Part one of a two-part series on the race to expand medical education in Texas.
Despite its glowing reputation, Austin has faced a gap when compared with other major metropolitan areas: the lack of a medical school and the cutting-edge research it can provide.
But that gap appears to be closing after Travis County voters approved a five-cent property tax hike this month to help finance a plan to overhaul the region’s approach to health care — including the construction of a research-intensive medical school that will be affiliated with the University of Texas at Austin.
“This was the final puzzle piece that needed to be found and fit into the puzzle,” said State Sen. Kirk Watson, D-Austin, who spearheaded the campaign for the ballot initiative.
The puzzle might be complete, but the hard work to create the medical school and an affiliated teaching hospital has just begun. Watson, however, touts the area’s “new playbook” for the project, in part because of the broad coalition of organizations involved.
With affirmation from voters, those groups are finalizing the school’s location, preparing to oversee its construction and developing the curriculum for the school, which could open as early as 2015 — though, UT-Austin President Bill Powers said 2016 was “probably more realistic.”
“We all have our own little to-do lists,” said Patricia Young Brown, the president and chief executive officer of Central Health, created in 2004 by Travis County to provide a health care safety net for the region’s underserved populations.
The new tax will generate $54 million annually to supplement Central Health’s activities rather than the bricks and mortar of new buildings. Of that total, $35 million will be set aside for patient services provided at the medical school, and the remainder would go toward other services, including those at the teaching hospital.
That revenue is also expected to draw up to an additional $76 million in federal matching money through a program aimed at transforming medical service delivery for needy patients, for a combined $130 million impact on the region’s health care system.
Brown’s team has been tasked with securing the federal funds, which are restricted from going toward the school’s construction but which she said were a key component of the overall vision. “It’s an education, training and service delivery ecosystem, and we rely on each other to make the whole thing work,” she said.
To put that money to best use, leaders are establishing an organization comprised of health care providers. Central Health will be the majority stakeholder of what is being called the Community Care Collaborative. Another project on the horizon is a technology network that would help the collaborative’s participants communicate effectively.
A key member of the collaborative will be the nonprofit Seton Healthcare Family, the region’s largest hospital system.
“We’re fortunate,” said Greg Hartman, a Seton executive and the president and chief executive officer of University Medical Center Brackenridge. “We are going to be able to create a brand-new medical school and create this new infrastructure right as health care is changing dramatically.”
Seton has committed $250 million for the construction of a teaching hospital, which it will own and run, though the land beneath it will be owned by Central Health. Hartman said his staff was finalizing their presentation for Seton’s parent company, Ascenscion Health, seeking final approval for the proposed teaching hospital.
“We feel good about that,” he said, “but we can’t say it’s done until it’s done.”
Approval must also be sought from state and federal regulatory bodies, but he did not anticipate any issues. “Any kind of weird regulatory decision could make things have to stop and be reconfigured,” Hartman said. “I don’t think it would kill it, but we may have to figure out different ways of doing things.”
The medical school facility, which will include academic and medical research space, will be financed by UT-Austin.
According to the university administration’s internal estimates, the cost of the entire endeavor is approximately $4.1 billion over 12 years. Central Health will cover about 10 percent, and Seton is expected to cover nearly half, including the clinical faculty and residency slots for graduate medical education.
The rest will largely come from UT-Austin.
In May, the University of Texas System Board of Regents, at the request of system Chancellor Francisco Cigarroa, approved a $25 million increase in its payout to the university from its endowment to help pay for the school. They also committed an additional $5 million annually over the next eight years for the recruitment of top faculty. This money was contingent on Seton’s commitment and an annual $35 million from the local community, which the new tax will provide.
For the location of the facilities, the parties are eyeing a tract of land between the existing Seton-run UMC. Brackenridge and UT-Austin’s special events arena in east-central Austin.
The university is beginning the search for a medical school dean. In the time leading up to enrollment of the first class, the dean will shape the curriculum, go through the approval process with the Texas Higher Education Coordinating Board and secure accreditation.
Approval or start-up funds from the Legislature is not required because the planners are making the medical school a part of UT-Austin, bucking the state’s history of having medical institutions separate from its academic universities. “That’s part of the new playbook,” Powers said.
He said one of the benefits of this arrangement is that students will be able to take advantage of the university’s existing programs, which may in turn be enhanced by the addition. There is already talk of joint degrees between the medical school and the law and business schools.
“I think people will look back and say, ‘How did this community work without having a major medical center here?’” Powers said.
The coalition is still hoping to expand. Leaders of the city’s second-largest hospital system, St. David’s HealthCare, a for-profit entity, spoke out against the tax hike. Watson called the opposition, which came late in the campaign, “surprising and disappointing.” But it does not appear to be disqualifying for a potential working relationship.
"St. David’s HealthCare continues to believe that a medical school will be good for this community, and we are committed to ensuring its success,” David Huffstutler, the president and chief executive officer of St. David’s, said in a statement this week. “We are looking for ways that we can substantively and meaningfully participate in the ongoing effort."
And as the process gets under way, more will also be asked of Austin residents.
“The community investment was made pretty clear in the vote,” Hartman said, “but the community also needs to invest through philanthropy.”
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