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New emergency telemedicine regulations are good for healthcare, they are good for competition, and they are good for consumers.

Millionaire country music stars like to pretend they spend their weekdays driving a tractor and their weekends driving pretty girls down dirt roads in their pickup truck. While they can only dream, many Mississippians live the true country life in all its glory.  It is a good life, but not as simple as the performers portray it to be. Living far away from population centers can mean reduced access to many essential services, like healthcare. Maintaining access to rural emergency medicine could be the difference between life and death for many Mississippians. 

In Mississippi, there are 64.4 primary care physicians for every 100,000 residents, far below the national median of 90.8. Half of the Mississippi’s rural hospitals are in financial risk. Some have closed down completely, or shuttered critical services such as emergency rooms. 

Rural emergency rooms are difficult to maintain. They must stay open 24 hours a day, seven days a week. The hospital has to hire several emergency room physicians to take turns covering those shifts. If those staff physicians cannot cover a shift, the hospital has to bring in a temporary physician – often from out of state. Not only is it expensive to staff an emergency room, it can be hard to recruit multiple emergency medicine physicians to live and work in a small town. Moreover, if a rural hospital does succeed in staffing an emergency department, it will see relatively few patients. Rather than bringing additional income to the hospital, it will likely cost the hospital money to operate. 

Emergency telemedicine allows some small hospitals to keep their emergency rooms open, by staffing them with physician assistants and advanced practice registered nurses. When a patient arrives, an emergency medicine physician in another location – often a larger hospital – uses audio/visual technology and remote diagnostic tools to see the patient, and to instruct the nurse or physician’s assistant on the care that is needed.  Some small hospitals choose to keep a physician in the emergency room, but use emergency telemedicine to provide an additional layer of expertise and consultation for their emergency department patients. 

Despite the clear benefits of emergency telemedicine, its use in Mississippi has been limited. Current regulations prohibit physicians from providing emergency telemedicine services to small hospitals unless they worked at a Level One Hospital Trauma Center with helicopter support. Mississippi only has one Level One hospital in the state, so there has been no competition for this service. However, any physician who is board certified in emergency medicine is capable of providing emergency telemedicine services, and is able to transfer a patient by helicopter, regardless of the type of hospital the physician works for. 

In short, the current regulations do not make sense, and prevent new providers from offering more options for emergency telemedicine. They are also vulnerable to a legal challenge, as they likely violate the due process and equal protection guarantees of the Mississippi and U.S. constitutions, and may violate federal antitrust laws.

One telemedicine provider that has been locked out of the emergency care market is T1 Telehealth located in Canton, Mississippi.  T1 Telehealth was the state’s first private telemedicine company, and it developed a new model for emergency telemedicine that it believed would provide a better service for rural hospitals and patients. But it could not offer that new model due to the regulatory restrictions.

T1 Telehealth retained the Mississippi Justice Institute – a nonprofit constitutional litigation center that I work for – to challenge the emergency telemedicine regulations. After months of input and discussions with T1 Telehealth and other stakeholders, the Mississippi State Board of Medical Licensure has taken the right approach to make the regulations fair and to increase access to healthcare.  New proposed regulations have been adopted that will allow any licensed emergency medicine physician to offer emergency telemedicine services in Mississippi. 

The new proposed regulations will be reviewed by the Occupational Licensing Review Commission before becoming final. Approval by the commission seems assured, as it is chaired by Gov. Phil Bryant, who has been a tireless champion of expanding telemedicine in Mississippi and a strong supporter of efforts to reform the state’s anticompetitive emergency telemedicine regulations.  

The new regulations will be a great development, not just for T1 Telehealth, but for all telemedicine providers, for small rural hospitals that rely on telemedicine, and for patients across Mississippi. Competition encourages innovation, more options, better services, and lower prices. All things that will make rural healthcare and Mississippi country living that much better.

This column appeared in the Clarion Ledger on May 29, 2019.  

Payrolls in Mississippi jumped by 3,000 in April, erasing the slow start to the year. 

The number of employees in Mississippi rose to 1,164,200, according to preliminary estimates from the Bureau of Labor Statistics. And March’s numbers were revised upward from 1,159,700 to 1,161,200. 

After posting a decline in the number of jobs over the first three months of the year, Mississippi posted a solid job growth rate of .26 percent last month. And over the past year, Mississippi has added a little more than 11,000 jobs. 

