Title: Ron J. Anderson, MD, MACP,
1Infrastructure Stresses and Strains in Texas
The Case for Regionalization
- Ron J. Anderson, MD, MACP,
- Parkland Health Hospital System
- Dallas, Texas USA
2More Texans Live in Poverty Then in the US as a
Whole
People Living in Poverty, 3-Year Average, 2005
to 2007
Poverty is defined in 2007 as annual income
under 21,027 for family of four)
- Only 7 statesAlabama, Arkansas, Kentucky,
Louisiana, Mississippi, New Mexico and, West
Virginiahave higher poverty rates than Texas
Source US Census Bureau. Income, Earnings and
Poverty Data from the 2007 Community Survey.
Accessed May 4, 2009. http//www.census.gov/prod/2
008pubs/acs-09.pdf
3Minorities, Other Than Asians, Are More Likely to
Live in Poverty
- Fewer disparities between Texas and the US as a
whole, but Hispanics of any race are poorer in
Texas
Source US Census Bureau. Income, Earnings and
Poverty Data from the 2007 Community Survey.
Accessed May 4, 2009. http//www.census.gov/prod/2
008pubs/acs-09.pdf
4Only 12 States Have Median Incomes Lower Than
Texas
- Median income, 2007
- US 50,740
- Texas 47,548
- Demographic changes threatened to increase this
disparity, even before the current recession
began, according to a 2000 report from Texas
AMs Center for Demographic and Socioeconomic
Research and Education
Sources US Census Bureau Tables from website and
Murdock, et. al. 2002. Center for Demographic
and Socioeconomic Research and Education. Texas
AM University, 2000. A Summary of the Texas
Challenge in the 21st Century Implications of
Population Change for the Future of Texas.
http//txsdc.utsa.edu/download/pdf/TxChall2002Summ
ary.pdf
5Average household income in Texas could decrease
from 5,000 to 6,500 from 2000 to 2040
Assumes net migration of ½ or equal to 1990-2000
Source Murdock, et. al. 2002. Center for
Demographic and Socioeconomic Research and
Education. Texas AM University, 2000. A Summary
of the Texas Challenge in the 21st Century
Implications of Population Change for the Future
of Texas. http//txsdc.utsa.edu/download/pdf/TxCha
ll2002Summary.pdf
6More Households Will Earn Less
Source Murdock, et. al. 2002. Center for
Demographic and Socioeconomic Research and
Education. Texas AM University, 2000. A Summary
of the Texas Challenge in the 21st Century
Implications of Population Change for the Future
of Texas. http//txsdc.utsa.edu/download/pdf/TxCha
ll2002Summary.pdf
7If Current Trends Continue, Hispanics and Blacks
Will Earn Less Than Other Groups
Median Household Income in Texas in 1999 by
Race/Ethnicity of Householder
Source Murdock, et. al. 2002. Center for
Demographic and Socioeconomic Research and
Education. Texas AM University, 2000. A Summary
of the Texas Challenge in the 21st Century
Implications of Population Change for the Future
of Texas. http//txsdc.utsa.edu/download/pdf/TxCha
ll2002Summary.pdf
8Historically, Texas Has a Higher Percentage of
Uninsured than the US as a Whole
Sources US Census Bureau Historical Tables from
website
9Texas Has More Uninsured Than Any Other State
Three-Year Average percentage of People Without
Health Insurance Coverage by State 2005 to 2007
Source US Census Bureau. Income, Poverty and
Health Insurance Coverage in the United States
2007. Accessed May 4, 2009. http//www.census.gov/
prod/2008pubs/p60-235.pdf
10Before the Recession Began, Higher Numbers of
Uninsured Were Projected
- Recession-related job loss will push these
numbers even higher, at least in the short term,
since 59 of insured American were covered by an
employment-based program in 2007.
Sources US Census Bureau Historical Tables from
website, Income, Poverty and Health Insurance
Coverage in the United States 2007 and Gilmer
and Kronick. 2003. Its the Premiums, Stupid
Projections of the Uninsured through 2013, Health
Affairs Web Exclusive. April 15, 2005
11Cost of Health Insurance Is Rising Faster than
Inflation and Income
12If market forces could solve health cares
problems, they would have done so by now.
