Reforming the reform
It is doubtful that few, if any, in the city of Houston are greater scholars of the health care reform bill than Dan Wolterman, president and CEO of the Memorial Hermann Healthcare System, the state's largest non-profit health care organization with more than 20,000 employees.
The 2,000-page bill sits behind his desk in the new tower at Memorial Hermann's Memorial City Medical Center. And, yes, he has read it all.
With more than 27 years experience in the health care industry, Wolterman is often invited to speak about the status of health care in America and health care reform before various local, regional and national groups and organizations. And the conversation inevitably moves to the Patient Protection and Affordable Care Act, signed into law in March 2011.
"My role is to be apolitical so the bill is what it is. It does give access to health insurance but it's not necessarily going to be a panacea for Houston."
CultureMap sat down with Wolterman recently to discuss the current state of health care and his view of the changes coming in health insurance for all Americans. Following are excerpts from that conversation.
CultureMap: What is the basic problem with health care today?
Dan Wolterman: We need a more coordinated approach to how we deal with the uninsured and the poor who need access to health care in this community. We have a lot of resources being thrown at it. But it's uncoordinated. It's duplicative. And we're not getting value for the dollars we spend. I would love to see a coordinated community-wide effort to help deal with the problem of access to health care for the poor.
CM: The new health care bill is supposed to resolve that, isn't it?
DW: I don't believe that it's all going to change and here's the reason why. This is not a criticism of the bill. My role is to be apolitical so the bill is what it is. It does give access to health insurance but it's not necessarily going to be a panacea for Houston.
We lead the country in the uninsured, about 33 percent. Under the bill when it goes into play in 2014, it specifically excludes undocumented individuals. An undocumented individual cannot get insurance coverage either under this bill or even if he has the proceeds to go buy it himself. They are prohibited from obtaining it and insurance companies can't sell it to them.
CM: What does that mean for Houston?
DW: Most people say that of the 33 percent that are uninsured, anywhere from 12 to 17 percent is made up of the undocumented. So we believe that we are going to have 15 to 16 percent still uninsured at the end of the day, a number that the rest of the country won't have. The only access to care that they can then have is in our hospital emergency rooms.
And (with the new law) there's no payment because the federal government, in order to pay for the health insurance of the other Americans, is taking away what is called Disproportionate Share Hospital payments. That pays entities like Memorial Hermann that does so much charity care. They're taking those dollars away to insure these others.
Now in other parts of the country that don't have the undocumented problem, that's fine. But for us, we're still left with the undocumented and now I get no additional funds to help offset my costs, which we had been getting. It still didn't cover all the costs but it helped cover some of the costs. Now, we're going to be left without those safety net dollars but still having to take care of a very high percentage of the uninsured.
CM: But you still have to provide for the undocumented?
People say then just don't care for the undocumented. Well, federal law says that we have to serve everyone who comes to the emergency room. It's called EMTALA, the Emergency Medical Treatment and Active Labor Act and it requires hospitals and ambulance services to provide care to anyone needing emergency health care regardless of citizenship, legal status or ability to pay. So everybody knows that's out there. So we have to take care of them.
Even it we didn't, it becomes a public health hazard for this community. If individuals are walking around with a communicable disease and spreading it across the community because they have no access to care, no way to get medicine, then Houston is not going to be a healthy place and that will start to have a drag on our economic prosperity as a growing community.
We have to find a way to treat all individuals in this community in a systematic fashion. I don't want to get into the debate about immigration whether it's good or bad. To me they're human beings that have a health problem and we have a moral obligation to do something about it.
Then the real argument is who should pay for it. As a health care provider, I'm more interested in the care than in who should pay for it.
CM: So this is a challenging problem on many levels.
DW: The problem with the health care reform law also is that it really doesn't attack the fundamental problems driving the cost of health care in this country. It does not get at the issue of over-utilization of the system. By that I mean too many tests being ordered, too many hospitalizations.
And that's all being driven by our reimbursement system, which historically has been what is called fee-for-service. A doctor or a hospital doesn't get paid unless a patient comes in ill and you provide a service to them to help cure them and you get paid. You don't get paid for prevention and wellness.
The fee-for-service system has been around for a long time and as health care costs grew, payers, whether the government with Medicare or Medicaid or commercial insurers, wanted to ratchet down what they pay a doctor or a hospital. So when they ratchet that number down, all the doctors and hospitals do is add more volume.
I remind people that the cost of health care isn't the cost of what you pay a physician or a hospital. It's what you pay that's price times volume, that equals costs. People forget about the volume. It's the volume side that has driven up the cost of health care in this country. And this bill does does nothing to change the reimbursement system.
Fee-for-services is not a reimbursement system that you find in very many other countries. It's usually some kind of fixed payment per year per person system. The providers are then incentivized to keep you healthy and well because they are getting only a fixed amount and it's better to keep you healthy than wait for you to get sick and then take care of you.
