Wow, what a blow to the island.

My mom's friend and her husband both work there.

I used to work there. I left after they had a large RIF in 2006. Still have quite a few friends there who are sweating it out since they work for the hospital part.

Whew...just found out my mom made the cut. This is her third time sweating it out.

Someone needs to investigate what seems to be a politically motivated waste of taxpayer's money.

UTMB provides health care to the people who can't pay. Poor patients are referred to them from all over the state. Every 2 years when the legislature goes into session our "representatives" are irate and amazed that UTMB is losing money....well Duh!

#1-the state isn't supposed to be in business to make profits.
#2-if you give your services away this precludes making a profit.

I have read that one Rep from Brenham suggests "abandoning" the campus and moving it to someplace "more productive".
This is a multi-billion dollar campus she is recommending they abandon.
There is no place you can move to and not lose money if you give your services away.

The rumors have been around for years that "the politicians" want a medical school in Austin. I guess some of them are flexing their power now and pi$$ing our money away at the same time.

Traditionally, UTMB was the tertiary care hospital over the county hospitals for a large portion of the state. The county took care of basic medical conditions, but more serious cases were transferred up to UTMB. Residents and students had a heavy patient load and saw a broad range of pathology. The model that UTMB operated under basically used residents and students to treat indigents. The state provided the money and got relatively cheap indigent care as well as well-trained doctors. This is the classic House of God model that many academic hospitals across the country used.

UTMB is unique in Texas because it was established so long ago. The medical school and the hospital are a single institution owned by the State of Texas. UT Southwestern was the next medical school established nearly 60 years later and was established as a separate institution from the hospitals that it served (Baylor was private and is a whole different story). Subsequent medical schools were established along the UT Southwestern model with a medical school housing educational and research facilities but minimal clinical facilities contracting with private or public hospitals (none specifically owned by the State of Texas).

UTMB did well and was a respected training institution up until about 15 or 20 years ago. Then its model began to come under pressure. Medical care costs skyrocketed with most of the increases going to medications, equipment, or support staff. Indigent care could no longer be significantly economized by using underpaid and overworked trainee doctors due to Medicare rules and the 80 hour work week. Due to political changes, the Texas legislature has been increasingly reluctant to support indigent care. And why would they give extra support to medical training in Galveston when other medical schools were doing it so much more cheaply (and more prestigiously and in more politically important locations)?

The overall result was that UTMB started bleeding money. UTMB has gone through a couple of rounds of painful cost-cutting in the last 10 years which have significantly impacted its mission. However, these changes improved the math temporarily without solving the fundamental problems. UTMB is not in a geographically favorable location. Sandwiched between the Gulf of Mexico and the Texas Medical Center, the paying patient population is limited. This didn’t matter under the old model (indigents would come from anywhere to get their medical care paid for by the state), but is now unworkable. Attempts at adjusting UTMB to a more sustainable model (establishing mainland clinics to improve the insured patient catchment or two-tiered medical service) have been met with a great deal of internal and external resistance.

Now, the UT Board of Regents wants to adjust UTMB’s organization. The political resistance will be less, and it doesn’t make sense to spend half-a-billion dollars to rebuild UTMB to go back to losing $50 million a year. And so UTMB is not bouncing back from Ike anytime soon.


[This message has been edited by APE2AG (edited 11/30/2008 6:52p).]

quote:

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And why would they give extra support to medical training in Galveston when other medical schools were doing it so much more cheaply (and more prestigiously and in more politically important locations)?

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Please elaborate a little--where, in Texas, do they provide the same medical more cheaply?
What are the differences?

Why did they use tax payer money to buy all the private practices in the area and now they abandon them?

Just trying to collect more information and understand what seems like serious mis-management of our state resources.

Is the state trying to ease itself out of providing health care for the illegals & uninsured?

quote:

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UTMB provides health care to the people who can't pay. Poor patients are referred to them from all over the state. Every 2 years when the legislature goes into session our "representatives" are irate and amazed that UTMB is losing money....well Duh!

#1-the state isn't supposed to be in business to make profits.
#2-if you give your services away this precludes making a profit.

---

Bingo. They were looking to get out of the business of providing specialty care for the poor. This hurricane was their excuse to do so. There are tons of poor all over the region that are left without care with the absence of UTMB. State and local medical programs are scrambling to find answers for them now that they've been "fired." Right now, there are no answers...