13Situation Has Worsened
- Projections Indicated Situation Would Worsen
Before Current Recession Began - Average household income in Texas may decline due
to increase in percent of population engaged in
lower-paying activities - Percentage of uninsured likely to rise,
especially as unemployment rises - Cost of health care and health insurance likely
to increase
14Parkland Fills the Gaps for Dallas County
4 of 10 HIV/AIDS patients treated here
1 in 4 trauma cases go here 4 in 10 for major
trauma
More than half the countys doctors train here
More than 1 in 4 residents lack insurance and
are likely to seek care here
More than 3 of 10 babies born here
Source Parkland Health Hospital System, 8/2008
15Parkland Serves a Predominately Minority
Population
Inpatients
Outpatients
Source Parkland Health Hospital System, 8/2008
16Parkland Remains Areas Busiest Hospital System
1Observation days increased due to chest pain and
abdominal trauma protocols, reducing admissions
by over 2,000. 2WISH visits included in
Outpatient totals
Source PHHS Annual Reports
17Community Oriented Primary Care
18COPC Health Centers Clinics, 2009
Extend into Non-traditional Settings
- 780-bed hospital
- 11 Health Centers
- 8 Womens Clinics
- 11 Youth/Family Centers
- 4 mobile vans
- Senior Outreach Program
- Partnership with Dallas Independent School
District and MetroCare (MHMR)
Source Parkland Health Hospital System, 8/2008
19Areas Throughout Dallas County Are Considered Low
Income
80 of Median HH Income (Low Income) 50 of
Median HH Income (Very Low Income) 30 of
Median HH Income (Extremely Low Income) Greater
than 80 of Median HH Income
Source 2000 Census definitions of poverty by
Census Bureau personnel, July 2003
20Suburban Poverty Is Increasing
Source Brookings Institute. 12/2006. Two Steps
Back City and Suburban Poverty Trends 1999 to
2005. http//www.brookings.edu/reports/2006/12pove
rty_berube.aspx Accessed 1/29/08.
21Relative Need in Dallas County A Historic
Comparison
- The three maps below present the evolution of
relative need in Dallas County over the twenty
year history of the COPCs. - The current system of COPC health centers is
presented on the 2007 model for reference.
1992
1987
21
22An Updated Need Assessment
- Parkland has adopted four new tools/information
sources since the original need assessment was
designed. - The Community Need Index (CNI) is a product of
Thompson-Reuters (previously Solicient) - Aggregates five socioeconomic indicators known to
contribute to health disparity income,
culture/language, education, housing status and
insurance coverage. - Applied at the zip code level to produce a score
ranging from 1.0 (low need) to 5.0 (high need). - Residents with the highest CNI scores twice as
likely to experience preventable hospitalization
for manageable conditions. - The Prevention Quality Indicator (PQI) index is a
product of Agency for Health Research and Quality
(AHRQ). - 13 PQIs for adults and 5 for children that
measure rates of inappropriate hospital
admissions - Index designed for adults and one designed for
pediatrics. - Preventable hospitalizations are expensive
23COPC Health Centers and Service Areas
- The need assessment includes those centers that
serve as medical homes. - Included are the nine Health Centers,
School-based Youth and Family Clinics and the
HOMES program. - Excluded are the ACC and EPO centers.
- The Health Center primary service areas are drawn
in black outline. - The Health Centers provide good coverage of the
higher CNI zip codes.
COPC Health Centers (Pediatric Only) Other low
income providers
24Three Views of Need / Opportunity
- The findings from the evaluation methods are
presented below. - The three zones of need/opportunity that are
consistent in each methods results are circled
on each of the maps. - Several zones of need/opportunity identified by
one or two of the methods are also noted.
CNI and PQI Avoidable Inpatient Admissions
PCHP MembersAssigned to Other Providers
Avoidable ED Visits
25Need Assessment Conclusions
- Updated need assessment methodologies support and
confirm the earlier assessments and the existing
health center placements. - The market demographics have changed through
gentrification, poverty is expanding out from the
urban core along the major highways into the
suburban markets. - The COPC sites have demonstrated that access to
primary care does reduce preventable inpatient
admissions and avoidable emergency department
visits. - Significant areas of need for primary care still
exist. - Further COPC system development should consider
the following - Responsiveness to current need and projected
demographic shifts, - Capacity and capability of existing sites,
- Use of models adapted to the needs of specific
sites, - Plans of other county health care systems and
providers, and - Comprehensive coverage of Dallas County
(especially post-universal coverage.
