Changing the face of health care

Gulf Coast Health Center modifies its mission for 2011 to rewrite the health care equation                                                  

It began life as the Port Arthur Community Health Center, chartered in 1989 as a nonprofit corporation whose resources would be used to provide primary health care services to needy people in the area.
In the more than 20 years since its founding, things have changed both at the center and in the business of medicine in this country. In 1998, the name changed the Gulf Coast Health Center (GCHC) even as many people previously covered under employer health insurance have found themselves on their own, without a “medical home.”
Their service area extended far beyond Port Arthur to facilities in Beaumont, Silsbee, Newton and Orange. The Beaumont clinic near Baptist Hospital shut down in mid-2008, but plans are in the works to reopen it later this year.
The goal of our physicians, nurses and administrative support staff is to ensure all patients have the opportunity for quality and affordable health care for the entire family. While other doctors are ceasing to accept Medicaid and Medicare, we are expanding our services to meet the needs of our community,” said David L. Hartman Jr., CEO of GCHC.
“We want to ensure the women of Jefferson County have access to the care necessary for healthy pregnancies and overall health. Our goal is to change the face of health care throughout Southeast Texas,” he added.
That’s a daunting task, and one that Hartman has tackled with a degree of skill and enthusiasm that is transforming GCHC in ways both simple and profound, without losing sight of its core mission.
“Our health center is a private, nonprofit community-based organization. This permits us to be partially funded through DHHS/HRSA. We are therefore able to supplement our services by sliding patient fees, third-party insurance, donations and private foundations. The benefits from this support are passed on to our customers through affordable rates for every family and individual in the Jefferson, Orange, Hardin and Newton counties and their surrounding communities,” he said.
The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary federal agency responsible for improving access to health care services for people who are uninsured, isolated or medically vulnerable.

‘Our goal is to change the face of health care
throughout Southeast Texas.’
-      David L. Hartman Jr.
             CEO, Gulf Coast Health Center

