Burnt Orange Report

News, Politics, and Fun From Deep in the Heart of Texas

Support the TDP!

June 11, 2005

The Unbearable Lightness of UTMBing

By Jim Dallas

The Houston Press has a cover story this week on the alleged problems with UTMB Galveston's prisoner care program.

UTMB having problems is not exactly news. I used to believe that the Houston media was biased against UTMB, acting as sort of a permanent run-away jury in the World's Largest Frivolous Malpractice Suit. But there's only so long that you can be a part of a community before recognizing that it's problems are, in fact, problems. And UTMB has problems.

I'm about as close as one can get to an institution with UTMB as one can get without being an insider. My brother and sister were born there (as were countless friends), my parents have worked there for decades (as have countless friends-parents), I did several school projects with the support and in UTMB labs.

So I'm going to try to be generous in dissecting UTMB's problems, and proposing what I think may be the only solution to put health care in south-east Texas back on track.

To Boldly Go...

The University of Texas Medical Branch at Galveston is not "a hospital." This is a mis-conception that needs to be clarified out front.

Rather, UTMB is a sprawling, 85-acre, 13,000-employee, $1.3 billion-a-year campus (link) which includes six hospitals and a slew of other clinics, centers, and institutes, a product of perpetual growth.

It all started over a hundred years ago with one building: Big Red. Since then, many tens of buildings have been built, rebuilt, torn down, replaced, and so on; there are now 53 building in the UTMB campus.

While this is about half the number of buildings at the Texas Medical Center in Houston, the TMC is a conglomeration of a dozen (or so) different education systems, ten major hospitals, and dozens of other institutions each with its own independent administration and institutional focus.

Aside from the Shriners Burn Hospital and a few smaller entities, which are independent, UTMB shares a common administration and mission. It lacks, however, a clear institutional niche.

It is probably fair to say that UTMB dabbles in a little bit of everything - prison care, research, indigent care, specialty care, teaching (and not just medical students), etc. To fully grasp the enormity of the insitution, you have to look at the multiple org charts which are necessary to explain it (one alone would not suffice).

UTMB's practice is extensive for several reasons. The first is history; until 1949, UTMB was the only medical school in Texas, and for years afterward was the primary center for treating indigent. As such, UTMB had to adjust to treating patients of every age and condition.

In more recent times, however, UTMB has actively sought out new lines of work (such as caring for Harris County's prisoners). In the last ten years, the number of outpatient visits has doubled and is on track to hit 900,000 per year. Additionally, UTMB now does nearly 50,000 telemedicine consultations a year (up from none less than ten years ago).

This growth comes, in large part, because it has been an economic imperative.

I'm A Doctor, Not A Miracle Worker: UTMB and the economics of the Health Care Industry

Like many institutions of higher education, UTMB has been getting less money from the state and has been expected to "earn" more of its money, like a business.


While there was a slight-drop off in 2004, earned revenue (from patient care, etc.) now makes up about 70 percent of UTMB's income, with state funding at a mere 18 percent (it was 40 percent in 1995). In terms of actual dollars spent, state funding for UTMB has not changed significantly in the last ten years.

These numbers, however, only scratch the surface of what has happened.

In the last ten years, competition has become intense among health care institutions over prized HMO/PPO contracts. UTMB has succeeding in winning quite a few of these contracts - according to the 2000 strategic plan (which appears to be the most recent source), 56 contracts covering 165,000 people. The move away from HMOs and towards PPOs, however, has given many insured area residents more choice in picking a provider. And all too often, those who can afford not to are not chosing to go to UTMB. Often, patients who use to go to UTMB for care go to more-specialized, highly ranked hospitals such as Texas Childrens (ranked number 4 in US News and World Reports "Best Hospital" list for pediatrics) or M.D. Anderson (Ranked number 1 for cancer). UTMB wasn't even listed in the 2004 US News and World Report rankings, much less ranked.

The result of this is that UTMB is having to squeeze every last dollar out of those patients who do choose to seek care in Galveston - as well as those, such as prisoners - who really don't have a choice at all.

While UTMB trumpets the large amount (nearly $500 million worth) of free care it provides to the indigent and others, it has gotten into the practice of rationing health care for the uninsured. Moreover, UTMB's staff is seeing a lot more patients than they used to:


To be sure, the overwhelming majority of visits are outpatient. This can still lead to considerable headaches for staffers, however.

The result is that UTMB's patient demographic is shrinking into two sectors - the poor (and working class families with insurance who are still more-or-less forced to go to UTMB because of HMO/PPO rules) and those who are seeking treatment for ailments which are, essentially, not profitable to treat. This trend is basically at odds with UTMB's profit directive, and is leading to further and further belt-tightening at the further expense of overall happiness.

At the same time, of course, UTMB is still burdened with the responsibilities of bringing up the next crop of medical students, doing world-class research, and so on and so forth. There are limits to how far UTMB can go with its business-like mentality before it cuts into these very un-business-like priorities.

He's Dead, Jim: A Prescription for Reform

At the risk of being a pessimist, I am going to go ahead and concur with those I know who know best (disclaimer, I would include my dad among them) that UTMB is, frankly, caught in a death spiral. It is too large, too generalist, under-funded, over-extended, and terminally-incapable of reviving its reputation.

What UTMB needs is shock therapy. First, it needs a major increase in state funding to set its books in order. Second, it needs to do what any troubled business would do: downsize and spin-off its constituent parts. Specifically, UTMB needs to probably split itself into several institutions with clear niches and institutional goals.

