Testimony to Reconsider Proposed Funding Cuts

Mar 1, 2017, 15:50 PM by Ben Raimer

Ben’s Blog 2017 (#3); Feb 21

UTMB Old Red Ashbel Smith Bldg

Over in the House …

Dr. David Callender, UTMB president, provided testimony before the House Appropriations Committee’s subcommittee on Article III (Higher Education) on Tuesday, Feb. 21. Rep. Trent Ashby serves as the subcommittee chair (as he did last session), with Rep. Helen Giddings serving as vice chair. Also serving on the Article III subcommittee are Representatives John Raney, Donna Howard, Gary VanDeaver, Linda Koop and Mary Gonzales.

Dr. Callender introduced UTMB by noting that the campus had just celebrated its 125th anniversary and thanked the Legislature for its past support. He noted many of the milestones that define the campus’ success, including:

  • the graduation of over 1,300 students over the past year;
  • a 38 percent increase in enrollment in our schools of medicine, nursing, health professions and graduate studies since 2008;
  • the fact that 64.6 percent of our medical school graduates stay in Texas to care for Texans;
  • UTMB’s 98th percentile ranking nationally for medical students who stay in the state to practice;
  • UTMB’s national leadership in student diversity:
    • 1st nationally in the number of Hispanic medical school graduates,
    • 4th nationally in the number of African-American medical school graduates, and
    • 2nd nationally in the number of under-represented minority graduates;
  • the continued growth in clinical outreach in 2016, with over one million outpatient encounters and over 30,000 inpatient discharges;
  • research awards in excess of $120 million in 2016; and
  • -vaccines against Ebola, Zika, plague, Salmonella and influenza brought to clinical trials over the past year by UTMB’s Galveston National Laboratory and World Health Organization Vaccine Center.

Dr. Callender acknowledged the $26.3 million in proposed budget reductions in the House’s budget bill (HB1). These reductions are considerably less than the cuts proposed by the Senate, which amount to more than $47 million to UTMB for the next biennium (FY18/FY19).

Dr. Callender asked the House to reconsider principal elements of the proposed reductions, including:

  1. Formula Funding. He requested restoration of cuts to this funding source, noting that the rate for enrollment growth for the Health-Related Institutions (HRIs) was essential for Texas to produce the necessary health professions workforce, provide the necessary campus infrastructure and drive research excellence that is essential for the future health of our state.
  2. Hospital Formula. He again requested that the Legislature transition UTMB’s current General Revenue appropriation for the UTMB Hospitals into a patient-based formula that permits a metric-driven and accountable system for future funding. This proposal would not require additional funding from the budget, but it would provide consistency in the bill patterns for those HRIs that have state-owned and -operated hospitals, like UT Health Northeast in Tyler and MD Anderson Cancer Center.
  3. Special Item Funding. UTMB has several priorities related to this category of state funding:
    1. Bio-Containment Critical Care Unit. This item was funded at $8.2 million during the last session, and UTMB has requested that same amount for the completion of the unit, staff training, equipment and operations. If funding is not secured, then UTMB’s proposed regional center of excellence for advanced biosafety level IV treatment of infectious disease will likely be delayed until funding is available. In effect, Texas will not be able to properly treat patients with Ebola or other Level IV diseases until this unit is funded and operational.
    2. Indigent Care funding. In 2016, UTMB provided care for 20,838 indigent Texans from 124 different counties, for a total of 33,600 patient encounters. The total cost of that care was $49.6 million; of that, $47.7 million was not covered by collected payments. Without indigent health care funds, UTMB will have to curtail its services to the working poor, uninsured and severely ill who have lost their insurance because they are unable to work and do not qualify for Medicaid or a county indigent care program. UTMB is asking the Legislature to restore $3.4 million in Article III funding and $8.9 million in Article II funding (unclaimed lottery funds at the Health and Human Services Commission).
    3. Primary Care Physician Services. UTMB currently budgets $9.6 million to fund innovative programs that pique student interests in primary care programs. Texas has made primary care a priority for residency training and UTMB is among the nation’s leaders in this work. The Senate’s proposed budget would eliminate the program altogether and the House would reduce it by $6.1 million. Such an austere budget would essentially result in the closure of key programs and the reduction of graduates choosing primary care as a career.
    4. Area Health Education Centers (East). The proposed House reduction of $1.8 million and the Senate’s elimination of funding would have a devastating impact on a well-known, community-friendly program that introduces students in 111 central and eastern Texas counties to programs that promote public health, advance health care careers and provide recruitment of health professionals into underserved areas of the state. AHEC’s work also provides economic development assistance to communities. That work also draws down a dollar-for-dollar federal match. So, state General Revenue cuts to AHEC would result in equal cuts in federal funding to these areas.
    5. Additional reductions have been proposed for UTMB’s chronic home dialysis center as well as institutional enhancement funding. 

In addition, UTMB continues to prioritize support for Graduate Medical Education (GME), which funds residency slots. Over the past several years, all of the state’s HRIs have been on paths to improve the quality and number of the health professions workforce, including physicians. GME funding helps in this regard, because physicians tend to practice in the state where they completed residency training. The more residency slots we can fund, the more physicians we are likely to keep in Texas.

Ideally, we would like Texas to achieve a 1:1.1 ratio between its SOM graduates and first-year residency slots. That dream is now stymied at a 1:1 ratio, with an impending erosion of that number through a budget reduction and the Governor’s hiring freeze. Both have an adverse impact on GME growth and are likely to place Texas in the undesirable position of becoming a net exporter of its health care graduate talent to other states where GME positions abound.

It is no secret that Texas faces a very challenging budget environment this session. The reasons are complex, but we take heart in the fact that UTMB’s priorities are strongly related to our mission of improving health. It is that mission we have in mind in every meeting and every hearing, as we provide state officials information they need to make decisions about the future of Texas.

As always, stay tuned…