You think this is all a way to slide out of paying for health care for those who can't pay?

I don't think our politicians have the guts to do it. I am not arguing the right vs wrong I just don't think they can stand the heat. When a few stories make the news about someone who died because they didn't get free care--I don't think they can do it.

They didn't even have the courage to announce this "decision" until after election day--when their jobs were safe for another 2 years.

IslandAg,

I did not say that it is cheaper to provide indigent health care in other places in the state. I said that medical education was provided more cheaply at other institutions in Texas. Basically, the legislature (as it sees it) gets more bang for its buck in terms research and medical training when those dollars aren't tethered to indigent care.

As far as buying out the competition, UTMB hasn't been buying much of anything in the last decade. Their buying spree (culminating in the purchase of St. Mary's, now Rebeca Seally) was done back when the old model was still working. Besides, Galveston is a city of less than 60 thousand, and there just isn't much room for a major medical center and significant competition.

They bought the private practices & St. Mary's, rested a while and now are spending lots more expanding onto the mainland.

I am not nearly as familiar with the UTMB model but I do know that in San Antonio the hospital connected (physically and figuratively) is owned by the county. There is also a program called disporportionate share. Which is a way for hospitals to get money from the feds depending on what their payer mix is.

Disclaimer - I only know enough about hospitals to be dangerous. Maybe someone can shed more light on the different hospital models.

IslandAg,

UTMB expansions onto the mainland were limited prior to Ike. They ran obstetrical clinics around for pregnant poor women, but that had outside funding (I think). They had bought an ortho clinic in League City as a trial and more recently had spread some pediatric clinics around. UTMB's big push onto the Mainland was to be with the Victory Lakes facility in League City (which, after meeting stiff political resistance, still has yet to break ground). The idea with that was to locate outpatient clinics in a strategic place to tap the affluent and rapidly growing north Galveston County population thereby expanding their insured patient population. Surgeries and inpatient admissions (which pay well) would still be on the island. Now, post-Ike, UTMB is probably planning for a more significant mainland presence.

Thanks for the information but in my mind there are still a few main points:

1-Is the state going to stop paying for the health care of the uninsured and illegals? If not then it makes little sense to try and juggle it around--no matter where they go it will cost money.

2-UTMB is a long established, complete medical facility and being on the Island is no more risky than when MD Anderson flooded a couple years ago. Abandoning the campus is a waste of taxpayer money.

3-I disagree a little about their presence on the mainland. Some of these may be Post-Ike, temporary locations but they also have/had clinics as far away as Brownsville.

UTMB Orthopaedic Clinic at South Shore Harbour
3023 Marina Bay Drive
Suite 101
League City, Texas 77573
(281) 334-0620

Texas City Family Healthcare Center
9300 Emmett F. Lowry Expressway
Suite 138
Texas City, Texas 7759

ALVIN

Pediatric Associates, Alvin
218 E. House St., (281) 585-2530
Fax (281) 585-3819
Pediatric primary and specialty care services including gastroenterology, neurology, psychology and surgery.
[view map]

Psychiatry
The Gulf Coast Center
101 Brennen Lane, (409) 370-3285
[view map]

DICKINSON

UTMB Blood Center
2441 West FM 646, Suite A, (281) 534-8836
Now open for apheresus blood donations (double red cells, platelets & plasma) & therapeutic phlebotomies
(by appointment only)
[view map]

FRIENDSWOOD

Pediatric Associates, Adult & Specialty Care
128 W. Parkwood, corner of FM 528 and 518. (281) 482-5695
Fax (281) 482-3963
Pediatric & adult primary care, general surgery, organ transplant, vascular lab ultrasound services, vascular surgery, plastic surgery & neurosurgery.
[view map]

University Eye Center, Friendswood
400 W. Parkwood, Ste. 120, behind Popeye’s. (281) 996-7564
Fax (281) 996-9944
A full-service eye center for your family.
[view map]

GALVESTON

Fast Track Clinic
UTMB Trauma Center, 800 Harborside Drive, (409) 772-2166
Fax (409) 772-0497
Open to Family Medicine patients (by appointment only).
Mon.–Fri. 8 a.m.–5 p.m.
[view map]

Geriatric Clinic, Galveston
700 University Blvd., on the first floor of the University Eye Center
Specialized care for adults and seniors 55 and up, featuring UTMB geriatricians
[view map]

