5 Things Texas: Q&A w/Dr. Diana L. Fite, Contact tracing, John Henderson

This is hard. Staying at home is hard. Distance learning is hard. Watching businesses collapse is hard. Watching loved ones get sick is hard. None of this is easy. We are going through a collective trauma together. It’ll reshape our society, our commerce and our politics.

But, right now, when we’re going through it, we might try to give ourselves a little grace. None of us are at the top of our game. We’re not working from home. We’re at home… trying to work. So, if you’re having a tough time (as seems to happen a few times during my day), go for a walk. Take a nap. Cut back on the caffeine as it can up your anxiety.

And, if you need to, feel free to send me a note to tell me how you’re doing. I may not have anything smart to say, but I’ll read it and I’ll see you.





With help from Michael Goldberg

1. Q&A: TMA President Dr. Diana L. Fite

Houston area emergency medicine physician Dr. Diana L. Fite was sworn in last week as the 155th President of the Texas Medical Association (TMA), America’s largest state medical society. Just a few days into her term, reporter Michael Goldberg spoke with Dr. Fite to hear her assessment of where the Texas health care system stands as the state begins to re-open its economy. They also discussed bureaucratic interference in medicine, which Dr. Fite hopes to address, along with getting doctors Medicaid payment increases she feels are long overdue.

“Bureaucracy is a factor in a ‘metrics focused’ type of system where administrators require physicians to see a certain number of patients per hour, order a certain number of tests through a hospital system rather than, perhaps, ordering tests from a different place that might save the patient money or be the patient’s preference. If you don’t go along with it, you can risk losing your job or decreasing your salary.”

2. Banning: A Marshall Plan for primary care

Tom Banning is the CEO at the Texas Academy of Family Physicians. He has started an occasional column with us at State of Reform, where he highlights some of the stories about medicine, health care and physician leadership in Texas.

He has also highlighted the need for “A Marshall Plan to save primary care, public health.” In it, he and Chris Crow, CEO of the Health Catalyst Network, say primary care needs to be put on a prospective payment system and that telehealth needs to be granted more equity to in-person visits and flexibility to adjust to the “new normal.” They also call for greater integration of public health and primary care.


3. Video: John Henderson, CEO of TORCH

John Henderson, President and CEO of the Texas Organization of Rural and Community Hospitals (TORCH), joins us in this edition of “What They’re Watching” to discuss Medicaid hospital payments and the impacts of hospital closures on rural health.

“Forty-six percent of rural Texas hospitals have negative operating margins and you can’t exist for long when you do that, so we’re just trying to get them back to even…We also have learned to talk in terms of economic development. It’s not just a hospital closes and its a hundred jobs; what we see is the pharmacy closes and the grocery store closes and the bank closes and you go back to a community that’s lost their hospital a couple years later to find that the community is not there anymore. It just falls down.”

4.  The real numbers on the economy, jobs, and the state budget

This morning’s unemployment numbers are breathtaking: 14.7%. However, they understate the problem. First, the unemployment numbers are a survey. They ask folks if they have a job, and if they don’t, the survey asks if the respondent has looked for one. If you haven’t looked for a job in the last week, you’re not counted as “unemployed.” Rather, you have “left the workforce.” This results in a strong undercount of those unemployed. It counts anyone who has part-time employment as “employed,” even if that is only one hour a week.

In Texas, 44% of businesses with under 500 employees received federal assistance to subsidize their payroll (PPP, Tranche 1). That equals about 2.1m jobs now subsidized in Texas among the 4.7m people employed in a business under 500. In the last 8 weeks, 1.94m new jobless claims have been filed in Texas. Of the total, 11.7% come from the “health care and social assistance” sector. When you add in the 492k who were unemployed at the outset of this pandemic, you’re looking at 2.36m Texans out of work at some point in the last two months. That is 18.2% of the non-farm labor force in Texas. Of course, that doesn’t count those small business jobs coming when federal assistance starts to run out in four weeks. Expect the trend to move higher this summer.

What size hole will this leave in the Texas state budget? The Urban institute says April year-over-year tax receipts are down 19.8% in Texas.


5. Texas gearing up contact tracing efforts

While Texas ranks 48th in the U.S. for COVID-19 tests completed per capita, a new online app for contact tracing being developed by DSHS will be integral to re-open the economy safely. The app – Texas Health Trace – will be used by 2,850 contact tracers the state plans to hire, adding to its current workforce of 1,150.

In his latest column, State of Reform Columnist Jim Capretta takes up the topic of federal support by breaking down Congress’ $25 billion investment into testing and tracing as part of the latest round of COVID emergency funding. Of that funding, $11 billion will go to states, territories, and tribes to acquire tests and hire contact tracers; $1 billion will go to the CDC to broaden and modernize its surveillance; and $1.8 billion is slated for NIH to speed research on accurate serological and point-of-care testing kits.