A career military man who spent 25 years in the U.S. Army in hospital administration, Hartman left the service and became a senior human resources administrator with TOTAL Port Arthur Refinery. As such, he was active in the Port Arthur Industrial Group. He became aware of Gulf Coast Health Center when he was asked to join the nonprofit’s board of directors.
Once there, it became obvious the clinic was in trouble. Organizational fatigue had set in, and a series of turnovers led to management failures by board members and staff that had the clinic reeling. They continued to see patients in a crumbling facility under difficult conditions.
His fellow board members set out to convince Hartman to leave TOTAL to become CEO of GCHC. In January 2010, he agreed, and the former soldier with a MBA in health care management assumed his new duties.
Hartman was brought in to stop the bleeding, an unfortunate metaphor for a health care facility, but it applied to this situation.
“What we had to do internally is recognize the fact we were a business and that we had to operate under solid business principals,” said Hartman, who immediately set to work to reinvent a clinic with faded walls, dangling window treatments and the occasional hole in the sagging floor. Patients sat for hours, and the staff ranged from disorganized to disinterested with training and medical uniforms in short supply.
“I had to start with basic infrastructure – painting walls, buying new furniture, fixing the building,” he said. “We put money into employees – hiring more staff and training staff to be responsive to patient needs.”
The change came not a moment too soon. Hartman had to confront the reality that Gulf Coast had become what he described as a “clinic of last resort” for people with few health care options.
“You’d make sure you’re here at 6:30 in the morning and don’t plan on leaving until 3 or 4 o’clock in the afternoon – we did away with that,” he said. “We took down the barriers to health care. We made a pact that we would try to get people appointments as soon as possible, and when they come in, we get them in and out the door in a reasonable amount of time.”
One constant throughout this process has been the performance of GCHC physicians.
“None of our doctors have ever had any kinds of issues at all. Dr. Annette Okpeki, for example, has been here for eight years – she came here right out of residency. Dr. Patricia Patterson has been a practicing pediatrician in the Port Arthur area for 30 years – she merged her practice with us. Dr. Mary Pastor, a family practice physician, has been with Gulf Coast for eight years so she has a lot of experience,” Hartman said, describing perhaps GCHC’s greatest assets when he arrived.
“The service they can provide is only as good as the infrastructure to provide it in,” he observed. “If you’re limiting their practice to one or two exam rooms and you give them one assistant — these guys still have a heart for medicine but they can’t give that quality service without the infrastructure.”
In the course of a year, there has been a remarkable transformation, albeit one that definitely remains a work in progress. The walls have been painted, new carpet laid and the dingy, old furniture consigned to the dustbins of history. Bright artwork adorns the walls, including a number of paintings by Herb and Cindy Kreutzer of Kizmet Studios in Groves.
Patients sit in discrete waiting areas, depending on which practice they need to see. Their numbers at any one time have dwindled because the new appointment system has imposed order where chaos once reigned. Plant workers in Nomex suits sit alongside other men and women, with most youngsters in waiting rooms designated for sick and well children.
A series of specialty clinics dedicated to women’s health and pediatric care are nearing completion with services including well-woman visits, immunizations, prenatal/obstetrical care and well-baby visits with ancillary services and even sports physicals. Partnerships with local hospitals for delivery services are enhanced by the new electronic medical records system that ensures all relevant patient information will be available at the hospital at the time of birth.
Hartman’s background in military health care has no doubt contributed to his early success at GCHC, and his attitude remains optimistic. Hanging on his office wall is a portrait of another optimist, Ronald Reagan.
In response to a question from a visitor, Hartman said he is not a doctrinaire Republican. He described meeting the president when he attended 1984 Republican National Convention in Dallas. He had press credentials from an uncle who was an editor with the magazine U.S. News and World Report, and was allowed on the delegate floor where he shook hands with Reagan.
“I admired Ronald Reagan,” said Hartman. “He was somebody that I felt truly cared about people.”
A larger part of his commitment to improving access to health care is personal, as he described the plight of his brother.
“He and I were blood cousins but we called each other brothers and were inseparable for years,” began Hartman. “Don was a self-employed contractor and had a lot of problems obtaining health insurance and he had medical issues. Because he couldn’t get medical insurance, he often couldn’t get his medication. When times were good, he had plenty of money and had health care. When times were bad and he had no income coming in, he cut back.”
Pausing for a moment to reflect, Hartman finished the story.
“At the time, I didn’t know there were places like (Gulf Coast) and neither did Don … as a result, he died at the age of 55 and a lot of it could be attributed to poor health care. Had he received routine treatment, he would be alive today.”
A significant alteration to the GCHC equation is the determination of who is medically needy these days, with so many people lacking basic coverage, including many with jobs.
“We offer to see them on a sliding scale,” he said. “As more and more private physicians refuse to take Medicare and Medicaid, we are seeing many of those patients here.”
Even more surprising is the way this former “clinic of last resort” is expanding its client base in the shifting health-care environment.
“As businesses reorganize their benefits, a lot of them are dropping their health-care options. Health-care costs are rising so much that people need to find a way to make their medical dollar go further,” said Hartman, adding that the new GCHC is willing and able to lend a hand.
“We negotiate with companies who can no longer afford health care. Instead of dropping their employees altogether and paying the fines – something like $750 a year under the health-care bill – they still want to offer (employees) something, so they come to us,” he related.
“We negotiate a capitated rate — in other words, we agree to see their employees and we are their primary care home. All the company then has to do is offer a plan in case there is a catastrophic need,” said Hartman, who described a scenario that would have been unthinkable just a few short years ago.
“For example, they can agree to give us $70 a month per employee and we will see those employees as often as the employee needs to see us,” he said. “There could be a negotiated co-pay, but we will see the employee if they come six times or 15 times for that set fee. It gives us the incentive to take care of that patient while they’re here instead of creating an atmosphere where they have to keep coming back again and again.”
As GCHC continues to broaden its client base, they have not neglected other areas of concern beyond its headquarters on Memorial Boulevard in Port Arthur. Their innovative approach to serving uninsured and underinsured patients while offering employers another health care option will continue in Port Arthur, Silsbee, Newton, Orange and Beaumont when that facility reopens later this year.
GCHC is also reaching out to another underserved population – the homeless.
“We have a mobile unit to start a homeless outreach,” said Hartman, an effort that will be funded by homeless outreach grants from HRSA.
“The idea is to have the mobile unit at the same place each weekday to offer medical services at no cost to homeless people by a nurse practitioner or physician’s assistant,” he said. “They are part of the group showing up at emergency rooms in insulin shock or having some kind of chronic disease we could help manage.”
Hartman suggests these unnecessary ER visits are further inflating medical costs and clogging emergency rooms with patients who don’t need to be there.
“Beaumont has the distinction of seeing 800 percent more non-emergent cases than anywhere else in the state of  Texas meaning people that who do not have medical homes go to the emergency rooms for anything,” he said.
Finding ways to treat medically underserved patients before they end up in the ER makes sense from both a social and financial point of view.
“I was standing in Baptist emergency room last week and the majority of the people sitting there could have been seen in a private practice office, but they don’t have a medical home through lack of insurance or under-insured,” said Hartman. “Baptist has a huge patient set that shows up who have Medicaid and Medicare – they just have nowhere to go.”
Ultimately, this system is unsustainable.
“It increases the cost of health care,” Hartman said. “For Baptist, the moment the ER patient walks through the door, it costs $200 and they are only reimbursed for $45.”
Some combination of innovation and a return to traditional practices that provide patients with a medical home will be required to restore sanity to the practice of medicine for the masses. David Hartman and Gulf Coast Health Center don’t pretend to have all the answers, but it seems they are asking the right questions. 