CM: Are there other areas of concern with the health care reform law?
DW: There's a second issue of the bill — that there is no requirement for individual accountability for good health and that's been a perplexing problem. People say, well we can't put it in because this is America and people can do whatever you want. And I agree. This is America and people do have choices. They can choose to smoke. They can choose to abuse alcohol or be obese or whatever it may be. I'm not refuting that.
But I think there ought to be a consequence to that action. It's costing society and everyone else who is trying to do the right thing.
So whether it's an incentive for people to stay healthy and they get a big deduction off their insurance premium or there's a negative where you add to somebody's insurance cost, there ought to be some consequences to your individual health choices. We need to get our hands around that as a country.
CM: But at least everyone will now have health insurance and we can resolve those issues?
DW: There is a big problem with this bill in that the underlying premise is that more people will be insured. I'm not a believer in that personally. I've spoken all over the country on this. And there are now studies coming out. There was one that said 30 something percent of employers will drop health insurance in 2014.
And here's the reason why. In 2014, employers who have 50 or more employees have a mandate to offer insurance. It also says though that if you do not wish to offer your employees insurance then you can opt out and meet the law by paying a $2,000 penalty per employee per year. The problem with that is that today a current employer now pays about $12,000 for a family policy. Health economists say that by 2014 that number will probably be $14,000 or greater. So if it's costing you $12,000 today, or $14,000 down the road, and you can opt out at $2,000, why is an employer staying in?
And I've tested this. I spoke in Phoenix recently, where I spoke to 34 of the 50 largest employers in America. At the end of the day, I said to them "How many of you are actively thinking of dropping health insurance?" Every hand in the room went up. Not one single hand remained down.
When I asked why, they reinforced what my thoughts had been all along. One, "our shareholders are going to say that the dollars are too big. These are large international employers. And the gap difference is too big of a savings. Shareholders are going to demand that we do it."
Number two, "We are competing in a global economy today and the price of our product has embedded in it the high cost of health care in America for buying insurance. We're competing against China and Japan and Germany, who only have this amount of health care cost in their product. My product can't be priced competitively and we're losing market share. So now the shareholders are going to say, 'Wait a minute if you can go from $14,000 to $2,000 and use that savings to reduce the price of product and now you're competitive, you sell more products'."
(Wolterman used Memorial Hermann as an example. Heath care costs last year were $108 million. In 2014, under the opt-out plan, Memorial Hermann would be required to pay only $44 million in penalties by opting out. "I save $64 million that could go to health care services. It's a compelling argument against why offering health insurance," he said.)
CM: But aren't there some legal issues at the moment regarding the requirement that everyone get health insurance?
DW: Yes, the second mandate is the individual mandate which is under challenge by the court system. Let's assume it's constitutional. An employee goes to state health insurance exchange where he's offered insurance at the bronze, the silver, the gold or the platinum level. He's looking at a $6,000 to $7,000 spend for the bronze, but he can opt out too. The penalty is $98. He can opt out for $98.
For middle income Americans or even lower income Americans $6,000 or 7,000 is a big number. My premise is that most people will opt out. This is the biggest flaw of the bill.
CM: But what if someone opting out suffers a catastrophic illness or some such?
DW: It's not an issue. Say that I elect not to insure anyone in my family. We're healthy. My wife gets hit by an 18-wheeler and I learn that it's going to be a long, drawn-out recovery, a $1 million issue. The first thing I do is place a call to the state health insurance exchange and say I need insurance and I'll take the platinum policy, effective immediately. They cannot deny that because of this thing called pre-existing conditions. Under the bill no pre-existing condition can be a basis of denying insurance. So I can buy insurance anytime I need it.
So if you can get out for $98, and Americans will probably start getting knowledgeable about this, and no pre-existing conditions can keep you out and you can at any time opt in and opt out, why would you buy health insurance? So I think the uninsured will go up in the country.
I think employers will exit. I think individuals will not buy and then they will only buy when they need it. People say I'm wrong. They say that in Massachusetts, 98 percent of the people are insured. Yes, but that's not for the entire year. Data from insurance companies reveals that the average health policy is held 5.5 months. If you dig below that, they will tell you they buy it when they need it, when they have an event, and they drop it the moment the last bill is paid. That's why it's 5.5. months.
If you really want the uninsured problem to be fixed, you should have set the opt out penalties closer to the current cost of health care to make it really difficult for an employer to opt out or an employee to do it. But that's not what we have. And so the bill's got to be fixed . . . One way is to give a person only one time a year the ability to opt in or out of the system. You opt not to take it if you get ill during the year, you're rolling the dice, you can't come in.
We can't deny you at the beginning of the year for a pre-existing condition, we've got to insure you. But you made that decision, you could've bought health insurance, that's your decision we're not going to bail you out.
CM: This is disturbing information. What next?
DW: The bill's got to be fundamentally changed, to change the incentive. There are a lot of flaws in this bill.
