January 8, 2014 | Volume 101 / Number 2

Healthcare In County Faces Changes

County, FMDH Giving Health Department A Look

Health prevention is becoming a bigger focus in the medical industry. Many of the mandates in the Affordable Care Act (ACA) have hospitals and healthcare professionals focusing on prevention strategies to keep people from becoming a diabetic or to educate on sexually transmitted diseases (STD) before it happens to a patient or client.

The Valley County Health Department has had that focus for several years. One of its main focuses has been education and prevention. Discussion among county commissioners to possibly change the way the county handles the department started just after October after Vicky Bell, former director, resigned for a new job after 30 years.

What started out as Commissioner Bruce Peterson looking at what they might pay a new director became a realization that many Montana counties in the state were running their health departments differently. Peterson began to research other counties on not only what salaries ranged in, but how they were funded. He stated at a commissioner meeting on Oct. 23 that a lot of the county health departments were grant driven and not funded by the county.

Valley County isn’t too far from that reality. A majority of those funds come from grants. Peterson explained that around $200,000 comes from the county’s general fund, while $100,000 comes from budget revenues from vaccinations and insurance. An additional $100,000 then comes from grants.

While digging into the county budget, the full amount budgeted for the health department comes in around $322,900. A grant for the breast and cervical program covers $12,000, another grant for bioterrorism education and prevention comes in at $88,000. The family planning program, which is one of the most utilized programs in the county, brings in $22,750 in revenues from insurance and payments and an additional $72,200 comes in a grant. Maternal child health brings in $7,608, immunizations $5,350, and the billing service generates $12,600.

These funds might seem excessive, but the department’s Karla Thompson, a nurse who has applied for the director position, explained that the public health department covers a wide variety of health issues for the county. Many of the grants that it receives are attached with a string. The department must collect data, provide certain services and assess community health issues, and keep preventative strategies and plans for worst case scenarios.

The county provided almost 3,500 immunization shots between July 2012 and June 2013. The average number of people they see per day can range from 18 to 30, depending on the quarter. Currently there are 150 active cases in the family planning program. Thompson also said that the department does between 90 percent and 97 percent of infant and young children immunizations in the county.

While those numbers may reflect only some uses of the county health department, another large portion of the job is education. Teaching youth and adults about STDs, training on abstinence, parental involvement, and healthy habits are all provided. Women the age of 30 or over have access to screening for their breast and cervical health. If something is found they then are referred to the local hospital. Thompson explained that many of these services used to be free, but as funds grew tighter they were forced to check for insurance and learn a little more about their clients.

“Tax funded vaccinations became a problem, we had to provide the service fees to get the grants,” Thompson said.

Much of their work has been collaborating with the hospital. The ACA now mandates that the hospital must perform a community assessment and come up with some strategies to address the county’s top health issues. Nick Dirkes, director of marketing and Hi-Line medical services at FMDH, explained that the hospital worked with the county health department to get some of that information. He explained that they have managed a relationship with the health department. Thompson also agreed that the health department has been working with the hospital over time. So it may not have come as a surprise when Peterson asked the hospital to attend a commissioners meeting to talk about the possibility of the hospital working with the county health department, or possibly taking on some of those responsibilities.

At a meeting that took place on Oct. 29, FMDH CEO Randy Holom discussed some of those issues with the commissioners. He explained that there are some overlapping services that will take place with the new ACA, but that the hospital would not have room to house the public health department. Thompson told the commissioners that the health department worked differently than the hospital and that the health department should remain as a place for resources and referrals.

Holom asked about how the health department was funded and how many employees worked in the health department. Currently there are 3.8 employees keeping the doors open, with one empty seat being that of the health director.

Peterson then asked Holom if they knew of other hospitals that had taken on public health services, he was not aware of any. Peterson then explained that Stillwater, Carbon and Powell counties had health departments run by the hospitals. He also explained that Beaverhead County used to do that but quit the arrangement in 2007. As the meeting adjourned, Holom said he would look into other areas where the health department and the hospital could work together more closely. Thompson added that she would like to get the public health board and the state health department involved.

“Right now is a time to gather information so we can make the best decisions out there,” Thompson said later in an interview. “We all want what’s best for the residents of Valley County.”

Thompson explained that the department’s funding has been decreasing, along with their staff and they try to continue to run bigger programs that have grown. Some of those programs investigate when diseases, such as the West Nile Virus, are reported in the county. A total of seven programs run out of the public health department.

Peterson said that every county does things differently. Public health services vary so much from county to county that it may take some time to figure out what will work best for Valley County. With changes in healthcare here, it was time to look into changing how things work. Peterson explained that the Montana code on what to do is vague and non-specific, requiring just a board, and suggests that they should have some prevention and report diseases to the state.

“There are some things we could do better for the entire area,” Peterson said. “The effects of the Affordable Care Act aren’t certain yet.”

Commissioner Dave Pippin also explained that the current building the health department sits in doesn’t have the greatest accessibility. He showed the ramps that were installed on the outside of the building as they are steep and winding, not ideal for the icy winter months. The building also lacks an elevator.

With so many services provided and an uncertain future, all parties involved are continuing to gather information. No decisions have been made yet but the discussion has continued and will continue into the New Year. Shrinking budgets and changes in healthcare make public healthcare changes inevitable. The question people are now asking: What will it look like?

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