Home Health Care Patients Will Be Served By Other Agencies, Hickner Says
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County nurses have provided skilled and personal home health care for years but only unreimbursed personal care will be continued.
Shrinking home health care caseloads.
Reduced federal Medicare reimbursements.
Super tight county budgets made worse by the need for rising subsidies from the general fund.
The situation is clear. Bay County can no longer afford to employ 6.6 nurses to provide home health care to 320 patients, according to County Executive Thomas L. Hickner.
What's the solution?
One nurse or home health aides can take care of the 120 patients needing personal care who have no resources, no insurance and don't qualify for Medicare or Medicaid. The county has a responsibility to continue to serve the elderly, ill and helpless, even though the county has no income to offset the cost of that care, Mr. Hickner feels.
"These people tend to be older, frail, living in senior citizen high rises and often have had strokes, heart attacks or congestive heart failure," the executive said. "They most often have no family and can't take care of basic needs. We must continue to serve them."
The skilled nursing care program will be phased out gradually. No current patient's care will be changed. A moratorium will be placed on acceptance of all new skilled medical care patients.
Nurses, who are in great demand, can easily get other jobs. They may get a five year enhancement in county retirement benefits and an incentive payment to retire. That proposal would be the subject of an actuarial study.
It's a situation of great pain for County Commissioners, and it calls for understanding and courage to deal with it.
Consider these three-year statistics: Between 2001 and 2003, federal Medicare patient caseloads dropped 18 percent from 244 to 200 while Medicare revenues decreased by 36.4 percent, from $1,432,512 in FY 2001 to $911,568 in FY 2003.
Root of the problem is a change in the federal Medicare reimbursement policy from a per-visit fee system to a "prospective payment system" (PPS). "Today, home health care providers receive a fixed Medicare reimbursement regardless of the number of home visits required to ensure quality patient care," the executive wrote commissioners.
Patients needing skilledmedical care will be served by other agencies through Medicare, says Mr. Hickner.
Patients and nurses crowded the Board of Commissioners chambers on the fourth floor of the County Building this week and stated their opposition to the proposed reduction in nursing staff.
A final decision on a plan to eliminate the jobs of several nurses and transfer the patients to other health services will probably be made in late August, Mr. Hickner said.
The county general fund reimbursement to the home health care program increased by about 160 percent, to $401,558 in fiscal year 2003, Hickner has told Commissioners. The general fund subsidy for home health care rose from $154,764 in 2001 to $231,525 in 2002.
By eliminating part of the service the county can save about $150,000 a year. In these days of super-tight budgets, that's a lot, the executive said, indicating the county is under extreme financial stress because of reduction of state revenue sharing caused by federal cutbacks.
"Historically we have stayed in the business of skilled care, that is reimbursed by Medicare, to offset the cost of personal care, that is not reimbursed," Mr. Hickner said.
Other providers, Heartland Home Health Care and Hospice for example, with about 2,500 patients, have superior financial resources and are able to leverage larger patient loads to be profitable. Other providers are Bay Visiting Nurse & Hospice of Bay Regional Health Systems and Visiting Nurse Association of Covenant Health Services. The two hospital-based programs have direct access to patients discharged from their hospitals.###
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