DSRIP SUCCESS STORIES
In Wise County, two DSRIP projects have improved diabetes monitoring and reduced readmission rates for patients with congestive heart failure. The county’s Total Diabetes Care program employs two full-time nurse educators who provide diabetic education and monitoring services in one-on-one and group settings.
In three years, the program significantly improved primary care monitoring of diabetic patients, reducing the incidence of long-term complications and costs associated with the disease. After establishing a chronic disease education and management program, the area’s hospital readmission rates for congestive heart failure fell by almost 50 percent from 2012 to 2017.
In Medina County, a DSRIP-funded, nurse-staffed advice line has reduced potentially preventable admissions and emergency department visits, according to an external quality review.
And in November 2013, the Golden Plains Community Center in Borger used DSRIP funding to create an affordable care clinic designed to divert patients from unnecessary visits to the emergency room. Initially, the clinic operated in a hallway connected to the emergency room and served 96 patients in its first month. The clinic grew steadily and moved to an offsite location in 2018; it now sees about 600 patients each month.
UNCERTAINTY FOR HOSPITALS
Texas’ health care delivery system faces several challenges as the 1115 Medicaid waiver winds down.
First, DSRIP funds will expire completely at the end of 2021, potentially ending a series of innovative health services and programs that have helped many Texans who sorely needed them. Some of these services aren’t sustainable without continued funding.
Second, changes in the methodology used to calculate the uncompensated care pool — the maximum funding available under the program — negotiated in the 2017 waiver will affect total UC funding and the distribution of payments to individual hospitals. Beginning in 2020, UC costs will apply only to hospital costs for uncompensated charity care and services provided to low-income patients. Importantly, it will no longer cover the difference between the actual cost of a service and the reimbursement paid.
As the Texas Hospital Association outlines it, this change could cause children’s hospitals to receive less funding, since they usually serve a larger share of Medicaid recipients than uninsured patients.
Furthermore, CMS will reduce available UC funds to Texas hospitals by a share of the payments they receive through the Medicaid Disproportionate Share Hospital (DSH) program. DSH is an annual allotment of federal funds to hospitals that serve a disproportionately high share of uninsured patients; this change could reduce their funding by an estimated $600 million each year.
Other states including California, Indiana and Maryland have renewed their 1115 waivers in recent years. FN
For more information on Texas’ 1115 waiver program, visit the Health and Human Services Commission.