April 17, 2009


County to examine health costs

Home Health Agency, Environmental Health Department focus of review

Health CostsBob Ellis/staff photographer
Nurse Lynn Gehr asks 76-year-old John Gibbons medical-related questions during an hour-long visit to his Hamlin Street home Thursday afternoon as part of the county’s Certified Home Health Agency program, which the county is considering eliminating and replacing with private health care providers.

Staff Reporter

County officials are considering discontinuing the county’s Certified Home Health Agency program and the Environmental Health Department to save money but health officials are concerned that the departments’ services are essential community.
Legislator Carol Tytler (D-3rd Ward) urged officials at the April 8 Health Committee meeting to cut expenses in services not mandated by the state.
Tytler said the county should look at discontinuing the Certified Home Health Agency program and having a private agency take control.
“We need to look at the pros and cons. If we didn’t have it there, what would be the cost savings to the county,” Tytler said.
The county is not mandated by the state to provide the Certified Home Health Agency.
The agency provides home services to patients countywide, which include physical and occupational therapy services, speech pathology and social services.
County Health Department Director Catherine Feuerherm said some of the services the county agency provides cannot be duplicated.
“We play a broader public health role. We bring the public health perspective in and make sure immunization rates in the county are where they need to be. We take flu shots into the home during flu season,” Feuerherm said as an example during an interview Wednesday.
The county also provides a valuable health response during emergencies, Feuerherm said. The Certified Home Health Agency delivers mass immunizations during disease outbreaks, home safety checks during storms, and can staff shelters during evacuations.
The county agency is operating at a loss. In 2008 the agency operated at a loss of $350,000, which is about $200,000 more than lost in 2007.
Feuerherm said one-time expenses accounted for the majority of the county’s 2008 loss in revenue for the County Home Health Agency. She cited the purchase of a new $160,000 computer system and revenues that were not billed in 2008 because of that new system.
The 2008 budget for the Certified Home Health Agency was about $2.3 million.
Legislator Kathie Wilcox (R-5th Ward) backs the idea of examining privatizing the service.
“It is not that we would be losing service, just the county would no longer be providing service,” Wilcox said, mentioning Cortland Regional Medical Center as a possible alternative provider.
In January 2008, the state denied CRMC’s application to become a certified home health agency on the basis that it might put the county’s program out of business.
Feuerherm will report back at the May 13 Health Committee meeting about both the Home Health Agency and the Environmental Health Department.
She will provide caseload statistics, information about patients such as their location, the severity of their problems, and where they were referred from, budget information and a list of mandated services within Environmental Health.
“We all have to ... look objectively at the services we provide. Services that the county residents get from us and try to put a price tag on that,” Feuerherm said.
Feuerherm hopes that legislators can decide from the facts she provides whether it would benefit the county to eliminate the programs.
Feuerherm said the goal for the agency is always to break even but in order to do that in 2009 caseloads would have to increase and the overhead would have to decrease.
Feuerherm said a three-year contract with the agency’s 10 nurses was renewed in January but if the county could open the contract to negotiate decreasing benefits packages and salaries that could be a potential area of savings.
“Every little bit counts,” Feuerherm said, mentioning other cost-saving measures the county is already employing such as using faxes and e-mails to communicate instead of paper to cut costs.
The county’s program faced a declining caseload during the first half of 2008 after St. Joseph’s Hospital Health Center became a certified home health agency in January.
St. Joseph’s approval was granted because it was expanding its boundaries from Onondaga County to serve the county and did not need final approval from the state Public Health Council. St. Joseph’s has an average caseload of 25 in Cortland County.
Feuerherm said that since July 2008, caseloads at the county agency have gradually increased and are now steady with about 95 to 105 patients being seen by the staff of 10 at any one time. In the first half of the year caseloads had been down to about 80 per month, due in part to St. Joseph’s expansion.
Since the county home health agency does not turn down patients as long as they are county residents and their problems are severe enough, Feuerherm said it is hard for a county agency to turn a profit.
The county agency will, for example, evaluate a patient or provide some services to them even if the patient cannot pay.
County Board of Health President Stuart Gillim is concerned that a private agency would not serve the outlying areas of the county and also may not handle Friday discharges as well as the county.
“Friday is the standard day of discharging patients from hospitals ... and I am not sure privates would be able to handle that service,” Gillim said of for-profit agencies.
He said those agencies might also not travel to outlying areas such as Willet and Cincinnatus to care for clients.
Feuerherm said it is important to regularly evaluate the county’s services to ensure efficiency and she said she is happy to provide the necessary information to legislators so they can make an informed decision about what to do.
Feuerherm said the county is being responsible in evaluating its performance to ensure efficiency and to make sure it is benefiting the community.
“These are Cortland County tax dollars at work and the community has to decide where it stands on the issue,” Feuerherm said.
Tytler said she hopes officials can know within the next few months if it would benefit the county to eliminate any of the services.
“We don’t want to make a decision based on a deadline, we want to make a responsible decision. If it could be made in four months, then four months it is,” Tytler said.


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