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Health Care

Health care is a growing industry in Central Texas, and an important engine for job growth. Health care providers – both hospitals and companies providing home health care and physical therapy – are among the largest private employers in the region’s metro areas.

Health care providers – both hospitals and companies providing home health care and physical therapy – are among the largest private employers in the region’s metro areas.

In Waco, the top ten private employers include two hospitals and one home health care company. In Bryan-College Station, three of the top ten employers are hospitals. The ten largest private employers in the Killeen-Temple-Fort Hood metro area include a hospital and a home health care company.1

These providers contribute significantly to the region’s economy. Healthcare occupations – doctors, nurses, medical technicians and administrators – generally are high-paying jobs. And health care access is closely tied with economic development, since a healthy work force is a productive one.

Exhibit 35

Central Texas Hospital Ownership, 2008

57.1 percent of the hospitals are non-profits. 14.3 percent are publicly-owned. 28.6 percent are for profit.

Source: Texas Department of State Health Services.

Health Care Infrastructure

Hospitals are key factors in any state’s health care infrastructure. They provide a central point for advanced medical services, encourage the growth of affiliated medical services in surrounding areas, and often are a major source of local employment. Scott and White Memorial Hospital, for instance, is among the ten largest employers in both the Killeen-Temple-Fort Hood metro area and Bryan-College Station. In Waco, Hillcrest Health System and Providence Health Center are among the largest private employers, as is Saint Joseph Hospital in Bryan.2

In all, Central Texas is home to eight for-profit hospitals, 16 nonprofit hospitals and four public hospitals (Exhibit 35).3 Of these, Waco, Bryan and Temple each have three, while the remaining 25 hospitals are in smaller communities.4

Scott and White Memorial is the region’s largest hospital, with 636 beds. Waco and Bryan have the next-largest hospitals in the region. In 2008, the region’s acute care hospitals – that is, hospitals treating patients for intensive or emergency care for a short period of time – had a total of 2,848 beds, while its psychiatric hospitals had 84 beds.5

Central Texas also has five hospital districts (Exhibit 36).6 Under Texas law, these districts can levy taxes within their jurisdictions for the support of health care and hospital services.

Four of Central Texas’ 20 counties have no hospital (Exhibit 37).7 Some of their residents must travel relatively long distances to reach hospitals, which can be critical in emergency situations. For example, Leon County residents must travel for about 30 to 45 minutes to reach the nearest medical facilities in Palestine, Huntsville, Bryan-College Station and Madisonville.8

Exhibit 36

Central Texas Region Hospital Districts

Burleson County Hospital District
Fairfield Hospital District
Hamilton Hospital District
South Limestone Hospital District
Teague Hospital District

Source: Source: Texas Department of State Health Services.

Exhibit 37

Central Texas Counties Without a Hospital and Primary Care Health Professional Shortage Areas, 2007

See text alternative.

Source: Texas Department of State Health Services.

View text for Counties Without a Hospital and Primary Care Health Professional Shortage Areas.

Waco Hospitals Expand

In Waco, a $186 million project for Hillcrest Baptist Medical Center was one of the 10 largest construction projects breaking ground in Texas in 2006. The project includes a six-story medical center and a two-story women’s and children’s facility with 236 beds in all. Construction was completed in April 2009.9 Hillcrest has the area’s only Level II trauma center and nine neighborhood clinics.10

Another Waco project, worth $48.5 million and launched in 2006, expanded the Providence Healthcare Network, doubling its number of emergency room beds and expanding operating rooms, intensive care rooms and space for a number of other medical services. The project was completed in Spring 2008.11 Providence also operates a 64-bed psychiatric and substance abuse treatment facility, home health care services, hospice care and a residential facility that provides independent living, assisted living and long-term care. Seven Providence clinics in Waco provide outpatient care.12

Texas A&M Health Science Center

The 2007 Texas Legislature appropriated $33 million to expand the existing Bryan-College Station and Temple campuses and to create a new Round Rock campus of the Texas A&M Health Science Center College of Medicine (HSC-COM). These funds will be dedicated to developing the existing programs at the Temple and Bryan-College Station campuses into full four-year programs. Currently, students are able to complete their first two years of basic science training at the two campuses. Afterwards, students must go to HSC-COM’s clinical affiliates for clinical training for the remaining two years. In addition, a new two-year clinical campus will be established in Round Rock. The new facility would offer clinical teaching, student life and student service support, contain a simulation center with computer-programmed manikins and provide administrative support.

