The Ottumwa Courier

August 16, 2013

River Hills to reduce cost for county-referred patients

Courier staff writer

---- — OTTUMWA — A new agreement between Wapello County and River Hills could lessen the financial blow on the county's budget from the mental health redesign.

River Hills Community Health Center is offering an agreement with Wapello County's Central Point of Coordination, Jail and General Assistance offices to provide them with medical, dental and behavioral health services "for the patients they want to refer to us that they're financially responsible for under the code of Iowa," said River Hills CEO Rick Johnson.

The Wapello County Board of Supervisors will consider the contract at its meeting Tuesday.

"We're trying to partner with Wapello County to give them a reduced rate for services they're going to have to pay for when they refer people to our clinic in Ottumwa," Johnson said.

While an official contract was never in place, River Hills had accepted referrals from the county, but as more and more are being referred from the jail, CPC and GA, Johnson said an agreement needed to be secured with a bill.

"We can't give a government entity a sliding fee discount like we give individual patients ... but we can contractually agree on some other figure to provide services to the population they refer to us," he said. "It should be a good thing for the county and give them a pretty good reduction in what we charge for providing those services.

"We all work together for the same purpose of giving people quality care, but we don't want to charge them the full fee for everything because they are a government entity and they're limited on funds."

The statewide mental health reform, which takes effect in July, places counties into regions of mental health services and will change how many clients each county serves and how much funding they'll receive. Wapello County now falls into the South-Central Behavioral Health Region with Appanoose and Davis counties.

"Before, the state used to give us a lump sum of money and we used property tax dollars to pay for everybody eligible [whose county of residence] was Wapello County," said county supervisor Steve Siegel.

But starting last month, anyone who is on Medicaid is now a state case, not a county case, which means the county has fewer patients. The Medicaid expansion takes effect in January, which will reduce the county's client list, Siegel said.

Fewer county cases mean Wapello County will also see less revenue.

"They lowered our max levy for mental health by a third starting this current year," he said. "But there will be further limitations. For every one of our clients that switches over to Medicaid starting in January, 80 percent of those savings will be reduced from our maximum levy. It's unclear whether we'll be in better shape or worse."

On average every month, River Hills receives 25 to 30 people from the county.

River Hills will only provide necessary, emergency procedures for county referrals. For example, River Hills would charge a flat fee plus 15 percent of the cost of a simple dental procedure, such as a filling or pulling a tooth. But for more complex, restorative procedures, such as a root canal or crown, River Hills would charge the county a flat fee plus 50 percent of the procedure's cost.

The changes will affect different counties in different ways. O'Brien County is now unable to pay for mental health services, according to the Des Moines Register, after Gov. Terry Branstad vetoed the $13 million that was supposed to help counties transition to the redesign.

"They have no money for mental health for the rest of this fiscal year," Siegel said. "There will be others joining that list, but we won't be one of those, at this time anyway."

That's because Wapello County has "a decent fund balance leftover" from fiscal year 2013.

"Apparently O'Brien County does not, and they had a bunch of people added: less money and more clients," he said.

While the mental health redesign won't have a direct impact on River Hills, Johnson said the Affordable Care Act will "hopefully" drive more patients to the health center.

The IowaCare program "bites the dust" on Dec. 31, he said, and then Branstad's Iowa Health and Wellness Plan goes into effect, which Johnson hopes will allow more county residents to come to Ottumwa for medical care.

There are approximately 4,200 IowaCare patients in the eight-county region who have to go to Iowa City or Des Moines for medical care.

"We lost a lot of patients over the last three to five years with the IowaCare program," Johnson said. "I'm hopeful they'll return to this area now that IowaCare is done. I'm hopeful we'll have a lot of those patients return to us as patients under the Iowa Health and Wellness Plan."

The board will meet at 9:30 a.m. Tuesday in the boardroom on the third floor of the courthouse.

County to secure tech director to eliminate waste

The county will also consider hiring Paul Culver for a newly created position: information technology director.

This spring, several county information technology specialists from across Iowa came to Ottumwa to tour county offices and examine the computers, buildings, Internet service and phone usage.

"They found an uncoordinated mess," said supervisor Steve Siegel.

Each department was making its own decisions in regards to the Internet and computers. The study resulting from the tour showed that the county could save between $100,000 and $300,000 per year if all technology was corralled under one department.

"We had too many Internet accounts, we weren't getting some of the discounts we could've gotten [on cell phones], we weren't coordinating purchasing supplies ... and we have too many servers," Siegel said. "Security was another issue. We don't have a unified email system, so they were able to stand outside and crack everybody's password in seconds.

"Basically, it's just an uncoordinated mess, and now it's going to get coordinated."