26Mammography
- Cancer Prevention and Intervention Program
- Provides screening mammograms, breast cancer
education, and case management services to
medically-under served women in Dallas County - Mobile unit visits COPC health centers and
community health fairs - New mammography center planned
27HOMES Homeless Outreach Medical Services
- Serves 28 homeless shelters
- Mobile medical record
28Dallas Healthy Start
- Infant mortality for 2 target areas, Southeast
and West Dallas, declined from 11.9 per 1,000
births in 1990 to 6.7 in 1996
Parkland Birth Outcomes With and Without Prenatal
Care, per 1,000 live births
29Parklands Neonatal Mortality Rate Does Not
Follow Texas and US Trends
When adjusted for severity, Parklands rate for
white women is better than the national average.
PHHS gets many referrals of high-risk women.
Source PHHS data, 1999-2001 Texas Bureau of
Vital Statistics, 2001 US Bureau of Vital
Statistics 2000. Latest available for all.
30Relationship Between Prenatal Care and Preterm
Births
31Dallas County Jail Health
- Gifted to us by County Commissioners
- No additional funding
- Use as public health opportunity to find ways to
decrease - Tuberculosis
- Sexually transmitted diseases
- Mental health-related admissions to jail
- Each day, 1,100 to 1,300 of over 7,000 inmates
have mental health-related diagnoses - Current cost is 34 million/year
32Other Community Outreach Initiatives
- Hogg Commission grant to COPC to provide mental
health care integrated into the primary care
setting - Community Health Improvement, Measurement and
Evaluation System (CHIMES) - Center for Clinical Innovation and Research
- Next
- Institute for Community Medicine and Health
- Research, Professional Education (professional),
community health promotion and improvement,
outcomes - Regional Health Information Organization
33Integration of Insurance/Assurance Through the
Community Health Plan
Parkland HMOParkland Community Health Plan, Inc.
Platform for insurance for the working poor
- Under this model, patients
- Remain in the same health plan
- Keep the same primary care doctor
- Receive services at the same COPC Health Center
or primary care area - Retain the same Medical Record
- Have their information retained in the same data
base - Integration of subspecialty care and care
management - Have their cost of care funded by a combination
of Medicaid, Disproportionate Share, or ad
valorem taxes
34Enrollment in PCHP Healthplus Programs,
September, 2007
Children 0-18
Perinate
116,230
77,000
24,593
5,653
18,940
Healthfirst
KIDSfirst
Healthplus
(40 market share w/o perinate, 52 market
share with perinate)
(51 market share)
Source Parkland Community Health Plan,
September, 2007.
35PCHP Outcomes
- Improved emergency room utilization through the
establishment of a medical home and through
management of outliers. - Lower percentage of low birth weight births than
the community average.This has extended to beyond
the Parkland system to the community based
providers. - Asthma disease management program has with 2,000
children enrolled is a public/private partnership
for disease management. The private company is
at 100 risk for improved outcomes.
36What Is the Safety Net?
- Providers of last resort for more than 5 million
uninsured Texans - Often provide services that will never be
available in some areas of Texas, for example - High fixed-cost services, like trauma, burn care,
neonatal and pediatric intensive care - High-cost, low-volume services like subspecialty
referral and tertiary care - Usually crucial to emergency preparedness and
linked to public health infrastructure - Funding vulnerable to changing economic
conditions and fluctuating public support
Source Safety Net Monitoring Initiative.
http//www.ahcpr.gov/data/safetynet/netfact.htm
37In 2000, Safety Net Described as Intact but
Endangered
- 2000 Institute of Medicine (IOM) report the
health care safety netthe Nation's "system" of
providing health care to low-income and other
vulnerable populationsis "intact but
endangered." - Precarious financial situation of many
institutions that provide care to Medicaid,
uninsured, and other vulnerable patients. - Changing financial, economic, and social
environment in which these institutions operate. - Highly localized, "patchwork" structure of the
safety net.