Some might complain that breaking up UTMB would impede its ability to provide "holistic" care to the Galveston community, which is sort of a nice way of saying that UTMB won't be the Super Wal-Mart of health care any more, with a little something for everybody and the possibility of cradle-to-grave service. However, the fact is that one institution simply cannot provide for an individual any more, at least in an age of three-year jobs and under our employer-pays health care insurance regime.

Posted by Jim Dallas at June 11, 2005 09:51 PM | TrackBack

Post a comment

Remember personal info?

June 2005
Sun Mon Tue Wed Thu Fri Sat
      1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30    

About Us
Advertising Policies


Tip Jar!

Recent Entries
BOR Edu.
University of Texas
University Democrats

BOR News
The Daily Texan
The Statesman
The Chronicle

BOR Politics
DNC Blog: Kicking Ass
DSCC Blog: From the Roots
DCCC Blog: The Stakeholder
Texas Dems
Travis County Dems

U.S. Rep. Lloyd Doggett
State Sen. Gonzalo Barrientos
State Rep. Dawnna Dukes
State Rep. Elliott Naishtat
State Rep. Eddie Rodriguez
State Rep. Mark Strama
Linked to BOR!
Alexa Rating
Truth Laid Bear Ecosystem
Technoranti Link Cosmos
Blogstreet Blogback
American Research Group
Annenberg Election Survey
Polling Report
Rasmussen Reports
Survey USA
Texas Stuff
A Little Pollyana
Austin Bloggers
DFW Bogs
DMN Blog
In the Pink Texas
Inside the Texas Capitol
The Lasso
Pol State TX Archives
Quorum Report Daily Buzz
George Strong Political Analysis
Texas Law Blog
Texas Monthly
Texas Observer
TX Dem Blogs
100 Monkeys Typing
Alt 7
Appalachia Alumni Association
Barefoot and Naked
BAN News
Betamax Guillotine
Blue Texas
Border Ass News
The Daily DeLay
The Daily Texican
Dos Centavos
Drive Democracy Easter Lemming
Get Donkey
Greg's Opinion
Half the Sins of Mankind
Jim Hightower
Hugo Zoom
Latinos for Texas
Off the Kuff
Ones and Zeros
Panhandle Truth Squad
Aaron Peña's Blog
People's Republic of Seabrook
Pink Dome
The Red State
Rhetoric & Rhythm
Rio Grande Valley Politics
Save Texas Reps
Skeptical Notion
Something's Got to Break
Stout Dem Blog
The Scarlet Left
Tex Prodigy
View From the Left
Yellow Doggeral Democrat
TX GOP Blogs
Beldar Blog
Blogs of War
Boots and Sabers
Dallas Arena
Jessica's Well
Lone Star Times
Publius TX
Safety for Dummies
The Sake of Arguement
Slightly Rough
Daily Reads
ABC's The Note
BOP News
Daily Kos
Media Matters
NBC's First Read
Political State Report
Political Animal
Political Wire
Talking Points Memo
CBS Washington Wrap
Matthew Yglesias
College Blogs
CDA Blog
Get More Ass (Brown)
Dem Apples (Harvard)
KU Dems
U-Delaware Dems
UNO Dems
Stanford Dems
GLBT Blogs
American Blog
Boi From Troy
Margaret Cho
Downtown Lad
Gay Patriot
Raw Story
Stonewall Dems
Andrew Sullivan
More Reads
Living Indefinitely
Blogroll Burnt Orange!
BOR Webrings
< ? Texas Blogs # >
<< ? austinbloggers # >>
« ? MT blog # »
« ? MT # »
« ? Verbosity # »
Election Returns
CNN 1998 Returns
CNN 2000 Returns
CNN 2002 Returns
CNN 2004 Returns

state elections 1992-2005

bexar county elections
collin county elections
dallas county elections
denton county elections
el paso county elections
fort bend county elections
galveston county elections
harris county elections
jefferson county elections
tarrant county elections
travis county elections

Texas Media
abilene reporter news

alpine avalanche

amarillo globe news

austin american statesman
austin chronicle
daily texan online
keye news (cbs)
kut (npr)
kvue news (abc)
kxan news (nbc)
news 8 austin

beaumont enterprise

brownsville herald

college station
the battalion (texas a&m)

corpus christi
corpus christi caller times
kris news (fox)
kztv news (cbs)

crawford lone star iconoclast

dallas-fort worth
dallas morning news
dallas observer
dallas voice
fort worth star-telegram
kdfw news (fox)
kera (npr)
ktvt news (cbs)
nbc5 news
wfaa news (abc)

del rio
del rio news herald

el paso
el paso times
kdbc news (cbs)
kfox news (fox)
ktsm (nbc)
kvia news (abc)

galveston county daily news

valley morning star

houston chronicle
houston press
khou news (cbs)
kprc news (nbc)
ktrk news (abc)

laredo morning times

lockhart post-register

lubbock avalanche journal

lufkin daily news

marshall news messenger

the monitor

midland - odessa
midland reporter telegram
odessa american

san antonio
san antonio express-news

seguin gazette-enterprise

texarkana gazette

tyler morning telegraph

victoria advocate

kxxv news (abc)
kwtx news (cbs)
waco tribune-herald

krgv news (nbc)

texas cable news
texas triangle

World News
ABC News
All Africa News
Arab News
Atlanta Constitution-Journal
News.com Australia
BBC News
Boston Globe
CBS News
Chicago Tribune
Christian Science Monitor
Denver Post
FOX News
Google News
The Guardian
Inside China Today
International Herald Tribune
Japan Times
LA Times
Mexico Daily
Miami Herald
New Orleans Times-Picayune
New York Times
El Pais (Spanish)
San Francisco Chronicle
Seattle Post-Intelligencer
Times of India
Toronto Star
Wall Street Journal
Washington Post

Powered by
Movable Type 3.15