Funding for public health under scrutiny

A decades-long relationship between Greene County and Greene County Medical Center may be coming to an end as medical center administrators and trustees look at how its public health department impacts the bottom line of the facility’s budget, and the county supervisors look at what they can do with the funds they have available.

“I can honestly tell you there was sticker shock,” supervisors chair John Muir told medical center CEO Carl Behne of first getting the medical center’s public health budget request in December. The proposed budget asks for an increase from the $150,000 county allocation this year to $275,000 in FY 2018, $437,000 in FY19, and $614,000 in FY20.

Behne was at the supervisors meeting Feb. 9 to answer questions about the public health budget. Some of the supervisors have met with Behne and public health director Becky Wolf since the request was made in December.

The increased allocation would transition the actual cost of public health from the medical center to the county. Total cost for FY18 is projected at $926,000; cost after revenue is projected a $550,000. Cost after revenue is projected to increase to $614,000 by FY20.

According to Behne, the medical center has absorbed the cost of public health, although the Code of Iowa requires counties to provide services to protect and promote the health of the public. “It has always cost $600,000, but we accepted $150,000 as the county’s share. We masked the loss,” he said.

Behne said his ultimate goal is for the medical center not to subsidize public health. “I need to put those funds to my surgery department, to my inpatient, to my ER, to have Dr Wahl here and Dr Holcombe here, providing my clinic services like I do. My board’s commitment is to where our funds need to be based on our mission.”

The county has paid the medical center to provide public health services since 1984. Public health became a department of the hospital in 2002, and over the years the lines have become blurred between the medical center and the public health department. Behne mentioned the “synergy” of the relationship several times during the Thursday conversation.

“We know we’re enjoying the relationship, but we have to look at what we can afford,” Muir told Behne. The county is already levying the maximum allowed for the general fund. The county also has revenue from the local option sales and service tax. That has been used for rural property tax relief in the past, although the earmark was removed when the tax was renewed. Significantly increasing funding for public health would require cuts elsewhere.

For FY18, the supervisors intend to increase their allocation for public health, although as of Thursday, they are not prepared to commit to the entire $275,000 requested.

They also plan to look at other options. Guthrie County operates its public health department independently of the county hospital. Supervisor Dawn Rudolph has already gathered information from Jotham Arber, director of the Guthrie County public health department. The total budget for FY17 is $954,000. Of that, only $139,000 is coming from county tax funds. The remaining comes as payment (including from insurers) for services.

The budget proposal from Behne and Wolf also showed a side-by-side comparison of costs for hospital-based public health and county-based public health. That comparison tallied county-based costs at $999,000 per year, $72,000 more than the hospital-based total.

In advocating for the medical center’s role in public health, Behne said, “I don’t believe that for $600,000 in you’d be able to provide the space, the staffing, the service model and all the things you do currently in public health on your own. You have to decide if that $600,000 brings so many resources to the community that it’s money well spent.”

Guthrie County’s Jotham explained via email that regulatory standards are different for hospitals and for home health/public health, and that by functioning independent of a hospital, his department needs only to comply with regulations applicable to it, not to facility-based regulations.

The supervisors hope to gather more information before committing to funding for FY19.


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