to a hospital district. We have determined that is not going to be necessary.”
Overall, Vela said he and Valley Baptist are “very positive” about the potential outcome from the creation of a hospital district.
“We certainly want the opportunity to participate in discussions throughout the entire county because it is going to impact all four corners of the county. I think it is only fair to all residents in the county that we try to build as big a coalition as possible, including our communities. They are going to benefit from this. They are going to help pay for it but, at the end of the day, our county truly benefits from the medical school and all that comes with that. There is nothing wrong with our communities pitching in to help the medical school. I think everybody benefits because it involves the health and well-being of all of our communities.”
Vela added that Cameron County residents should keep in mind the fact that some local hospitals have been providing financial support for uncompensated care for the indigent and residency programs for medical students for many years.
“Don’t lose sight of the fact that hospital providers like Valley Baptist have been providing financial support for the precursor programs that are currently in place,” Vela said. “I say that with a great sense of pride. We are proud of the partnership we have established over the last decade with UT-Health Science Center San Antonio.”
UTHSCSA administers the RAHC.
“We are going to be even more proud as we transition into this new medical school, under UT-RGV,” Vela added. “In today’s world, everybody is competing for legislative dollars and UT dollars. I think it is a very fair statement to suggest UT and our elected officials are going to be looking to the (Cameron County) community to have a vested interest on the financial side.”
“I say that with a great sense of pride. We are proud of the partnership we have established over the last decade with UT-Health Science Center. We are going to be even more proud as we transition into this new medical school, under UT-RGV. In today’s world, everybody is competing for legislative dollars and UT dollars. I think it is a very fair statement to suggest UT and our elected officials are going to be looking to the community to have a vested interest on the financial side.