The Dallas County Medical Society has decided to shut down Project Access Dallas, its successful 10-year-old program that provides charity care to the uninsured, in 2013.
The DCMS board voted Wednesday to discontinue the program after falling short of getting the funding it requested under the new 1115 Medicaid Waiver. The DCMS board withdrew its support for the waiver’s regional health plan in a Nov. 15 letter to the Texas Department of Health and Human Services.
Jim Walton, DO, the program’s medical director, and Richard Snyder, MD, DCMS president, issued a joint statement on the decision:
“Dallas area hospitals will receive increased federal tax dollars totaling over $4 billion in Dallas, Denton, and Kaufman counties over the next four-year period. Despite DCMS efforts to influence the decisions, we were informed that local hospital systems had unilaterally created plans for these funds to compensate hospitals using over 95 percent of the available funds, leaving the balance for private physicians and charitable clinics.
“This action disregarded the 1115 waiver’s primary intent, to transform and improve access to primary and specialty physician care. Without a more just, collaborative, and transparent process to negotiate delegation of these resources, local physicians and charitable clinics are unable to meaningfully participate in this important project for our area. The imbalance and unfairness of these health care funding decisions minimizes the critical role of physicians and charitable clinics in reducing uncompensated hospital care.”
Snyder said Project Access Dallas was going to go away regardless of what happened. The program was partially funded by the federal Upper Payment Limit funding and in-kind physician services from UT Southwestern, all of which were being redirected through the waiver.
“The waiver, as it is written, is very heavy on access to physicians. Physicians are at the centerpiece of this. But we were not represented in the design or the funding mechanism,” Snyder said.
DCMS was proposing to transform Project Access into a program called My Medical Home, which would have been eligible for funds under the waiver. Snyder said DCMS asked for $38 million of the $4.2 billion expected under the waiver in the next five years.
“It was originally agreed to, and then we were told it would be cut in half. It was a bolt out of the blue. It was something we were not expecting,” he said.
Other county medical societies are experiencing similar roadblocks in regional plans being drawn up throughout Texas, Snyder said.
Project Access served more than 4,000 patients this year. Its network included more than 2,000 physicians, 17 hospitals, 14 community and charity health clinics, 10 ancillary service support organizations, and two national laboratory service organizations.
The program plans to transition its 3,000 patients to new medical homes over the next three to six months before ceasing operations. Project Access employs 30 people, including three physicians, a nurse practitioner, a physician assistant and several case managers who help secure medical services.
The Tarrant County Medical Society said it regrets the DCMS’s decision to end Project Access. TCMS does not plan to end its Project Access program, which completed its first year in September.
“DCMS was very supportive in helping us establish Project Access Tarrant County and we will always be grateful for their guidance and unwavering support of our program,” said G. Sealy Massingill, TCMS president.
JPS Health Network, Tarrant County’s public health system, is the Region 10 anchor entity for the Section 1115 Medicaid Waiver plan.
“We are proud to work with the doctors of the Tarrant County Medical Society,” said JPS CEO Robert Earley “They share our passion for providing care to some of the patients with the greatest need in our county. We are pleased with our ongoing relationship with TCMS and look forward to sharing the progress We make in transforming health care through the 1115 waiver projects.”
Massingill said TCMS “has had a seat at the table, and we are actively working with JPS Health Network and all our partners to expand health care access to the area’s uninsured and underserved.”
In Dallas, Baylor Health Care System released a statement saying it was “shocked and saddened” by the discontinuation of the program: “Baylor has been a supporter of Project Access since its inception. We have had a unique collaboration with Project Access for the past decade, providing health care to the underserved patients of Dallas County ,and we believe this is a much-needed service. Regardless of this decision, Baylor will continue meeting the needs of the communities it serves through its seven community clinics and through its Diabetes Health and Wellness Institute in South Dallas.”
Similarly, Texas Health Resources said it committed to the full amount DCMS requested “and, in fact, increased our commitment to funding for Project Access Dallas. We believe caring for the indigent should be a shared responsibility of all of the health care providers in Dallas County, and Project Access is a good mechanism for making that happen. We’re committed to contributing our fair share, and we are concerned about the impact on the community if funding is inadequate. We will continue to work with physicians and other providers to resolve this issue and provide access to care.”
Steve Jacob is editor of D Healthcare Daily and author of Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at firstname.lastname@example.org.