5 Things Texas: Gov. Abbott, Building capacity, David Bergman

The impact of COVID is real, even if your community hasn’t been hit by it directly. From worry driven by our social networks and media to the economic impact across the state, this is a trying time for us all.

How this public health crisis and economic trauma impact our politics is yet to be seen. But, with 208 days until the November election, we won’t have to wait too long to get a clear answer to the question.





With help from Monte Whaley and Michael Goldberg

1. COVID numbers in context

According to DSHS, there are 177 fatalities linked to COVID-19 in Texas with 1,491 confirmed COVID-19 patients currently in Texas hospitals. Yesterday, Texas surpassed 10,000 total cases, and passed Washington State – the state that was the first epicenter in the US – in its total case count. Texas now has the 11th highest state total in the country.

One item to watch will be the number of folks dying at home in rural counties, rather than at the hospital. In New York, they are seeing “staggering” increases in undetermined deaths at home, compared to pre-COVID times. As the disease spreads into rural areas, particularly East Texas and the Panhandle, folks may simply stay at home when they otherwise need care, resulting in an increase in how many folks with fragile health will go untreated, resulting in deaths that may have otherwise been prevented?

2. Local hospital, political leadership stand out

According to Gov. Abbott, more than 75% of Texans are now in under a “Stay at Home” order issued by local governments. While cases in rural Texas begin to climb, the leadership of the DFW Hospital Council and Dallas County Judge Jenkins stand out as among the most collaborative, thoughtful and careful efforts of any public-private engagement we’ve observed in the nine states we cover carefully.

In this story, I outline how the DFW area leadership fits into the broader state context. The DFW area sounded the alarm early, using both careful political communication, and thoughtful policy recommendations. Some of those recommendations have been adoped by state leaders. Meanwhile, Gov. Abbott gets decidely mixed reviews, which are notably now less about policy and more about a lack of clarity in his political communication.


3. Video: David Bergman, HMA

David Bergman is a Principal at Health Management Associates. He joins us in this edition of “What They’re Watching” to discuss the innovative ways that heath systems are using their IT infrastructure to leverage smart strategies for data and creating tools for improving care delivery and financing.

“There are a lot of interesting things happening around digital health and telemedicine; how the flow of information and funding is going from governments to payers to different kinds of providers, and how those tools are actually being used by consumers in order to drive behavior change that ultimately results in cost savings.”

4.  Is it time to revisit Medicaid expansion?

Three trends are converging. First, oil prices have collapsed, pulling state revenues down. Second, COVID is proving to be a uniquely costly enterprise to hospitals, threatening rural hospitals in particular already concerned about MFAR. Three, there is not yet a policy vision for what comes after DSRIP funding in Medicaid.

Sen. Nathan Johnson argues in the Dallas Morning News yesterday that amid these trends, it’s exactly the right time for Texas to become the 37th state to expand Medicaid. Sen. Johnson: “Supporting expansion now is not flip-flopping; it is altering strategy in response to better information and different circumstances.”

It’s clear things in Texas health care have changed. Have the politics of Medicaid expansion changed, too?


5. Building system capacity quickly

Available hospital beds in Texas have increased 142% since March 18th as a result of collaboration between Gov. Abbott and the state’s hospitals. It has completely reshaped the threat of COVID overwhelming the Texas hospital capacity ahead of the peak now expected in 13 days.

Retired nurses and physcians are getting recruited to return to service, as well. Serena Bumpus of the Texas Nurses Association says “We are still nurses. We still have the skills necessary to take care of patients.” Likewise, the Texas Medical Association heralded the move, allowing docs of all specialties to help triage. Dr. David Fleeger, the president of TMA, noted “I’m a rectal surgeon so you won’t see me on the floor running an IV drip.  I will be talking to patients, assessing what they need, what kind of care we can steer them to.”