TMA to HAC Subcommittee on HHS: Make Patient Access Top Priority

Date:  Feb. 23, 2009

To: The Honorable John Zerwas, MD, Chair
House Appropriations Committee, Subcommittee on Health and Human Services 
Members, HAC Subcommittee on Health and Human Services  

From:  Texas Medical Association 
Texas Pediatric Society 
Texas Academy of Family Physicians

Subject: Texas Department of State Health Services


On behalf of the nearly 47,000 physicians and medical students our organizations represent collectively, thank you for the opportunity to comment on the Texas Department of State Health Services' legislative appropriations request. Our organizations understand the balancing act you and your Senate counterparts will face over the next few months trying to craft a budget that will meet the health, educational, and safety needs of a diverse and burgeoning state - specially while facing a slowing and uncertain economy. Physicians are keenly aware of your challenge. As you review priorities and expenditures, we ask that you keep patient access at the top of your list. We urge you to make decisions that help Texas patients receive effective, timely, and affordable care.  

Prevention - coupled with early detection and treatment of illness - is the cornerstone of an efficient and effective health care delivery system. Texas' growing population combined with a slowing economy will put even more pressure on the state to do more with less. Funding preventive health interventions is a proven strategy to stretch limited dollars. By giving patients access to care in their communities before they need more costly interventions in a hospital, long-term care facility, or even jail, the state can use its dollars more efficiently. At the same time, the state can improve the quality and health care outcomes for the people it serves.

As you consider the DSHS budget request, we urge you to place a high priority on the following.

Mental Health  

  • Support timely, effective mental health services by continuing the funding allocated in 2007 to redesign mental health crisis services and supporting the $88 million DSHS exceptional item to implement transitional and postcrisis programs that help patients manage their illness in the community rather than through the emergency room or jail.

An initial evaluation by Texas A&M University shows the crisis service redesign program to be working well, having met or exceeded established performance goals. At the same time, the evaluation pointed to the need for additional funding to expand crisis services as well as ongoing, transitional services that will help patients with severe mental illness manage their condition in the community vs. in the emergency department or jail. As you contemplate this request, we also advocate that a portion of the funding be targeted to children and youth. In 2007, of the 14 programs funded, only three addressed the unique issues facing children.

Substance Abuse  

  • Support timely and effective community-based substance abuse treatment by funding DSHS exceptional item 9 requesting $69.7 million over the biennium to expand the number of Texans who receive treatment. Like untreated mental illness, substance abuse has significant economic cost to the state. In 2007, addiction to drugs and alcohol cost the state some $33.4 billion in lost productivity, and higher rates of crime and incarceration, morbidity, and premature death. There also are the short- and long-term health care and educational costs associated with treating and teaching children born to drug-addicted mothers and the impact on the state's foster care system, where children of drug-addicted parents often are placed.   

Substance abuse treatment is cost-effective. Data from DSHS shows that in 2005, emergency room costs were 35 percent lower for drug/alcohol-abusing Medicaid patients who received needed DSHS substance abuse treatment. Texas could further reduce its Medicaid expenditures by expanding comprehensive treatment to adults. In its 2009 report, Texas State Government Effectiveness and Efficiency, the Legislative Budget Board estimates that Texas spends about $109.5 million (all funds) on treatment of substance abuse disorders. The cost of expanded treatment - about $31.4 million from all funds/$13.3 million from general revenue - would be offset by reductions in Medicaid-funded hospitalizations and other health care services as well as savings from decreased incarcerations.

Cystic Fibrosis  

  • Support early detection of cystic fibrosis by funding the DSHS exceptional item 11 to add cystic fibrosis screening to the current genetic screening panel. DSHS is requesting $2.9 million in general revenue to add cystic fibrosis screening to the current genetic screening panel. Early detection and treatment of cystic fibrosis leads to improved growth and cognitive development in children; increased life expectancy; and reduced medication, hospitalization, and mortality. Forty-seven states and the District of Columbia require screening for cystic fibrosis by law or rule as recommended by the National Newborn Screening and Genetics Resource Center.

Health Care-Associated Infections  

  • Improve health care quality by supporting a comprehensive plan to collect and report data on hospital-acquired infections. DSHS is requesting $4.3 million within exceptional item 3 to collect data from hospitals and ambulatory surgical centers (ASCs) regarding infections acquired within a facility.  SB 288, adopted in 2007, directed DSHS to establish a data collection system. The Health Care Associated Infections Advisory Panel created by that legislation supports enhanced data collection and reporting. Data collected as part of the infection reporting system will increase awareness about the incidence of health-care associated infections; help hospitals, ASCs, physicians and the state better identify where those outbreaks are more likely to occur and why; design more effective interventions to reduce those infections; and improve the quality of care for all hospitalized Texans. 

Obesity Prevention  

  • Support evidence-based initiatives to reduce the incidence of obesity among adults and children by supporting DSHS exceptional item 11 to fund the Healthy People/Healthy Communities (HP/HC) Program. HP/HC is a community‐level program similar to the comprehensive tobacco control model endorsed by the Centers for Disease Control and Prevention and used effectively in several Texas communities in the past. HP/HC provides competitive grants to communities to foster collaborative activities by cities, counties, businesses, faith-based organizations, schools and other community groups to help their residents increase physical activity and adopt healthier eating habits. Texas' fiscal health is dependent on its physical health. While Texas has been a leader in recognizing the health and economic costs of obesity, the problem persists. In 2007, two-thirds of adults and one-third of high-school students were either overweight or obese. It is estimated that obesity costs Texas businesses some $3.3 billion in 2005, a figure that could rise to $16 billion by 2025 if the state fails to take bolder preventive health steps.