Stakeholder ForumTexas Health Care Policy Council

Ben G. Raimer, MD, FAAPChair, Texas Statewide Health Coordinating Council

bgraimer@utmb.edu

April 8, 2008

BorderHealthIssues

Epidemic ofObesity

Threats ofBioterrorism

LowImmunization

Rates WorkforceShortages

MentalHealthIssues

Grow inTexas’

Population

Growth ofThe Uninsured

HealthDisparities

IncreasedHealthCosts

HealthSystem

Pressures

“The Perfect Storm”

How will Texas fulfill its commitment to create a health professions workforce for the future …

… who are able to provide culturally competent,

linguistically appropriate,quality health care

for the state’s increasingly diverse population?

Factors Affecting Workforce Supply Resulting in Shortages

o Aging workforceo Declining enrollments in professional schoolso Feminization of the workforce o Workforce participation / lack of interesto Poor minority representation in health professions schoolso Distribution of providerso Salary & benefits of providerso Working conditions of providerso Lack of unified state plan for workforce development

Prepared by: Health Professions Resource Center, Center for Health Statistics, Texas Department of Health, 3/4/03; National Center for Heath Workforce Information and Analysis, 3/26/02, Marilyn Biviano.

Factors Affecting Workforce Demand Resulting in Shortages

o Aging population / longevityo Expanded scope of practice (genomics)o Medical advances o Insurance coverageo Insurance reimbursement – e.g., dental providers

accepting Medicaid patientso Advances in technologyo Population growtho Impact of chronic illness

Prepared by: Health Professions Resource Center, Center for Health Statistics, Texas Department of Health, 3/4/03; National Center for Heath Workforce Information and Analysis, 3/26/02, Marilyn Biviano.

2005 – 2010 State Health PlanPrimary Care Recommendations

• Support of public health prevention and education programs, especially targeting chronic diseases

• Reinstatement of general revenue funds in support of the Medicaid draw-down of federal funds for graduate medical education

• Elimination of current outdated federal caps on funding for graduate medical education training slots

• Restoration of funding for graduate medical education to 02-03 levels

• Support of 300 new resident positions ($50,000 each), phased in over four years

• Funding for Physician Education Loan Repayment Program from “all” Texas medical schools

• Support of enrollment increases at pharmacy schools

• Increase the number of Federally Qualified Health Centers in Texas

• Support methodologies for development of innovative models for primary care delivery

• Support of demonstration projects that utilize interdisciplinary teams of health professionals for prevention and management of chronic diseases

• Track outcomes to providers• Include advanced practice nurses in networks• Support the training and use of state certified

community-level health providers• Provide incentives to providers who use evidence-based

practice guidelines

2005 – 2010 State Health PlanPrimary Care Recommendations

Federally Designated Primary Care HealthProfessional Shortage Areas

as of February 1, 2007

Prepared by: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, 2/1/07

Designation StatusNot DesignatedSpecial Population DesignationPartial County DesignationWhole County Designation

Health Data

• Ensure the adoption of the “Minimal Data Set” for all health profession licensing boards with availability of that data to the SHCC and the Health Professions Resource Center (HPRC) for workforce analysis.

• Adopt a state model for projecting future health profession supply and demand to facilitate appropriate planning.

• Ensure adequate funding for the electronic capture of this data by all licensing boards.

• Consider the creation of a single licensing agency and workforce data center for all professions.

Health Profession Shortages• Maintain and expand state policies that contribute to a

stable medical practice environment fostering workforce retention and growth (loans, tort reform, etc)

• Ensure adequate state and federal funding for medical school and GME necessary to support anticipated increases– Expand the entering class size for existing medical schools– Increase the number of funded GME programs by 300– Develop a business plan prior to the creation of new state medical

schools considering best options,• Expansion through regional academic center models• Development of new schools from “ground up”

– Optimize recruitment and retention of “out-of-state” and international health professional graduates

Mal-distribution of Professionals

• Create economic incentives for health professionals who elect to practice in HPSAs.– Medicare and Medicaid reimbursements– Locum tenens services (discounted)– Community development funds (ORCA)– Continuing education programs (AHEC)

• Provide economic assistance with technology applications

• Expand loan repayment programs for practitioners who select HPSA sites

• Increase the number of Federally Qualified Health Centers (FQHCs)

Diversity

• Emphasize the importance of cultural as well as language competency for health care providers.

• Reward health professional programs for the recruitment of students from diverse and under-served communities.

• Assure recruitment of students by utilizing K – 12 health career promotions.

• Provide scholarships and loan programs that are attractive for student participants.

• Recognize potential barriers that may adversely impact the recruitment of students from disadvantaged backgrounds, such as lack of scholarships, tuition costs, length of training programs, lack of undergraduate preparation, etc.