Only Tennessee, which added 5,000 jobs last month, had better job gains among neighboring states though there .16 percent growth rate was lower than Mississippi’s. Alabama added 1,100 jobs while Arkansas added 200 jobs. Louisiana lost 1,100 jobs last month. 

Construction (+300), manufacturing (+1,000), trade, transportation, and utilities (+1,500), financial activities (+200), education and health services (+100), leisure and hospitality (+100), and government (+600) all added jobs last month. Professional and business services (-600) was the only sector to see job losses last month. 

Encouraging numbers, but problems exist

While this is good news on the whole, particularly as it compares to our neighbors, and we should celebrate job growth, there are two areas of concern that should be noted.

We added 600 jobs through government. When our population and in-migration rates stay flat (or decrease) but our government jobs increase, that’s a sign of a dependence on government for economic growth. That’s not a good free-market policy and usually indicates a lack of reliance of the private sector. Mississippi already produces approximately 56% of its economic output from the public sector, putting it fourth worst in the nation for reliance on government.

Professional and Business Services dropped by 600 jobs. This is not a trend we hope to see continue. To grow our economy from the private sector, we need more entrepreneurs, start-ups, and professionals. These jobs tend to focus on creativity and serving customers in innovative ways that create meaningful and long-lasting value. Such businesses also can create more jobs, more companies, and even generate significant wealth for founders, who often turn around and invest in new companies or donate generously through charitable giving and philanthropy.

We applaud the improved job growth numbers, but we want to see improvements in these two areas so that our economy can generate more sustainable, long-term growth.

A non-profit organization that receives most of its budget from federal grants and implements healthcare and education programs in the impoverished Delta region has a CEO whose salary and benefits has exceeded $350,000 for the past seven years.

The Delta Health Alliance — a 501(c)(3) non-profit organization based in Leland — is led by Karen Matthews, whose staff had 10 employees earning $100,000 or more per year in 2017. 

The DHA was created in 2001 as a collaboration by the five public universities led by former U.S. Sen. Thad Cochran to meet the healthcare and educational needs of the 18 counties in the Mississippi Delta region and funded by earmarks from the former chairman of the Senate Appropriations Committee.

In 2017, DHA had $18,806,915 in revenue, primarily from federal and state funds and the group spent $19,340,337 for a deficit of $533,422. Among the $14,275,706 in government grants received by the organization in 2017 include:

Program services accounted for $14,391,625 of those expenditures.

Matthews was paid $417,576, with a base salary of $301,705, bonus and incentive compensation of $91,935, $18,102 in retirement and deferred compensation and $6,374 in nontaxable benefits.

Henry Womack Jr. is the Delta Health Alliance’s vice president of finance and administration. He was paid $217,191 in base salary, $28,917 in bonuses and $14,767 in retirement for a total of $260,875.

During the previous five years, Matthews was paid:

According to data from the Mississippi Department of Employment Services, the average chief executive in the state makes $112,310 per year and an experienced one averages $151,460.

According to a 2016 report on non-profit CEO compensation by Charity Navigator, the median CEO salary at 4,587 charities examined in the report was $123,362. According to a graphic in the same report, a charity with a similar amount of expenses as reported by the DHA would pay their CEO a median wage of about $200,000.

Among its 52 programs, the alliance owns a medical clinic in Leland, tobacco cessation programs throughout the Delta and operates the promise neighborhood programs in Indianola and Deer Creek. 

This Obama era program run by the U.S. Department of Education was created in 2009 and uses grants to non-profit organizations to help children growing up in distressed areas like the Delta have access to improved schools and better family and community support. 

DHA received a five-year, $30 million grant from the U.S. for Indianola in 2013 and another similarly sized grant in 2016 for Deer Creek, thanks to influence of Cochran, who chaired appropriations in the Senate at the time.

The salary largesse wasn’t always the case with the Delta Health Alliance. As recently as 2007, the center only paid its two top executives, CEO Cass Pennington and then-chief operating officer Matthews (known as Fox at the time) she was about $110,125 combined. The program had about $4.66 million in revenue and about $4.53 million in expenses, with $3.65 million spent on program services.

That changed in 2008, when the group received a Delta Health Initiative Grant of $12,868,684 and the salaries of both Pennington and Fox received huge boosts. Pennington’s salary climbed to $94,066 while Matthew’s increased to $154,960.

