VNA closes; shifts care to new owner

The Vineyard Nursing Association new headquarters building in Vineyard Haven has added to the agency's outstanding debt. — File photo by Ralph Stewart

Updated at 10:15 am, March 13

The Vineyard Nursing Association (VNA) and its Nantucket Visiting Nurses unit closed on Tuesday, its services to Island patients assumed by the Visiting Nurse Association of Cape Cod (VNACC), part of Cape Cod Healthcare (CCH). VNACC took over the Vineyard agency’s business whose finances had become desperate, in part due to changes in Medicare rules and reimbursements.

All of the VNA’s patients have been told of the change, given the option to continue receiving homecare services from VNACC, and provided the documents necessary to coordinate their care, according to Michael Goldsmith, chairman of the VNA board.

“Cape Cod will become custodian of health information for all current patients and all patients who have been in the care of the Vineyard Nursing Association during the past seven years,” Mr. Goldsmith said in a press statement Tuesday. “Patients will see a seamless delivery of care. “In fact, aside from a nametag with a different company name, there should be no noticeable change to patients. Cape Cod will rely on the professional and paraprofessional staff formerly employed by the VNA to carry out care.”

Dianne Kolb, chief executive and president of the VNACC, also promised continuity of care. “We are excited to join the Martha’s Vineyard and Nantucket communities and look forward to a long and rewarding partnership with patients, providers and community leaders,” she said.

CCH announced that the VNACC would acquire the assets and liabilities of the VNA in a January press release, after VNA chief executive Robert Tonti ended similar discussions with the Martha’s Vineyard Hospital and Martha’s Vineyard Community Services, instead favoring the VNACC’s greater size, familiarity with the business, and financial strength. In fact, the actual arrangement arrived at between VNA and VNACC did not include assuming ownership and debt on the VNA headquarters.

The takeover is expected to stabilize homecare service on Martha’s Vineyard and Nantucket , with the help of VNACC’s annual budget of between $50 and 60 million, an organized staff of 4,700 employees, and more than 300,000 visits made each year to more than 2,000 patients. As a branch of CCH, the VNACC is backed by the umbrella organization’s annual budget of $700 million.

The VNA had struggled financially over the past couple years with an annual budget of about $4 million, largely from Medicare, Medicaid reimbursements, and from private pay and or private insurance. The agency had been a durable, critical Island health service for a quarter century.

Troubled times for Island-based homecare

Financial problems for the VNA began in 2009, when Medicare reimbursement rates for homecare organizations were cut. By 2018, these cuts will reach 13.5 percent. Revenue loss for the VNA totalled $466,000 in the first half of 2013, primarily as a result of these cuts and a decline in the number of patients.

“This year,” said Mr. Tonti, referring to 2013 in a November 19 statement, “Revenue for patient services has decreased 13 percent, with Medicare and third party insurance programs responsible for 84 percent of our shortfall.”

Mr. Tonti said that a combination of rising costs and decreased funding was making a small homecare agency like the VNA less financially viable. “The drop in revenues and increase in expenses over the past year are due to Affordable Care Act reductions in reimbursement rates by two percent, sequestration reductions on Medicare reimbursements by two percent, increased compliance and regulatory systems and policies that make accessing home care benefits more restrictive, and seasonality of workforce demands and balance of having the right workforce at the right time,” he said.

The VNA’s financial issues may also have resulted in part from expansion during a time of economic pressure. The VNA extended its services in May of 2011, under the name Nantucket Visiting Nurses, to Nantucket, after the Nantucket Cottage Hospital ended its homecare and visiting nurses services. Then, in November of 2012, the VNA opened its new headquarters on Breakdown Lane in Vineyard Haven, a property on which it owed $1.25 million in a mortgage before the takeover.

Since January, when the VNA announced that it had turned to Visiting Nurse Association of Cape Cod to take over the provision of home care services on Martha’s Vineyard, the terms of that arrangement have changed. This story has been updated to reflect the fact that a simple description of the transaction as a purchase of assets and liabilities by VNACC, including the VNA’s new headquarters, had become incorrect, though the details of the actual arrangement have not been made available. A VNA representative, in an email to The Times, could not explain the changes in the terms of the deal, but she wrote, “It was always our plan that patient’s would transition to CCVNA in March.  Patients were notified over the weekend and given the option to have care from CCVNA.  Most clinical staff and home health aides were hired by CCVNA to provide care, so there should not be much of a difference in what patients see. To keep the priority on patient safety we needed to set a plan in motion that would ensure that care would be uninterrupted.  As of today, all patients are in CCVNA care.”