Source Safety Net Monitoring Initiative.
http//www.ahcpr.gov/data/safetynet/netfact.htm
38In 2005, Safety Net Described as Threadbare
Its Strength Overestimated by the General Public
- 2005 Kaiser Commission on Medicaid and the
Uninsured report the health care safety net is
threadbare." - Demands on system too great
- System fragmented, leaving patients to bounce
from one facility or program to the next to find
medications, medical equipment, lab and x-ray
services, rehabilitation services, specialty care
and even hospital care - Over a third of uninsured report not getting
needed care, a rate 3 times that of insured - At least 18,000 Americans die prematurely each
year due to lack of health care coverage
Source Kaiser Commission on Medicaid and the
Uninsured. 2005. Threadbare Holes in Americas
Health Care Safety Net. Accessed May 5, 2009.
http//www.kff.org/uninsured/upload/Threadbare-Hol
es-in-America-s-Health-Care-Safety-Net-report.pdf
39Texas Is a Mix of Rural and Urban
- 132 counties are rural
- 122 counties are urban
- 77 are part of metropolitan statistical areas
- 45 are considered micropolitan (urban area with
population of 10 to 50 thousand plus surrounding
counties linked by community ties - 87 of Texans live in urban areas
- Urban areas are clustered, with most of the state
being rural
Source Rural Policy Research Institute.
Demographic and Economic Profile Texas Updated
April 2006. Accessed May 7, 2009.
http//www.rupri.org/Forms/Texas.pdf
40Most of Texas Is Medically Underserved
- Index of 4 variables
- Ratio of primary care physicians per 1,000
population - Infant mortality rate
- Percent of population below poverty level
- Percent of population over 65
Source Rural Policy Research Institute.
Demographic and Economic Profile Texas Updated
April 2006. Accessed May 7, 2009.
http//www.rupri.org/Forms/Texas.pdf
41Most of Texas Needs More Healthcare Providers
- Shortages of 1 or more
- Primary care providers
- Dental providers
- Mental health providers
42Defining the Urban Safety Net in Texas
- Initial attempts focused on provider
characteristics like open-door policies and
services to vulnerable populations - More recently, focus has shifted to more
quantifiable factors - Uncompensated care expense
- Adjusted uncompensated care market share
- Specialty service lines like neonatal and
pediatric ICU, burn care and trauma - Tier 1 1st decile ranking uncompensated care,
all 4 services, 3 years of data - Tier 2 2nd decile or higher ranking
uncompensated care, some but not all services gt3
years of data - Tier 3 uncompensated care community level
services - Undesignated dont meet Safety Net criteria
Sources Brett D. Stauffer, MD Ruben
Amarsingham, MD Sue Pickens, M.Ed Ron J.
Anderson, MD. "Comparing the financial condition
of Texas hospitals using a novel definition for
the safety net." Texas Medicine, Vol. 104,
Number 8. August, 2008, pp55-62. and R
Amarasingham, S Pickens, RJ Anderson, "County
hospitals and regional medical care in Texas an
analysis of out-of-county costs." Texas
Medicine, June 2004, pp. 56-59.
43Hospital Distribution Using Safety Net
Designation Formula
Short-stay, General Medical/Surgical Texas
Hospitals from MSA 193
Undesignated Hospitals 140
Designated Hospitals 53
Non-Safety Net Hospitals 140
Tier 1 Safety Net Hospitals 19
Tier 2 Safety Net Hospitals 19
Tier 3 Safety Net Hospitals 15
Sources Brett D. Stauffer, MD Ruben
Amarsingham, MD Sue Pickens, M.Ed Ron J.
Anderson, MD. "Comparing the financial condition
of Texas hospitals using a novel definition for
the safety net." Texas Medicine, Vol. 104,
Number 8. August, 2008, pp55-62. and R
Amarasingham, S Pickens, RJ Anderson, "County
hospitals and regional medical care in Texas an
analysis of out-of-county costs." Texas
Medicine, June 2004, pp. 56-59.
44Hospital Distribution by Ownership Safety Net
Designation
Sources Brett D. Stauffer, MD Ruben
Amarsingham, MD Sue Pickens, M.Ed Ron J.
Anderson, MD. "Comparing the financial condition
of Texas hospitals using a novel definition for
the safety net." Texas Medicine, Vol. 104,
Number 8. August, 2008, pp55-62. and R
Amarasingham, S Pickens, RJ Anderson, "County
hospitals and regional medical care in Texas an
analysis of out-of-county costs." Texas
Medicine, June 2004, pp. 56-59.
45ER Visits Admissions by Safety Net Designation
Parkland in 2005 143,601
38,793
Sources Brett D. Stauffer, MD Ruben
Amarsingham, MD Sue Pickens, M.Ed Ron J.