With DHA’s revenues increasing to $28 million per year by 2011, Fox’s base salary was increased from $233,325 to $393,398. 

Pennington was the executive director of the Delta Health Alliance from 2004 to 2008, is part of the DHA’s governing board and was later appointed by Gov. Phil Bryant to the state’s lottery board. He was the former superintendent of the West Tallahatchie School District and later led the Indianola School District.

Matthews was under the cloud of an investigation by the U.S. Attorney’s Office after a former employee who was fired in 2010 accused her of wrongdoing in his wrongful termination lawsuit that was settled in 2011. No charges were filed against Matthews.

Among the allegations included a lease on a condominium in Oxford, paying for two cars on top of a $3,000 a month car allowance and payment for her childcare.

The organization also paid the Delta Council, a powerful advocacy group of Delta farmers, community and business leaders, an average of $272,000 per year for administrative services. 

The number of administrative personnel in Mississippi public schools increased by 51.1 percent from 1993 to 2018 while the inflation-adjusted spending on K-12 increased by 78.54 percent during the same span, according to analysis of data by the Mississippi Center for Public Policy.

In 1993, K-12 spending from state, federal and local sources added up to$2,737,277,644, adjusted for inflation. By 2018, that figure ballooned to $4,886,998,652, despite the number of students shrinking from 505,907 in 1993 to 470,668 in 2018.

While the number of public school students decreased by 6.96 percent, the number of Mississippi teachers increased by 10.13 percent

But despite the additional spending, student outcomes when judged by the ACT test remain mired in the doldrums.

Over the past 25 years, inflation adjusted education spending has gone up 78 percent while the number of public school students has decreased by 35,000 and ACT scores have largely remained flat

Composite scores on the ACT test from 1993 to 2018 remained largely static at 18.7, a solid determinant of student performance since all public school students in the state take the test and it measures readiness for college work in four subject areas.

These findings are in line with a report by state Auditor Shad White’s office. It showed that the growth in K-12 spending on administrative and other non-classroom costs from 2007 to 2017 outpaced the increase in the amount spent in the classroom. 

According to the report, administrative costs increased 17.67 percent during the decade, while instruction costs increased 10.56 percent.

The biggest gain for administrative staff at Mississippi public schools wasn’t school administrators — which increased from 1,478 in 1993 to 2,003 in 2018, a gain of 35.52 percent — or district administrators, whose numbers went from 833 in 1993 to 976 in 2018, an increase of 17.17 percent. 

Personnel listed as administrative support staff, either at the individual school or district level, increased 37.54 percent during that time.

The number of teachers increased from 28,376 in 1993 to 31,252 in 2018. 

One gain in student performance has been on the National Assessment of Education Progress (NAEP) tests administered to fourth graders.

In fourth grade mathematics, Mississippi students have improved from 202 in 1992, which was 17 points below the national average, to 235 in 2017, which is only four points below average.  In 1992, only 36 percent scored at or above a basic achievement level in mathematics. In 2017, 77 percent were at or above the basic level.

On the fourth grade reading test, the state average score was a 215, six points below the national average. That’s a huge improvement from 1992, when the 199 average by Mississippi students was 16 below par nationally. In 2017, 60 percent of the state’s fourth graders were at or above a basic achievement level in reading. That’s a drastic improvement from 1992, when only 41 percent of Mississippi students were considered at least proficient at a basic level.

Between 2009 and 2015, the state’s average on the science test for fourth graders improved by seven points, rising from 133 to 140.

The data from the analysis came from the U.S. Census Bureau, the National Center for Education Statistics and the ACT board. The Census bureau releases an annual survey of school system finances, while the NCES issues an annual report on the number of students, teachers and other data. The ACT issues an annual report on how test takers perform.

While liberal states push to legalize abortion to the moment of birth, pro-life states are responding. 

Last week, Alabama passed the strongest pro-life legislation in America. Gov. Kay Ivey signed into law The Alabama Human Life Protection Act, banning abortion in nearly all cases. The only exception has been reserved for the physical endangerment of the mother’s life. Mental and emotional reasons for aborting will not qualify.

Predictably, left-wing media headlined that 25 men passed the pro-life bill. Also predictably, they left out the Pew polling data that Alabama women are more pro-life than the men of the state. This came after a debate where Alabama State Rep. John Rogers shocked America with a despicable statement that “some kids are unwanted, so you kill them now or you kill them later.”

