Health Care spending in Dallas Texas
Faced with data showing Dallas doesn't give good value for money in health care, North Texas medical, insurance and other business leaders are discussing a transformation of one of the area's biggest industries to curb spending and improve quality. The talks began in late July. They involve archrival hospital chains Baylor Health Care Systems and Texas Health Resources as well as other hospitals, physician groups, the Greater Dallas Chamber of Commerce and insurer Cigna HealthCare.
A second round of meetings is scheduled for this week.
Toomey said changes in hospital and physician practices won't be enough to slow the increase in spending without greater attention to public health in Dallas. State health statistics show Dallas County with the highest level of obesity among adults in the state, where two-thirds of men and women are either overweight or obese.
Obesity often leads to diabetes, kidney failure and heart disease, but it hasn't become a significant issue for government leaders.
"We're one of the unhealthiest cities in the country, in one of the fattest states in the country," Toomey said.
"We're going to have to hold each other accountable."
David Toomey, president of Cigna's Texas operations, initiated the effort with help from the Washington-based Brookings Institution and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
Dartmouth research with Medicare data shows Dallas among the highest-spending areas of the country, and with some of the most rapidly escalating costs. If the area's doctors and hospitals practiced medicine as it's done in Waco, Dartmouth concluded that Dallas could save $1 billion a year just in Medicare spending.
Separately, BlueCross BlueShield of Texas president Darren Rodgers said his firm's research of privately insured patients shows Dallas as the highest spender among large Texas cities.
Toomey said the Dartmouth research shows Dallas health care providers are "wasting" $1 billion a year for a Medicare population of less than 300,000 people.
"Why is it, with this can-do attitude in Texas, we're out of control?" he asked.
Toomey worried that, if the current trends continue, employers faced with high medical costs would shun Dallas.
"In five to 10 years, guess who won't be relocating here?" he said.
Leaders unite
Toomey said he plans to meet with Mayor Tom Leppert on Tuesday and hopes to include the mayors of Fort Worth and Arlington as well as other local insurance companies in the ongoing discussions.
The talks aim at convening a North Texas health care summit on Sept. 30 where company and government executives would see whether they can agree on payment, practice and transparency fixes leading to competition based on quality and cost efficiency.
"For years, Dallas has struggled with high and rising costs," said Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution. "What's different now is that a critical mass of leaders in health care, business and government believe slowing spending growth and improving care is both achievable and urgent. And they are working together to do it."
Baylor president Joel Allison already has announced that his company intends to move to a new business model that rewards high-quality, cost-effective treatments rather than greater numbers of tests and procedures. Texas Health Resources president Doug Hawthorne said his company was prepared to compete on cost efficiency as well as quality of care.
Toomey and others described the Dallas initiative as separate from congressional health care reform, but it could benefit from changes in the legislation covering the way Medicare pays doctors and hospitals.
Conversely, cost-cutting efforts in Dallas and other communities could help Congress break an impasse over health care reform if they show how the nation can lower its $2.5 trillion medical bill.
"The reform of health care in this country won't be done inside the Beltway," Hawthorne said. "It will be done in communities."
Poor scores in Texas
While hospital chains across North Texas have pushed quality initiatives in recent years, health care in Texas has scored poorly in several independent reviews.
A state scorecard compiled two years ago by the Commonwealth Fund gave Texas an overall rank of 49 among the 50 states. In the study, Texas did poorly on avoidable hospital use and costs, in patients readmitted to a hospital within 30 days of discharge and in preventive care administered to patients with chronic diseases such as diabetes, asthma and congestive heart failure.
Research by BlueCross Blue Shield of Texas shows Texas physicians administer evidence-based treatments to their patients only half the time, with patients in poorer areas getting the worst of it.
Yet Texas health care providers spend more on Medicare patients than all but two other states. Dartmouth research with federal data shows Dallas spending was $10,103 for each senior enrolled in Medicare in 2006 ? 13th highest in the nation among 306 hospital referral regions.
Medicare is a federal health insurance program that provides coverage for all Americans over the age of 65, as well as some disabled Americans. It accounts for nearly half the money spent on health care in the United States.
Physicians and hospitals across the country provide detailed patient treatment reports to the U.S. Department of Health and Human Services to gain reimbursement for treating Medicare patients.
For several years, Dartmouth researchers have used this Medicare data to study regional disparities in health care spending to learn why some parts of the country spend more than others to treat the same types of patients and illnesses.
Big spenders
The highest spending in Texas was in the McAllen hospital referral region, where spending averaged $14,946 for each Medicare enrollee.
(BlueCross and BlueShield of Texas research shows Wichita Falls as the highest spending region among privately insured patients in Texas.)
The rate of increase in spending showed an even more worrisome trend, said Julie Lewis, the Dartmouth institute's director of research.
Between 1992 and 2006, "Dallas was fourth in the absolute increase" of Medicare spending, she said.
Lewis and Aaron McKethan, research director of the Engelberg Center for Health Care Reform at the Brookings Institution, joined Toomey in meetings with 18 Dallas area health executives on July 20 and 21.
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