Travis County Commissioners Court
August 19, 2008
Item 26
>> number 26 is to receive and discuss the proposed budget of the Travis County health care district for fiscal year 2009 and the associated tax rate. Morning.
>> morning.
>> good morning.
>> I'm trish young, president and ceo of the Travis County health care district and I have some members of staff and our board hear today. We have our board member ms. Bobby barker who is joining us to talk about our budget. And our chief financial officer, ms. Carolyn canecki is actually going to a presentation today. Christie garvey is our communications officer. She will be operating our presentation for us. Thank you for your time and attention. Judge, do we have a time certain that you would like us to get to a hard stop?
>> well, our standard is typically with reasonable speed.
>> [ laughter ]
>> I think we can do that.
>> if I start yawning, you know --
>> [ laughter ]
>> sarah will take care of that, right?
>> [ laughter ] okay. We'll get started. We do have a powerpoint that we'd like to walk you through. And have you backup that was -- and you have backup that was submitted I believe Friday.
>> good morning. You should have the backup, so I'm not going to read every single item on here as we go through the pages, but if you have questions, certainly stop me and trish will answer your questions.
>> [ laughter ] so we would like to review with you today the preliminary fy '09 budget. And it has three programmatic components in the budget this year. Health care services. Of course our most important function. The chc or you will hear me call it also the clinic transition as they transition out of the city and into another format. And district operations. And effect on the revenue and tax rate. This next page is a recap of the strategic priorities. This you have all seen before in other presentations and I'm not going to read every single one of them. But just highlight a couple. It doesn't mean they're more important than the rest, it means these are some that are really affected in this budget. Increased to health care for eligible residents. Again, our most important priority. Strengthen the chc system network through successful transition from a city department to a new nonprofit organization. And max bemize district resources by working with regional partners on solutions to making affordable health care available to all residents of central Texas. In the note I made on this one is mental health. Mental health is something that we work with other partners on. You will see that again in this budget. In the fy '09 budget, expenditure increases are prily related to increased access to primary and specialty care services. Again an important priority of ours. 'The budget does an increase encounters in the chc of 23% and an increase in map enrollees or the medical ace sense program of 16 percent. Increased access to mental health services. There's additional funding in the budget which would take it from about 10 beds funded in the fy '08 budget to about 18 beds funded in this fy '09 budget. There are transition costs including associate infrastructure building as the district continues evolve as its own independent entity. An expected annual cost increases due to inflation. On page 5 there's a budget summary for you that actually shows a high level of revenue and expense detail. The 2009 budget is 95.2 million and it's funded by a proposed tax rate of .0679. It use 7.67 million. About half of that was expected to be extended next year and that also comes from reserves of about 13.6 million. The next page, previously when we looked at district operations we counted them all as overhead. Everything else was health care and our operations were overhead. The transition made change the way we look at this because we have the medical assistance program transitioning out of the city of Austin into direct district operations and become being a part of the district and then therefore it looks like it's counted as overhead. When in reality that's providing health care to patients. We may want to relook at how we provide -- how we show the budget itself. So in the future you may see a little bit of change in how we showed the budget, but on in page we've attempted to show you how fy '09 would look on the left if we used it the same way as an fy '08. Those medical assistance or map program operations would have been part of health care delivery, keeping health care delivery up in its 88%. District operations would be nine percent and transition would be three percent. Transition is a multitude of costs, some of which are one time or as I say two time costs as we transition through two fiscal years. And the right side shows how it looks in fy '08 '09 with health care delivery at 86%, counting map as part of district operations.
>> let me add to that. The primary reason why with that is reflected that has to do with the budget bujt has been developed over the years. All salaries and costs related to people have been shown in district operations. And because we have not had those employees on our payroll so to speak until this upcoming year, those costs have been paid out to the city and have been reflected as a health care delivery cost because we are paying someone else. Those salaries will now actually be in our salary line. And as she said, even though they reflect salaries and cost of operations, they really are directly related to the delivery of care to patients. It's directly supporting patients getting enrolled in the map program, being managed in the map program and care being provided to them. So it really has to do with how our budget is currently structured as opposed to how the expenses are actually being expended. And I don't know if I've just made that more confusing, but it is a little bit tricky.
