Growth of health care issues causes alarm Community medical care

for the county, accounting for more than $300 million of total charges at an average cost of $54,000 per patient.

Montgomery County hospital patients stayed 5.4 days at a cost of $42,000 — the highest averages in the Houston region.

Escott said those charges are most damaging to families living paycheck to paycheck.

He said that if there were more primary care options like clinics and health centers in the community, many admissions could be avoided. For instance, patients often seek hospital care after their blood pressure elevates and they can’t afford their prescribed medication.

“But that one hospital visit would’ve paid for their hypertension medication for the rest of their lives in many circumstances,” Escott said, adding that other problems include patients running out of medication and not scheduling an appointment, or not being able to afford a refill.

Most of the residents admitted to Montgomery County hospitals live in Conroe and in the southeastern and northwestern corners of the county, according to state data.

A 2013 Texas Health Institute study revealed that one in five Montgomery County residents did not have a primary care provider. Another 15 percent reported foregoing care because of costs. Dealing with growth

Many residents don’t seek care unless they’re sick, Escott said.

“We’re taught from a young age that we should go to the doctor when we’re sick,” he said. “But in reality we should go more often because even though you feel fine, you’re probably not.”

Montgomery County is on pace to have 1 million residents by 2040, twice its current population. Two hospitals have already broken ground in the county, and they’re expected to be operation- al later this year. Still, the county is struggling to serve an increasing population of low-income residents.

The Tomball nonprofit provides health care to uninsured, low-income families and individuals in Montgomery, Harris and Waller counties. Deyo said TOMAGWA provides post-hospitalization and follow-up care. She projects more than 14,500 uninsured patients will visit this year

However, Deyo said the number of people seeking medical care is outpacing resources, and officials last year were forced to turn away patients, a decision she hopes to avoid this year.

“It was a very tough decision,” she said. “It’s my belief that there aren’t enough resources in the county to meet our needs.”

She said she’s hoping to see more in-kind gifts, grants and donations this year.

Many communities in the Houston area are underserved, according to the U.S. Department of Health and Human Services. Such communities have a lower-than-standard ratio of primary medical care physicians per 1,000 residents. At least half of Montgomery County has more than 3,500 residents for every one physician.

With more patients headed to the ER, the Texas Department of Health Services has a program to curtail avoidable admissions, but for now less than half of Texas counties qualify. The state now provides aid to 13 counties, including Liberty and Walker counties, on a budget of about $2 million set aside by lawmakers. So far, that investment has resulted in a 14.8 percent decrease in hospitalizations and a sub- sequent drop in hospital bills, which fell by $10 million from 2012 to 2013.

“We have a long way to go,” Gilliam said. “But our hope is that the initiative will grow and help the state provide better health care for everyone.” Solving problems

The initiative works by identifying the specific admissions each county struggles with and then educating health care officials on solving the problem. For instance, in Liberty County, county residents are admitted for bacterial pneumonia, congestive heart failure and chronic obstructive pulmonary disease.

The program has led to the county establishing nutritional and smoking-cessation services to lower admissions.

“It allows us to see how to better serve a community,” Gilliam said.

The Texas health department plans to ask lawmakers for $3.4 million to expand the program to support 27 additional counties, Gilliam said.

The state estimates that by funding 27 severely affected counties with low to moderate populations, it would result in 6,450 fewer hospitalizations and $230 million less in hospital charges. “Every county is different and has its own set of issues,” Gilliam said. “We hope this program will lead to better health care and lower cost across the state.”

Though Montgomery County doesn’t qualify for state assistance, Escott said the community is focused on solutions.

“We’ve had many success stories,” he said. “What people needed was not a hand out — they needed someone to help them be engaged. We’re creating plans that actually work, and that goes beyond simply writing a prescription.”

john.harden@chron.com