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2004 consultants' warnings to Parkland

2004 consultants' warnings to Parkland

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A consultants’ report in 2004 urges Parkland to move from the “dominance of the teaching model” that let UT Southwestern residents have vast autonomy because it had “serious impacts” on patient care.
A consultants’ report in 2004 urges Parkland to move from the “dominance of the teaching model” that let UT Southwestern residents have vast autonomy because it had “serious impacts” on patient care.

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Published by: The Dallas Morning News on Jul 30, 2010
Copyright:Attribution Non-commercial

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08/17/2011

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H
EALTH
M
ANAGEMENT
A
SSOCIATES
 
Long Range Planning Issues for theDallas County Hospital District 
Prepared for:The Dallas County Commissioners Court By:H
EALTH
M
 ANAGEMENT
SSOCIATES
November 2004
 
180 North LaSalle Street Suite 2305Chicago, Illinois 60601Telephone: (312) 641-5007Fax: (312) 641-6678
 
One Michigan Avenue Building120 North Washington SquareSuite 705Lansing, Michigan 48933Telephone: (517) 482-9236
 
180 North LaSalle StreetSuite 2305Chicago, Illinois 60601Telephone: (312) 641-5007Fax: (312) 649-6678100 East Broad StSuite 1400Columbus, Ohio 34215Telephone: (614) 464-44668888 Keystone CrossingSuite 1300Indianapolis, Indiana 46240Telephone: (317) 575-40801015 18
th
Street, N.W.Suite 210Washington, D. C. 20036Telephone: (202) 785-3669Fax: (202) 833-8932Kleman Plaza301 South Bronough StreetSuite 500Tallahassee, Florida 32301Telephone: (850) 222-0310Fax: (850) 222-0318
 
 
Long Range Planning Issues for the Dallas County Hospital District
 
Health Management Associates
 
November 2004
 
Introduction
In May of 2004, the Dallas County Commissioners Court contracted with Health ManagementAssociates (HMA) to develop a “Long Range Planning and Policy Analysis for the DallasCounty Hospital District.” HMA assembled a team of ten senior staff and seven sub-contractorsto thoroughly evaluate the strategic priorities for Dallas County as they relate to the financing,operation, clinical focus and governance of the health care delivery system for low-incomepeople in Dallas County. Over the course of the past six months, HMA has interacted with over250 people (see list in the Appendices), reviewed all previous consultant reports, analyzedfinancial and demographic and utilization data, met with government officials in countiesadjacent to Dallas and in Austin, participated in meetings and forums, reviewed public healthsystem models in comparable communities, and spent considerable time with the leadership ofthe County and the Parkland Health and Hospital System to assure that our conclusions wereaccurate and our recommendations were feasible.HMA approached this project as one that would have significant consequence for the Dallascommunity. We attempted to take into account the unique history, relationships, and othercultural and environmental issues that would mean the difference between a report that wastechnically correct but not likely to be implemented and one that is essentially a work plan totake a highly regarded and vitally important health system successfully through the nextdecade when there will be mounting pressures and challenges. The report that followsdocuments key findings and recommendations based on the analysis of the last several months.Additional supportive information is included in the Appendices.HMA would like to thank the Dallas County Commissioners Court for the opportunity to havecontributed to this important initiative.Pat Terrell, Project ManagerDoug Elwell, Finance LeaderTerry Conway, MD, Health Services LeaderDave FergusonGaylee Morgan Jane LongoMatt PowersLarry BaraDonna Strugar-FritschDavid FosdickWe would also like to acknowledge the contributions of our sub-contractors: Susan Greene, ESI,Robin Herskowitz, Linda Wertz, Jon Hockenyos and Travis James, and Ann Kitchen. Finally,we want to thank Colleen Porter and Kathryn McRay for their invaluable administrativesupport.
 
Long Range Planning Issues for the Dallas County Hospital District
 
Health Management Associates
 
1
November 2004
 
Table of Contents
Executive Summary...........................................................................................4
 
Chapter 1: What is the Current Health of Dallas County?................................14
 
A. The Population to be Served.......................................................................................................14
 
The Dallas County Population...................................................................................................14
 
The Parkland Patient Population...............................................................................................16
 
Future Demographic Trends......................................................................................................17
 
B. The Health Status of Dallas County...........................................................................................18
 
What is “Health Status?”.............................................................................................................18
 
Health Status of Dallas County..................................................................................................19
 
Health Status of the Parkland Population................................................................................20
 
Key Health Conditions to be Addressed..................................................................................21
 
C. The Dallas County Economic Climate and the Impact on Health Care................................22
 
Characteristics of the Dallas County Economy........................................................................22
 
Health Care and the Dallas Economy.......................................................................................23
 
D. Expenditures on Low-income Health Care in Dallas County................................................25
 
Medicaid/SCHIP..........................................................................................................................26
 
Medicare........................................................................................................................................27
 
Tax Support...................................................................................................................................27
 
Other Public Support...................................................................................................................27
 
Parkland Foundation...................................................................................................................28
 
Private Hospital Charity Care....................................................................................................28
 
E. Health Care Providers Serving Low-Income Patients in Dallas County..............................28
 
The Parkland System...................................................................................................................28
 
Private Hospitals..........................................................................................................................29
 
F. Financing Low-income Health Care in Dallas County............................................................31
 
Medicaid/SCHIP..........................................................................................................................31
 
County Subsidies..........................................................................................................................31
 
Chapter 2: How Effective is the Public Health and Hospital System in Dallas?33
 
A. The Dallas County Hospital District as a System of Care......................................................33
 
System-Wide Priorities................................................................................................................33
 
Primary Care.................................................................................................................................36
 
Specialty Care...............................................................................................................................44
 
Emergency Care............................................................................................................................49
 
Inpatient Care...............................................................................................................................53
 
Gaps in the Current System of Care..........................................................................................57
 
Disease Management...................................................................................................................58
 
B. The Relationship of Parkland to the University of Texas Southwestern School ofMedicine.............................................................................................................................................63
 
History...........................................................................................................................................63
 
The Faculty Contract....................................................................................................................64
 
Medical Staff Leadership.............................................................................................................68
 

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