>> okay. So important base budget changes. The medical assistance program expenses of 1.88 million, those are moving out of the city or the health caroline item into the district. Facilities and ii. Ti infrastructure previously provided by the city. The city has provided all i.t. For the clinics, for the district, for everybody in the system that will no longer be in effect, we'll either be paying them or paying someone else for those services. So we have $2.8 million budgeted for that.
>> but up to now the city provided the i.t. Services free of charge?
>> that's basically.
>> each year. So in effect they've done that for what will be almost five years by the end of the agreement.
>> transition expenses are 2.8 million. And again, many of those are one-time expenses. Some of those are two-time expenses and there may be some ongoing that we will shake out over time. Staff to perform fudges. And those are related to the strategy initialtives. So if there's an initiative and there's not current staff to do it, there's staff targeted in the budget to do it. Fy '09 budget has increased health care service levels. There's $4.2 million in increased health care service levels. Specialty care of .9 million or almost a million dollars. Primary care, .6 million. And service capacity expansion of 2.7 million. And this is our service expansion section of our budget. This is above and beyond what's in the base budget as we identify or bring to conclusion some initiatives that we're working on, these things would come into play.
>> and just to add to that, you'll rather that in prior years we have had a service expansion line item in our budget. And to the extent that those dollars were expended and become ongoing service commitments, they are now in our base budget. So we have been increasing expenditures for health care service over these last years and they're now part of our base.
>> does that necessarily mean that you're taking more folks, trish, or -- it may an combination of more folks and more services.
>> that's correct.
>> is it a combination?
>> it's truly a combination, yes.
>> okay. Included within total expenditures, the budgeted transition costs for fy '09 is 2.8 million. I reference that before. That's a multitude of items. It's insurance for property. It's worker's comp and unemployment insurance not charged out separately by the city. In other words, they've borne that cost and not really charged it back to us. It's audit fees for the new clinic organization. It's maintenance on billings that we'll assume that we hadn't previously. And basic business redesign of those functions. So it's a slew of items and items necessary to get us through that transition.
>> and when you -- I guess looking at this pain, when you look over at the community health centers, the five 0 one c three is that where you're going to transfer over the care or the inclusion of what have been -- people who have been covered by Travis County previously, correct?
>> it continues to be Travis County.
>> and the qhc structure that will transitioned over?
>> yes. It is the federally qualified health centers that will be in that organization.
>> okay. And then I guess the questions I've gotten is how soon will this take place? And I forgot what you told me last time. And because people are saying, well, in the meantime folks are ill and they need service. So what do we -- where are we sending them at this point?
>> well, the patients still continue to be served the community health centers, and some additional expansion activities that have been going on around primary care have to do with with both expansion in the clinic system and in other areas. You will recall that I believe a year, almost two years ago we did fund support of an urgent care center located adjacent to brackenridge hospital. The community health centers are about to open a new clinic, I believe in late September, down at i-35 and william cannon, which will be a new expansion site to add additional capacity.
>> so they will be able to go to that one, but in the meantime they can go to community health center.
>> yes.
>> I think it's fair to say that we've been continue to go try to expand the access within the community health centers as well as expand availability of services elsewhere such as contracting with people's community clinic, contracting with el buen to the extent they have the capacity to serve patients.
>> I suppose kind of the closeout question would be in the transition will there be any reduction of -- will we see any reduction in the capacity to serve the health care needs of the community.
>> there's no planned reduction. I think the thing that we probably will -- we're struggling with now will continue as a challenge because changing organizations does create complications. It's provider vacancies. It's a very tough market to recruit doctors right now, family practitioners in particular, there are few of them and they're in higher demand. So I think it's more of a struggle to keep up with those provider vacancies and keep those positions filled. There's been no reduction in staff levels or anything related to that. So it's really keeping on top of that.
>> so in terms of that recruiting issue, would that recruit issue exist whether we were in a transition or not?
>> that's exactly right. And it will continue. It's going to be a challenge for us in the future.