This year, pro-life measures such as Heartbeat bills swept the nation, limiting abortion at the point of an ultrasound detectable heartbeat. A fetal heartbeat begins around 21 days post-conception but is currently detectable with ultrasound closer to 6 weeks gestation. Ohio, Tennessee, Georgia, and Mississippi worked tirelessly to pass these Heartbeat bills, which were all almost immediately halted by activist judges. 

Unsurprisingly, the Hollywood elite raged online about trending Heartbeat bills. A slew of celebrities even promised to boycott Georgia for filmmaking due to their Heartbeat bill.

While a growing number of states stepped up to protect life, a couple of states tragically passed pro-abortion legislation. New York, being the most extreme, legalized abortion to the moment of birth and decriminalized the death of any preborn child. Virginia Gov. Ralph Northam was in favor of similar legislation in his state that ultimately did not pass. Gov. Northam infamously added in a radio interview how medical professionals might keep born alive infants “comfortable” while they die following a failed abortion.

In Connecticut, pro-life pregnancy centers are fighting for their lives as the legislature considers restricting their ability to ethically advertise. If successful, this legislation will meet a battle with NIFLA, the pro-life organization that triumphed at the U.S. Supreme Court last summer with a similar case brought forward in California.  

Given this traffic jam of pro-life and pro-abortion legislation across the country, one might ask why now? What’s causing this huge flux in abortion legislation? 

In short, the battle has restarted over Roe v Wade, the Supreme Court decision that first legalized abortion in all 50 states in 1973. Pro-life legislation like Alabama’s are welcoming disputes to higher courts. 

On a national scale, this is the most politically feasible time to introduce pro-life legislation since the Reagan era. With two Trump-appointed SCOTUS justices, the first president to speak at the March for Life, lower court appointees recommended by conservative groups like The Heritage Foundation, the first Pro-life Senate Caucus, a pro-life cabinet, a civilian pro-life advisory council for Trump, a Supreme Court win for pregnancy centers, an executive order to end funding for the Mexico City Policy, and large social demonstrations such as last week’s ultrasound blasted in Times Square, it’s a good time to be pro-life. 

The pro-abortion lobby also knows this. They also know that the number of abortions in the country continues to decline. 

They have responded accordingly – with a screeching war cry. The left has tried so hard to back peddle this progress that they have gone too far even by some self-described pro-choicers standards. The U.S. Senate blocked efforts to protect babies born alive from failed abortions. New York, Virginia, and other usual culprits scrambled to become America’s biggest loser on abortion policy. 

In some cases, these efforts brought them to a 360 degree, not a 180 degree, turn. Actress and social activist, Alyssa Milano, laughably called for a “sex strike” in response to the success of the pro-life movement. “Our reproductive rights are being erased,” she tweeted.“Until women have legal control over our own bodies we just cannot risk pregnancy. JOIN ME by not having sex until we get bodily autonomy back. I’m calling for a #SexStrike. Pass it on.” 

Of course, conservatives have always offered abstinence as a great option to prevent unplanned pregnancies. In a strange twist of mental gymnastics, many on the left joined the #sexstrike and joined the sentiment of the religious right—only introduce sex when you are willing to accept the possibility of a child being conceived.  The dichotomy has joined the ranks of the twilight zone. So, what can we pull from this conglomeration of legislation, cultural response, and political climate? 

It’s come down to this – there is a blossoming Culture of Life and an aggressive Culture of Death. The Culture of Death will not passively lose. It’s becoming more and more difficult to take a stance in the middle, as the culture of death becomes more radicalized against any choice other than abortion. 

When our descendants look back on this critical era, where will you say you stood? 

While House Education Committee Chairman Richard Bennett (R-Long Beach) killed a renewal of and a small expansion to the state’s Education Scholarship Account program this session, Tennessee and Florida have been moving forward to provide new options for children.

Florida has long been a champion of school choice, and is home to the nation’s largest program. The Florida Tax Credit Scholarship Program provides a tax credit on corporate income taxes and insurance premium taxes for donations to scholarship-funding organizations that provide scholarships to low and middle income students and children in foster care. A program that served approximately 15,000 students in 2003 now serves nearly 100,000. 

Florida is also home to two other school choice programs that serve another 40,000 students.