I still believe in the fundamentals of the bill, but even Congress doesn't understand it. Most people haven't read it. Congress hasn't read it by and large and they don't know what's in it. I've studied it. Give speeches on it. There are some good things in the bill. I don't want to trash the bill. We need to insure everybody and give them access to health care.
The problem is that there are more fundamental flaws in this bill because it's a patchwork of different concepts and they just threw it all together and it just doesn't work.
CM: What's your final take on this?
DM: Let's don't get caught up in the health reform bill. Those of us who've been in the industry for a long time, whether it's a physician or a health care executive, the great majority will say in a moment of honesty that the system is broken. It has been broken for a long time. It needs transformational change.
The current system is unsustainable. It's unsustainable for the patient. They can't get access and they can't afford it. It's unsustainable for business. They can't afford it. And its unsustainable for the federal and state governments. It's causing them to run huge deficits. We have to change it and frankly the system can be changed to be better.
So the question is how and when and that's where the big debate is. No one can come to an agreement. Everybody has different ideas. I believe the provider community has to rise up and come up with a common system that we think is in the best interest of the patients and quality of health care and propose it. I think if we wait for the government to come up with a system, it will fail. But the providers are so mixed in the thinking on how to fix this that we haven't even come close to putting a solution out there.
CM: Where do you personally intend to go with this?
DW: As I approach 55 and start thinking about the latter days of my career, one of the things I'd like to go out as is as being one of the people who helped drive a transformation of the American health care system. One that's better for the patients, better for the providers and affordable and sustainable financially for the country. It's going to take courage, creativity and innovation. I'd like to be a part of that.
I dread the alternative. The alternative is on a collision with government controlled health care.
Dr. Ron DePinho doesn't become head of the University of Texas M.D. Anderson Cancer Center until Sept. 1, but he's already raring to go. "I think Houston is going to be the place where cancer is tamed," he said during a recent interview. "We're going to kick cancer butt."
DePinho, who is leaving his position as director of the Dana-Farber Cancer Institute's Belfer Institute for Applied Cancer Science in Boston, has made weekly trips to Houston throughout the summer, where he has met with hundreds of employees across all levels of the institution to better understand how it works.
"I've been down here at least a dozen times (in the past) to give lectures, but to really look under the hood and see the inner workings of the institution, it's very exciting. I don't think that there is something of this magnitude and this depth that exists elsewhere," he said.
He was drawn to the fight against cancer after his father died of the disease in 1998. "That transformed my career from one of thinking about the science and publishing high-profile papers to one (of believing) that it only counts if the science actually ends up getting into the clinic," he said.
As only the fourth permanent president in Anderson's 70-year history, DePinho says one of his chief goals will be to translate the latest scientific research into effective clinical trials, targeting specific cancers with specific new drugs that show high promise to cure or curtail the disease and get them to market.
"M.D. Anderson is the best cancer hospital on earth. For it to remain in that premier status it must embrace and incorporate today's brilliant science fully into the fabric of how we do clinical medicine. That science is really going to enable us to change the course of this disease in a most fundamental way," he said.
As an entrepreneur who has founded several biotech companies, he also sees building relationships with the private sector as a big part of his role.
"One of the deficiencies in Houston is the biotechnology community needs to be better developed," he said. "My experience in building a half-dozen companies over the past decade is going to help me with that activity."
"One of the deficiencies in Houston is the biotechnology community needs to be better developed," he said. "My experience in building a half-dozen companies over the past decade is going to help me with that activity. Houston's got great resources. It's got a phenomenal talent pool and work force. It's got the infrastructure and the space. The only thing that it's missing is gifted managerial leadership with a lot of experience in biotech. That, I think, can be fixed."
His groundbreaking work on reversing the aging process has drawn a lot of attention, including an appearance on The Colbert Report in January where he matched wits with host Stephen Colbert.
"I love to educate and communicate," said DePinho, 56. "I thought it would be a great forum to educate the public about what's going on in the aging sciences and what the challenges are."
Being in the public eye will be "one of my key jobs" at Anderson, DePinho said. "I am the face of the institution. This position here in the most important cancer enterprise on earth demands that you be engaged with the public, the government and the scientific and clinical community at large."
Here are some excerpts from our conversation.
CultureMap: What factors attracted to you to M.D. Anderson?
Ron DePinho: It has a lot to do with where we are in the history of cancer medicine. We're finally at a point where there is a confluence of genomics, computational firepower, the ability to manipulate genes at will, to engineer living organisms with precisely the same mutations that enable us to identify the best targets and the best drugs for those targets. I think the rubber is going to meet the road in bringing those scientific discoveries to clinical end points.
M.D. Anderson has already done the hardest part of that equation, which is to get the best cancer medicine and the most powerful translational cancer medicine programs on the planet. The challenge now is to bring all of that newfound knowledge into the clinical arena. Historically it's been very difficult to bridge that chasm. In the past couple of years that has changed completely because our ability to conduct science in the clinical arena is now possible. It's a remarkable opportunity.