The funds are expected to allow HSC-COM to increase its basic science research faculty in Temple and Bryan-College Station and recruit talented educators and physician scientists. Of the $33 million in appropriated funds, $9 million was set aside for medical education at HSC-COM’s new Round Rock campus.15 Construction of the new Round Rock two-year campus began in late 2008 and should finish by fall 2009.16 Although the Round Rock campus is yet to be fully constructed, 35 third and fourth year HSC-COM medical students are currently undergoing clinical training by working rotations in a wide range of Williamson County hospitals.17

Veterans’ Health Care

In March 2009, the U.S. Defense Department announced that a portion of the federal stimulus funds would be used “to modernize its hospital system,” and that a new hospital would be built at Fort Hood to treat soldiers and veterans.

Central Texas is home to the Central Texas Veterans Health Care System, which operates two Veterans’ Affairs (VA) hospitals – Olin E. Teague Veterans Center in Temple and the VA Medical Center in Waco.13

The Central Texas Veterans Health Care System is an umbrella agency for both medical centers and numerous other veteran services. Serving veterans in 32 Texas counties, it includes one of the nation’s newest VA hospitals, a large inpatient psychiatric facility, nursing home beds, a state veteran’s home, a new research center and a rehabilitation center for the blind.14 The system has medical school teaching affiliations with both the Texas A&M Health Science Center’s College of Medicine and the University of Texas Medical Branch in Galveston. Nurses, physicians’ assistants, and other medical professionals are trained at the hospitals.22

In June 2008, the system enrolled its 10,000th veteran of the Afghan and Iraq wars, more than any other VA system in the U.S. (Combat veterans qualify for five years of health care from the Veterans Administration after leaving active service.)23

The system’s Olin E. Teague Veterans’ Center is the nation’s fourth-largest medical complex of its kind, with more than 2,800 employees and an annual operating budget of more than $97 million.24 The Teague center also opened a new clinic for spinal cord injuries in April 2008. The clinic has wide halls to accommodate wheel chairs and mechanical lifts to help transfer patients safely.25

Waco’s 77-year old veterans’ hospital and campus, once threatened with closure, has received new funding to expand its mission and improve the services it provides to veterans. A new $3.5 million mobile magnetic resonance imaging (MRI) unit will be used at the hospital as well as at Fort Hood in Killeen and at the Olin E. Teague Center in Temple. The MRI unit will be used in the study of post-traumatic stress disorder (PTSD). The Waco VA Center is one of three centers nationwide studying PTSD and traumatic brain injuries.26

The Waco VA center also has received $49 million in federal funding for a series of new projects and renovations. These include a new Center of Excellence for Research on Returning War Veterans to study mental health issues, as well as expanded mental health treatment services. The center’s Blind Rehabilitation Unit will be expanded to 30 beds and other critical repairs will be undertaken.27

In addition, Bryan-College Station has a VA Community Based Outpatient Clinic (CBOC).28 In 1995, the U.S. Veterans Health Administration (VHA) added CBOCs in an effort to improve the delivery of primary care to veterans.29 The goals of the CBOC program include improved preventive care and early disease intervention.

In March 2009, the U.S. Defense Department announced that a portion of the federal stimulus funds would be used “to modernize its hospital system,” and that a new hospital would be built at Fort Hood to treat soldiers and veterans. The new hospital will replace the existing Carl R. Darnall Army Medical Center, which was built in 1964 and has been expanded over the years. The first phase of the hospital construction is expected to cost $621 million and construction is expected to last three years.30

Recently, the Central Texas Veterans Health Care System received 105 vouchers for housing homeless veterans in its service area. The vouchers, offered by the VA and the U.S. Department of Housing and Urban Development (HUD) to the Waco Housing Authority, provide for five years of housing in the Central Texas VA service area as well as case management services to assist veterans with budgeting, finding employment, child care and other needed services.31