Amazon’s Texas Rumble

Gov. Rick Perry sides with company in $269 million tax dispute

By James Shannon
Business Journal

When the Dallas Morning News asked the Texas Comptroller’s Office in 2008 why retailer didn’t collect sales tax when it operates a distribution center in Irving, it prompted a state audit of Amazon’s operations.

Last August, Comptroller Susan Combs sent Inc. a bill for $269 million in uncollected sales tax on sales to Texas residents from December 2005 to December 2009. That action became public when Amazon disclosed it in a quarterly filing with the Securities and Exchange Commission in October.

Wrangling between the parties in the ensuing months proved fruitless. With the case pending before the State Office of Administrative Hearings,  decided to pull out of Texas and close its distribution center in Irving.

A total of 119 people stand to lose their jobs according to a letter the company sent to the Texas Workforce Commission. The notice from Amazon was required by the federal Worker Adjustment and Retraining Notification Act if an employment site shutdown will result in job loss for 50 or more employees during any 30-day period.

The notice came one day after Amazon vice-president Dave Clark’s e-mail to workers about the Irving center’s closing was obtained by the Associated Press. In that e-mail, Clark said Amazon also is scrapping plans “to build additional facilities and expand in Texas, bringing more than 1,000 new jobs and tens of millions of investment dollars to the state.”

The tide in Amazon’s Texas rumble may be turning, however. Last week, Gov. Rick Perry told the Washington Examiner (a conservative D.C. weekly not connected with the Beaumont Examiner) that he disagreed with Comptroller Combs’ attempt to collect the disputed $269 million from Amazon.
"The comptroller made that decision independently. I would tell you from my perspective that's not the decision I would have made," said Perry.

His comments were not limited to criticizing Combs. Perrry said he would ask the Texas Legislature, currently in session, to enact a bill resolving the dispute in Amazon’s favor.

“Hopefully someone will be able to craft some legislation - and actually do it - before Amazon walks out the door. Texas should be a place a bastion for businesses not one where they're sitting there going 'we'd rather go over to go to Oklahoma where we get a better deal."

In fact, disputes over sales tax collections on Internet sales are not limited to Texas – or Amazon. According to a Wall Street Journal report, “Critics of the status quo argue and other Internet retailers enjoy a significant advantage over brick-and-mortar competitors, which collect sales taxes. It also comes as many states wrestle with large budget deficits and look for new sources of revenue.”

Amazon has also been involved in battles regarding sales tax laws in states including New York, North Carolina and Colorado.

This article appears in the February edition of the Beaumont Business Journal

NCS rocks Super Bowl

Beaumont firm touts IT prowess

Southeast Texas television viewers of the Super Bowl saw more than an exciting game of football. Wedged between bouts of gridiron glory from the Green Bay Packers and Pittsburgh Steelers was a brief commercial from Network Centric Solutions featuring NCS founder and CEO Desi Ramsey and his ubiquitous marketing and new media director Vyki Alleman.

In a visually compelling spot produced by Derek Womack, Ramsey and Alleman come across like Scully and Mulder from the X-Files as they emphasize that technology is changing faster than ever and pose the question “Is your business ready?”

They have an answer, of course: Secure your future, go to