As the November 1 date looms, many Wright County residents (and others across the state and country) are still voicing their anger and disappointment about the county Board of Health’s decision to decertify home skilled nursing care. At last week’s forum for the candidates running for supervisor, at least half the time was spent answering questions about Public Health and home care. More than once, angry interruptions and boos from the audience could be heard in response to the candidates’ answers.
Various questions at the forum and elsewhere have asked what the local hospital’s role in public health home nursing could or should be. In a recent interview, Iowa Specialty Hospital (ISH) CEO Steve Simonin explained the hospital’s position on the matter and why they are not in the position to play a big role in home care.
Simonin says to understand the hospital’s role, one must understand the history of the ISH and its tax structure. In 2007, Belmond Medical Center and Wright Medical Center in Clarion started working together, and in 2012, they came together under the umbrella of Iowa Specialty Hospital. Simonin says that ISH in Clarion is owned by the city but has little city oversight, while Belmond’s ISH is more closely tied to the city.
Since these Wright County hospitals came together, they have done well. More specializations and locations have been added over the years. “We have been uniquely successful,” says Simonin. “There has been only one year when we were in the red.” He adds that they are happy to maintain the two hospitals in the county so they can still be a Critical Access Hospital, which is a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services.
In the midst of the current controversy, some have noted that other hospitals in the area, like the Hancock County Health System, provide skilled nursing home care. Simonin points out that this is because that is a county hospital, not a community hospital. The hospitals in Clarion and Belmond are not affiliated with the county. This means that they do not receive county tax dollars. Simonin adds that because there are two hospitals in Wright County, it would be difficult to decide which one would be the ‘county hospital’ even if that is a direction they’d want to go. If this system did change to allow a county/hospital affiliation, it would come at a large cost to county taxpayers.
Simonin also points out that the factors that in part led to the county decertification also affect the hospital and would make it difficult for them to be successful at providing that service too. “When Medicaid went towards Managed Care Organizations (MCOs) to deliver services, it really hurt small healthcare entities, like ISH and county public health.” Consequently, Medicaid reimbursements have not been good for rural hospitals either. “We get cents on the dollar when we bill,” said Simonin. In short, the hospital would likely have the same problems providing cost effective home care. “If there is anyone to blame for this whole situation, it really is the changes in Medicaid,” Simonin summarizes.
Additionally, like the Board of Health officials and the county supervisors have said many times, Simonin brought up the concern of competition in home health care. The point has been made that there are other entities that can provide Wright County patients services, both from other counties and private groups. “This is an emotional issue, but we still have to think of the business side of things” Simonin said. “Why would the hospital jump in where someone else is already providing services?”
Finally, Simonin emphasizes that even if the hospital was in the position to come to the rescue, it would not be possible in the next month before the November 1 decertification deadline. “The applications, red tape and bureaucracy would take several months to over a year to get through to become certified.”
At the end of the day, Simonin is proud of the services ISH is currently providing for people in and around Wright County. Though there is no plan to take over home nursing care, he says they are happy to offer opportunities like telehealth to make receiving care even more accessible. He emphasizes, “We have creative partnerships and we are here to help people in whatever way we can.”