CM: How is this big institution going to change under your leadership?
RD: All institutions that are focused on cancer are going to have to change and M.D. Anderson is no exception. While we know a lot, we don't know enough yet to cure this disease. And so every few years we are humbled by our ignorance. It's clear that cancer is extraordinarly complex and we need to understand it more. So under my leadership we are going to be strengthening multiple aspects of the science. Where we will stay the course is in maintaining our leadership position in the clinical arena. We are going to keep our eye on the clinical ball.
There's an enormously high rate of failure in cancer drug development — a 95 percent failure rate. Over 50 percent of those failures occur at Phase III clinical trials. Let's think about ways to reduce the rate of failure. Our clinical trials often fail because we don't know where the gene is important or which patients we should apply that drug to. So what I hope to develop is a goal-oriented continuum of activites that responsibly takes discoveries from these very early stage observations to highly validated targets.
CM: Are you going to put more resources into research?
RD: We have a lot of headwinds here. We have contracting state budgets, decreasing pay lines from the NIH, research is more expensive. We have diminishing clinical revenues as a result of reimbursement for managed care. All of these forces are conspiring to reduce our resources. So we're doing lots of things to enhance our resource position. I will work tirelessly to inspire our community to support us.
Another component is to enhance the science so we're more competitive in securing grants and attracting the finest trainees to this instiution. I'm going to put a lot of effort into enhancing the graduate program, the young physician scientists, the clinical fellows to attract the best and the brightest and once they're here educate them so that they achieve their fullest potential.
CM: What has surprised you about what you've seen?
RD: The enormity — 18,000 people (work at Anderson). One of the things that has been a really pleasant surpise has been the excellence of the science. The clinical and translational activity here is so world leading and so powerful that I don't think the science gets as much respect as it deserves. To see the collective talent that exists in the basic science department has been refreshing and quite impressive.
More broadly, the Houston macro environment is something I've been pleasantly surprised with. I was born in New York. I think one of the really pleasant surprises of Houston is its progressive nature. Its culture is quite impressive. The restaurants here are fantastic. I'm having to redouble my efforts in the gym. Not a surprise has been the warmth and hospitality of the community. I've seen this at all levels.
CM: What is the largest number of people you have managed?
RD: I manage currently a couple of hundred at the Belfer Institute. I think what's positioned me best to run (Anderson) is not any single effort that I have organized or run but the collective experience I have had.
I've run a large lab in basic and translational science. I've run an institute which developed this new construct for applied cancer science at Harvard. I have two of the most significant academic corporate alliances in history that have helped me build productive relationships between academia and industry. I've started and founded and help direct several biotechnology companies. That taught me a lot about business and how to develop drugs. And I've been a physician. I love clinical medicine.
It's the diversity of these experiences. I feel very comfortable talking to the business guys, because I know a P&L. I can talk to the physicians because I can diagnose chest pain as well as they can. And of course, I know a lot about basic science. One of the critical things I'm interested in in Houston is to actually build more productive relationships with the private sector.
CM: Sometimes it's hard to convince executives to come to Houston because of the city's perceived negatives. Was there any issue with your family?
RD: Everyone has prejudices. Once I learned the facts I was shocked at how great it was at every level. You've got fantastic schools, a great economic advantage, the cost of living for a city of this size and sophistication is extremely reasonable. My kids were thrilled to learn they can now bike in the winter. And then the whole cultural side of things is great.
Also, it's a very diversifed economy. I've been an entrepreneur so I really enjoy business in general. This is obviously a capital for many different businesses. It has a very diversified base. I find that to be very vibrant and exciting. This is the biggest macro environment for life sciences in the United States.
(Note: DePinho's wife, Dr. Lynda Chin, will also join the Anderson faculty. She is currently the scientific director of the Belfer Institute for Applied Cancer Science at the Dana-Farber Cancer Institute. The couple has three children.)
CM: What is the greatest weakness this insitution has?
RD: I don't think it has any significant weaknesses. It's No. 1 for a reason. Its weaknesses will emerge if we do not fully embrace the science. We must have the courage and conviction to be able to bring the best science towards the clinic. And I think the institution has that. I have confidence in that.
CM: What was the Colbert experience like?
RD: I didn't know who Colbert was. I got an email from his producer that I deleted, but my secretary was cc'ed and then my lab found out and they all marched into my office and said, "You have to do this." There was no prep. It was completely ad hoc. Everyone was really frightened that I was going to get eviserated. But my New York upbringing prepared me. It was a fun experience. I was determined to have fun and to stay on message. It certainly penetrated a (younger) demographic I don't normally speak to, which is why I did it.
The much-maligned Bachelor (and Bachelor Pad 2) starlet Vienna Girardi touched down in Houston for a July 15 nose job by plastic-surgeon-to-the-stars, Dr. Franklin Rose. Serving as rhinoplasty liaison was none other than Vienna's Bachelor Pad 2 costar and Dr. Rose's daughter, Erica Rose.
