As Cook County North Shore Hospital and Care Center continues to deal with government reimbursement levels that do not cover the cost of care, an ongoing funding reduction at the local level challenges the provision of home health care that could keep patients out of the hospital or nursing home.
At the February 21 hospital board meeting, Administrator Kimber Wraalstad reported that for the last three years, funding from Cook County Public Health & Human Services has been decreasing for home health care provided to patients on a sliding fee scale who have no other means of making up for the cost of their care. The county used to provide in-home health care before the hospital took over the program.
In a February 13 memo Wraalstad wrote to the board about the 2013 contract, she said, “The purchase of service contract allows the county to purchase home health care services for clients who are receiving care on a sliding fee basis. The county will provide payment up to $39,323. This amount is a 2.76 percent reduction from the $40,439 in the contract signed in January 2012. The 2012 and 2011 contracts were also reduced 3 percent from the previous year’s agreement.
“…Due to the ongoing reduction, I contacted Sue Futterer, director of Cook County Health and Human Services. According to Ms. Futterer, it is the intent of the Cook County Public Health Board to continue to reduce this contract by 3 percent per year until the reimbursed amount is $0.00.
“…The home health division has had a net loss from operations. In 2012, services in the amount of $50,489 were provided to clients on the sliding fee scale and the amount of reimbursement from the county for these services was $40,439.
“…I have asked Ms. Futterer to reconsider the plan to eliminate reimbursement for sliding fee scale clients. Recently, emphasis has been placed on providing care in the home so that individuals are able to successfully remain in their home with limited readmissions to the hospital and delay or eliminate admission to nursing homes. The intent to eliminate this contract by the Cook County Health Board seems contradictory to the goal to keep people in their homes.
“…During the next year, we will provide Cook County Public Health and Human Services information about the limitation of various insurance coverages for home health services and share information to allow the Public Health Board to reconsider their decision.”
The 2013 contract states, “If actual expenditures exceed $39,323 prior to the fourth quarter, the provider will continue service provision without further compensation.” Wraalstad told the hospital board that the hospital would not be able to continue making up the cost if funding continues to decrease.
If the county saves money by reducing its allocation to the hospital, said hospital board member Howard Abrahamson, it will pass costs on to the hospital, which would likely be passed on to taxpayers through the hospital levy. Raising the hospital levy while the county keeps its levy down would make the hospital look bad, he said.
Wraalstad said she didn’t want to sound like they were disparaging the county and told the board she would be discussing this with the county before next year’s contract comes up.
In other hospital news…
Administrator Wraalstad has been preparing requests for proposals to send to architectural firms regarding the remodeling of the facility. In a separate interview, Wraalstad said she wants the project to be “cutting edge” so it won’t become quickly outdated and will serve the community’s needs for as long as possible. Regarding any building project, she said, “It’s expensive and it’s disruptive.”
Technology is driving a lot of changes in hospital care, Wraalstad told the board, and this affects how hospital buildings need to be configured. Similarly, trends in patient services are driving changes in the design of nursing home facilities.
“I think for us,” Wraalstad said, “flexibility is going to be the key.” She anticipates finding an architectural firm that can design a building that could be easily reconfigured to meet new needs. . The board voted to send a letter of intent to the Cook County Local Energy Project (CCLEP) stating its interest in becoming a customer of the proposed biomass-fueled district heating plant in Grand Marais. If the project moves forward, the hospital’s entering the project would be contingent on a workable financial model and would need to meet the hospital’s needs.
“The timing of this project is fortuitous,” Administrator Wraalstad wrote in a February 13 memo to the board. “In any building project moving forward, our heat plant will need to be updated.”
Paul Nelson of CCLEP said they are finding some potential sources of funding for the project. “The project is moving along,” he said. The plant would be designed with the potential to add new customers. The financial model they are working with would cover the cost of hooking individual customers into the system and would start out the first year with customers paying no more than they were paying for other types of fuel, with the costs expected to be significantly less than the cost of fossil fuel as time goes by. . In December, the board approved a motion supporting a “Commons Health Hospital Challenge” movement that recommends discontinuing the sale of sugar-sweetened beverages on hospital grounds. Administrator Wraalstad wrote in a monthly management report that care center residents would still be offered these beverages. “The care center is their home and residents who want to have a sugar sweetened beverage (Coke, root beer, etc.) have the right to have that beverage.
“Comments from many employees expressing their disagreement with the decision have been received,” Wraalstad wrote. Doctors can still order these beverages for patients as needed.
The sugared sodas were expected to be sold out of the vending machines by the beginning of March and are being replaced by Sprite Zero, Cherry Coke Zero, and Fresca. Available as before will be Diet Coke, Coke Zero, and Vitamin Water Zero.” . Staff wearing red on February 1 to promote American Heart Month received a sugar cookie from the dietary department, as did the care center residents. Administrator Wraalstad said she requested chocolate chocolate chip cookies, but the dietary department said that was not heart-healthy. Sharon Bloomquist countered, saying chocolate is good for you. “Everything in moderation,” said Wraalstad. County Commissioner Heidi Doo-Kirk asked why they didn’t give out apples that day. Wraalstad said, “It’s more expensive.”
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