Nov. 7 was a good day at the East Austin headquarters of Travis County Central Health – an unsurprising conclusion confirmed recently by Central Health spokeswoman Christie Garbe.
Unless you've managed to avoid any local news source for the better part of this fall, you can understand why: On Nov. 6, Travis County voters overwhelmingly approved a 5-cent-per-$100 property valuation tax increase for the district. It was a landmark outcome in at least two respects. For starters, the local electorate said OK to a relatively large tax hike that will be used to weave a brand new portion of our otherwise diminishing Texas social safety net. And the vote also kicks off the development of a new community care service delivery model – centered on a deal still not completely consummated between the Seton Healthcare Family and Central Health – that will offer a host of health and wellness programs to lower-income Travis County residents. It also heralds the probable 2015 or 2016 opening of a full-service University of Texas medical school.
"Kicks off" and "heralds" would be the operative words. Despite popular sentiment, our electorate did not – nor did it need to, at least not explicitly – give its approval to UT for it to move ahead with the med school. Nor did voters actually vote to establish the Seton/Central Health partnership. That, says Central Health President and CEO Patricia Young Brown, will be finalized by the parties in the wake of the voter endorsement. Indeed, just about the only thing voters did was hand Young Brown, Central Health, and Seton a heavy – if welcomed – new workload.
For Young Brown and her colleagues, this starts with finalizing the Seton agreement. The 26 programs funded by the now-voter-approved tax increase are set to be run by a collaborative entity established by the two parties. Though Young Brown says some of the programs approved at the ballot box will begin immediately, the full establishment of the Seton/Central Health partnership isn't expected to be up and running for another nine to 12 months. "We have to build the Community Care Collaborative," she said. In addition to negotiations with Seton, that effort will also require the input of the Texas Health and Human Services Commission – and we all know how quick and easy it can be for Travis County entities to work with state-level organizations.
There's also the not-so-small matter of final federal Medicaid approval for grant funds Central Health expects to receive for those voter-approved efforts. A major selling point for the tax increase was the fact that Central Health would be able to use the Medicaid 1115 waiver program – simply put, transform your regional health care efforts, and get free money from the feds – for which it became eligible when all of Texas' Medicaid efforts turned to managed care. According to Garbe, all of this will happen some time in April.
And what of St. David's? The other regional private hospital chain came late to the anti-Prop. 1 party, announcing its opposition to the idea only two weeks before Election Day. That may have been, as St. David's said, serious disagreement over the funding mechanism – or as others suggested, sour grapes or concern over profit margins (see "Health Care Elephants Battle Over Med School Prop. 1," Nov. 2). In any case, Young Brown said she isn't holding the opposition against St. David's. "They've had an open invitation, [and] that invitation is still open," she said of the opportunity for St. David's to join Seton and Central Health in a formal partnership. (No matter the final outcome of those negotiations, it appears that St. David's – through its emergency room – will continue to play at least some role in the care of Travis County's indigent population. Indeed, that is a point of concern for the hospital.)
St. David's President and CEO David Huffstutler seems ready for a meeting of the institutional minds. "St. David's HealthCare continues to believe that a medical school will be good for this community, and we are committed to ensuring its success," he said via email. "We are looking for ways that we can substantively and meaningfully participate in the ongoing effort."
It also remains unclear how, precisely, Central Health will interact with UT's new medical school. Recently, the Austin American-Statesman ran its take on what will be next for the university. The paper reported that UT Executive Vice President and Provost Steven Leslie said the first class of 50 UT-Austin med students would commence in 2015 or 2016, following what are sure to be hefty faculty recruitment efforts and what could be three years before the school gets its accreditation. Though there have been promises of interaction – and hints at codependence – just how that all shakes out remains to be seen.
UT spokesman Gary Susswein said via email that the university has "already started meetings with our partners to work out the details of our relationship." The school's research focus, another opportunity for it to extend its arms into community health, will be determined, said Susswein, as the med school's faculty staffing and general direction get sorted. "Of course," he added, "the research will build on important work our faculty is already conducting in the Department of Biomedical Engineering, at the Dell Pediatric Research Institute, and through other units of campus."
In case you'd forgotten, Susswein also continued to stick to the pre-election line about what the med school will bring to Central Texas. "This is a unique and important moment for UT Austin, the city and all of Central Texas," he wrote. "The medical school will improve care and bring more doctors to town. It will also leverage the resources we already have to conduct world-changing research. The medical school is the last piece of the puzzle for UT Austin to be a world leader in bench-to-bedside medical research and clinical care."
With all the post-election momentum, it's easy to forget that there is still the threat of legal action, although a court ruling last week suggests an uphill battle for the plaintiffs. In a federal action filed before the election, the Travis County Taxpayers Union accused Central Health of violating both state law and the U.S. Voting Rights Act by means of the language it placed on the Nov. 6 ballot. TCTU spokesperson Roger Falk called Prop. 1's wording "convoluted and extremely misleading." He also argues that it violates a section of Texas' Health and Safety Code, and that the Prop. 1 ballot writers "have taken free reign. ... You can't just have a semi-colon followed by a 65-word advertisement" for Central Health.
Falk said he doesn't "see how the court can find anything other than" against the proposition. If he's right, TCTU's suit would halt the canvassing of Prop. 1 ballots and effectively nullify the election. Nonetheless, when the parties went before Travis County Judge Lee Yeakel on Nov. 14, he didn't so much agree. Though Yeakel did not dismiss the case outright, the canvassing of the vote – set for Monday, Nov. 19 – was allowed to continue.
However, that might not be all. When reached for comment on the afternoon of that ruling, Falk hinted that a district court case could be in the future.
Meanwhile, another last-minute entry in the Prop. 1 opposition sweepstakes – an effort by local Jewish leaders concerned that Seton's affiliation with the Catholic Church might undermine women's reproductive options – hangs in the air. On Oct. 19, that group held a press conference that was prefaced with a concerned release. "Three leaders from the Austin Jewish community, including a Rabbi, will hold a news conference Friday [three days before the start of early voting] to voice concerns about public funding of the construction of a proposed Catholic teaching hospital that does not support the constitutional rights of women seeking reproductive health care services," it read.
The notice went on to quote Rabbi Kerry Baker: "[I]t is inappropriate for the government to expend public funds, whether federal or local, for the construction of a new Seton owned teaching hospital that will not provide services to women in our community whose religious faith or secular beliefs affirms [sic] a woman's right to choose. ... [A]bsent clear guidance about the sources of funding for the construction of a new teaching hospital I cannot support Proposition 1 and ask all people of faith who support a woman's right to choose to join me in opposition."
Not much has changed since Prop. 1 passed, said Bob Ozer, who was listed as a media contact for the group. "I think there is a real issue ... and that has not changed," he said.
Nevertheless, Planned Parenthood (a de facto voice for women's health issues) signed on to support Prop. 1. On the Friday after Election Day, Planned Parenthood of Greater Texas' VP of community affairs, Sarah Wheat, wrote in an email that she and her colleagues backed the question "for many of the reasons that The Austin Chronicle did."
"We have heard some of these questions too, but at this point believe that the current system (using St. David's to provide services or medical training that Seton can't) will remain in place," Wheat said. "We'll continue to track this new initiative in the months ahead."
If you're keeping track at home, that's three votes from interested parties (Central Health, St. David's, and Planned Parenthood) for St. David's to get itself involved in the new Travis County community care paradigm. That's the same St. David's that broke publicly against Prop. 1 and the care programs that will result from it.
Like we said, lots of work to do.
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