Island Pediatric Urgent Care
UTMB Trauma Center, 800 Harborside Drive.
Open 24/7. Walk-in patients welcome.
[view map]

Stark Diabetes Endocrine Clinic
700 University Blvd., on the first floor of the University Eye Center
[view map]

Stewart Road Family Health
6710 Stewart Road, (409) 772-2166 or (409) 744-4030
Mon.–Fri. 8 a.m.–8 p.m.; weekends 9 a.m.–1 p.m.
Family medicine & pediatric primary care, dermatology, orthopaedics, vascular surgery, vascular lab ultrasound services, and psychiatry.
[view map]

University Eye Center, Galveston
700 University Blvd., (409) 747-5800
Fax (409) 747-5825
A full-service eye center for your family.
[view map]

UTMB Blocker Burn Unit
John Sealy Hospital, 8th and Market St.; (409) 772-2023
Outpatient burn clinic, 1 p.m. weekdays.

UTMB Sleep Disorder Center
John Sealy Hospital, 5th Floor (409) 772-1078
Office hours Mon.-Fri., 8 a.m. to 5 p.m.; appointments for sleep studies available Monday through Saturday nights; physician referral required.
Fax (409) 772-2470

LEAGUE CITY

Pediatric Associates & Family HealthCare
6465 South Shore Blvd., Suite 500, behind Kroger’s on Hwy 96. (281) 538-7735
Fax (281) 538-3936
Pediatric and adult primary care, dermatology, pain management and Center for Weight Management.
[view map]

Pediatric After-Hours Urgent Care
3023 Marina Bay Drive, Suite 101, next to CVS. (281) 334-6578
Mon.-Fri. 5:30–10 p.m.; weekends noon–10 p.m.
[view map]

South Shore Orthopaedics
3023 Marina Bay Drive, Suite 101, next to CVS. (281) 334-0620
[view map]

Women’s Health Center at Bay Colony & University Fertility Center
1804 FM 646, Suite N, next to HEB. (281) 534-6414
Fax (281) 534-2770
Fertility, incontinence, gyn-oncology, pelvic pain and general obstetrics & gynecology.
[view map]

NASSAU BAY/WEBSTER

Clear Lake Specialty Care Clinic
2200 NASA Parkway, Suite 210, in the Bank of America building across from JSC. (281) 333-2273
Fax (281) 333-9833
Adult and pediatric specialty services. Adult services include gastroenterology, allergy/asthma, pulmonary and neurology. Pediatric services include allergy/asthma and cardiology.
[view map]

Harbourview Sleep Lab
2060 St. John Drive, Suite 404, across from JSC, (281) 333-0703
[view map (directions are approximate)]

Psychiatry
17300 El Camino Real, Ste. 107D, corner of El Camino & Hercules. (409) 370-5859
[view map]

TEXAS CITY

Family HealthCare Center
9300 Emmett F. Lowry Expwy., Suite 138, next to Sam’s Club. (409) 986-9686
Fax (409) 986-7890
Adult primary care services, general internal medicine, hematology, nephrology, endocrinology, oncology, infectious disease/HIV, urology, and ear, nose & throat.
[view map]

UTMB Texas City Geriatric Clinic
Oceanview Transitional Care Center (formerly Danforth)
519 9th Ave North, (409) 948-8862
Fax (409) 945-0113
Specialized care for adults and seniors 55 and up, featuring UTMB geriatricians formerly serving Galveston Island and Santa Fe
[view map]

Pediatric Associates, Texas City
6400 Memorial Drive, off Hwy 3. (409) 938-8466
Fax (409) 938-1827
Pediatric primary and specialty care, including nephrology, endocrinology/diabetes, infectious diseases, genetics, psychology, hematology-oncology, urology and cleft palate.
[view map]

Island Pediatrics
6400 Memorial Drive, next to Mainland Medicine Specialties off Hwy. 3, (409) 938-8466
Fax (409) 938-1827
Open weekdays 4:30-8 p.m.
[view map]

Mainland Medicine Specialties
6504 Memorial Drive, off Hwy. 3, next to Pediatric Associates. (409) 938-7409
Fax (409) 938-1479
Adult specialty services include gastroenterology, rheumatology and endocrinology/diabetes.
[view map]

