VNA focuses on the mission while adapting to change

Bob Tonti, chief executive of the Vineyard Nursing Association, spoke with Inez Janger, president of the MV Donors Collaborative at the VNA opening in November. — File photo by Ralph Stewart

Every morning, as Vineyarders are waking and starting their day, the Vineyard Nursing Association (VNA) sends a small army of clinicians and home health aides out on the roads to visit patients all over Martha’s Vineyard. In the course of a year, our caregiving staff will make more than 40,000 visits to more than 1,000 patients, to ensure that they receive the care they need to remain healthy and safe in their homes.

Fortunately, our residents don’t have to worry about whether their home care is going to be delivered in a caring and compassionate way. It is. And they don’t have to worry about whether it will be delivered at all. It will, as it has been by the VNA for nearly 30 years.

Of course, every year Vineyard Nursing faces new obstacles to overcome so that we can continue delivering compassionate care to all those who want and need it. This year was no exception, though it was exceptional in other ways for Vineyard Nursing.

2012 review

We are all familiar with the “silver tsunami” that began as the baby boomers became Medicare eligible and will continue for the next 17 years. Certainly, that will have a dramatic impact on home care in the nation and on the Vineyard. In fact, the aging population will grow even faster on the Vineyard as we are a retirement destination. According to the 2010 census, Dukes County is the fastest growing county in the state, including the fastest growing per capita population of residents over 65.

The VNA is already seeing an interesting impact from the boomers who want to stay fit and active as long as they can. As they elect to have hips and knees replaced, we are being called upon to provide corresponding services in numbers not seen before. So much so that we recruited, to augment our per diem staff, a full-time physical therapist from Maryland, and we will continue to recruit more physical therapists to help us handle the growing demand.

In fact, during the past year we saw demand for clinicians and aides grow in each of our three major programs:

Visiting Nurses, serving people who need help recovering from illness or surgery; Elder Services, a state-subsidized program delivering homemaking and personal care for people 60 and older who need help to remain safe in their home as they age; and Private Care, providing an array of services ranging from personal care to transportation to doctors’ appointments to respite services for caregivers.

The challenge with these programs is to recruit the staff needed to serve our growing patient list, which now exceeds 400 on any given day. We are actively working to create education programs that will increase our ability to add qualified nurses and aides, at the same time as we use “travelers” (temporary help) to meet the current demand.

On the business side of the VNA, financial stress is an ongoing concern. As Medicare tries to rein in health care costs, it is reducing reimbursements to home care agencies. To combat the trend, a few years ago we decided that acquiring our own building would help reduce overhead costs. In September, we achieved that goal and relocated to our new home: a 7,450-square-foot structure with the training and office space that will allow us to grow with the increasing demand for services needed on the Island. Raising the remaining $1.2 million needed to pay down the debt will enhance our financial position.

With our new home and a staff of 120 clinicians, aides, and administrators, we begin the New Year ready to face a fresh set of challenges in 2013.

2013 and beyond – a changing environment

Now that Obamacare is settled law, the health care industry will need to adapt to the new rules. Mostly that means becoming more efficient in delivering care and achieving better results for patients. We are also going to see more collaboration between providers in trying to drive change to meet those new rules

Clearly, forces in Washington and around the nation are struggling to contain the growth of Medicare and health care costs in general. During the next few years, as a provider, VNA faces diminishing Medicare reimbursements in our traditional visiting nurse business. This will force us to find new opportunities in other areas of home care. At the same time, hospitals are experiencing changes that will affect patients and require partnerships to bring about improvements. Part of the new Medicare reimbursement model emphasizes payment for “good results” and reduces payments for “poor results.”

Studies have shown that the most expensive place to care for people is in the hospital emergency room, and the least expensive is the home. Furthermore, too many people are discharged from hospitals only to return to the emergency room for care for the same reason they were admitted in the first place, and in fewer than 30 days after discharge. Medicare thinks this is an example of a poor result.

A new care model is testing whether hospitals can provide better results if they are responsible for the patient, not through discharge but rather until 30 days after discharge, which can include care in the home. Collaborating with home care agencies should be a key to success for hospitals that adopt this new approach, and a new opportunity to serve more patients for us.

Emergency rooms also see unnecessary visits from patients with chronic diseases — unnecessary because patients suffering from diseases such as diabetes and congestive heart failure, for example, can see better results with new models of care that are being tested around the country. Home care agencies working with other providers in the new care models are critical to successful results in this area, and are yet additional opportunities for us.

These and other innovations will allow VNA and other home care agencies to play a major role in controlling healthcare costs and improving care. The coming years will no doubt see dramatic changes in the healthcare industry. We know one thing for sure: home care agencies will be an important part of the change.

Bob Tonti is the chief executive of the Vineyard Nursing Association.