School of Medicine School of Medicine

Under-represented Minority Students

Cla

ss o

f 20

11

28%

14%

23%

21%

12%

18%

15%

UTMBUTMB

Texas TechTexas Tech

UT - SAUT - SA

UT - SWUT - SW

Texas A&MTexas A&M

UT - HOUUT - HOU

UNT-COMUNT-COM

25%

12%

17%

26%

12%

16%

7%

UTMBUTMB

Texas TechTexas Tech

UT - SAUT - SA

UT - SWUT - SW

Texas A&MTexas A&M

UT - HOUUT - HOU

UNT-COMUNT-COM

Cla

ss o

f 20

10

School of Medicine School of Medicine Number of Under-represented Minority Medical Graduates

03/04/05 (3YEAR TOTAL)

1 Howard University 214

2 UMDNJ 182

3 Meharry Medical College 153

4 University of Illinois 143

5 University of Texas Medical Branch 126

6 Temple University 107

7 UTSWMS 106

8 Harvard University 104

9 Baylor College of Medicine 101

10 University of Pennsylvania 71

10 University of Southern California 71

12 Drexel University 68

13 Michigan State University 63

14 University of Kansas Medical Center 55

15 Yale University 50

#1 in US in numberof Hispanic graduates

#1 in US in numberof Hispanic graduates

Aging of the Workforce

• Promote “creative” retirement options that permit health professionals to continue to work in part time positions post-retirement.

• Provide “second career” opportunities in the health professions workforce for early retirees (i.e., military,).

• Provide para-medical professionals to extend the healing touch using PAs, APNs, community health workers, promoters, and clinical nurse specialists who function with physicians who function in health care delivery teams.

• Create specialized / certified programs for workers in niches such as nursing homes, correctional facilities, and state schools.

• Create careers for certified health workers who manage chronic illness.

Mental Health Professionals

• Increase awareness of the opportunities within the mental health profession.

• Address service reimbursement inequities in private, state and federal insurance programs.

• Utilize telemedicine technology to address access in under-served areas as well as to provide mental health sub-specialty services such as geriatrics and child/adolescent services.

Impact of Technology

• Education– Shortages of educators in nursing and other critical fields

demand that Texas’ colleges and universities exploit the tools of technology to provide access to courses for students.

– Distance learning, web-based courses, and tutorials should be available to learners as applicable.

• Clinical Services– HPSAs should have ready access to telemedicine, electronic

records, and other tools that improve patient access and improve workforce efficiency.

– Payor systems should encourage the use of technology through their reimbursement programs.

– Licensure rules should support such programs.– Implement the recommendations of HITAC.

Education

• Restore Medicaid GME funding with viable funding process to FY 02-03 levels

• Ensure equitable federal Medicare GME funding for Texas teaching hospitals– Texas base rates are lower than most programs in

northeastern U.S.– Eliminate federal caps on GME funding

• Support 300 new resident positions over next 4 years• Restore and stabilize Title VII GME start-up programs

and HHS Children’s Hospital GME• Continue to identify innovative practice incentives to

improve physician ratios in medically underserved areas

UTMB School of Medicine Match Day

UTMB School of Medicine Match Day

2008

94% Matched

56% in Texas

36% at UT-SystemPrograms

22% UTMB, including 6 in

Austin

2008

94% Matched

56% in Texas

36% at UT-SystemPrograms

22% UTMB, including 6 in

Austin

Education

• Consider adoption of a state model for projecting future physician supply/demand to facilitate responsible state health professions planning in collaboration with SHCC, TMB, TMA, BNE and other health professional societies.

• Examine the impact of the proliferation of advanced health profession degree programs (such as pharmacy, nursing, PT, OT, etc) upon the cost of education, years required for training, availability of practitioners, and recruitment of students from disadvantaged populations.

• Support public health prevention and education programs, especially those that target chronic illness.

Education

• Expand programs that promote K-12 student interest and preparation for careers in the health sciences (AHEC).

• Fund pilot educational programs that utilize multi-disciplinary teams and technology to maximize educational resources.– Combined PA-ANP programs with common faculty.– Basic science courses that combine students from medical

school, allied health science schools, and nursing schools on the same campus, or from remote campuses utilizing distance education technologies.

• Increase specific funding for BSN programs that are associated with superior patient outcomes.

UTMB School of Medicine UTMB School of Medicine

USMLE Step 1 Results

99

93

99

96

93

96

9392

93

88

90

92

94

96

98

100

2003 2004 2005 2006 2007

UTMB NATIONAL

232

218

226224

221223

217216216

205

210

215

220

225

230

235

2003 2004 2005 2006 2007

UTMB SOM Student Performance (Step 1 +2)

UTMB SOM Student Performance (Step 1 +2)

% Passing (Step 1& Step 2 Combined)

Data fro

m T

HE

CB

– 03-12-08

UTMB

UTSWMS

TAMU

UTHSC-SA

Tx.Tech

UTHSC-H

88%

90%

92%

94%

96%

98%

100%

2005 2006 2007

A Healthy Texas is a Productive Texas