By Xiomara Levsen, The JOURNAL
The Washington County Board of Public Health discussed its budget for the 2018-19 fiscal year and will ask the county to assist the department by funding it 49 percent at its meeting last Thursday.
Fiscal administrator Peggy Wood gave the board several reasons why they were going to ask the county to do this. The first reason is the revenue projected for the 2018-19 fiscal year is expected to decrease 15.3 percent.
?I will tell you the large bulk of that ? $65,000 of that ? is because we no longer have case management,? Wood said.
The elderly waiver case management program was still in the budget for this fiscal year, she added.
The next highest amount is Medicaid ? which covers skilled nursing and other skilled services ? is projected to be down $25,000, Wood said.
Physical therapy and occupational therapy is also another area affecting the department because they?re not being fully reimbursed from Medicare for these services, Wood said.
?We?re starting to look at things a little differently internally because what we?re finding is if your primary class of clients is Medicare and they?re receiving therapy services ? Medicare, as you may or may not know, we have to bundle-bill,? Wood said. ?It?s very difficult to determine how they?re reimbursing each service.?
There are many explanations they have gotten from Medicare about why there is a variance with the payments, she added.
?We want to get a better handle on that number somehow just so we can get a better number on that,? Wood said, ?so just know we are looking at that.?
Another item affecting the department?s revenue is decreased amounts in grants.
One example Wood gave to the board members was the Emergency Preparedness Grant. The grant went from paying each emergency preparedness coalition to regionalization, which includes eight other counties besides Washington, and every county in the region is confused about what they can spend the grant money on.
?This is something we?ve talked about at our regional meetings,? Washington County Public Health administrator Danielle Pettit-Majewski said. ?We?ve had people from IDPH (Iowa Department of Public Health) saying, ?We don?t know what we can spend this money [on], because it has to be reallocated back to your work plan; then related to a capability, which is what we worked toward.?
The way to submit claims to this grant is a very difficult process, Wood added. Everything is tracked differently and if you don?t do it correctly there is a chance the claims could be denied.
The other grant that didn?t renew in July was the Dental Wellness Plan, Wood added.
?As you can see, the difference between the revenue and expenditures is a big number,? Wood said. ?We?re asking for the county to fund the department at 49 percent ? that is clearly the most we have asked for in many, many years. Since I?ve been here.?
Wood also discussed where the 49 percent came from.
The directive from the supervisors was a zero percent increase for each department not including wages.
?That?s challenging because I think this is the third year where we?ve had to maintain zero on the rest of our expenses,? Wood said. ?I?ll tell you why that?s difficult [because] we don?t have a lot of controllable expenses.?
They pay $39,000 in rent a year, $25,000 for clinical software, travel and mileage for staff to make visits to clients is $27,000, vaccines and supplies is $19,000 and phone and Internet is $9,000 a year, she said.
?My point to all of this is we get down to not a lot that is controllable to us,? Wood said.
They were able to decrease overtime from 136 hours to 48 hours to keep a closer eye it on because this is one of the areas in the budget the department can control, she added.
The supervisors have told each department that if there something they would like additionally they can come talk to them about it, but Wood said this is good and bad. They still have a full-time nursing position left in the budget for the next fiscal year, hoping it?s filled, but what the budget directive from the supervisors didn?t account for were the increases they?re going to see next fiscal year for items such as the clinical software they use and information technology needs.
?We are unique ? I use that term loosely, because we are not tied to the county computer system,? Wood said. ?We have spent more than in years past with different IT needs. My talents can only go so far with the server. There are things that require outside help with that, so $3,000 or $4,000 makes a big difference when you?re getting down to $30,000 to $40,000 that you can really only affect.?
Public health will have a budget work session with the supervisors Jan. 30.