The plastic surgery pairing was a match made in heaven.
"It's funny," Erica tells CultureMap, "before I left for filming my dad said to me to tell Vienna that he wanted to do her nose. I said, 'No, dad, that's rude!' but it ended up working out."
After arriving at the California set of Bachelor Pad 2, the 25-year-old Vienna first approached Erica about Daddy Rose rearranging what she felt was a feature that didn't match her body.
Vienna elaborated on Twitter: "I want my surgery to be looked at as positive reflection of how I feel. If it makes you feel better about yourself then DO IT. xoxo."
"Vienna confessed that she's always wanted her nose done," Dr. Rose says. "She felt her nose was too long and not too attractive."
Vienna explained to Entertainment Tonight, "I have wanted it since I was a little girl. Nine, ten years old I remember not liking my nose. I have my dad's nose. But I don't want a boy's nose. I want to feel beautiful." She added, "I am a little nervous but I feel like it's Christmastime for me. I am finally getting something I have always wanted." Dr. Rose notes that this wasn't the reality star's first time under the knife.
Prior to Vienna's Christmas in July present at the Utopia Plastic Surgery and MedSpa office in Uptown Park, Erica entertained her reality TV homegirl with a Houston Dynamo game and visits to one of the new funeral bars (Roak), La Griglia and Crave Cupcakes.
During her operation at Utopia, Vienna had Erica at her side — along with the film crew of Entertainment Tonight, which developed a feature on the surgery for a segment that recently aired.
Once the cameras turned off and the anesthesia wore away, Vienna was pampered for three days chez Rose.
"She's a very pretty girl, very polite and charming," reports Dr. Rose of Vienna's stint recouping at his family's home. "She was just hibernating in her room. We had to keep a close eye on her because she's a well-known celebrity."
And that celebrity is pleased with her results. "She sent me a text yesterday that said, 'I love love love my new nose xoxo,' " says Dr. Rose. Vienna tells Us Weekly, "It has only been a few days since my surgery and I'm in a ton of pain but the excitement of seeing my new nose soon is keeping me in good spirits. I have my wonderful boyfriend Kasey Kahl here taking care of me and my girlfriend Erica Rose."
The surgeon says that Vienna will have a nose unveiling party in LA in the weeks ahead. "I'm excited to see her new nose once the swelling is down and she has makeup on," Erica says.
Bachelor Pad 2 premiers Aug. 8. Both Erica and Vienna "did very well" on the show according to Dr. Rose. "I think I'll come off in a positive light," Erica says, but she warns, "I get caught in the middle of the drama between Vienna and Jake because I think Jake's not a bad guy. That was kind of stressful. It strained our friendship, but we got over it."
The season also holds "a little bit of romance and a lot of fun" for the University of Houston law student.
"I'm definitely back in summer school," reports Erica, who is on track to graduate from the UH Law Center in December. Regarding her post-commencement ambitions, she says, "That's still up in the air. I could definitely see myself going into entertainment law."
Meanwhile, another Bachelor Pad 2 contestant (whose name cannot be revealed) is beginning talks with Dr. Rose on a potential breast augmentation.
It's a Small World After All
When Baylor College of Medicine’s Center for Globalization opened its doors in March, it was just making official what has been already been happening within the system for years. Inspired by the legacy established by Dr. Michael DeBakey and the ease of connecting to faraway places through evolving technology, BCM is poised to extend its reach to even the smallest corners of the world.
Dr. Navneet Kathuria, BCM's chief performance improvement officer, is at the helm of the center, which serves as an umbrella for BCM's existing international programs, as well as new global initiatives in education, research and patient care. With BCM trustee Wallace S. Wilson’s gift of $5 million, the center’s joined forces with Max India Group, the country's leading comprehensive provider of standardized, seamless and international class health care services.
Kathuria began exploring opportunities with Max in 2007 when he was on faculty at Mt. Sinai School of Medicine and he believes the partnership is mutually beneficial.
As technology brings countries closer together, it is easier for doctors to share insight and information through avenues such as Skype.
“Now that we have formed this agreement, it provides a framework for our research and for scientists to work and learn from each other,” Kathuria says.
While India is the first collaboration of the new center, BCM already had 314 different research projects underway that fit the mission of reaching beyond the immediate borders for education and research, including Latin America, Asia, Africa and Europe, plus research projects in 33 countries. As technology brings countries closer together, it is easier for doctors to share insight and information through avenues such as Skype.
“In the past it would have taken years to travel continents to collaborate with other scientists,” Kathuria says. “Science knows no bounds and this moves science forward."
He points to the economic rise of India, China and Brazil as places the center can reach out to and exchange information. He also stresses that even when a disease seems to be contained to a distant part of the world, it still affects the global population. Everything from SARS to diabetes can be addressed through a comprehensive program developed by collaborative projects.
