Consulting firm discusses plan to address medically underserved Laredo

Following last week’s stakeholder meeting with Healthcare Management Associates, city leaders heard more about the consulting firm during Monday’s city council meeting.

Laredo Health Department Director Richard Chamberlain recommended the firm for their past work, but the decision will be made at the next council meeting.

“We did meet as a group of stakeholders, which did include local providers and of course executives from our health care organizations here in the City of Laredo, and it was our recommendation to go with HMA as a consultant that can help guide us but also provide us a plan of action,” he said.

Stephen Palmer and Iliana Gilman represented the firm and spoke at length about the Healthcare Management Associates and the consulting process Laredo would undertake. Gilman indicated that three workstreams would be used that would review hospitals and interview stakeholders, solutions to bridge gaps and a funding mechanism.

While the firm was not hired on Monday, Palmer indicated that the service would take approximately six months and would cost approximately $225,000. Councilmembers Alberto Torres and Marte Martinez made sure to point out that the consulting firm’s guidance was needed by the city as well as a funding source to fund Laredo out of the medical undeserved designation.

According to Palmer, if contracted, Laredo would be the first South Texas border city they work with, but that the firm has worked with similar cities. However, Mayor Pete Saenz brought up the unique aspect of a border city, which is how residents travel to Nuevo Laredo to find affordable health care. He said that they have dealt with different areas where residents seek care in different ways, but that HMA is accustomed to taking it into account and understanding the different subgroups in a population need.

The presentation outlined the workstreams, as the first would see analysts on-site at the local hospital and health care sites for two to three days. HMA would catalog the facilities, services and the gaps in care. Additionally, they would assess active provider supply and personnel resources and examine current and projected health care services and capacity.

The second portion would be to find gaps. This would include gathering information to inform the city on forming a municipal hospital authority. Palmer said that the group of stakeholders advised HMA to not research a public hospital district but a municipal health authority. This is an established structure by a city that can lease hospital services from private hospitals.

One challenge HMA noted Laredo’s high rate of uninsured residence that go to ER or clinics for health care needs, Palmer said. This results in a need to improve the financing of health care, through public or private funds and attracting new providers and physicians.

The presentation also stated that while gathering information, the approach would analyze the statutory framework of the city, analyze the landscape of other municipal hospital authorities in Texas and interview stakeholders involved with others in Texas. Palmer cited that the move may increase hospital bed capacity at hospitals, but Health Authority Dr. Victor Trevino indicated that the issue came down to the lack of nursing staff to attend the number of beds.

Trevino said that the difficulty in retaining nurses is due to the disparity of salary, which sees nurses move to other areas where they get paid better. Palmer said that while for-profit hospitals have to maintain their margins and may not issue a higher salary, the municipal hospital authority can issue bonds to make local investments in health care infrastructure.  

In regards to financing, the final workstream would involve developing an understanding of health care funding mechanisms. HMA would research and advise the fund flow and balance, research and advise on appropriate funding structures, including tax sources and bond issuances and lastly create an assessment and recommendations for facilities and equipment.

Ultimately, the choice will lie on the councilmembers in the upcoming council meeting, however the HMA representatives highlighted why they believe the firm can help the city step away from being medically underserved.

They stated that since starting in 1985, the worked to provide realistic and actionable strategic planning and the firm is made up of experienced local and national thought leader for tailored solutions. Furthermore, they laid out a map of experts that would help in the efforts that include policy experts, hospital and health care executives and more.

Gilman herself is originally from Laredo and cited that while they would look at national trends, local solutions are a focus. She cited the pandemics impact which prompted the city to address the decades long issue. As the pandemic stabilized and the federal health experts announced that the country is pushing out of the pandemic phase in April, time is of the essence until the next health crisis to address the current health concerns of the city.


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