Testimony on Interim Charge 12 on Medicaid Cost-Containment Efforts for Long-Term Care Facilities by Philip Huang, MD, MPH
House Appropriations Subcommittee on Article II
April 4, 2018
Good afternoon, Chair Davis and members of the committee. I want to thank you for the opportunity to testify on the charge to study the state’s readiness to care for aging Texans. I am Philip Huang, MD, MPH. I am a family physician, and I have served for ten years as the health authority for Austin Public Health, following many years of service at the Texas Department of State Health Services (DSHS). Prior to joining the state, I was an Epidemic Intelligence Service (EIS) Officer at the Centers for Disease Control and Prevention. I chair the Travis County Medical Society’s Public Health Committee and am a consultant to the Texas Medical Association’s Council on Science and Public Health. I am here today on behalf of the 51,000 members of the Texas Medical Association.
TMA appreciates the opportunity to submit our comments on the charge to this committee to study the state’s readiness to care for aging Texans, specifically in identifying methodologies to: support high-quality care for Texas seniors; accommodate new models of long term care; and encourage care coordination to treat higher incidence of complex conditions. In light of the most recent influenza season and how it affected the vulnerable residents of our long-term care facilities (LTCFs), we believe that providing disease prevention to our Texas seniors should be prioritized. TMA members welcome the opportunity to work with you to navigate these population and public health challenges.
Texas has the third largest elderly population in the U.S., with 12 percent of its residents aged 65 or older.[i] Texans who can no longer live independently because of serious acute or chronic illnesses that limit their ability to care for themselves often become residents of one of Texas’ 1000 plus LTCFs. Some of our most vulnerable and medically fragile Texans reside in these facilities. Anyone living or working in a LTCF is more likely to be exposed to communicable diseases because of the vulnerable health conditions of residents and the close living environment. Furthermore, risk is increased with the frequency of family members and visitors visiting these sites and possibly spreading these diseases. Communicable diseases such as influenza disproportionately affect the health of vulnerable seniors living in LTCFs — often requiring hospitalization and sometimes leading to death. The complexity of conditions prevalent in senior populations often arises from the compounding factors of both chronic and communicable diseases.[ii] For example, patients with diabetes tend to be at a greater risk for various infections and, when diagnosed, oftentimes have associated health complications.
With this knowledge and their expertise in mind, Texas physicians urge the state to focus on ensuring high-quality care for Texas senior patients by protecting them from infectious diseases, managing their complex conditions, and implementing new models of care that support collaboration between LTCFs and local and state health departments. Preventive and clinical care in a medical home by physicians must be supported with a strong public and community health system. This integration of medicine and population health presents the best opportunity to reduce and mitigate both chronic, communicable conditions and disabilities associated with aging. These include support for state and local agencies to perform key public health functions in planning, monitoring, surveillance, assessment, and programming:
- Stronger local public health monitoring and surveillance of communicable diseases. This could be accomplished through new statutory reporting requirements by LTCFs for any communicable diseases, especially flu outbreaks inside these facilities;
- Reduce the threat of the spread of multi-drug resistant organisms (MDROs) between transferring facilities by requiring greater collaboration between all health care facilities. Currently, facilities are not responsible to notify a receiving facility of the presence of a MDRO in the patient’s originating facility. Elderly patients often transfer back and forth between LTC and tertiary facilities.
- Preparedness planning to support the aging population in the event of a disaster or infectious disease emergency.
- Assessing how to address gaps and strengthen our statewide child and adult vaccination programs, and emphasizing strong policies to support vaccination of caregivers and health care workers in LTCFs and other health care facilities. ImmTrac, the state’s immunization registry, could be utilized to maintain current records on how up-to-date both workers and residents are in their protections. This information is critical and timely during an outbreak.
As this charge focuses on cost containment, TMA wishes to emphasize that prevention through effective planning, programming (such as those that implement vaccinations), monitoring, and surveillance, can save Texas millions, if not billions, of dollars. The Texas Department of State Health Services (DSHS) report on preventable hospitalizations [iii] confirmed that many people are hospitalized for conditions that can be avoided (2008-13). The most costly of these conditions was more than 280,000 hospitalizations for bacterial pneumonia at a cost of more than $10 billion. Bacterial pneumonia can be largely prevented, and Texans over age 65 years in particular are most vulnerable if they are not properly vaccinated.
TMA thanks the committee for supporting long-term care in prior legislative efforts and for all of your dedication and prioritization of Texans’ health. We are already working with other stakeholders in the long-term care community, including providers, consumers, and agencies to identify ways to prevent and manage the spread of infectious diseases in these essential health care facilities. We stand ready to assist you in your efforts for elderly care in LTCFs, which will impact the lives of millions and could save Texas taxpayers countless dollars. Please let me know if I can answer any questions at this time.
[i] United States Census Bureau, Quick Facts Texas, https://www.census.gov/quickfacts/TX, accessed Mar. 28, 2018.
[ii] John H. Wasson, “Multiple Health Problems in Elderly People: Adapting what is known,” British Medical Journal, 336, no. 7650 (Apr 2008): 950-951, accessed Mar. 28, 2018. doi: 10.1136/bmj.39532.671597.94.
[iii] Texas Department of State Health Services, Potentially Preventable Hospitalizations, https://www.dshs.state.tx.us/ph/, accessed Mar. 28, 2018.
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