By Anthony Spangler, Fort Worth Star-Telegram, Texas
Jul. 27–FORT WORTH — After years of increased demand on the Tarrant County Hospital District and correlating expansion of its clinics, offices and hospitals, the board of managers for the taxpayer-supported system is wanting to slow growth and focus on ensuring that patients are getting the services they need.
Although most board members want to continue adding school-based clinics, some want to bolster staffing at community clinics and identify other ways to improve patient access to the district, which operates as the JPS Health Network.
“Instead of focusing on how many clinic doors can we open, we should focus on how many patients can we get in on a timely basis and referrals done in a timely manner, while still tending to growth,” JPS Board Chairman Steve Montgomery said.
A series of consultant reports in 2007, which cost about $800,000 and were kept from the board of managers, depict JPS as a system riddled with bottlenecks, long waits for appointments and inadequate housekeeping. After a series of stories by the Star-Telegram that included some of the consultant’s findings, state health officials and an agency that accredits JPS to receive federal funds conducted surprise inspections that revealed dozens of problems.
The JPS board will meet Saturday for its annual budget retreat. In preliminary budget discussions, some board members have said the budget needs to ensure those problems are addressed and do not resurface.
By the numbers 4 percent: Growth projected in hospital admissions
23 cents: Current tax rate
$77 million: Projected surplus this year
6,932: Estimated number of births next year
31,190: Projected school-based clinic visits this year
What’s proposed
JPS administrators are proposing a $603 million budget that would include employee raises and $6.6 million in new spending initiatives to bolster staffing, hire more interpreters, start a school-based psychiatric program and expand cardiac services.
The budget recommendations project a $77 million surplus by the end of the current fiscal year Sept. 30 and another smaller surplus in 2008-09, even with a 1/4 -cent to 1-cent reduction in its tax rate, which stands at 23.0397 cents per $100 of assessed value or about $230 for a $100,000 home.
Montgomery said he wants JPS to consider a zero-based budget next year. He said that in previous years the board may have relied too heavily on the administration regarding budget details.
“The board has to step up and provide some management oversight,” he said. “While I’d like to start a zero-based budgeting process, it would be reckless with a new CEO, CFO and a couple of new board members. The budget process already started in the middle of our turmoil.”
Physician concerns
Dr. G. Sealy Massingill, an obstetrics/gynecology physician and president of the JPS medical staff, said that next year’s budget should emphasize quality of care and pour money into the network’s community clinics.
“Mainly, we think there are problems with access to primary-care physicians because we don’t have enough,” he said. “We need to make sure physicians have enough resources so they can see 25 patients a day rather than 20 patients a day.”
Other doctors at JPS have recommended studying the impact of reducing patient co-payments and suggested that JPS either eliminate or reduce them.
Board concerns
JPS board members have suggested slowing growth of its facilities, studying whether more staffing is needed throughout the network and continuing the expansion of school-based clinics.
Board member Martha Walker echoed concerns of medical staff regarding co-payments.
“We’re talking about people who are making little or no money at all and have to pay $20 per doctor visits,” she said. “It is the repeat business that is really troubling. If they have an illness and have treatment where they have to come back again and again and have to pay $20 each time, I think it is a burden. I want to know how the charges are affecting them.”
Board member Tonya Veasey wants to scrutinize whether clinics have adequate support staff.
“If they don’t have the support staff they need to move the patient along, the patient is waiting longer than they need to for service,” she said.
Tax rate cut urged
When JPS administrators briefed Tarrant County commissioners recently regarding the surprise inspections by state health officials, a majority of the commissioners said they want to see the hospital board cut its tax rate given JPS’s sound financial position.
Commissioners J.D. Johnson and Gary Fickes have urged JPS to consider cutting its tax rate following years of surpluses.
“I think JPS, in the past, has had a positive cash-flow situation that is better than the alternative,” said Fickes, whose district encompasses Northeast Tarrant County. “It is prudent to keep reserves up to a point. I would like the JPS board to work on increasing access, which is going to cost some money. We just want them to use their dollars prudently.”
Series of changes
After criticism from its own physicians and some community groups that JPS leadership was more concerned with commercially insured patients than serving the needy, the JPS board replaced two of its top administrators.
The board accepted the resignation of Chief Executive Officer David Cecero and named JPS’s former head of community affairs, Robert Earley, as interim CEO. Shortly after Cecero’s departure, the district’s chief financial officer resigned. Former budget director Randy Rogers was named interim chief financial officer. And the JPS board fired its environmental-services contractor, which is responsible for keeping JPS facilities clean.
Under the new administrative leadership, a majority of the JPS board indicates they will work toward a budget that pumps more of its surpluses into patient care instead of brick-and-mortar.
Sound financial position
Last year, JPS brought in about $97 million more than it spent and continues to acquire land and buildings, construct new facilities and build its cash reserves and investments — touting more than $400 million in its portfolio.
JPS recently moved its emergency department, surgical rooms and intensive-care unit to a new, five-story, $96 million patient pavilion. Also opened this year were an urgent-care clinic in Arlington, a community health clinic in Watauga and three school-based clinics, with two more expected by year’s end.
As interim chief executive, Earley said he does not want to tamper drastically with the budget but wants the board to revisit the budget in midyear, when the fate of some federal funding is determined, to be realistic about surplus expectations. In the past, JPS has not factored in tens of millions in federal funding and then pocketed those funds at the end of the fiscal year.
“If we get those funds in midyear, I want us to consider putting that money toward programs that won’t make it into the budget,” Earley said. “We still need to run a surplus, maintain our reserves and to fund future capital projects. But we’re not going to pretend like those federal dollars aren’t coming in and then when they do show another large profit.”
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