Critics of Central Health, Travis County’s health care district, have been pressing for months for a review of the taxpayer dollars supporting Dell Medical School, but a consulting firm’s report issued this week did little to clear up their concerns.
Central Health commissioned the two-part, $350,000 review last spring amid calls from critics for an independent assessment of whether its contribution of $35 million a year to the University of Texas’ Dell Medical School is an appropriate use of tax dollars.
The public debate over that subject has been a thorn in the agency’s side since 2012, when voters approved a proposition to raise taxes to support the school. The issue prompted a small group of eastern Travis County residents to file suit in October.
The first part of the review by consulting firm Germane Solutions, released Tuesday, found that Central Health is “a well-functioning hospital district that compares favorably to similar systems across the country,” though it noted shortcomings in the agency’s transparency with the public. The second part of the review, examining Sendero Health Plans, will be released later this month.
Fred Lewis, one of the attorneys representing the residents filing suit, said Wednesday the review is “not what was requested or needed.” Lewis said the review is an “organizational assessment,” rather than a true performance review or spending audit.
“It doesn’t answer the questions that were asked, which is how a quarter of a billion dollars of taxpayer money going to Dell (Medical School), Seton, Sendero (Central Health’s nonprofit health care plan) and other partners benefited the community and low-income people’s health care,” he said.
Lewis and other critics were also disappointed that Central Health chose its auditor, rather than leave the choice to a third party, such as Travis County.
The Travis County Commissioners Court, which oversees the agency’s budget, had required a performance review be filed every five years to “evaluate the relationships between Central Health and affiliated and non-affiliated entities.”
Central Health President and CEO Mike Geeslin said Wednesday the review’s purpose was not to delve into the Dell Medical School spending, but rather “to look at how Central Health operates, the effectiveness of our partnership model, and ultimately how we are serving low-income, uninsured Travis County residents.”
He pointed out that the consultants rated the agency’s funds flow as “above average,” and said management agreed with the overall assessment.
Central Health “is among the best in the country, in our estimation, in terms of how it tracks and records sources and uses of its own funds,” the report reads. “However, since Central Health provides many services through partnerships, it does not have full control over how funds allocated to its partner institutions are used.”
That is “the core of the issue” with Dell Medical School, the report concludes, adding that while there are certain legal limitations, nothing is stopping Central Health from requesting its partners to be more transparent about their use of funds.
Geeslin also pointed to a September report from a certified public accounting firm that found that the Dell Medical School’s use of money from taxpayers is in keeping with an affiliation agreement between the university, Central Health and the Community Care Collaborative, a nonprofit that Central Health formed with Seton Healthcare Family to provide health care services.
Critics countered at the time that compliance with the agreement is not in question but rather the legality of the agreement itself.
Officials also have said their hope is that the lawsuit resolves the issue over the Dell Medical School contributions once and for all.
The review gave the agency overall high marks but identified shortcomings in some areas, such as transparency and communication with the public.
“We have definitely validated that you are among the most complex public organizations in the public health sphere in the country,” said Tracy Kulik, vice president of health access at Germane Solutions, who presented the findings to Central Health’s strategic planning committee Tuesday.
Central Health oversees programs for health care services for Travis County’s poor, uninsured and underinsured residents, but unlike many other hospital districts, it doesn’t own or operate its own hospital. The agency provides services through its nonprofit partners, including CommUnityCare, its affiliated federally qualified health center system, and Community Care Collaborative.
Central Health also supports delivery of services at Dell Seton Medical Center, which serves as Dell Medical School’s primary teaching hospital and as a key part of the region’s safety net for indigent patients.
Given that complexity, the review found, the agency could do a better job of explaining how that web of entities works to benefit the community and how money flows through it.
“You guys are amazingly good at providing transparency from where it starts with you and through to the partner entities,” said Matt Boll, director of public health at Germane Solutions, who also presented findings. “However, sometimes when it gets to the end user (the public), there isn’t as much transparency that goes on there.”
Latino Healthcare Forum President Jill Ramirez, who has been critical of Central Health, was pleased the review touched on transparency issues. “It was really good that this group that might not have been so independent actually did come up with that,” she said.
The review also recommended Central Health engage in more dialogue with the community about how well its public-private model is working; set a more defined plan for addressing physician shortages, especially for specialty care; and diversify its funding sources by looking at other options such as external grants and fundraising, among other recommendations.
Consultants drew from two public input meetings August, review of previous Central Health patient surveys conducted at clinics over the past two years, interviews with members of Central Health’s leadership, a benchmark analysis with comparable health districts and other secondary research.
Central Health received mostly above-average scores, with its top scores in areas such as oversight of the Community Care Collaborative (100 percent), and its lowest score in specialty physician access (25 percent).
“Central Health cannot just sit and wait for the supply-demand imbalance in specialty care to sort itself out and needs to be more creative in finding ways to create new specialty access for its patients,” the report read. It suggested increased use of technology, such as electronic medical consultations, and advanced practice professionals, such as nurse practitioners and physician assistants.
The report also raised concerns that Central Health lacks the ability to track patient care between various providers.
Geeslin said Central Health is working on making its data sharing programs more robust, but implementing a uniform record system could cause extra expense for local hospital systems, so it would have to be studied.
The public can review the report at centralhealth.net/performance-review and send questions and comments to firstname.lastname@example.org. Germane Solutions will release its review of Sendero Health Plans, Central Health’s nonprofit health maintenance organization, on Feb. 28. Central Health will hold a March workshop on the findings, then develop a plan for adoption by May.