Texas Bioscience Institute

The Texas Bioscience Institute (TBI) in Temple was created to meet the Central Texas area’s growing need for more bioscience and medical professionals. In 2006, TBI began offering qualified area high-school students college-level coursework in science, math and biotechnology in 11th and 12th grade. This dual-credit program allows students to earn college credit while in high school and to graduate with an Associate of Arts or Applied Science in biotechnology degree. Starting salaries for entry-level biotechnicians range from $25,000 to $30,000 per year.18

Temple College, a two-year community college, partnered with Scott & White Hospital, Texas A&M University College of Medicine, the Temple Health and Bioscience District, the City of Temple, area schools and other community partners to make TBI a reality. The partners provide instructors, internships, hands-on lab research opportunities and jobs for TBI students. In January 2007, Scott & White Hospital opened a state-of-the-art classroom and laboratory facility on its west campus that provides TBI students with the latest equipment and technology as well as proximity to faculty members and scientists.

TBI students are exposed to rigorous college courses in a medical setting that requires them to attend seminars led by scientists and physicians and obtain hands-on experience in medical research laboratories. TBI statistics show that their students have consistently met and exceeded regional test performance averages. The Texas High School Project notes that “TBI has made a significant contribution to the community by preparing under-represented – minority and female – students for a career in a medical field.”19 Sixty-five percent of the 2007-08 class of 108 students was female.20

TBI has received several recognitions and awards for innovation. At the national level, TBI program received the Bayer Foundation STEM K-12 “Best Practices” for strengthening K-12 Science, Technology, Engineering and Math (STEM) education. Within Texas, the program received the Texas High School Project T-STEM “Early Innovator” grant and recognition. TBI also received the 2007 Bellwether Award in the “Workforce Development” category in recognition of the partnerships it formed to promote community and economic development.21

Psychiatric Care

The Texas Department of State Health Services’ (DSHS’s) Waco Center for Youth is a psychiatric residential treatment facility serving Texas children aged 13 to 17 with emotional or behavioral problems. The center is open to children who already are under the care of a DSHS facility or a community mental health and mental retardation center, or who are in the custody of the Texas Department of Protective and Regulatory Services.32

The region is scheduled to receive additional crisis mental health care services through state aid from DSHS. Waco’s Heart of Texas Region Mental Health Mental Retardation Center, which provides mental health and mental retardation services for the residents of six Central Texas counties, received $1.7 million from the state over two years to provide a 24-hour crisis center, including an observation unit and a 16-bed residential unit for short stays.

These new services will expand treatment options for people with mental health problems and ease the duties of local law enforcement personnel, who often spend hours waiting at local emergency rooms until persons can be evaluated for mental health issues, and who may have to transport them to another region if the local psychiatric hospital is full. The new center will provide mental health triage services that can help to quickly evaluate a person’s mental status and refer them to appropriate treatment.33

Scott & White Memorial Hospital

Scott & White Memorial Hospital is a private, nonprofit organization with about 8,000 employees. The hospital is Texas’ largest multi-specialty practice and has a number of clinics throughout the Central Texas region. For five consecutive years, Scott & White has been on the Thomson Reuters 100 Top Hospitals National Benchmarks for Success list for major teaching hospitals. Thomson Reuters is a world leader in providing critical information on issues such as healthcare, and constructs its hospital ranking based on a national hospital scorecard that focuses on best practices.34 And in 2008, for the ninth year in a row, Thomson Reuters named Scott & White one of the nation’s top 100 hospitals for cardiovascular care.35

Scott & White also functions as a clinical educational site for the Texas A&M Health Science Center College of Medicine. Physicians at the hospital perform the dual roles of attending physician and professor to students.36

The hospital has continued to expand its presence in the Central Texas region. In 2007, Scott & White and Metroplex Health System, the primary healthcare providers for Coryell, Bell and Lampasas counties, have reaffirmed their strategic alignment agreement to expand medical services in Killeen. The new hospital is expected to have 70 to 120 beds and add up to 400 jobs to the local economy.37

The hospital also offers the Scott & White Health Plan, a nonprofit health maintenance organization (HMO). The plan, which began operation on January 1, 1982, currently covers 34 counties and has 200,000 members.38 It is one of the state’s highest-ranked HMOs.39

Central Texas is home to Scott & White, one of three Texas hospitals to receive the American Heart Association’s Get With The Guidelines Gold Performance Achievement Award.