>> okay.
>> and I guess the thing -- how do we keep people that their issues are being addressed and that they're not going to fall through the cracks, let's say, just because there's a shortage of dock be? How can we make them feel like they're going to be falling through the cracks?
>> I think that is a challenge. I think it's been a challenge because even though our system is the largest in this community, we've -- the community health centers have been serving over 50,000 individual people a year on a fairly regular basis. We know that the demand is much greater than that and so it's continually been a struggle to even take care of who is out there right now. So I think that there are -- as part of this transition, there are very significant efforts your honor way to try to look at how the community health centers will operate, how we can continue to maximize the number of patients they can see and balance that with the care that the patients need. It really is a balancing act between taking care of people when you bring them into your system to provide the care they need, particularly chroniclely ill. They want to make sure they're into care, they're seeing a doctor on a regular basis, they're maintained and then we have the issue of people with acute care need. Someone needs to be seen today. The expansion effort at william cannon is aimed to get at that. How do you provide the same day access to we're preventing people from having to go to the emergency room as a fall back.
>> right.
>> so we will continue to do that. I think it's still going to be a struggle because our system is just not sized. In a community the system is not sized to meet the demand. We have other work going on in terms of that trying to estimate the demand ta we can share with you at some point. But I think you highlight something that we need to be aware of as a dmunt that even though we continue to improve and expand access, it's still not meeting the need.
>> right. And the other issue that I think needs to be addressed at some point because it is creating some confusion. They've been reading about the medical school coming, this we're going to get into that business. They expect that doctors will be trained there to fill this gap. And if that's not the case, and I think that information needs to go out, start going outly so that people don't get further confused and their expectations are more than can be delivered.
>> I think that's a really good point you raise there. There has been a lot of dialogue about a medical school, about expanding medical education in this community. And I think that it very reasonable for people to assume that that's going to help fill a need. And so if it does in fact go through, we are hopeful that it will help us fill some of these gaps. As you've mention fire department you have doctors being trained here, hopefully more types of doctors and more doctors in general, our chances of bringing them here and having them stay would improve be as.
>> right.
>> as a matter of fact, that's something that needs to get out into the community because anywhere there is a training medical school, that medical school is tboicial the area because that is an where a lot of indigent is taken care of. But there is no question that with a medical school in this community that it would be a great benefit for us, not just the care that it would provide, but for keeping people around because I think the average is like 75% of the residents, wherever they train they want to stay in that community. So that is a selling point for a school in our area.
>> yeah. Medical education, expanding that in this community would provide more services. And that is a definite benefit of having that.
>> so it's a reasonable expectation for people to have.
>> it is.
>> it probably needs to be addressed with them.
>> to go back to discussing that transition one more time to say it is scheduled for March 1st 2009. That's the scheduled transition date. And you see on that slide that the way that's built like a house, the best sharing and basic systems in between, so the nonprofit organization that will house ght clinics and the district operations itself are going to share basic systems in order to better control costs and hopefully make it more efficient. Information systems such as human resources, finance, payroll, time keeping, etcetera, real estate management or telephone systems. Irks the cammie budget is 24.45 million. It includes information technology of about 2.4 million. Facility renovations half a million. Land and land improvements and building and building improvements, which total about $18 million.
>> and that is more than one item because we will be assuming responsibility for some other buildings as the transition occurs. And lastly, but not least is the reserve policy of the district. The district board voted to keep unallocated or rainy day reserves at 150 days of on hand to put us in good stead with industry benchmarks and meet their policy and we've held that. Allocated reserves may be needed for the transition for the medical assistance program redesign, mental health issuebe active, reductions in disupo, one of our services of revenue and other unforeseen expenses. Capital reserves are budgeted to be spent on clinic replacement and other capital items, i.t. District this year. -- i.t. Infrastructure this year. The next page shows the tax impact to the average homeowner. So the average homestead property with exedgeses is 211, 389. The proposed tax rate that the district has proposed in this budget will be an increase of $8.47 to that average homeowner. Or about two cents a day. That's a six percent increase, $8.47. So the rate would be going up from about 13516 for that average homeowner.