Although India is the first stop on the center’s map, Kathuria is quick to point out that it’s not just about India.
“Globalization has always been there. Dr. DeBakey was global health pioneer and any institution of higher learning and diversity is smart to partner not just locally, but around the world for their science,” Kathuria says. “It decreases the cost of globalized medicine and takes on a different texture.
"Health care is much more engaged."
No growing pains here
It's difficult to imagine the fledgling Texas Children's Hospital when doors opened in 1954 to a three story building with little more than 100 beds. One million patients and more than half a century of growth later, Texas Children's stands as one of the premiere pediatric hospitals in the country, one that continues to expand its reach beyond expected borders.
As Texas Children's president and CEO Mark Wallace says, "There is an incredible story unfolding at Texas Children's Hospital here in the Texas Medical Center . . . This is a story of growth at Texas Children's Hospital."
Indeed, Texas Children's has experienced exponential growth since the doors opened on that modest hospital encompassing 350,000 square feet. Today, with expanded facilities in the medical center, health centers scattered across the city and the spanking new West Campus, located at Interstate 10 and Barker-Cypress, the prestigious hospital commands 4.5 million square feet of serviceable space. And there is no slowing down.
This is not the stopping point. "We have to continue to grow," Wallace says, pointing out that the pediatric population in that Houston area is expected to grow by 32 percent from 2010 to 2030.
Texas Children's Hospital West Campus, for example, sits on 55 acres, the purchase of the large parcel clearly made with expansion in mind. As Wallace points out, there are 400,000 children living within a 10-minute drive of the hospital. The campus is currently operating 48 beds with a capacity for 96.
Wallace says of TCH in general, "Our needs are increasing on a daily basis with the hospital running 90 to 100 percent occupancy." And even as the largest children's hospital in the country, Wallace adds "We are undersized based on the current demand for our services."
Thinking really big
But let's not get ahead of the story. As Texas Children's bold Vision 2010 program moves into its latter stage, the hospital has much to shout about. The ambitious $1.5 billion capital campaign and expansion of facilities is astonishing. The fact that the huge sum could be raised during an economic downturn is high tribute to Texas Children's leadership and the faith of the Houston community in the hospital's future.
"Since our founding in 1954,"Wallace says, "our vision has been to serve as a mecca of pediatric medicine in Houston and in the state . . . our goals have always been to expand quality and excellence in our specialties. Houstonians demand this excellence." And they have contributed generously to these goals through foundations, private donations and corporations.
"We have been blessed with our resources. Houstonians are willing to invest in the future of Texas Children's to make sure that we have the capacity to take care of all children and to offer the very finest care."
The Pavilion for Women & beyond
One of the highly-anticipated programs of Vision 2010 is the Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births, which is expected to begin serving out-patients in November and move into full service in early 2012. By 2015, the Pavilion is expected to be delivering 5,000 babies a year, 25 percent of those at high-risk.
Included in the Vision 2010 package was the launch last December of the Jan and Dan Duncan Neurological Research Institute, where programming is headed by the renowned Dr. Huda Zoghbi; expansion of the Feigin Center; opening of the West Campus satellite; expansion of existing research facilities; and funding of new equipment and information systems to support quality improvement.
"The focus has been on research and accessibility," Wallace says.
For the man who has headed Texas Children's since 1989, there seems to be no limit to the growth potential of the hospital that consistently ranks among the top four children's hospitals in the nation, according to the respected U.S. News & World Report hospital ranking. Wallace's vision and that of the board is evidenced in numerous new and expanded initiatives, all moving to reality in recent months.
The continuing growth pattern
Texas Children's has taken steps to expand its reach in patient care and research much further than many would have anticipated. Just weeks ago, the hospital announced a 20-year affiliation agreement with Scott & White Healthcare, in particular with the new Children's Hospital at Scott & White that opens in Temple this fall.
As the news release on the partnership explained, "The affiliation couples Scott & White's expertise in creating a health care system providing care to a large, geographically diverse population with Texas Children's excellence in pediatric patient care across the full spectrum of primary care, specialty care and subspecialty care services."
In March, Texas Children's and its educational and research partner Baylor College of Medicine announced the creation of Texas Children's Center for Global Health and the appointment of renowned physician-scientist Dr. Russell E. Ware as director. The center will complement the work of Dr. Mark Kline, physician-in-chief at Texas Children's, through the Baylor International Pediatric AIDS Initiative, which operates a network of clinics across southern and eastern Africa and in Eastern Europe.
In June, Texas Children's and Baylor College of Medicine gained headlines with the relocation of the Sabin Vaccine Institute's vaccine development program to Houston that logically followed the recruitment to the city of its leader, world-renowned neglected-disease expert Dr. Peter Hotez.