Health Professional Shortages and Rural Healthcare

The U.S. Department of Health and Human Services has designated 11 of the 20 counties in the Central Texas region as having a shortage of primary health care providers – primary care doctors, dentists and mental health professionals (Exhibit 37).40

Many of the region’s 20 counties lack mental health professionals. In 2008, Washington, San Saba, Robertson, Mills, Madison, Limestone, Leon, Lampasas, Hill, Hamilton, Freestone, Falls, Burleson and Bosque counties had no psychiatrists working in their areas. Other counties were not much better off; Milam, Grimes and Coryell counties, had only one or two psychiatrists each.41

One successful model for rural health care is College Station’s Brazos Valley Health Partnership, created in 2002.

The region’s most acute health care professional shortages, however, are in Burleson and Robertson counties. In 2008, Burleson County had a population of 18,483 and only three primary-care physicians, while Robertson County had 16,898 residents and just four physicians. From 2000 to 2008, Burleson County’s ratio of population versus primary-care physicians rose from 5,164 to 6,161 residents per physician. Over the same period, Robertson County improved slightly, from 4,288 to 4,225 residents per physician.42

This situation forces Burleson County residents to travel to the Bryan-College Station area for healthcare. Robertson County faces similar difficulties.43

One successful model for rural health care provision is College Station’s Brazos Valley Health Partnership (BVHP), which was created in 2002 in response to a regional health assessment of a seven-county area – Brazos, Burleson, Grimes, Leon, Madison, Robertson and Washington counties – conducted by the Center for Community Health Development at the Texas A&M Health Science Center School of Rural Public Health.

BVHP has developed a model for rural health care called the “health resource center” – a single location that provides both health care and referral services, allowing medical providers to combine their efforts while reducing overhead costs. BVHP opened its first such center in Madisonville in 2003.44 In 2004, the center began providing free transportation for county residents who need to travel to doctor’s visits and other medical services. In 2007, volunteer drivers provided more than 540 rides.45

Today, the health resource center refers people to services and works with other groups to provide audiology and child care management services. The county’s indigent health care program, Brazos Valley Community Action Agency, Brazos Valley Council on Alcohol and Substance Abuse, Early Childhood Intervention, and the Medication Assistance Program all are housed in the center.46

BVHP also has helped to organize similar health resource centers in Burleson, Leon, and Grimes counties. Each is administered by a commission appointed by the county commissioner’s court. Office space for the centers has been donated by organizations such as the Madison St. Joseph Health Center, the Burleson County Hospital District, the Mental Health/Mental Retardation Authority of Brazos County, the Powell Memorial Health Clinic, Leon County and the Somerville Independent School District.47

Goodall-Witcher Healthcare Foundation

Founded in July 1966, the Goodall-Witcher Healthcare Foundation is a nonprofit corporation that owns and operates healthcare businesses in Bosque County and nearby areas, including a hospital and ancillary facilities. In addition to providing direct patient care, the foundation also offers nursing education, public education and emergency medical services.49

Today, the Goodall-Witcher Healthcare Foundation incorporates the 40-bed Goodall-Witcher Hospital, Clifton Medical Clinic, Goodall-Witcher Home Health Agency, Goodall-Witcher Nursing Facility and Meridian Medical Clinic, with approximately 240 employees.50 The hospital offers in-patient medical, surgical, obstetrics, nursery and intensive care. The hospital’s Discharge Planning Program has designated nurses who work with the physicians, social workers, therapist and nursing staff to formulate details on how patients will receive the best care towards recovery during their time at the hospital.51

The Goodall-Witcher Home Health Agency provides health care at patients’ homes during recovery, such as rehabilitative therapies and exercises designed to increase patients’ mobility.52

In 2004, Goodall-Witcher Healthcare Foundation was selected for the 2004 Solucient Performance Improvement Leaders award, based on management and clinical outcomes over five consecutive years. The foundation was one of 20 small community hospitals that won the award nationwide, including three from Texas. The award was based on Goodall-Witcher’s mortality rates, expenses and lengths of stay.53

Treatment for the Uninsured

A recent U.S. Census Bureau report revealed that Texas had a two-year average (2006-2007) uninsured rate of 24.8 percent, the highest of any state.48 Based on the U.S. Census Bureau’s Small Area Health Insurance estimates, all 20 Central Texas counties had rates of uninsured residents of more than 20 percent. The lowest rate was in Limestone County, with an estimated 22.7 percent uninsured, and the highest rate was in Brazos County, with 36.3 percent uninsured.54