Psychiatry
The Gulf Coast Center, 7510 FM 1765, (409) 370-5848
[view map]

Texas City Physical Theray/Occupational Therapy Clinic @ Oceanview
Oceanview Transitional Care Center (formerly Danforth)
519 9th Avenue North, (409) 943-5050
Fax (409) 943-5058 or (409) 943-5059
Mon.-Fri., 8 a.m. to 6 p.m.
[view map]

UTMB Cardiology at Mainland Medical Center
6807 Emmett F. Lowry Expwy., Suite 310, (409) 933-0017.
General cardiology, preventive cardiology, heart failure and transplant, interventional cardiology, electrophysiology, echocardiology, stress testing, Holter EKG, pacemaker check and cardiac catheterization.
[view map]

HOUSTON

Radiation Oncology patients receiving radiation therapy at UTMB before Hurricane Ike can now receive care from university physicians at St. Joseph Medical Center, 1315 St. Joseph’s Parkway, Suite 1003, in Houston. For more information, please call (713) 757-7593.
Fax(713) 756-8227
[view map]

Regional Maternal and Child Health Program Clinics (throughout SE Texas)
All of UTMB’s Regional Maternal & Child Health clinics (with the exception of our Galveston location) are open and seeing patients. Galveston patients should call the Texas City clinic at (409) 643-8359 or Dickinson clinic at (281) 534-2576.

IslandAg,

About the UTMB Mainland presence, I didn't mention the family practice, geriatric, and psych clinics, but those are pretty minor operations. Most of the clinics were peds and OB-Gyn (which extended way into the valley like you said, but did so per the direction of an outside grant as I understand it). The specialty clinics tried to set up clinics on the mainland post-Ike often occupying space in the peds clinics. Also, some specialties contracted to staff medical facilities (Mainland Hospital and St Joe's) with UTMB docs, but these are not UTMB owned.

UTMB's mainland presence was small, but probably needed to be much larger. Major medical centers usually draw from a patient population of over a million people. UTMB realistically had a couple of hundred thousand. In order to be a significant academic hospital, UTMB needed to split the Gulf Freeway corridor with the Texas Medical Center, and the closer that dividing line was to Houston, the better for UTMB. That was true befor Ike, and it is true now, if politically unpopular.

Since the storm, some of the indigents have been moved to other medical facilities. There is some state money availabe to fund their care, but the amount was always inadequate. It really wasn't even close to what was needed (hence UTMB's bad balance sheet). Care for these people will certainly cost more in the future with the UTMB crisis. The state legislature will pay more to have indigents receive health care in Galveston, or it will pay more for them receive care at other facilities, or it will not pay for their health care at all. I don't know what the state legislature will do. Several counties have been getting by very cheaply as well, by sending patients to UTMB, and that will change now.

I believe that it is riskier to place major hospital on a barrier island and it is more expensive (insurance and structures). That doesn't mean that it shouldn't be done, but you have be realistic about your goals and expectations and structure things accordingly.

IslandAg, could you detail your thoughts on the situation? What do you think are the main reasons that UTMB was loosing money? What do you think will happen now (or are afraid will happen)? What do you think should happen? I have an idea of what you're thinking, because there are a lot of people around Galveston seemingly coming from the same direction, but I would like to hear you explain it.

And then there's this from KHOU Channel 11 news out of Houston:

Asked why critical facilities weren’t relocated to higher elevations, David Marshall, said, “The hospital could make that choice, but they decided to spend $120 million on indigent care instead of spending that money to put things on a high floor. I think it was the right choice.” Marshall is assistant vice president of patient care and chief nursing officer at UTMB.

That may not be the dumbest thing anybody on Galveston has said since the hurricane hit, but it's probably in the top 5. How much indigent care is UTMB doling out now? David Marshall should probably be the assistant vice president of getting RIFfed.

The state is not the only entity that provides funds for indigent care. UTMB has contracts with counties to care for their indigent. Needless to say those along with state funds are not near enough to cover the cost.

They had just worked with the counties to renegotiate the contracts to try and cover the costs they were eating. Weeks after this, Ike gave them a better option, get out of the charity care and fire the needy.

quote:

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IslandAg, could you detail your thoughts on the situation?

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Probably not very well.

The "Island" thinking is wrong--I don't have dates but I would bet that Houston has flooded more times in the last 100 years than Galveston. To the best of my knowledge this is the first significant flooding since 1900.