The three programs reach far beyond the doors of the Texas Medical Center, a logical extension of Texas Children's sphere of influence, according to Wallace. "We have a moral obligation to serve children in Houston and in Texas and beyond . . . there are only a handful of children's hospitals in America that can do what Texas Children's does." From the beginning as set by its founders, the mission of Texas Children's has always been to reach far and wide in providing medical assistance to all children.
The vast hospital landscape
Texas Children's in conjunction with Baylor College of Medicine is currently participating in approximately 400 research projects and receives more National Institutes of Health research funding than any other pediatric hospital in the nation, no small testimony to its research strength. The current NIH grant is $40 million for research.
Beyond its vast medical center campus, Texas Children's operates five health centers across the city, five Project Medical Home programs (providing primary care to children regardless of ability to pay in medically underserved areas), and Texas Children's Pediatric Associates, a primary care network with more than 44 practices and more than 170 physicians. It comes as no surprise than that Texas Children's is one of the largest employers in Houston with 7,000 employees.
And this is not the stopping point. "We have to continue to grow," Wallace says, pointing out that the pediatric population in that Houston area is expected to grow by 32 percent from 2010 to 2030. As an example of the need, there are 1,200 babies and children on the wait list to be seen and have surgery in the Texas Children's Heart Center, headed by Dr. Chuck Fraser.
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Luxe plastic surgery center injects River Oaks with cutting-edge techniques, posh recovery suites, secret access, and more
With the holiday season in full swing and many prepping for a new look for the new year, image-conscious Houstonians have a new option for cutting-edge cosmetic treatments and plastic surgery in one of Houston’s most elite neighborhoods.
Nuveau Plastic Surgery + Medical Aesthetics, a local leader in cosmetic medical procedures, has quietly opened a sleek new facility in River Oaks (3720 Westheimer Rd.). Owned and operated by renowned (and board-certified) plastic surgeon Dr. Edward Lee, the facility offers myriad reconstructive surgeries for men, women, and children, as well as beauty treatments, touch-ups, and more.
Aside from top-of-the-line technology, instrumentation, and treatments, the boutique center has personalized service and features to the tony RO crowd. A secret entrance ensures privacy for discreet clients, much like similar operations in Los Angeles and New York.
Another top-drawer feature: Tastefully appointed pre-op and post-op suites keep patients in-house, rather than having to leave posh treatment centers and head to crowded hospital rooms for recovery.
In keeping with Lee’s insistence on a medicine-first approach, anesthesia for patients is provided by Medical Anesthesia Associates, an MD-only group.
A cut above
Notably, the center places a primary focus on plastic surgery, which, for the uninitiated, has a clear distinction from cosmetic surgery. Randy Rakes, managing partner, tells CultureMap that it’s important for clients to understand the difference.
“You have to understand, you have to go through hundreds of hours of training and cases — face and the entire body — to get that board certification, and go through rigorous testing in order to meet that specification,” he says.
Why is that important? The industry, Rakes notes, is rife with practitioners such as “OBGYNs or dermatologists or people who have not really been trained in the art of plastic surgery, who take a class somewhere and learn how to do liposuction or a fat transfer — and then they're ‘experts’ in aesthetic surgery.”
That’s especially key when selecting a provider for highly invasive — and potentially serious — procedures such as facelifts, eyelid surgeries, tummy tucks, liposuction, rhinoplasty, breast lifts and augmentations, breast reconstruction, and more, Rakes adds.
In an era of Instagram beauty demands, more choosy clients are opting for streamlining facial features. To that end, Lee is one of a select few surgeons in the U.S. who regularly performs “V-Line '' surgery. The set of procedures, popularized in South Korea where Lee honed many of his skills, aim to narrow the width of the jawline and the face.
Aesthetics with an expert eye
Lee’s elegant, 5,500-square-foot center is adorned with CASA Houston designs, Italian-influenced finishes, and soothing elements evocative of a modern art museum or luxury spa. The facility houses a Visia Skin Analysis Studio and seven treatment suites aesthetic work such as Botox, microneedling, VI peels, Halo Laser Resurfacing, Moxi Non-Ablative Laser, Broad Band Light Photofacials, Coolsculpting, Emsculpt, and more.
Rakes says that his registered nurses, nurse practitioners, physician assistants, and estheticians are elite, by design, as he and Lee insist on credentials. “All of our injectors are licensed in the State of Texas,” he says. “Most places don't have that, the reason being is that they are much more highly skilled than a traditional, regular nurse injector. So they have a much higher skill set. The people who do our lasers and things of that nature have 10 to 15 years of experience, so clients know that they're getting the best possible treatment with the best possible devices — we own every medical device that's considered cutting edge in the industry.”
Rakes, a longtime medical industry processional with a keen eye for trends and technology, says that his clients aren’t just looking for traditional services, but new technologies and treatment, such as PRP and other regenerative therapies. “I think patients are kind of moving a little bit away from the traditional Hyaluronic fillers like Restylane and really looking for something with a more natural approach.”