Anderson, MD. "Comparing the financial condition
of Texas hospitals using a novel definition for
the safety net." Texas Medicine, Vol. 104,
Number 8. August, 2008, pp55-62. and R
Amarasingham, S Pickens, RJ Anderson, "County
hospitals and regional medical care in Texas an
analysis of out-of-county costs." Texas
Medicine, June 2004, pp. 56-59.
46Total Amount of Uncompensated Care per Year by
Safety Net Status in Millions
Dollars in Millions
Safety Net Status ( of hospitals)
Sources Brett D. Stauffer, MD Ruben
Amarsingham, MD Sue Pickens, M.Ed Ron J.
Anderson, MD. "Comparing the financial condition
of Texas hospitals using a novel definition for
the safety net." Texas Medicine, Vol. 104,
Number 8. August, 2008, pp55-62. and R
Amarasingham, S Pickens, RJ Anderson, "County
hospitals and regional medical care in Texas an
analysis of out-of-county costs." Texas
Medicine, June 2004, pp. 56-59.
47Total Margin by Safety Net Status per Year
Total Margin
Sources Brett D. Stauffer, MD Ruben
Amarsingham, MD Sue Pickens, M.Ed Ron J.
Anderson, MD. "Comparing the financial condition
of Texas hospitals using a novel definition for
the safety net." Texas Medicine, Vol. 104,
Number 8. August, 2008, pp55-62. and R
Amarasingham, S Pickens, RJ Anderson, "County
hospitals and regional medical care in Texas an
analysis of out-of-county costs." Texas
Medicine, June 2004, pp. 56-59.
48Functional Capacity by Tier by Year
Functional Capacity
Sources Brett D. Stauffer, MD Ruben
Amarsingham, MD Sue Pickens, M.Ed Ron J.
Anderson, MD. "Comparing the financial condition
of Texas hospitals using a novel definition for
the safety net." Texas Medicine, Vol. 104,
Number 8. August, 2008, pp55-62. and R
Amarasingham, S Pickens, RJ Anderson, "County
hospitals and regional medical care in Texas an
analysis of out-of-county costs." Texas
Medicine, June 2004, pp. 56-59.
49Age of Plant by Safety Net Status Over 3 Years
Age of plant
Sources Brett D. Stauffer, MD Ruben
Amarsingham, MD Sue Pickens, M.Ed Ron J.
Anderson, MD. "Comparing the financial condition
of Texas hospitals using a novel definition for
the safety net." Texas Medicine, Vol. 104,
Number 8. August, 2008, pp55-62. and R
Amarasingham, S Pickens, RJ Anderson, "County
hospitals and regional medical care in Texas an
analysis of out-of-county costs." Texas
Medicine, June 2004, pp. 56-59.
50Special Challenges to Tier One and Two Regional
Hospitals
- Must maintain utility-like or value-added
services requiring high stand-ready costs - Must bear higher costs of caring for high volumes
of low-income patients - Must bear higher drug costs associated with
special populations like HIV/AIDS patients - Most must absorb cost of medical education,
clinical research, new procedure development - Must bear cost of emergency preparedness
Difficult to compete on price in the marketplace
51Parkland as an Urban Example of the Need for
Regionalization
- Began as a city effort
- Joined by county
- Became a hospital district to increase tax
fairness - Now sees increasing patient volumes from
contiguous counties and other parts of the state - Current system is not sustainable due to
demographic pressures and changing tax bases - Doughnut effect
- Poverty moving to suburbs
- More-rural counties accessing Safety Net services
52Evolution of a Health System
1913
?
1954
2014
1982
53Parklands trauma volume is twice regional and
national averages, 2003
27 increase
Parkland
Source Texas Trauma Registry/ Regional average
includes Parkland data for FY 2003 Source
National Trauma Data Bank, Report 2004 National
Average is a 5 year average.
54Parkland Incurs Substantial Costs for Trauma Care
Costs are defined as charges to the patient of
patients are for patients that have charges
available
55Parklands Out-of-County Trauma Patient Mix by
County (CY 2006)
- 60 come from contiguous counties
- 14 come from next tier contiguous counties
(Hunt, Henderson, Navarro, Cooke, Fannin,
Grayson, - 25 come from Texas counties, out of state or
outside the US - 1 are unidentified
Denton
Collin
Hunt
172 12.6
208 15.2
101 7.4
Rockwall
62 1.8
Tarrant
Dallas
Kaufman
163 11.9
66 4.8
Ellis
88 6.4
56Parklands Payer Mix for Out-of-County Trauma
Patients, 2006
Inpatients Outpatients
Source TII, download 2006 from Robyn Manning
57Parklands Burn Center Serves a Large Area.
