Thursday, September 26, 2024 Lina Fischer
Travis County commissioners unanimously approved a 6.5% tax rate increase and an $888 million fiscal 2025 budget for Central Health, the county’s health care district, on Tuesday, but there was uncertainty about potential conflicts between Central Health’s mission and how the district specifically spends its tax dollars.
Last week, the Commissioners Court postponed a vote due to confusion over Central Health’s affiliation agreement with the University of Texas Dell Medical School and whether it required the university to use the $35 million it gives the school annually directly on indigent care. The university told the county the terms of the agreement did not allow it to do so. Soon after, attorney Fred Lewis filed a lawsuit accusing the commissioners of misleading Mathers, the consultant who conducted a clean performance audit of Central Health, when it found no violations of the law on the district’s part. Lewis argued that state law, which governs the district, requires taxpayer money to be used on indigent care and that Mathers lacks standing to make that legal judgment.
When the budget, which included $35 million in annual transfers, was passed, Lewis wrote in a press release: “The committee undoubtedly knew from Mazars’ performance evaluations and public documents that Central Health had no financial controls and that UT was not providing care to the poor. Who would continue to pay them?”
With the budget passed, commissioners called for greater transparency and external review of the partnership agreements.
“One of the fundamental things that needs to be done is renegotiating the affiliation agreement,” said Chair Brigid See, “which is made even more difficult by the fact that UT has sent us a letter in response to our performance review saying that we are not allowed to provide care to the indigent. That’s a bit of a shock. I think it’s a stain on UT to say that we are not allowed to provide care to the indigent.”
Lewis argues the agreement should be thrown out entirely, writing in a press release on Tuesday that “as any competent, independent Texas attorney knows, the contract is invalid if it violates state law.”
Separate from the affiliation agreement, Central Health’s fiscal year 2025 budget will see an overall increase of $58.2 million, with 88 percent of the total budget dedicated to providing health services. Major increases have been in the areas of specialty care and mental health care, as well as improved post-discharge care at skilled nursing facilities and increased patient enrollment in Central Health Services. By the end of fiscal year 2025, the district aims to increase specialty care visits sixfold, establish a respite facility specifically for patients experiencing homelessness after being discharged from the hospital, and improve how the district coordinates care to reduce hospital relapses.
Dr. Patrick Lee, CEO of Central Health, made a special emphasis in explaining the diversity of Dell Med’s residents, saying that nearly all of the clinical services they provide are “in an environment that acts as a safety net. ” The greater the number of physicians at UT, the shorter the wait times for services, Dr. Lee explained.
“The students, residents and fellows attending these programs are very diverse, with 70 percent of the trainees being people of color. Approximately 50 percent of all graduates continue to practice in Central Texas,” he said.
Lee said patient retention is important because “patients can’t effectively access the advanced services they need — advanced cancer care, transplant services, advanced surgical services — by just going to Dallas, Houston or San Antonio.”
But the quality of Dell Medical’s graduates isn’t the issue, and Lee addressed the issue of the affiliation agreement, positioning it as a transparency issue rather than a violation of Central Heath’s mission: “My belief is that this medical school clearly adds value to access to health care in our community, but there are opportunities to improve how we communicate that value.”
Central Health board chair Ann Kitchen added that her board and Community Care’s board also plan to clarify the relationship between the two, saying: “We will be meeting over the coming months to discuss the relationship and come to a collaborative agreement on what that will look like.”
Before the unanimous vote, Commissioner Ann Howard summarized the commissioners’ consensus on the issue: “It sounds like the medical school is doing their job. I think this is kind of a communications issue and maybe a more detailed accounting issue. We’re all going to re-read the ballot language and the affiliation agreement and try to figure out a way to move forward.” All commissioners expressed confidence in Lee’s future stewardship of the district, and he promised greater transparency. “We just need to draw the line, very clearly, to make sure our mission aligns with the intent of the people’s vote.”
As these transparency efforts move forward, Lewis argues that the county should “hire independent outside counsel with expertise in special purpose district law to advise them on whether the gift of taxpayer funds is illegal under Texas law.” As Shea put it, the central question “what the public needs to understand is what are we getting for that $35 million?”
Photo by Larry D. Moore, CC BY-SA 4.0, link .
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