NORWICH – The Chenango County Board of Supervisors heard Monday a brief summary of the issues that surround a Public Health Department suggestion to close its home healthcare unit.
The suggestion was reviewed by members of the Health and Human Services Committee prior to yesterday’s board meeting. Department Director Marcus Flindt said details of the plan would be further resolved in committee later this month before coming to a vote before town supervisors in March. Any closure plan would then be subject to New York State Department of Health approvals, he said.
The proposed change could save the county about $200,000 in wages and benefits.
If the plan moves forward, the county’s home healthcare patients would be afforded equal and uninterrupted care by private sector homecare agencies pre-approved by the state health department. The private agencies would service the entire county, offer the full range of services as entitled through payer sources and be held to the same guidelines as the county’s health department.
“The only thing that will change for the residents of this county would be their provider agency. The transition from the county to a private agency should be a seamless process, virtually unnoticed by residents,” a press release from the county’s health department states.
“Nobody’s going to be abandoned,” Nursing Director Marianne Kirsch said. “There will be patients we’ve had for a number of years who are going to have a hard time with this. We don’t want them to think we are abandoning them or that their care will be any less.”
Public Health’s core nursing division, prevention services, would continue to provide regular programs, including visits to mothers, babies and children.
Flindt said the county can’t keep up with regulation changes and the high cost of providing home health care services any longer. Revenues from Medicare, insurance companies and third party payers have been cut drastically from a high of $1 million in 2003 to about $300,000 last year. He said there were 180 pages of Medicare billing changes this year alone, for example. (He referred to Governor Spitzer’s recently proposed budget for New York that suggests cutting spending for health care between $85 to $100 million.)
“No one wants to get rid of services,” Flindt said, “but we can’t do the preventative services side of the public health job well and also keep doing this. We have the interests of the people of Chenango County in mind ... to provide them with the best care.”
“We aren’t doing any patients any favors if we can’t do a good job at it,” Public Health Nursing Director Marianne Kirsch said.
A big problem, Flindt explained, is the growing number of patients who are being released from hospitals sooner and then require more technical and specialized therapies that might not be available locally. Transportation costs, longer visits and specialized therapies cannot continue in the face of the revenue shortages, he said.
“Home health visits aren’t short in and out visits any longer,” Kirsch said. “And it has been increasingly difficult to find the needed professionals to relocate to Chenango County.”
Flindt told town supervisors that private home health care agencies have more staffing flexibility and the financial resources to hire people to manage the constant programming and regulatory changes in Medicare billing.
During an interview following the board meeting, Kirsch said private agencies generally have one person who follows regulations and changes. “The person we have who does that has 17 other jobs to do,” she said.
The Chenango County Public Health Department estimates that the cost of adding more staff and updating clinical recording systems could be in excess of $600,000. The county could save approximately $200,000 in wages and benefits by closing the unit.
There are currently 11 nurses on staff, including two unfilled positions. Six nurses work in the preventative services unit and five in the home healthcare unit. Flindt said at least three of the five could be retained for a joint public health and social services offering this year, called New York Access.
“We are trying our best to retain the jobs ... at the health department or somewhere else,” Flindt said. “The New York Department of Health asks us to.”
DSS planned to hire nurses this year for a ‘single point of entry’ system, a plan created by the state last year that would streamline all of the available services in the county through one-stop shopping. The nurses would do assessment nursing in place of skilled nursing.
After Flindt’s presentation, Town of Pharsalia Supervisor Dennis Brown repeatedly asked how many jobs could be cut and whether the two open slots would be eliminated from the department’s budget next year. After learning about the shared DSS unit in need of nurses, Brown commented, “There’s nothing like government at its best ... chopping off half of the program but keeping the help.”
Flindt said the two open slots would be cut and because NY Connects is 100 percent state funded, there could be some additional savings on the levy in 2009.
“We wouldn’t put anybody in a position if the county didn’t need it,” Flindt said.
Town of Oxford Supervisor Lawrence Wilcox asked if liability costs were growing with the type of care required. Flindt said liability was “certainly an issue.”
Nearby Broome, Otsego and Oneida counties have already transferred their home health care to a private agency. Madison and Cortland counties are looking at options.
“Many of our peripheral counties are calling us to help with patients on our respective boarders. We are all having trouble handling the cost of providing this service,” Kirsch said.
“It is a terribly momentous thing that we are talking about getting out of. But private companies are willing to do this business in Chenango County. It wasn’t true in the past, but I think with this particular program, they could do a better job,” Flindt said.