Traditional 88,000 square mile catchment area
- Closing of Shriners in Galveston has caused a
ripple effect here - tripled our catchment area for pediatrics
- Resulted in the need to decline transfers from
within our usual catchment area because beds are
filled by patients from Galveston
58Burn Center Admissions Have Increased Overall
Due, In Part, to Galveston Closing
14
30
Projected admission numbers obtained using data
from Jan 09 thru April 09
Source Parkland internal data, May 2009.
59Parklands Out-of-County Burn Patient Mix by
County (CY 2006)
- 54.2 come from contiguous counties
- 45.8 come from other Texas counties, out of
state or outside the US
Denton
Collin
Hunt
45 7.2
53 8.5
20 3.2
Rockwall
0 0
Tarrant
Dallas
Kaufman
183 29.3
16 3.2
Ellis
22 3.5
Source TII, download 2006 from Robyn Manning
60Parklands Payer Mix for Out-of-County Burn
Patients (FY 2006)
Inpatients Outpatients
Source TII, download 2006 from Robyn Manning
61Parkland Trauma Revenue from Texas Bad Drivers
Bill
62NorthSTAR
Behavioral health and substance abuse services
for over 355,000 clients in 7 counties (Q3 2008)
Source Texas Department of State Health
Services. NorthSTAR Data Book Q3 2008.
http//www.dshs.state.tx.us/mhprograms/northstarda
tabase.shtm Accessed 11/12/2008.
63NorthSTAR
- Blended funding - State and local agencies
contribute wrap-around funds for a person's
treatment. No longer does a person have to mine
the various agencies and departments to receive
services. - Integrated services - Mental health and chemical
dependency treatment are coordinated under
behavioral health, allowing integrated treatment
in a single system of care. - Care management - Individuals receive the proper
amount of cost-efficient care. - Data-based decision support - A modern data
warehouse and decision support software is used
to evaluate and manage the system of care. - Behavioral Health Organization - Services are
provided via a fully capitated contract with a
licensed behavioral health organization. - NorthSTAR Quality Monitoring Strategies
Source Texas Department of State Health
Services. http//www.dshs.state.tx.us/mhprograms/N
orthStarhomepage.shtm Accessed 11/12/2008.
64NorthSTAR Volumes
- Types of Services
- Rehab, MH Outpatient, Case Management and ACT
services - Community Inpatient
- ER/Observation Room Services
- Medication Services
- CD Residential and Inpatient
- CD Non-residential and Outpatient
- Other Community Services
Source Texas Department of State Health
Services. NorthSTAR Data Book Q3 2008.
http//www.dshs.state.tx.us/mhprograms/NorthStarho
mepage.shtm Accessed 11/12/2008.
65NorthSTAR Volumes by County
Source Texas Department of State Health
Services. NorthSTAR Data Book Q3 2008.
http//www.dshs.state.tx.us/mhprograms/NorthStarho
mepage.shtm and Texas State Library and Archives
Commission. http//www.tsl.state.tx.us/ref/abouttx
/population.html Accessed 11/12/2008.
66Dallas County Has Worked to Overcome Many
Challenges
- Support for Parkland and its programs has been
strong for decades as shown by support for
hospital district taxes and bonds - 2008 bond proposal for new facility passed 82
for, 18 against, an overwhelming majority
67Master Facility Plan Revised Total Project
On March 14, 2008, the Blue Ribbon Panel
recommended that Parkland pursue completion of
the total master facility plan project
(hospitals, clinics and office buildings and
parking) with estimated total project costs of
1,371 million. On June 24, 2008, the DCHD Board
of Managers approved a revised projectwhich
meets the requirements of the Blue Ribbon Panel
recommendationcalling for new campus on the
north side of Harry Hines Blvd. by using a single
efficient hospital, moving space to lowest cost
facilities, maximizing surface parking, which
reduced estimated total project costs by 100
million to 1,271 million.
Clinics
Offices
Parking
Hospital
Lofland Parking- demo
Parking
Parking
Harry Hines Blvd.
