Click here to read the report from Health Management Associates' consultants about the Douglas County Health Center.
If local hospitals and nursing homes want to ensure that the Douglas County Health Center continues to take the most difficult and costly patients, those entities need to start referring patients to the health center who aren't so tough to treat and whose expenses are covered.
Consultants from Health Management Associates told Douglas County Board members Monday that keeping the health center financially viable is in the best interests of other health care providers and the community.
The board hired HMA last August to analyze operations of the health center — which provides long-term care, assisted living and skilled nursing services — and of the Community Mental Health Center — which provides inpatient and outpatient psychiatric care. The units are housed in what used to be the Douglas County Hospital near 42nd Street and Woolworth Avenue.
Commissioners want to reduce the amount of money the county provides to subsidize the health center's operations, which officials say is $1 million a month.
Doug Elwell, an HMA official, offered one example of how the health center gets stuck paying for more than it should. If a hospital's emergency department needs a place to send a person with behavioral problems, the health center routinely accepts the transfer, even if the person can't pay for his care.
But then the hospitals should refer “the next three grandmas they have that do have Medicare coverage” to the county health center, he said.
If that cooperation is absent, Elwell said, the health center's costs will become too much to bear.
The expense of caring for poor patients falls on taxpayers, and it should be a shared responsibility, he said.
On the mental health side, he said, the county may need to spend some money to help patients qualify for Medicare disability coverage, which would help pay for their medications.
Amid talk of privatizing the health center or outsourcing some functions there such as laundry, housekeeping and food service, board member Mary Ann Borgeson sought to reassure county residents. The board isn't talking about closing the health center, she said. Officials have talked about seeking proposals for privatizing the center's management, but even that hasn't been decided, Borgeson said.
Beth Furlong, one of 14 people who served on a committee that reviewed the health center's operations in 2011 and 2012, spoke against outsourcing, closing the health center, privatization or hiring an external management firm. Nursing home residents, their families and an external accrediting agency have attested to the quality of services that the current staff provides, she said.
Doug Kagan, president of the tax watchdog group Nebraska Taxpayers for Freedom, offered several suggestions for saving money. They included: serving only subsidized patients whom the county is legally required to serve; renegotiating union contracts under the threat of privatization; and lobbying the Legislature to reduce the number of mandated services and programs required.
He said his group doesn't support an expansion of Medicaid dollars for the center, as some have sought, because that simply is a tax shift.
Douglas County Clerk Tom Cavanaugh argued in a memo he distributed before the meeting that the county isn't “losing $1 million a month” on the health center, as board member P.J. Morgan often has stated.
The health and mental health centers provide services, as do the county correctional department, county government's information technology provider and the Sheriff's Office, he said. To be consistent, he said, Morgan should claim that those three departments are “losing” more than $2.6 million a month.
If the county can't subsidize health care for its residents, Omahan Matt Hillestad told the board, it means a failure of the community's obligations.
Morgan said board members are trying to determine whether the county can run the health center “for less cost, and continue the services. In other words, making certain that we're providing the services, but is there a greater efficiency.”
Borgeson said the search for cost savings won't end with the HMA report, noting that other areas of county government will get “the same in-depth look that we've done at the health center.”
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