Much of a joint meeting Tuesday between the Greene County supervisors and the county board of health on the future of public health was “second verse (or third), same as the first.”
The board of supervisors started considering a new course for public health since the budget request last December from Greene County Medical Center for providing public health services increased from $150,000 in fiscal year 2017 to $275,000 for the year starting July 1, 2017. Future proposed increases would peg the county’s charge for public health at $614,000 for the year starting July 1, 2019.
The large increase prompted to supervisors to look at returning to a county-based health department rather than contracting with the medical center.
The county board of health is appointed by the supervisors. The board of health is responsible for supporting the mission of public health, developing policy based on community input, assuring the county complies with the Code of Iowa pertaining to public health, and assuring accountable and quality processes for providing services.
Members of the board of health are chair Bill Raney, who is also on the medical center board of trustees, supervisor Dawn Rudolph, Dr Jon Vander Veer as medical director and Juanita Gilley. There is currently a vacancy on the board.
Raney, speaking as chair of the board of health, opened the meeting. “Public health is near and dear to us. We have to find a way to make it work for all of us,” he said.
Since the December budget proposal, medical center CEO Carl Behne and public health director Becky Wolf have lobbied the supervisors, providing justification for the increased cost. Until now, the medical center has subsidized the cost of public health, they say. The medical center administrators and trustees are working to assure the future viability of the medical center by scrutinizing all expenses and making needed adjustments.
Behne, medical center chief financial officer Mark Vander Linden and chief nursing officer Katie Heldt were also at the joint meeting, and the lobbying continued.
The portion of the budget the supervisors are most uncomfortable with is $311,300 for indirect expenses. Vander Linden explained that the figures came from a cost report prepared according to Medicare cost apportionment rules.
Wolf shared a revised FY18 budget showing a reduction in direct costs of $72,000. However, the budget shows an increase in indirect costs, which were pegged at $244,600 in the budget proposed earlier. The net savings is $5,000.
Behne named several items the supervisors should consider in making a decision about a county-based public health department:
- Funding sources (such as grants) and service contracts would need to be renewed or sought
- Specialized equipment such as vaccine refrigerator would need to be purchased
- Credentialing would be needed for insurance billing
- IT specific to health care would need to be purchased
- Patient transitions from the medical center or clinics would be less automatic
Heather Bombei, a regional community health consultant for the Iowa Department of Public Health, was at the meeting. She had met with the supervisors in April for what board chair John Muir called “Public Health 101.” Wolf was at that meeting. She repeated much of the same information, and said that of the counties in Iowa, 60-plus operate their own public health department and 30-plus contract out public health.
The supervisors noted they’re very satisfied with the services the medical center provides as public health. “There is a lot of value in the partnership,” Muir said. “We’re looking for how we can meet community needs in a fiscally responsible way.”
The supervisors have said repeatedly there is not money in the county budget to meet the funding expectation in future years, and that it would be impossible for them to increase levy rates enough without exceeding the legally allowed maximum.
The meeting was intended to be informational and a place to share concerns. Heldt suggested a useful next step would be for public health to share with the supervisors the results of a community needs assessment done a year ago. That would help prioritize what services are the most necessary.
Muir suggested a meeting of only the two boards to discuss those priorities.
The meeting was intended to be informational only. A future joint meeting date was not set.
