Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Annie N. Simpson

Second Advisor

Kit N. Simpson

Third Advisor

Glorimar Medina-Rivera


Objective: This study utilized Medicare 5% limited Data sets to compare total specialty care referral consultations for Medicare patients seen at FQHCs in Harris County to those seen at FQHCs in rural Texas counties. Currently, no published data is examining the changes in specialty referral rates for FQHC patients in the state of Texas. Evaluating these trends will allow system executives, public health officials, and patients alike to understand the magnitude of differences in specialty provider coverage in Texas. Methods: A retrospective cross-sectional study was conducted using CPT codes for patients living in selected rural and urban counties across Texas who have completed visit (s) with a specialist provider between 2012-2017. The primary aim of the study is to describe the population health impact of changes in specialty referral practices across the state of Texas. The selected CPT codes measured all defined specialty visits across the state of Texas. Results: The study found a change in the use of specialty referral consultations when comparing the two data years. Study results showed a significant reduction in the usage of specialty services for patients living in rural counties. The reduction may be attributed to a few changes currently happening in the state. Several researchers have indicated that the state is not producing or recruiting enough residents and practicing physicians to meet the growing population demand (Merrit Hawkins, 2018). Conclusion: The population in Texas continues to grow at one of the fastest paces in the U.S. As the population grows, residency programs in the state will need to adapt by creating more spots for residents. More focus will need to be placed in rural settings, possibly offering providers more incentives to work in these environments. As it stands today, many Texas counties have less than two specialists living in them. Hospital systems in these rural counties will also benefit by partnering with FQHCs in the area to ensure that specialty services are rendered by the FQHCs within the communities they serve. Lastly, The Resident Physician Shortage Act, if passed, will provide a much-needed boost of new physicians to the workforce. A boost of physicians in underserved areas, such as the rural counties in Texas, may provide a solution to the physician shortages in these areas.


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