With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:
Bruce Meyer is executive vice president for health system affairs and professor of obstetrics and gynecology at UT Southwestern. He is responsible for overseeing the entire UT Southwestern clinical enterprise, including the university hospitals, faculty practice and contracts with clinical partner institutions. Prior to coming to Dallas, he was chair of obstetrics and gynecology at the University of Massachusetts Medical School and CEO of the faculty practice at UMass Memorial Health Care. He received his undergraduate education at UT-Austin, his medical degree from UT Health Science Center at San Antonio, and his MBA from the University of Tennessee.
Editor's note: This interview has been edited for length and clarity.
Trib+Health: Since your role oversees so many health care institutions throughout the state, what is your perspective on the current economics of health care?
Bruce Meyer: I would say in the big picture perspective, we are challenged as a state because of our relatively high rate of uninsured folks. We have the highest rate of any state and the largest number of uninsured people. That challenges us despite the fact that we have a relatively robust county health and hospital system. It is much more robust pretty much than any other state in the country.
But we have an enormous number of people here who are uninsured, who don’t have good access to care and wind up using the emergency room as their vehicle for primary care. Or because they don’t get primary care, they are much sicker and therefore wind up coming to an emergency room needing hospitalization or interventions that could potentially have been prevented if they had a better system of access to primary care.
We have a pretty significant doctor shortage not just in primary care but also in specialty care throughout the state. Pretty much in every region of the state, even here in North Texas. UT Southwestern is the largest graduate medical education program in the state, the third largest in the country. We’ve produced almost 25 percent of the doctors here in Texas, but it is not enough.
We’re building two new medical schools, one in Austin and one in the Valley. And that is great in terms of producing physicians. The difficulty is we haven’t expanded our graduate medical education slots, and because we don’t expand those residency programs, we are in essence exporting trained medical school graduates to other states because we don’t have enough slots to train in a specialty area or even in primary care.
That is one of the things we are trying to work with the Legislature on, expanding those graduate medical education opportunities so we are not exporting talented physicians.
Trib+Health: Is that the general impact of academic medical centers in the state?
Meyer: That is one impact, although the impact of academic medical centers is far more reaching. From a purely economic standpoint, the American Academy of Medical Colleges estimates that the state impact of academic medical centers is over $35 billion. We are part of the local economy of pretty much every part of the state. UT Southwestern employs a little over 15,000 people. We are one of the larger employers of people in the Dallas-Fort Worth area. Those people are all buying houses and purchasing food, goods and services.
Academic medical centers have a significant impact around clinical care. The faculty practice here at UT Southwestern sees about 2.1 million ambulatory visits a year. We hospitalize over 90,000 patients a year. We do over 65,000 operations a year. That is an enormous amount of clinical care.
Trib+Health: You mentioned the issue with primary care. Are accountable care organizations helping?
Meyer: The short answer is yes, they are helping with health care quality, outcomes and with access to care. The difficulty is that accountable care organizations are set up to do care for a relatively specific population of patients, and virtually every ACO that exists in the country are taking care of patients with some form of payer. Whether that is a commercial payer, or Medicare or Medicaid from the government, they have something.
But the population that is not insured is not in an ACO. The problem is people who are not insured and are not eligible for the Affordable Care Act. That is where other states have done various versions of expansion of Medicaid. There has been some very creative things done: Arkansas and Indiana, a little of what they have done in Wisconsin, to expand access to care for those people who otherwise would not have a payer.
ACOs are something that we are all deeply invested in trying to make work in terms of decreasing the total cost of medical care in this country because we have an unsustainable financial model. But the ACO model doesn’t solve the problem of the uninsured.
Trib+Health: What is your perspective of women’s health in the state?
Meyer: If you look at access to care, women are particularly disadvantaged around access to care. Although we do have strong programs around pregnancy, 30 years ago the state was one of the first to ensure access to care for every pregnant woman through the Medicaid program. That had a profound impact on the outcomes of pregnant women and their newborns.
That is wonderful, and the CHIP program is great for kids because it really does provide access to care for virtually every child in the state. However, if you are a woman who is not pregnant and you don’t have insurance, it is very difficult to get access to care. Women are disproportionately in that group without insurance. That is a struggle that we really need to try to grapple with in the state and figure out appropriate solutions.
For those who do have access to care, we have made tremendous advances in terms of quality of life and outcomes in women in a host of different areas.
Trib+Health: What other major health issues are on the horizon?
Meyer: Population health and the idea of moving from a fee for service model to a fee for value model where we are not paid for what we do to patients but for keeping people healthy. They would be paid for improving quality of life, longevity of life and decreasing mortality and morbidity.
It is a pretty profound paradigm shift that we are just in the beginning of. That shift is highly impactful because it gives us the opportunity to decrease the total cost of care. So we can manage the financial problem we have around how much it costs for health care, but also give an opportunity to have incentives in an odd way to do more stuff to people but actually have incentives to keep people healthy and promote healthy lifestyles.