The fracturing, mill pieced health care system in rural Texas
This is part 1 of the Lubbock Avalanche-Journal’s health care series entitled, “Rural Healthcare — The Future of Medicine.”
Editor’s Note: Portions of the data and quotes used in the story were originally published last year as part of the A-J’s ongoing rural healthcare series.
The healthcare industry as a whole faces numerous challenges on a national level. The hurdles to receiving adequate healthcare are seemingly insurmountable, from rising drug costs to a workforce shortage.
Those challenges are only exacerbated in rural West Texas by the sheer size and space of the 108 counties that comprise the region.
Dr. Billy Phillips Jr., executive vice president for Rural and Community Health at Texas Tech Health Sciences Center, said the number of doctors in Texas is “barely adequate,” with a ratio of 1,300 to 1,600 patients per doctor.
“If you look at the United States, and particularly west Texas, for the next decade, 2034, we’re in the US are projected to be short about 125,000 doctors, and that’s even more profound in rural areas,” he said.
The ever-growing need for a workforce is prevalent, but there are other barriers West Texans face to receiving adequate healthcare — especially in emergencies.
However, Texas Tech Health Sciences has noticed these issues and is taking further steps to correct them before they worsen.
Connecting people across the Texas sea of dirt
It is a known fact that if you want to get anything done in the 21st century, you have to be connected to reliable internet.
However, according to the newly established Texas Broadband Development Office, nearly 2.8 million Texas households and 7 million Texans lack broadband access.
The office also compiled a map that shows the serviced area in Texas and whether the serviced area is being served 100 download and 20 upload megabits per second internet speed.
For context, it is recommended for midlevel quality individual video chat to have 1.2 Mbps and 2.6/1.8 Mbps for group calling on Zoom. For Netflix, it is recommended 3 Mbps for HD streaming, 5 Mbps for FHD and 15+ Mbps for UHD.
According to the Federal Communication Commission, this internet speed level is above the required 25/3 Mbps speed, which the Texas broadband office notes as inadequate for Texans.
The broadband office also notes some areas that are connected are receiving less than 25/3 Mbps and are classified as unserved.
According to the Washington Post, FCC Chairwoman Jessica Rosenworcel said in 2022 that the FCC should update the term broadband to 100/20 Mbps, but the commission has not done so.
The map also shows major swaths of the South Plains, Panhandle, West Texas, Far West Texas and Permian Basin regions where residents are not connected to the internet.
Recent legislation is working to address this issue, specifically through House Bill 9 of the 88th Texas Legislature.
This bill would create the $1.3 billion Broadband Infrastructure Fund, which would add much-needed funding in this area, but it’s currently on hold for voters to approve or deny it in the November election.
Funding Critical Access Hospital
Last year, the CEO of Covenant Health spoke to the A-J about the importance of rural hospitals receiving critical access hospital designation.
“The rule is you need to be 35 miles from the closest approximate hospital to be licensed as a critical access hospital,” Walter Cathey said. “If you look at the geography of West Texas, they’re these perfect little boxes, right? And pretty much every hospital sits at the county seat. They’re exactly 30 miles apart from each other.”
On average, Cathey said rural hospitals only see a profit of $50,000 to $100,000 every year and if they receive the designation, they will receive more funding from the federal government to support the hospital.
According to information pulled from the Flex Monitoring Team comprised of the Universities of Minnesota, North Carolina at Chapel Hill and Southern Maine, out of the 108 counties northwest of San Antonio, there are only 46 hospitals designated as CAH.
Only two Trauma 1 facilities and three Trauma 2 facilities are located in Lubbock and El Paso in the 108 country region. According to the state’s Health and Human Services, there are also 10 Trauma 3 facilities throughout the area.
According to the American Society of Trauma, the difference between each designation level is based on the type of surgeries/specialties the facility is equipped to do.
As the healthcare field changes, the need for funding is ever-present to help the hospitals stay open. According to a map compiled by the A-J, individuals can live far from their county’s or the next county’s hospital.
If an emergency arises, every minute counts and if a situation rises to the level where a patient needs to be transported to a Trauma 1 or 2 facility, then they will have to be transported hundreds of miles.
Another option is to build more hospitals across the region; however, building a new hospital comes with a hefty price tag. Cathey said that it costs over a million dollars per room to equip a hospital room with the necessary amenities.
This situation calls for more funding to be poured into the Texas Rural Healthcare System while also calling for innovations to help lessen the burden on the system, like telehealth, which also ties into the need for broadband access.
What’s the solution?
There are numerous issues the healthcare system is facing and there will be no one-size-fits-all solution; however, there is one entity in Lubbock taking that mantle to help fix the system.
Servicing 108 counties of the panhandle, border, Permian Basin and West Texas region, the Texas Tech University Health Sciences Center in Lubbock created a new institute to help solve this issue.
Naming John Gachago as the institute’s executive director and having a close partnership with the F. Marie Hall Institute for Rural and Community Health, the new Institute of Telehealth and Digital Innovation is ready to embark on its mission.
“It’s looking at this rural health scenario and saying, ‘How can technology be the differentiator?’” Gachago said. “How can technology work so that you living in Alpine or Presidio can get good quality care, even though there’s a long distance.”
Through the power of drones, reinventing NexGen 9-1-1, tapping into teletherapy, and so much more, TTUHSC and its institutes are leading the way in reinventing how healthcare looks for West Texans.