Madison County advised to keep home care

Members of the Public Health Committee of the Madison County Board of Supervisors and the Madison County Public Health Board heard an update on a home health care study conducted over the past three months.

Consultants reviewed three options open to the county but say the Health Department can hold onto its home health care and long-term home health care programs and make them more profitable. One of those services - the certified home health agency - made money, but long-term home health care saw a loss.

Timely documentation and comprehensive billing seem to be the key to helping those services pay for themselves.

In addition, some streamlining would allow the Health Department to up the number of individuals served, thereby increasing profits without increasing overhead.

Jane O'Connell of Boucher & Associates said certified home health agencies (CHHAs) are the engines that drive all other home care programs. She said CHHAs were established under Medicare law, but licensing requirements were left to each state. The CHHA designation is required to get paid by Medicare for services rendered.

It also is the mother program that allows the county to provide long-term home health care (LTHHC) services and bill Medicaid. LTHHC is targeted at keeping people out of nursing homes when a comprehensive care plan can be executed outside the institutional setting. According to O'Connell, the system for payment has changed several times, and each one of those changes has improved reimbursements.

Efficiently run CHHAs are very favorable because they can improve you bottom line, O'Connell said.

O'Connell's co-presenter, Dave Boucher, said with the CHHA making money and LTHHC losing money, the end result was a loss for the combination.

Expenses continue to trend up, revenue drops, and negative operating margins increase over time, Boucher said.

Staff productivity, management staffing and support staffing were among areas that could use improvement, Boucher said. O'Connell said the other counties surveyed during their study were comparable rural counties, but Madison County's cost for benefits was greater. She said staff productivity is just below mean, the department needs an additional management staff, and support staff is way above benchmark.

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