LCHD head defends hospice program budget

Hospice scale back

And maybe that service, rather than being discontinued, needs to be scaled back greatly, or needs to have additional attention to the budgetary line or funding that’s provided for it. But the service would still be there.”

Garry Seyb, Lee County Supervisor Chairman

Open books

We also welcome any questions from the public, our clients, and our funders regarding our bookkeeping practices and records.”

Michele Ross, LCHD Administrator

FORT MADISON – It would appear that a push by some on the Lee County Board of Supervisors to get out of the hospice business is at a stand still.
At Monday’s regular meeting of the board, Keokuk resident Mary Jo Reisberg  and an employee of the health department advocated for the county staying in the hospice business to make sure that every county resident has a choice for care.
Reisberg said she used Great River Hospice for her mother after a procedure because it was right across the pond, but she said it was having a choice that made the decision easier for her family.
Several members of the board, including Chairman Garry Seyb, said they don’t think the county should be engaged in business that competes with private for-profit companies.
Reisberg said the county can find that in many places,
“This idea that I read about you being concerned about competing with private business. You could probabliy look at a lot of the services you provide and see that. This is a service that you provide to residents of Lee County, but there are residents that a private business wouldn’t want to serve. Either because of financial reasons or their home conditions or personalities, you just never know.
That service needs to be there. For us, it was important to have a choice as well.”
Reisberg said the board needs to consider the service it’s providing similar to the county providing driver’s license services when they aren’t required to by the state.
Seyb said the health department is working on some things within their budget. He said the board will be discussing that budget at the beginning of the year.
“We’ll have to see where we’re at,” he said.
Seyb said the $250,000 back-to-back deficit spending in the hospice and home health care budget is something that is concerning to some on the board.
“In that specific service, that was the concern. And maybe that service, rather than being discontinued, needs to be scaled back greatly, or needs to have additional attention to the budgetary line or funding that’s provided for it. But the service would still be there.”
Michele Ross, the administrator of Lee County Health Department which operates the home health care and hospice service, clarified some of what is happening with the budget in an email to Pen City Current.
Ross was addressing concerns from Lee County Auditor Denise Fraise  who said she was going to speak with the state auditor’s office about the LCHD’s home healthcare and hospice budget.
Ross said she met with Fraise on Dec. 12, a day after the board’s meeting last week, to discuss the budget after reading Fraise was going to seek input from the state.
“I met with Denise Fraise the following morning on Dec. 12, 2023 after the BOS workshop in regards to the article that came out to ask her what her concerns were with our bookkeeping,” Ross wrote.
“She responded she had concerns about what was reported in the county workshop about using grant funds for some of our personnel in Hospice and how we are shifting funds around and using new grant dollars.  I explained in detail what has actually occurred.”
Ross wrote she shared that LCHD was asked by the state prior to the new fiscal year starting and a renewal grant was released to consider expanding the department’s capacity to serve more families in its Maternal Infant Early Childhood Home Visiting program (home visiting services). 
Ross said they would be willing to expand the program starting in October and the state provided funds to start training for the program staff. The extra staffing cost was included in the grant application which allows the department to reassign a portion of the salary of those current employees to the grant, and move it out of the hospice budget.
Ross said officials chose to include 10 hours per week of social worker’s time into the new grant program, allowing them 30 hours per week in hospice service.
She said four hours of the program director’s salary is being allocated to the grant program as well.
“After this discussion, Denise indicated to me she understands better what we were trying to explain in the emotionally-charged workshop for how we are reducing expenses in our Hospice program with changes that have  occurred as a result of new grant dollars received,” Ross wrote.
“She commented after the discussion she did not think she needed to contact the state auditor.  I did express that if she, the county budget director, or the state auditor, or ANY elected official needed to come to our department and examine our books, to please do so.”
Ross said she then met with other county officials, including Budget Director Cindy Renstrom, because the county’s employee timekeeping system, including payroll, are not matching LCHD’s internal numbers. She said discussions focused on making sure all reports are correctly coded so LCHD’s expenses/revenues match the county’s. Ross said Renstrom and Fraise agreed that LCHD’s payroll will be submitted independent of the county’s payroll system to make sure records match.
Ross wrote that she then called the state auditor to report on the meetings and welcomed them to come examine the department’s records at any time. 
“We also welcome any questions from the public, our clients, and our funders regarding our bookkeeping practices and records,” she wrote.
She said the grant program allows LCHD to serve an additional 15 families under the MIECHV program. 
At Monday’s meeting, supervisor Tom Schulz pressed Ross again about COVID vaccines that were given by the department that weren’t turned in to Medicare for a vaccine administration fee that Ross said was available to for-profit pharmacies. Ross said the sheer number and circumstances of giving more than 500 vaccinations prevented them from turning in the costs.
Schulz asked Ross if they were reimbursed at all for the vaccinations, and Ross said they received some grant funding.
“They could be charged a vaccination administrative fee to provide the vaccine against Medicare and private insurances, but we chose not to do that,” Ross said.
“We could’ve received compensation that would have cost the county nothing and we chose not to do that?” Schulz said. “We chose not to do that or we statutorily could not do that.”
Ross said there would be no way moving 400 to 500 people through a drive thru or mass vaccination campaign, getting their medicare charged and billing. There’s just no way we would have been able to do it on that mass scale.”
Seyb asked if anyone else in the state submitted the billing, to which Ross responded she didn’t know about public agencies, but pharmacies did. She said health equity funds helped cover the costs of the vaccines for the county.
Schulz said the department should have at least looked for an option to get that done, and added if the county was receiving funds for the shots, then those services shouldn’t have created a budget shortfall in another department.
Since Monday’s discussion was held in a workshop, no additional action was taken aside from the conversation. He said the board will give the health department time to present their budget and review numbers over the next three to four weeks.
“This is catching the highlight because it’s a very emotional subject,” Seyb said. “I’m confident in saying it’s not just the health department that’s feeling the pressure now on what we’re going to have to do going forward, especially getting our general fund back in good shape.”