In a 4-0 vote, the Saline County Health Department’s Advisory Council recommended that the Saline County Commission continue to make home health services available to Saline County residents, through its Health Department. Prior to her motion, Amanda Michaelis said it was also good that the County Commission had asked if its home health agency was competing with private providers. Voting with Michaelis were David Dupy, Ron Kramer and Gwenda Philbrooks.
Health Department Director Jason Tiller presented multiple spreadsheets to a joint meeting of the Home Health Professional Advisory Committee and the Health Advisory Council. In addition, Interim Coordinator Christi Ponton, Office Manager Donna Tremblay, and former Coordinator Jean Adams fielded questions about services provided, reimbursement rates and success rates.
Dupy, who also works as a physician at Salina Regional Health Center’s emergency room, said he didn’t see a lot of the agency’s home health patients in the ER. He said this wasn’t true for individuals served by other home health agencies. Tremblay noted that the agency’s patient satisfaction surveys showed great satisfaction with services provided.
Agency staff said they occasionally do welfare checks for the Department of Families and Children or other entities. At times, they have found a resident to be in a health care crisis and called 911. The County collects no revenue for providing this service. Adams noted that many of these individuals later become home health clients.
Kramer asked why it was significant that the other sixteen providers, identified on Tiller’s spreadsheets, were local. Dupy responded that the other providers “don’t have a stake in Saline County”. Tiller said that if a particular “market isn’t making money, they can shut that market down”. Philbrooks noted that Saline County’s home health agency had been in existence since 1966.
Kramer said those with insurance might look to use the agency’s services, even though they had other options. He wondered if this might be a drain on the County’s resources. Tremblay responded that the agency charges the same rate regardless of insurance. However, earlier in the discussion, the group learned that Medicaid pays $50 for a skilled nursing or physical therapy visit when the agency charges $150 per visit. Medicaid reimburses $39 per occupational therapy visit and $40 per speech therapy visit even though the agency charges $150 per visit. Staff acknowledged that Medicare paid more consistently and generally covers costs; Adams said the agency needs to have several Medicare clients to cover the costs not paid for in caring for an individual who has Medicaid.
When asked if the County’s home health agency ever turned people away, Adams acknowledged that this might occur. Every potential patient must be evaluated; the skilled nursing assessments are 25 pages. While many private agencies provide reduced cost or charity care, these agencies often have to consider the bottom line for their proprietary, for-profit services.
Gary Nelson noted that the County’s home health agency does no marketing. Tiller said “word of mouth” is how others learn of the service.
David Sanderson, Physical Therapist with South Wind Therapy, said that “with a stroke of a pen”, decision makers can “make things favorable or unfavorable for home health” care providers. Sanderson wondered if the delivery model could be tweaked to be able to provide more robust care that might support other parts of the Health Department.
Commission John Price acknowledged the efforts of staff and of the advisory groups but said that the County Commission still had much to study. Tiller asked for significant time to present the matter to Commissioners, perhaps on August 30th.