His treatment teams stimulate collagen with fillers such as Radiesse, “and then we combine that with energy-based devices to even further lift the tissue and work as a synergy between using the injectable and the device, because the combination of both of those things give the patient the best possible results,” Rakes notes. Lee and Rakes also focus facial care on medical-grade skincare brands Alastin, Revision, and Elta MD.
A global scope
Aside from his board certification in plastic surgery, Lee has also trained in craniofacial and pediatric surgery. His medical mission work has taken him to Thailand, Haiti, and Cambodia, where he has performed surgeries for nonprofits such as Operation Smile and Smile Train for those in need.
Those in need of non-traditional treatments can also trust Lee, says Rakes, who points to Lee’s work in the cosmetic and plastic surgery-obsessed Korea. “Some of the Korean techniques are much more advanced than the techniques that are available here in the United States,” says Rakes. “Dr. Lee does a lot of things that other physicians here just don't do.”
Those interested should book early, Rakes advises, as the holiday and new year rush is in full swing. The center offers “pre-buying” slots where clients can reserve space and time. “We’ve been very busy,” says Rakes, noting the local celebs who’ve shared the work they’ve received there on social media. “I think people come here because they know they’re getting the very best treatment and results available.”
For longtime Houston food insiders, Peg Lee needs no introduction. A lifelong local culinary instructor, she has been a fixture in the food scene since the 1970s, where she (often humorously) led cooking classes at Houston Community College.
She was a no-brainer to found and direct Rice Epicurean's cooking school. And the newly launched Central Market made waves in 2001 by enticing her to launch its now wildly successful cooking school, which, thanks to Lee, has lured top national and international chefs and food names.
Along the way, Lee mentored now well-known chefs such as Robert Del Grande, Greg Martin, and Mark Cox.
Quite apropos, the Houston legend is now the namesake for a new cooking school in one of the city's most beloved urban green sanctuaries, Hope Farms. The Peg Lee Culinary Classroom in Hope Farms' Gathering Barn now hosts field trips, classes, tastings, and free cooking demonstrations for children and adults.
Locals can also book the charming space, spearheaded by Recipe for Success/Hope Farms founder Gracie Cavnar, for cooking parties and cooking classes for anywhere from four to 24 students. Those interested can find more information on classes, which center on Cavnar's passion for healthy eating, and more here.
As for the classroom, visitors can expect a white, farmhouse-style kitchen with custom cabinets and high-end appliances, all reflective of a home kitchen. Butcherblock countertops, matte black accents, and farm-made tables and more adorn the space, while a Wolf Induction cooktop, A GE Café Smart Five-in-One Wall Oven, and other state-of-the-art appliances get folks cooking.
Fittingly, classroom water is tied into the farm's new rainwater capture system for the ultimate in sustainability.
“Peg was one of my earliest mentors in the imagining and crafting of what Recipe for Success Foundation would become,” Cavnar noted in a statement. “Then, when we began programing, she rolled up her sleeves and got to work, helping us teach children to cook and bringing her many resources to help us raise money and awareness for our efforts. It is my deepest honor to pay her tribute with the naming of our classroom.”
New craft brewery bringing 'bold American beer,' Texas comfort food, live music, and more to Sugar Land
Sugar land's new craft brewery
Houston’s growing craft brewery scene will add a new outpost in Sugar Land. Talyard Brewing Co. recently began construction on a 15,000-square-foot production and tap room that will open in early 2024.
Located in Imperial, a massive mixed-use development on the site of the former Imperial Sugar refinery, Talyard will occupy a three-and-a-half acre site that will include a beer garden with shaded seating areas, pickle ball courts, a playground, and a stage for live entertainment.
Principals Keith Teague and Chuck Laughter are Sugar Land natives and neighbors who bring experience from the business world to Talyard. In a release, Teague says that intend to serve “bold American beer” paired with a food menu of Texas comfort food made from locally sourced ingredients.
“We want to push the boundaries of style and tradition by combining old practices and new,” Teague added.
Ultimately, the brewery’s 20-barrel brewhouse will be capable of producing 10,000 barrels per year. For now, brew master Sean Maloney is dialing in recipes on a test system. Formerly of 8th Wonder Brewing, Maloney has been working on the West Coast and recently finished the World Brewing Academy’s Master Brewer Program, administered by the Siebel Institute in Chicago and the Doemens Academy in Munich.
“As I’m sure is the case for many ventures like ours, the idea of starting a craft brewery was hatched over beers in the backyard,” Teague said. “Sean attended high school with Chuck’s son, and over the years, we’d see him at family gatherings during the holidays when he was visiting from the West Coast. Those backyard beer sessions turned into area brewery tours together, and eventually the idea of sharing our passion here locally was born.”
Talyard will add to Imperial’s extensive entertainment options. The area also includes Constellation Field, home to the Sugar Land Space Cowboys, a weekly farmers market, and the Fort Bend Children’s Discovery Center.