JOHN DAY — The Blue Mountain Hospital District Board of Directors voted unanimously on Wednesday, April 26, to move ahead with a restructuring of its home health services program over the objections of the program’s director and others.

An eight-person committee of hospital district personnel, including CEO Cam Marlowe and Sylvia Ross, director of Blue Mountain Home Health and Hospice, has been studying a plan to increase insurance reimbursement for the cost of providing home health services.

Currently, those services are provided by certified nursing assistants, or CNAs, who work for the home health department. The new plan involves using nurses from the district’s Strawberry Wilderness Community Clinic to do home health care.

The change to the visiting nurse service or VNS model, Marlowe said, would allow the hospital district to bill Medicare, Medicaid and other insurance carriers for time spent traveling to see patients in far-flung areas of the county in addition to time spent actually caring for the patient — something it can’t do under the current structure.

In a report to the board, Marlowe noted that the district lost $380,000 last year in the home health department. “Transitioning to the VNS program,” he wrote, “would eliminate almost all of the losses we are currently experiencing in home health.”

The report also noted two potential drawbacks to the VNS model: Some patients would likely be charged a copay, and personal hygiene services could not be provided without additional changes to the current model.

Marlowe addressed those concerns during the board meeting.

The vast majority of patients receiving home health services are covered by Medicare, he said, with only about 6% of those patients being required to pay a portion of the cost out of pocket because they lack supplemental coverage. Some if not most of those patients would qualify for financial assistance from the hospital district, he said.

The Veterans Administration and most private insurers cover the service, Marlowe said, adding that the district would negotiate with any outliers to try and persuade them to cover it as well.

Personal hygiene services are currently provided by CNAs through the home health department, but the Strawberry Wilderness Community Clinic is restricted from providing CNA services. Marlowe noted that personal hygiene is currently a small part of the home health patient mix (averaging just over one visit per workday) and said the committee is exploring other options, such as partnering with another agency to provide personal hygiene care in the home.

“I recognize it’s really important that we continue offering those services, hygiene services, to our homebound patients,” he said.

Marlowe told the board that the last hospital he worked for had dropped its home health program. He argued that moving to the VNS model, with its higher insurance reimbursement rates, was the best way to make certain that the Blue Mountain Hospital District could keep its home health program viable.

“We have this opportunity that will put us in a really good spot long term that will ensure we can continue to provide these services,” he said.

Dr. Zac Bailey, the hospital’s chief of staff and another member of the VNS committee, echoed Marlowe’s position.

“I don’t see another way we can remain financially viable,” he said. “To not seize that (opportunity) I think is a mistake, and I think eventually we’re going to have to get on board.”

Several people in the audience, however, expressed concerns about patient care, insurance coverage and staffing problems. One of them was Ross, the Blue Mountain Home Health and Hospice director.

“I’m worried about hospice, that there’s not going to be enough staff to cover our county,” she told the board. “We’re being told things are staying the same, but our staff is being cut.”

At the last board meeting in March, several board members responded to rumors circulating in the community by saying that no changes to the hospice program are being contemplated and insisting they would never vote to reduce hospice or home health services.

No timeline has been set for moving home health to the visiting nurse service model, Marlowe told the Eagle after the April 26 meeting. He said the VNS committee would continue to meet to plan for the transition and work out details of the new arrangement.

As for the concerns expressed at the meeting, he said he thought most of them could be addressed and that they mainly reflected a fear of change in general. But he added that the district had to do something to keep home health services financially viable.

“We can’t keep things exactly the same,” he said.