Medical center asks county to assume larger cost of public health

The Greene County Medical Center public health department’s revenue changed significantly when it quit providing home health services two years ago, and medical center administrators are hoping Greene County will make up the difference.

Public health director Becky Wolf and medical center CEO Carl Behne presented their budget request for the next fiscal year to the county supervisors at their Dec. 19 meeting. The county allocated $150,000 for the current fiscal year. The medical center is asking for nearly twice that for fiscal year ’18.

The medical center is proposing that the county instead assume all net costs of public health, allowing public health to have a $0 net impact on the medical center’s budget. Historically, the medical center budget has absorbed a net loss in the public health department. That negative impact on the medical center’s Medicare Cost Report was $150,000 last year.

The new funding plan would be phased in over three years, with the county paying one-half of the projected net balance for FY18, or $275,147; three-fourths of the net balance for FY19, or $436,677; and finally the total net balance of $614,319 in FY20.

Wolf provided a list of 20 services the public health department provides, and also noted that Medicaid managed care organizations have created barriers, inefficiencies and delayed funding.

The medical center voluntarily decertified with Medicare two years ago, shifting the provision of home health care services to UnityPoint at Home or other home care providers. The shift was in part due to increasing federal regulations and changes in payment. Since then, the public health department has trimmed its staff from 20 to 9.25 fulltime equivalents. That included the retirement of persons at the top end of the pay scale.

The county public health department now provides home health services only as a “safety net” for residents who have no other way to pay for it. In FY 15 the department had $536,000 revenue for home health services through Medicare, Medicaid/waivers, and Veterans Administration homemaker funding. Total revenue was $881,000.

The projected FY18 budget shows $12,000 in revenue from those three sources and total revenue of $376,000, but total costs of $926,000.

Of the total cost, more than one-third is indirect costs of items like space and utilities, and services provided by the medical center like IT, human resources, community relations and environmental services.

Board chair John Muir said it was good to see three-year projections. “I think we realize it’s been a good ride for us, and we’re seeing it was a good ride at the hospital’s expense….. I don’t think we’re ever going to get to where you’d like us to get. We’re going to have to work from both sides and meet somewhere in the middle,” he said.

Supervisor Guy Richardson reminded Behne that the county is already at its maximum general fund levy of $3.50 (per $1,000 taxable valuation). The medical center also sets a property tax levy, now at 48 percent of the maximum allowed by the Code of Iowa. The medical center trustees have not increased the levy rate in nine years.

Behne said the trustees have discussed that. “From a taxpayer sense, it’s ‘left pocket, right pocket’. Whether you levy or we levy, it’s still a levy. In additional discussion with board leadership… they struggle a little bit to think we’d start to reach higher on our levy percentage…. At the end of the day, there’s still that sense that this (public health) is a piece of the puzzle that has to be developed and delivered by the county, not so much by the medical center…. The board would struggle with increasing their levy rate from a hospital perspective to do something related to public health on the county side,” Behne said.

“It is ‘left pocket, right pocket’. It’s all taxpayer money. Quite frankly, without us cutting in other areas, we have no place to go to get that money. We’re at our max,” Richardson said. “The trustees are going to have to be part of that discussion.”

“This is good information to look at and think about and figure out how we’re all going to make it work,” Muir said.

Behne and Wolf plan to meet again with the supervisors with medical center board chair Jim Schleisman and vice chair David Hoyt part of the discussion “on the next go round.”


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