I know there have been rumors here for years about moving the medical school, hospital, etc. to Austin. The speed with which they acted after Ike was as if the politicians all jumped in unison and said "here is our chance, here is our excuse". It seems they have a plan--downsize the hospital then it won't be big enough to support a medical school, nursing school, allied health school then this justifies moving. That campus is one damn big investment and to "abandon" it is serious mismanagement of taxpayer money because it will be rebuilt somewhere else. They were building on that campus up until the day the evacuation was ordered.

quote:

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What do you think are the main reasons that UTMB was loosing money?

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1-providing free care to uninsured citizens and illegals. No money in equals losing money.
2-Not providing good enough service to attract enough insured patients. Example-Many UTMB employees went elsewhere for their health care. In many clinics the service and care were good. In many it was terrible. This is management.

quote:

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What do you think will happen now (or are afraid will happen)?

---

I think this is the first step in moving the whole mess out of here. Rumors have been here for years that the "politicians" want a medical school in Austin. Rumors now that the Prison health care is moving to N. Houston. I don't like buying into rumors but wrt UTMB they seem to be coming true.

Galveston is a relatively poor community--I believe we have more government subsidized housing, per capita, than anywhere in Texas. UTMB, obviously was a major employer and provided health care to those poor people.

quote:

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What do you think should happen?

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I don't know the answers. Health care has gone berserk.
Used to be the patient paid the Doctor. Then the patient got insurance--patient paid the insurance and the insurance co. paid the doctor.

Now-patient pays insurance then pays a lot of the bill as deductible or co-pay. Then some gatekeeper screens the diagnostics & treatments suggested by the doctor and disallows some and squeezes the compensation to the medical facility. Doctor/hospital learns how to "unbundle" things to get more money for the same things. Insurance company changes the codes and hires another "in-between" company to counter the unbundling. Then some other company has a nurse screening and approving the treatment insuring it is correct and "necessary" for the patient.

Somehow all these companies have conned someone into believing that paying them a lot of money is actually saving money.

Used to be the Doctor had the Mercedes, now it is the health care administrator.

quote:

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I have an idea of what you're thinking, because there are a lot of people around Galveston seemingly coming from the same direction, but I would like to hear you explain it.

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Tell me what I am thinking.
I think the new head of UTMB was hired to do just what he is doing. He is lucky a storm came as it made his job easier.
Somehow, the politicians either need to realize they have to find alternatives to the status quo--expensive health care provided for free, or they need to pay the bill.
Moving "free health care" doesn't make it cheaper.

See todays paper-the man displaced from Galveston by the storm denied dialysis at multiple locations and he died.
This seems like the wimpy little way politicians work--sneak out of someplace, blame it on forces beyond their control, do it after election day and have a scapegoat.

UTMB is not the only problem spot in health care. Send all of UTMB's patients to MD Anderson and they will lose their a$$ too.

I've gone on too long. This is a discussion which is better with more give & take and would work better in person with adult beverages available. I don't know all the problems and certainly don't have the soluutions.

Agreed. A beer down at Molly's sounds pretty good right about now . . .

oh yeah . . .

damn.

Most UTMB employees get their medical care elsewhere because UTMB tells its own employees they have to wait two months at least for an appointment.

See Above.

quote:

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2-Not providing good enough service to attract enough insured patients. Example-Many UTMB employees went elsewhere for their health care. In many clinics the service and care were good. In many it was terrible. This is management.

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http://www.youtube.com/watch?v=bLJxmJZXgNI


Here is an example of why UTMB can't make a profit. They not only have their "fair share" of non-paying patients but they also have them referred here by many other counties and hospitals.

Also-Mayor Bill White (Houston) had an opinion on the Houston Chronicle editorial pages.

Here are some recent articles:

http://galvnews.com/story.lasso?ewcd=be0ab9af57247b98

http://www.texasmonthly.com/2009-01-01/btl.php?click_code=e01020fb90c1532dfe<br%20/>842ee6dcdc2eb8

If you read between the lines (along with some rumors) not only is UTMB in Austin a real (though small) possibility, but so is TAMUMB in Galveston. They are not mutually exclusive. These things are going to come down to personalities and a lot of lawyers.

[This message has been edited by APE2AG (edited 12/15/2008 5:16p).]