>> which represents a tax rate lower than that adopted last year.
>> that is correct.
>> so this preliminary budget was presented to the board for approval on August 14th, and they did approve it. It will be public hearings on this budget on August 28th and September fourth. That's when they're scheduled at this time.
>> what will they be?
>> one will be August 28th is here in this building at 5:00. The November 4th will be at the cesar chavez -- September 4th will be at cesar chavez at 6:30. No?
>> yes. Sorry. We went round and round on that. Let's recap. The first meeting is --
>> 5:00 in this building. So that's August 28th. September 4th, cesar chavez 6:30. We try very hard to set these time frames at different times so that the public would be able to attend.
>> cesar chavez and what?
>> it's 1111 east cesar chavez. At the intersection of waller street and cesar chavez.
>>
>> [inaudible - no mic].
>> the board is set to consider final adoption of the budget on September 11th. Again, that meeting is here at 5:30.
>> I believe so.
>> and then should that all occur in that sequence of time frames, bring the budget back for your consideration on September 16th. I'm sorry?
>> I thought you were done.
>> I am.
>> two or three quick questions then. Do you have an over 65 exemption in addition to the homestead?
>> yes. We adopt the same exemptions as Travis County.
>> okay. $65,000?
>> yes.
>> over 65 and/or disabled?
>> they are the same as the county's.
>> okay. And the -- have the employees who will be transitioned accepted or embraced the idea of having a new employer?
>> well, we certainly hope so. We're working on that, have been working with the employees over the last year. We have owe they have been given their information about their benefits packages, their retirement earlier this year, actually in February. And we are working through the transition items in terms of just creation of the standard operations, so I think that they're well informed and we continue to communicate very directly. And the employees themselves are involved in creating the transition. So I think it's been -- it's been a very concerted effort to have them involved.
>> is there an update on the new clinic site?
>> for north central?
>> out here a braker?
>> we have -- still have yet to go through our zoning process. That is scheduled to begin in September. And we continue to have conversations with members of the surrounding communities about that project. So if it goes through the process, it will be -- the zoning will be concluded, I believe, in October.
>>
>> [inaudible - no mic].
>> okay. Any questions or comments from the court we listen to citizens?
>> will there be any -- are there any other community meetings scheduled?
>> not at this point. We are moving to dialogue with neighborhood associations.
>> and that means --
>> we're meeting with the neighborhood associations themselves.
>> okay. So a neighborhood association that does not have a meeting scheduled needs to contact one of you?
>> well, it's -- it's a combination. There are certain associations that have agreed to meet with us and then there's going to be a combined meeting. And so those that are in that combined meeting have been notified.
>> okay. Anything else from the court? Mr. Castro indicated an interest in addressing the court on this matter. And ma'am, did you?
>> I think we're done.
>> please come forward. Anybody else who would like to give comments, please come forward. They're not leaving, they're just making their seats available.
>> thank you, judge. Good morning, judge and Commissioners. My name jimmy castro. I'm here to speak on my own behalf. I'm here to speak in support of the health care district budget. I believe ms. Young and the staff have done an excellent job of preparing the budget. I supported the health care district when it was first proposed and it went before the voters in an election. And if you take a look at what the health district is doing, they're doing exactly what was set out to do. And that is, to provide health services for the families here in the Austin area, Austin-Travis County area. And right now when you look at one clinic that they're proposing, and that's the north central community health care center. I live in north Austin, I live in the millwood area. I'm also a former board member of the millwood neighborhood association. Millwood is just north braker lane. It's one of the largest neighborhoods in north Austin we have over 2,200 homes. I've talked to the families in our neighborhood area. Also the area where the clinic is going to be is also near mcbee elementary. I've talked to the parents from lanier high school and pairns in the area and everyone supports this clinic. Two things need to be considered. First, that clinic is going to serve the families there in that area that do not have insurance and do not have means of seeing a regular physician. When you take a look at some of the private facilities in the area, when you look at north Austin medical center, north Austin medical center, their emergency room is always packed. When you take a look at Austin diagnostic clinic, their primary care for basic primary care, their patient load is packed. The staff I've talked to have told me, jimmy, it's not so much the patients that come in here with health insurance, it's the patients that are they're starting to see that don't have health insurance. And the same thing with true at north Austin medical center. When you take a look at north Austin medical center, there they average 3 babies that they deliver a month. What that shows is that north Austin area is growing. And this health center off of braker lane is going to help provide the health care for families that don't have that insurance. And also just a couple of key points. It was mentioned by the staff, there were public hearings of the st. John's episcopal church off of braker lane and they were well attended. There are bus stops in the area. And also there were 17 locations considered by the health district staff in the Travis County area. Also a couple other things, just to mention, that is service that it's going to provide in help to go prevent those families, instead of having to go all the way downtown to brackenridge hospital. As the staff mentioned from the health care district, what you want to do with the health care district is cut down those visits at the emergency room at brackenridge hospital. This way by having them go to the care centers, you can lower the cost and provide that health care that those families need. And I sure appreciate your time:
>> thank you, mr. Castro. Ms. Samez, right?
