Texas Indigent Health Care Association TIHCA

1. Texas Indigent Health Care Association(TIHCA) What county Commissioners and/or Hospital District Boards need and expect re: Information/Numbers

2. Information Manageable qualification standards. Assurance of acceptable Medical quality. * Process of referral for diagnosis or specialty treatment. Trends. *So as to manage around and avoid surprises. Sensitivity. * Training to assure people are treated properly.

3. Numbers Running rate of new qualifiers. Average costs per visit. Age demographics. Percentage (%) of referrals to total treated. Referral demographics by age and malady. Trends Reports.

4. GENERAL COMMUNICATE COMMUNICATE COMMUNICATE

5. HOOD COUNTY HOSPITAL DISTRICT LEASED COUNTY HOSPITAL CONTRACT FOR PROVIDING INDIGENT CARE

6. CONTRACT AGENDA MAINTAIN HOURS OF SERVICE. MAINTAIN QUALITY OF CARE. MAINTAIN MANAGEMENT OVERSIGHT. ESTABLISH MANAGEABLE QUALIFIERS. MAINTAIN ESTABLISHED RULES OF REFERRAL. ESTABLISH MANAGEABLE CONTROL OF COST EXPOSURES.

7. REVIEW OF EXISTING CONDITIONS Clinic property already owned by County Indigent services currently provided by local physician group. Relationship of local physician group to hospital is strained. Need to establish manageable control of costs is urgent.

8. Review of Existing Conditions (continued) Hospital already handles 90%+ of all referrals. 85% of all needed specialty referral is available locally. Case management of current service is suspect. Extremely high % of physician services currently deferred to NP service with some questionable liability exposure.

9. SOLUTIONS Design agreement centered on hospital providing all indigent services. Design agreement to allow hospital to grow remainder of clinic usage to supplement any loss via provision of indigent care alone. Design agreement with manageable caps on expenditures by County, while meeting all existing performance requirements.

10. SOME RESULTS Hospital provides all indigent services. Hospital provides all management costs. Hospital has unrestricted ability to grow clinic services outside indigent provisions. Case management added with specific guidelines. Anticipated rare specialty services are reviewed at management level of Hospital and County. All 3 of initial contract years are on a declining cap with 3rd year cost remaining in effect until 5yr. review.