And this year, Florida enacted the Family Empowerment Scholarship program, which will provide new funding for 18,000 low-income students in failing schools to attend private schools. 

“The reason I fought so hard for the new Family Empowerment Scholarship is because of what I heard from the families on the waitlist,” said Florida Gov. Ron DeSantis. “I was told how badly they wanted to send their child to the school they felt was best for them. Signing this bill will help tens of thousands of low-income children realize their dreams.”

While Florida has long been a school choice leader, Tennessee had been similar to Mississippi with just a small ESA for students with special needs. That program served under 150 students this year. But a new law will expand ESAs to students in Shelby (Memphis) and Davidson (Nashville) counties. While it is limited, those two counties make up about 25 percent of the state’s entire population. 

This bill was a top priority of Tennessee Gov. Bill Lee. In fact, DeSantis and Lee, both Republicans, made school choice an issue on the campaign trail while their Democratic opponents were vocal in opposition. It provided a winning issue on the campaign trail, and in their first year in office, both were able to deliver on a campaign promise. 

And students in Florida and Tennessee will be better off. We should find a way to allow parents in Mississippi to have options so parents can send their children to the school they feel offers the best chance for their children to flourish. 

With the statewide political campaigns gearing up, we are sure to hear often this year from candidates who say they want to stop government overreach from stifling small businesses, innovative startup companies, and job creation in Mississippi. This is a worthy goal.

But some may wonder, exactly what does this kind of government overreach look like? Where do we draw the line between the proper role of government and unnecessary government interference? 

To find the answer, we need only look to the travails of an innovative technology startup out of Madison named Vizaline. Two Mississippi businessmen put their experience and ideas together to offer something new. Brent Melton had worked in community banks for 42 years and knew they needed a way to understand the boundary lines of smaller properties they financed. For these smaller loans, surveys were neither required nor financially feasible. Scott Dow had spent two decades working with geospatial remote sensing and 3D computer modeling and he knew how to make this idea a reality. 

Together, they created software that could take a properties’ publicly available legal description – which is just cryptic words on paper generated by professionally licensed surveyors – and turn it into something anyone can understand: a drawing of the described property lines on a map.

Vizaline does not conduct surveys. It does not hold itself out as a professional surveyor. It simply takes information already generated by surveyors and puts it into a more user-friendly format. Vizaline only sells its services to small community banks who need and want a more cost-effective and user-friendly way to understand the properties they are financing. These are sophisticated customers. They know exactly what they are getting. And they want it. Nobody is getting duped.

Nevertheless, the government decided it needed to stop these transactions between a willing seller and willing, satisfied customers. The Mississippi Board of Licensure for Professional Engineers and Surveyors sued Vizaline. The government board claimed Vizaline was engaged in “unlicensed surveying.” It asked the court to shut down Vizaline, and to force them to hand over all the money they have ever earned.

Vizaline fought back. It obtained legal representation from the Institute for Justice and filed its own lawsuit, arguing that the government’s actions were unconstitutional. Everyone in America has the right to free speech, including the right to take existing, publicly available information, and create a new representation of that same information. Moreover, the government board – which is composed entirely of licensed surveyors and engineers – is not trying to protect the public. It is trying to protect its own industry from competition. Unfortunately, for the board, that is not a constitutionally valid function of government. 

While Vizaline’s lawsuit was still ongoing, the Mississippi legislature had an opportunity to stop this government overreach. A bill introduced last session would have clarified that the Mississippi Board of Licensure for Professional Engineers and Surveyors does not have the authority to stop companies like Vizaline from doing business in our state. The legislature missed that opportunity, which is disappointing, given how many of our elected officials campaigned on stopping exactly this type of government overreach.

Vizaline is currently appealing its case in federal court. The Mississippi Justice Institute joined the Cato Institute and the Pelican Institute to file a legal brief supporting Vizaline’s case, and urging the court to uphold all Mississippians’ right to disseminate public information, and to do business free from unnecessary government interference.  

So where is the line between proper exercises of government power and government overreach?  While the government tries to stop it from drawing lines on paper, Vizaline has drawn a new line in the sand against government overreach. Broadly enforcing vague laws simply to protect industry insiders from competition with new, innovative competitors is not a valid function of government. The Mississippi Justice Institute is proud to stand with Vizaline, and would be proud to stand with any Mississippian facing similar government overreach.  

This column appeared in the Meridian Star on May 17, 2019.

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