State, counties need plan to restore UTMB services

(as printed in the Houston Chronicle, December 7, 2008)

State, counties need plan to restore UTMB services
Area's medical facilities flooded by displaced patients
By BILL WHITE, ED EMMETT AND DR. RED DUKE

Before Hurricane Ike, the upper Texas Gulf Coast was already at the center of a storm — the crisis of unreimbursed medical care provided to working people and children not covered by health insurance.

After Ike decimated UTMB in Galveston, the storm surge receded but other medical institutions in the region have been flooded by the patient case load displaced from this historic, invaluable Texas asset.

UTMB serves several critical functions. It has educated a large percentage of practicing physicians in Texas. The medical school also is an important research institution, with state research dollars supplemented by federal grants and private gifts.

UTMB provides clinical care, especially for patients requiring medical specialties to supplement the primary care offered by physicians in 40 counties in this region and elsewhere in the State. UTMB serves patients with private insurance, Medicare and Medicaid and provides unreimbursed services for patients who cannot afford to pay and have no insurance.

As with all great medical institutions, the educational, research and clinical services depend on each other. Without a place for faculty members and residents to practice medicine involving a large volume of patients requiring various specialties, you cannot retain the faculty for a great medical school. Without a great faculty, a medical school cannot obtain competitive research grants.

Medical education, research, and medical treatment for those without insurance are not "free." Like many other essential public services, including military and police protection and public education, these cannot be supported by simply the revenue they generate.

The applied medicine of UTMB, including scarce specialty and emergency services, are part of the social safety net for this region. Only 10 percent of patients receiving care at UTMB have commercial health insurance.

The balance of the patient revenues come from Medicare, Medicaid and payments from the state for prisoner care. Twenty percent have no means of payment. In the wake of Hurricane Ike, much of the patient base and revenues disappeared, which led to a reduction in UTMB's employees.

Both the state of Texas and counties in the upper Gulf Coast need to quickly develop a plan to restore these services with three related elements. This crisis transcends the issue of UTMB's role in the island's economy.

First, funds from FEMA and insurance policies need to be available immediately to restore the medical, research and physical facilities to the capacity required before Hurricane Ike. We should let both private insurers and FEMA know that we expect prompt payment on valid claims. The UT System must make hard choices concerning the location of some clinical facilities and recognize historic ties to the island, while being convenient to customers, including more insured patients.

Second, there must be a plan for sustained funding of some portion of uncompensated care for the region served by UTMB. The Harris County Hospital District was formed over four decades ago in response to the crisis of unreimbursed care within Harris County. There should be a formula for fair funding of contributions by the counties served by UTMB in proportion to the uninsured patients served from those counties. Counties relying on UTMB should assess their commitments under current agreements with UTMB. In the longer term, leadership should consider the need for one or more hospital districts. In addition, Texas should continue its historical support for this great medical school from general funds. But this state support should not bear the principal burden for patient care for which there is no or inadequate reimbursement.

Third, some portion of the federal Community Development Block Grant (CDBG) funds for Texas should be earmarked for a program to compensate those providers who now receive the uninsured patients diverted from UTMB.

Congress has authorized HUD to permit this use of CDBG dollars with a waiver from the HUD secretary. This program should last only for a 12-24 month period or until UTMB's clinical capacity is restored, and should be linked to the losses from patients diverted from UTMB. Of course, CDBG allocations must also take into account other pressing needs for these limited funds.

These amounts can be supplemented by state funds available for trauma care.

We have watched as this region's medical community stepped up to handle extraordinary patient needs following big hurricanes. We owe it to them to make sure that the safety net provided by UTMB is restored as a sustainable institution. Emergency relief should not become a permanent disaster of unmet patient needs or financial catastrophe for the remaining providers to uninsured patients.

White is the mayor of Houston, Emmett is Harris County judge and Duke is a John B. Holmes Professor of Clinical Sciences at the University of Texas Medical School in Houston and a trauma surgeon at MemorialHermann.