Douglas County Health Center is not closing

Is Medicaid expansion one answer to financial shortfall?

The Board of Trustees for the Douglas County Health Center voted on March 26 not to close or sell the facility, which apparently they had no intention of doing in the first place.

Trustee Mary Ann Borgeson told a near capacity crowd in the legislative chamber, “It was not our intention to close or sell DCHC. The reason we put this item on the agenda was to kill it - to put all rumors and all scare tactics out there to rest. We put this out there so we could vote it down.” And then she repeated herself,  “We are not going to sell or close the hospital,” after which she received a hearty round of applause.

The 9:30 a.m. meeting continued for four hours, while the Board listened to public comments about the second item on the agenda-- whether to prepare Request For Proposals to outsource the management and employee piece of Long-Term Care, Assisted Living and Community Mental Health Center operations. In plain language, the question being debated was, “Will the Board take the first step toward privatizing the health center?”

After dozens of heartfelt comments by the public, DCHC employees and relatives of patients, that option was voted down in the waning minutes of the meeting.

The Board unanimously voted to allow the existing management to implement recommendations made by Health Management Associates in their $311,000 study of DCHC. They agreed to discuss at the next meeting whether to hire a consultant to assist the staff with that process.

HMA’s report offered no magic solutions to make the health center pay its way, or reduce the $12 million dollars it costs taxpayers per year to run the facility.

Many questioned why DCHC operates by different rules than other county-run facilities. No one expects the jail to pay for itself. Why should the health center? County Clerk Tom Cavanaugh circulated a memo prior to the meeting which stated, “Property tax cost for our county’s Long-Term Care and Assisted Living services equates into an annual tax payment on a medium priced home in Douglas County of $7.78 per year, or about 2 cents per day.”

Mary Clarkson, a plaintiff’s lawyer representing appeals of social security litigation, commented that one hundred percent of the people now served by DCHC would be served by the Medicaid expansion of Obamacare. “What is the downside of the Medicaid option?” she asked. “I don’t see one. And the HMA report gives you the cost savings. The lifeline is there. I urge you to grab it.”

The HMA report also urged the Board to “Advocate for the Governor to reconsider the current rejection of Medicaid expansion. This is especially important for the Mental Health Center and the Pharmacy.”

Director of Finance Dede Will explained, “The definition that everyone is focusing on is simply the amount of dollars the County puts in over and above the fees that are able to be collected.” She apportioned the $12.1 million shortfall over the various cost centers.  In 2012, the amounts were: Long-Term Care and Assisted Living $3.8 million; Mental Health $6.2 million; Primary Health/General Assistance $1.1 million; and other county programs at the Youth Center, the Morgue and the Health Department  $1 million.

Will reported one success resulting from a previous analysis of the health center’s policies. The pharmacy is currently under budget by $1.8 million due to the combined effort of DCHC, CMHC and PHC in utilizing Patient Assistance Programs where drugs are provided directly to patients by pharmaceutical companies. Patients are required to apply for the programs if they are eligible.

Now that the course has been charted, DCHC’s Administration will begin working with the Board on a matrix of HMA’s recommendations. Some items require additional investment such as updating the outdated IT system in the pharmacy or renovating certain patient rooms. Closing down the Assisted Living Facility beds through attrition or converting them to nursing facility beds is up for discussion. 

Many of the recommendations are actions to be taken by the Board and some of them will not be popular. They include decreasing employee benefits to industry standards and challenging staff ratios; direction as to negotiations in Union contracts; determining what indigent patients or population it would be responsible for and the patient mix it will accept.

Borgeson cautioned the staff about preparing for the future. “This should be a time where we are coming together to find a solution to make sure the health center goes on. By 2030, the population of elderly is going to explode. Who is it that’s going to take care of them?” 

posted at 10:04 am
on Monday, April 01st, 2013

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