>> yes. Just to reiterate what I said, and as they said, it was well attended, but I was travelling with business, but the need back I got it it was well attended but people were against that clinic going there. And the reasons, once again, is that there was no input from the community. The proposed location does not best serve its clients. New data is required for a comprehensive analysis to determine the best location for the new north central location and to also determine the impact for the closing of the existing clinic and confirm this grave action. The neighborhood associations in the area, which are north park estates and gracie woods, we feel that the current zoning is appropriate and will maintain the character of our neighborhoods.
>> Margaret, so you all -- you don't -- you think that the folks that live in the neighborhood are not against the need for a new clinic. Y'all's opposition is where it is being put.
>> yes, sir. Absolutely. We're totally in favor of taking care of the indigent, and that's not an issue. And the feedback that I've gotten, and it's secondhand, is that we were accused of not wanting to take care of the children. That is so far off base. And I'm a mother, and I am all for the children. I work and help -- in the agape ministry, which are young-un wed mothers. We just don't feel like this location is the best location for everybody. Thank you.
>> what location do you think is --
>> I just think it needs to be relooked at, it needs to be stepped back and to have other locations looked be at. And you will have to talk with walt esquivel, the president who has looked be at it. I'm just representing him. I don't have all the data. I'm sorry, I can't answer your question.
>> thank you.
>> but he will be able to answer your question. Thank you.
>> thank you.
>> if those who are interested in the ta that the Travis County health district has traibl, it's on their website with a series of graphs, statistics, and a scatter plot of the current residences of those who are utilizing the northeast clinic. And it's available information. Of course additional information is always welcome as part of the dialogue.
>> yes?
>> if I may address very briefly, jennifer gale, five-time candidate for mayor of Austin. I know how hard the Travis County health care district works and I want to thank you on the board for doing all that, putting in all that time because I know it's very frustrating. We're not solving our problems, though. We're continuing these problems and they continue year in and year out. It sounds like they're being exacerbated. I've been asking for a long time for a university of Texas medical branch and it hasn't come to fruition. I'm suggesting that we usurp, that we take the initiative from the state and build our own hospital for our veterans and for the people in community so the people in the community know that this is a friendly place for everyone to go. That we are going to be educating our nurses there. All the specialties that you need to have for a hospital. Let's open up more areas so that we have a world class hospital right here along our river. And that we anyone throughout the district knows that they can come here and that they will get the medical care they need and they'll get it right away because you're going to have doctors and nurses that have got to have that training. They've got to have that knowledge. And as our population gets older, because we're a good bedroom community, this will be a good place for doctors and nurses to get that education. Thank you.
>> thank you. We are not postd for action on this item. But for discussion and consideration. We will be asked to take action on separate 16th. If significant changes are made to the proposal in the preliminary budget, then if those could be brought to our attention probably a week before the 16th, if possible. I know the board will take action on theth, I think. -- on the 11th, I think. But if it's substantially the same, my guess is it's probably all right for us to see it. Don't you think?
>> thank you.
>> thank you.
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Last Modified:
Wednesday, August 20, 2008 8:37 AM