Home health ongoing hospital budget issue

After a brief discussion at the Thayer County Health Services board meeting June 29, home health care remained in the budget for another year, but CEO Michael Burcham said the service continues to wedge a negative $261,000 into hospital operations.
Heartland Home Health nurses and a certified nursing assistant travel to patients in hospital vehicles across a wide area, known as windshield time.
Medicare doesn’t reimburse for mileage and one home visit could rack up over 100 miles. To help alleviate the problem last year, the hospital board’s auditor recommended TCHS apply for a shortage designation area, which would give the hospital access to the rural health clinic benefit cost reimbursement.
“As much as we love taking care of patients, we need to provide it more efficiently,” Burcham said.
He said he initially went through the regional office of the Center for Medicare/Medicaid Services to apply for the designation, but he was kicked back to the state, along with a large file substantiating TCHS’s position as the primary home health provider in Thayer County, a rural landscape with miles of terrain between home stops.
Mike Fierberg, a public affairs officer for CMS, said TCHS probably wouldn’t receive the designation because it isn’t the only home health care provider for the county.
“He may be the only one physically located in Thayer County, but he is not the only one licensed,” Fierberg said, adding three home health agencies are licensed to provide services in the county.
But Burcham said one of those facilities, Good Samaritan in Hastings, barely eats into Thayer County with its one visit to Byron.
Jefferson County won’t cross the county line and Tabitha may have seen a patient in Carleton, Burcham said.
When he contacted Tabitha, Burcham was told to send them information on the visits Heartland schedules because Tabitha wasn’t sure they could help.
“We are committed to taking care of those patients. That has never been the question. Medicare has provided an avenue to help us, but we are battling for the designation spot,” Burcham said.
He said he has contacted Sen. Deb Fischer’s and Congressman Adrian Smith’s offices. Those contacts and Burcham’s pursuit for legal advice should make for a healthy package as TCHS pleads it case in the near future.
He said a formal presentation will be ready in about three months.
Burcham was informed via a June 24 email from CMS he could submit a formal request for Visiting Nurse Services with TCHS’s leverage being the government’s third criteria for unreasonable traveling distance based on climate and terrain.
In that same email, CMS relayed the state’s decision no home health shortage exists in Thayer County.    
While home health care eats up miles, “medical tourism” chews into the revenue that could be for the hospital.
Medical tourism is when people receive care at other hospitals, such as in Lincoln and Omaha, or closer to home in Hastings, and are told where to receive their follow-up care, which, unfortunately, is typically not their hometown hospital.
“That is money that this county loses when patients seek health services outside of Thayer County Health Services. It cost the community money,” Burcham said. “Being a small rural hospital is a disadvantage, but we’re one of the best places for care there is.”
“Patients need to know no matter what happens, they can choose to go back to Thayer County Health Services,” he added.
Burcham is also looking into how the hospital will increase in referrals and explore chronic care management, a program to offset home health care.
Chronic care management, however, may be limited in scope as a patient needs two chronic care conditions expected to last at least 12 months or until death to qualify through Medicare, and has a minimum of 20 minutes of clinical staff time per month.  
The program encourages patients to engage in self-care to reduce spending and promote health.
Burcham said chronic care naturally transitions to home health care as patients need.
“Chronic care does not get rid of home health,” he said.