The number of uninsured is prompting many of the region’s communities to explore ways to provide them with adequate and affordable health care. The Greater Killeen Free Clinic relies primarily on volunteer physicians and other medical professionals to operate its twice-weekly clinic. Only the uninsured in Killeen and surrounding communities can receive its services.55 The clinic, founded in 1994, relies on a number of community organizations that contribute services to its patients. Among these are Bell County Public Health District, Metroplex Hospital, Scott and White Hospital and the Susan G. Komen Breast Cancer Foundation.56

In Bryan, Health for All is a free clinic that provides health care for uninsured area residents who cannot afford regular medical care. It also offers mental health services, lab and x-ray services and prescription drugs, as well as periodic clinics for vision and podiatry services.57 In 2007, Health for All saw nearly 1,000 patients. Recently, the clinic doubled its number of exam rooms to eight, and hopes to hire a full-time physician. In addition, the Texas A&M Health Science Center’s School of Medicine provides the services of its medical students under the supervision of a physician.58

Exhibit 38

Ischemic Heart Disease Six-year Average Age-Adjusted Mortality Rates for Central Texas Region by County 1999-2004

See text alternative.

Source: Texas Department of State Health Services.

View text for Mortality Rates for Heart Disease by County.

Heart Disease

Cardiovascular disease (CVD) is a term for heart problems caused by narrowed or blocked blood vessels (ischemic heart disease) that can lead to a heart attack or stroke. In Texas, CVD is the leading cause of death, accounting for two out of every five deaths in the state.

Ischemic heart disease is of particular concern in Central Texas, where 11 of the region’s 20 counties have mortality rates from this disease that are significantly higher than the average state rate (Exhibit 38). In four of the region’s counties – Hill, Bosque, Limestone and Brazos – mortality rates from stroke are also much higher than the state average.59

Fortunately, Central Texas is home to Scott & White, one of three Texas hospitals to receive the American Heart Association’s (AHA’s) Get With The Guidelines (GWTG) Gold Performance Achievement Award. Scott & White received the award for meeting the highest standard of care for both coronary artery disease and stroke, as measured by nationally accepted standards and recommendations. Scott & White’s heart care and stroke programs have been recognized in this way three times.60

Heart attack patients at hospitals that follow AHA guidelines experience lower death rates. One study found that hospitals not following AHA guidelines had death rates that were higher – 17.6 percent – than those of hospitals adhering to the treatment guidelines, which had lower death rates of 11.9 percent.61

In 2008, Scott & White’s Heart and Vascular Institute launched the Women’s Cardiovascular Health Clinic and a free online screening program called HeartAWARE. The online heart risk assessment tool evaluates a woman’s risk of cardiovascular disease and, if its results show a high risk factor, invites the person in for a free screening at the clinic. The AHA notes that cardiovascular disease is the number-one killer of American women.

To help combat cardiovascular disease, Scott & White partnered with the Tem-Bel Health and Wellness Coalition, a group of Central Texas community leaders, to implement the National Institutes of Health’s We Can! program to enhance children’s activity and nutrition.

To help combat cardiovascular disease, Scott & White partnered with the Tem-Bel Health and Wellness Coalition, a group of Central Texas community leaders, to implement the National Institutes of Health’s We Can! program to enhance children’s activity and nutrition.

This national education program offers families tips to healthy eating and fun activities designed to encourage physical fitness. It also provides community groups and health professionals information to implement programs that encourage families to adopt a healthy lifestyle.62

The Central Texas We Can! program has received two awards for its efforts to educate parents and children about the risk factors for heart disease and stroke, which include physical inactivity and poor eating habits. The honors include an Outstanding Program Award from the Texas Council on Cardiovascular Disease and Stroke and “Best Practices” recognition from the Texas Department of State Health Services.63 Continued support of community efforts to help families and children adopt healthier lifestyle habits should help the Central Texas region reduce its rate of death due to heart disease.

Biotechnology research at Texas A&M University.

Biotechnology research at Texas A&M University.

PHOTO: Texas A&M University

Endnotes

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