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| Vol. 22, No. 11 |
| Jun 15, 2000 |
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New CEO at the Harris County Hospital District by ROGER WIDMEYER Texas Medical Center News
A The financial situation at the [Harris County Hospital] District needs to be stabilized - and improved upon. That's the priority. There's really no special insight, just a lot of hard work. I do think that, out of necessity no doubt, the District has been very internally focused. You can't drive down the road just looking at the speedometer and the odometer; you need to look out the windshield to see where you're going. We need to know where we want to go and how to get there. Even very good organizations can find this challenging. I think the board of managers shares this vision. I don't think the District has a history of adapting, and health care has changed so dramatically. So I guess the question is can this staff adapt, be leaders and work hard? I like people who are not afraid of making a mistake, so long as they learn from it and move on. Organizations need to learn from their mistakes.
A I suspect there will continue to be massive changes in the way science and technology are applied to taking care of people's health. Of course the District has a great and mutually respectful relationship with Baylor [College of Medicine] and UT [The University of Texas-Houston Medical School]. They bring their knowledge and skills to our patients. There's a theory about being second, but doing it very well. The one in first place gets to make the mistakes. But with our financial constraints, we just need to be one of the very best seconds. There are some things we just cannot do, transplants, for example. But there are some things we do very, very well - primary care and trauma care for example. The Hospital District has a tradition of providing health care to especially vulnerable populations. That's an important mission here, and we all are dedicated to continuing that. There are two first-rate trauma centers in this community, Memorial Hermann [Hospital] and Ben Taub, and both the systems are pretty stressed. But that's common across the country. Ben Taub is highly regarded throughout the community, of course, and is there for everyone. I have heard it said that each of us is just a car wreck away from Ben Taub.
A Those folks are very hard working. This salary issue... Well, we tried something but made a small mistake. We really didn't intend a revolt. But you can see that some experienced nurses might be surprised when graduate nurses come on board at the same salary they're making after several years. The nursing shortage seems to be cyclical. When there's a shortage, it's very painful and you just need to hire the nurses you have to have. Then there are periods of, I think, taking nurses for granted. This budget that we are into does have some funds set aside for critical staffing positions, so our management team is looking at this issue now. Nursing is a critical profession for us, and we can't function as a major health care organization without them. The Hospital District is a great training ground for graduate nurses, but most of these nurses don't come to the District for their entire career. In fact they don't stay with us long enough, and I don't think that's a sustainable paradigm. We need a stable and experienced staff here, a staff that wants to be here after 10 or 15 years. We need to work towards that.
A The budget is $550 million, and the tax revenue portion will be $305 million. That's about 60 percent - which is substantially different than what it has been the past five years. Remember that the tax rate itself will not be set until September, so I can't be exact about that. This year we will see approximately a 52 percent increase in tax support, essentially taking it back to where it was before the drastic cut several years ago. The District has been quite underfunded for five years. We - and I'm including the board and the Commissioners Court - looked at the funding per person in the hospital districts across the state, and determined a fair funding level for this hospital district. When it was announced that I would be coming here, people started asking "What can you cut?" and I said I just did not want to begin doing that. I would need a year to look at things closely. People say how efficient the District is, but saying so doesn't make it so. We're looking down that road and trying to see what we should do.
A I'll have a problem if we're not marketing our services to paying clients. The odds are stacked against public providers in this regard. In San Antonio - and I think it's pretty similar here and almost anywhere - 85 percent of the population without insurance will use the public provider, and 15 percent will seek care at private hospitals. Interestingly, 85 percent of Medicaid patients are seeking health care in the private sector and only 15 percent actually come to the public hospital and clinics. With Medicare, of course, it's about 5 percent [public] and 95 percent [private]. If we could raise our Medicare share from 5 to 7 percent, that would be a success. And most of our Medicaid funds have come after the patient has come through the front door. We need to re-do that pattern. It's the reason I want to give our Medicaid managed care program [Community Health Choice] another chance. I think we can more effectively market that product. The larger question about these percentages is what they say about the quality of service you are providing. I define `quality' as meeting or, when reasonable, exceeding the expectations of your customers. That's not just service, it's business survival. This hospital district is pretty unique actually. No other one I know of is recognized so much as a safety net and not a competitor. In San Antonio - in Dallas, Fort Worth, the other districts, too - there are aspirations to take care of a broad spectrum of the population, not just the people without resources. That makes for good quality of service and adds another financing mechanism. When you decide not to compete, you will be non-competitive and you become what you've aspired to be. There's been a paradigm shift: the poor have choices. CHIP [Children's Health Insurance Program] is a good example. In the end, what we do has to be paid for. So the question is, do we want to be reliant on local taxes and the federal government?
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