Present Hospital
Present Clinics
ER Parking- sold
Motor St. Parking
Amelia Ct. Parking
67
68Revised Total Project Scope and Costs
New Replacement Hospital 862 adult beds,
1.68 million square feet, open April 2014
1,053 million (83) Adult bed
complement Completed Shelled
Total Current 675 0
675 Proposed 816 46
862 Capacity Increase 141 (21)
46 187 (28) Clinic Buildings
387,000 square feet, open April 2014
105 million ( 8) Office Buildings 269,000
square feet, open January 2011 50
million ( 4) Parking (2,035 new garage spaces,
2,800 new surface spaces) 42 million (
3) Net Land Purchases, Sales, Demolition,
etc. 21 million ( 2) Total
Project Costs 1,271 million plus 60 beds
for an expanded PMR service and 46 beds for
enhanced inpatient services if performance can
provide needed revenue equals the 968 beds per
the PwC/Blue Ribbon Panel studylocation which is
yet determined includes 117 newborn and 96 NNICU
beds. also need 4-5 additional COPC health
centers and 2 subspecialty clinics
68
69Proposed Project Financing
G. O. Bond Proceeds Series 2009
534 million Series 2011 or
2012 163
million Revenue Bond Proceeds
42 million Philanthropy
150 million Interest on
Bond Proceeds 32
million Future Cash (Note 1)
100 million Cash Reserves
250 million Total
Project Costs 1,271
million G. O. Bond Size 705
million Revenue Bond Size 42
million Total Bonds 747 million G. O.
Bond Tax Support 2.5
cents Tax on Median Homeowner (Note 2) 46.24
Note 1 - Future cash of 100 million in excess of
operating cash reserves would be required to be
transferred to the project fund prior to
beginning construction on the 105 million clinic
buildings. Note 2- Includes operations tax
support of 1 cent beginning in 2014 median home
value 132,000. 83 million raised to date
69
70Regional Planning Funding Critical
We must address the artificial boundaries that
affect our ability to improve public health
geographical, political, economic.
- Disaster preparedness (hurricanes, tornados,
etc.) - Terrorism (including biological agents)
- Pandemics (Influenza)
- Indigent care
- Mental Health
- Regionalization for tertiary and quaternary care
- Trauma/burn
- Cancer care
- High-risk perinatal
- Transplantation
71Regionalization Could Provide Answers
Existing Texas Health Department Regions could
provide initial organizational structure
72Regionalization Would Allow Fairer Distribution
of the Tax Burden
Many counties have neither public hospitals nor
hospital districts.
73Existing Medical Schools Could Serve as Important
Resources
74Creating a Win-Win for Dallas County and Its
Neighbors
- Expand regional UPL concept
- Brought Dallas County area hospitals 130 million
in new federal matching for Parkland taxes - Participating counties with hospitals owned by
Baylor, THR and HCA systems - These dollars could be used to re-invest in
regional infrastructure as well as pay for
tertiary care support
75Pending Legislation on Regionalization
- SB2476
- North Texas Trauma and Burn Authority Act
- Sen. Bob Deuell (R)
- HB515
- Expansion of the Boundaries of the Dallas County
Hospital District - Rep. Allen Vaught (D)
76SB2476North Texas Trauma and Burn Authority Act
- Purposes
- Development, implementation, management, and
supervision of an integrated and cohesive system
for improved Level I and Level II trauma and burn
care in the 19 counties of northern Texas that
comprise Trauma Service Area E - Creation of regional trauma and burn authorities
to develop and implement plans to design, modify,
and expand infrastructure to support trauma care
facilities - Reduction of burdens and demands on the limited
funds available for trauma care and to increase
the effectiveness and efficiency of expenditures
for trauma care and - Seek funding from the federal government under
the American Recovery and Reinvestment Act of
2009 (Pub. L. No. 111-5) and from other funding
sources.
Source Texas Legislature Online. Accessed May 4,
2009. http//www.legis.state.tx.us/
77HB515Expansion of the Boundaries of the Dallas
County Hospital District
- Contiguous counties may file a petition
requesting inclusion in the District - Commissioners Court may pursue issue of annexing
territory to the District - Annexation must be approved by Dallas County
voters and voters in territory to be annexed - If territory is in another hospital district, the
election will dissolve the other district in that
territory - Dallas County Commissioners appoint an advisory
committee to represent the interests of the
annexed territory
Source Texas Legislature Online. Accessed May 4,
2009. http//www.legis.state.tx.us/
78- You cannot escape
- the responsibility of tomorrow
- by evading it today.
- Abraham Lincoln