oratively identify the most effective interventions for the re- gion, a key area for physicians to lend their expertise, says Gil- berto A. Handal, MD, an infectious disease specialist at Texas Tech University Health Sciences Center. “Everyone is trying to do what they believe in their minds will improve care. But we are working in the same silos instead of addressing problems in the broader context,” he said. The El Paso Hospital District, the local anchor, assigned $1 million over the duration of the waiver to the El Paso County Medical Society to develop an initiative. Dr. Handal says the society is still debating what meaningful projects it could ac- complish with the funds, since many of the ideas discussed that would be “truly transformative” had budgets well above that figure.
The waiver is an op- portunity to create not just new projects, but also new relationships among all players to improve health care, he says. Leaders of Project Ac- cess Dallas (PAD), a long- running charity program started by the Dallas County Medical Society (DCMS), announced that the program will close this year after reaching an impasse in waiver funding negotiations. The program was on track to transition into a more sophisticated medi- cal home waiver project that would expand pri- mary and specialty care to twice as many patients; link participating hospi- tals, physicians, clinics, labs, pharmacies, and others into an electronic data exchange to measure health outcomes; and compensate doctors for ongoing patient management. That went beyond the limited volunteer work they did under PAD, according to DCMS.
the fact of the matter is, physicians help carry that load with hospitals, and the 1115 waiver is an opportunity to appreciate that reality,” said Jim Walton, DO, PAD’s medical director. Financing wasn’t the only issue, Dr. Walton says.
“When the needs assessment says we need more primary and specialty care to reduce uncompensated care, that by defi- nition suggests a need to involve the physician community in the design and implementation of a solution,” he said. Instead, doctors were left out at the 11th hour.
“We’re not short of ideas, and the waiver promises new fi- nancial resources. Ideal transformation means a commitment to sit at a common table with all the stakeholders willing to take care of these vulnerable patients, because this is a com- munity problem,” Dr. Wal- ton said.
SYSTEM WITH A DECENTRALIZED APPROACH, YOU ARE GOING TO HAVE DIFFERENCES.”
YOU CREATE A “ANY TIME
All of that necessitated additional funding, which PAD thought it had until its private hospital partners cut the pro- gram’s $38 million budget in half. The private facilities helped fund PAD under the former
UPL system. But without additional waiver support, the pro- gram folded.
Physicians thought they had a deal that included some com- pensation up front in return for helping hospitals reduce their uncompensated care burden and meeting certain accountabil- ity measures. “Clearly, hospitals have a tremendous burden to carry. But
18 TEXAS MEDICINE March 2013
Officials at Parkland Health & Hospital System, the regional anchor, de- clined to comment, saying the 1115 waiver is “still a work in progress.” Barclay E. Berdan, chief operating officer of Texas Health Resources, one of the private hospi- tal partners, says shared responsibility remains its focus. “All of the [reform] pro- grams, including this one, have metrics that have to be achieved for pay- ment to be forthcoming. All that we asked was the county medical society share in that risk,” he said. The waiver imposed a new set of rules and chal- lenges on everyone, Mr. Berdan added. “Any time you create a
system with a decentralized approach, you are going to have differences. Whether that’s good or bad, we will have to see how it turns out.” Despite those differences, Dr. Walton hopes the waiver suc- ceeds and is a chance for physicians to help drive change. The process is here to stay for at least the next few years, and the federal government has yet to approve the projects. “There’s still time for physicians to play an important role in this conversation,” Dr. Walton said. n
Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by tele- phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
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