Work Session
February 27, 2012
Present were: Mayor Grenier; Councilors Théberge, Ducharme, Otis, Morgan-Allain, Remillard, and Rozek; Councilors Nelson and Higbee were absent.
Others present included Sylvia Poulin, Brian Valerino, Mike Perreault, Angela Martin Giroux, Pamela Laflamme, Yvette Leighton, media and public
Proposed Change to OHRV Ordinance Allowing Year Round Trail Access
Assistant Chief Valerino explained that the existing language in the ATV ordinance is causing problems and he suggested striking the language that prohibits atv’s from riding in the roadway on the connector trail after the first snow. There would be an addition of closing the trail coordinating with the State’s closure for mud season. Mayor Grenier confirmed that the Trails Bureau is aware.
Councilor Théberge argued that atv’s are not mandated to join a club like snowmachines and they should not be allowed on the groomed trails. Councilor Rozek noted that the proposed ordinance change would increase safety because atv’s attempting to ride on icy sidewalks is not working. With this change, they would continue to go in the road.
Councilor Remillard commented that this is not to allow atv’s on snowmobile trails but to use the street on the connector trail. Mayor Grenier added that only the areas at the intersection of Mason & Hutchins and Cole & York as well as Cole & Dead River Park would be affected.
Councilor Théberge suggested sending the issue to the Traffic Safety Committee along with a request to find a better route for the trail. Mr. MacQueen stated that the existing trail is the result of several years of meetings with a group that included ATV and snowmobile enthusiasts as well as Chris Gamache from the Trails Bureau. He offered to convene a meeting of the group to hear Councilor Théberge’s concerns.
Councilor Otis expressed that atv’s ruin groomed snowmobile trails; however he did not have a problem with this compromise to allow atv’s the use of the roadway to access the connector trail. Mayor Grenier indicated that an ordinance would be up for first reading at next week’s meeting.
Moving Downtown Forward
Sylvia Poulin addressed the Council regarding the Moving Downtown Forward project. She said that the Committee has already started to work on initiatives proposed by the consultants who guided the project. May 18 there will be a Day of Caring for the downtown; work is being done with a developer on the old t-birds building. In their report, the consultants stressed the importance of the City consistently funding the effort.
Ms. Martin-Giroux informed the group that the Workfare people are available to sweep, pull weeds, rake or do other work in the downtown. Councilor Remillard acknowledged that the City has to promote itself and others will come on board.
Ms. Laflamme stated that some of the budget estimates put together by the consultants have really big numbers and it is important to realize that the plan can be deviated from. PSNH is on board though it may not be for $2 million dollars. Enthusiasm for the community and its efforts will get people interested; it’s important to stress the positive.
Discussion of City’s Visiting Nurse Program
Mr. MacQueen reported that he prepared a memo and to bring the Council’s attention to an issue occurring in the Health Department. The Federal government is mandating home health agencies to provide electronic medical records by purchasing software and networking capability that will cost about $100,000 for the initial investment and $40,000 per year after the initial investment. The city’s covered costs and return from Medicare/Medicaid has been declining which raises questions of what to do and how to do it. The Rumney Trust could be used to fund the capital investment but there is still $40,000 per year for a software license fee that will be difficult to pay for with declining revenue.
The following options were laid out for Council’s consideration:
Option 1:
The City continues its Visiting Nurse program as is and bears the costs of upgrading by January 2014 while making every effort to minimize its losses including turning part-time staff (2) into per diem and utilizing all per diem as little as possible. Under this option, we would continue to monitor how Electronic Health Records (EHR) effects time needed by nurses and account clerk (billing) to possibly reduce costs by reducing hours or eliminating staffing as needed. This option may involve absorbing costs of monthly fees (approx. $3,400 a month) if not recoverable from billing due to decreased payment scales by Medicare and Medicaid and private insurances. We believe that this option will be less and less self-supporting in the future.
Option #2
The City continues to keep its Visiting Nurse program but does not upgrade to the required new software platform and instead petitions the governmental entities for some type of waiver to continue in this mode. We are not currently aware that there is any provision or likelihood for obtaining this type of waiver. We do not believe this to be a viable option.
Option #3
The City provides no nursing services at all expecting that other local agencies may be able to fill some of the gap. Currently, two other agencies in Berlin provide visiting nurse services or contracted services for office type basic health functions. Under this option, we would ask the other two agencies to purchase our stock of medical supplies to mitigate losses, and the positions of Nurse Supervisor and 3 full-time nurses, 1 full time account clerk, 2 PT nurses, and 4 per diem nurses would be eliminated. Under this option it is possible that the hospital or other nursing operations MAY be able to absorb some or all of the people from the eliminated positions. Patients will be offered the choice of the other two local agencies.
Option #4
The City divests itself of just the home health nurse program as in Option #3, but two part-time nurse positions would be retained. Under this option, we would maintain this PT nursing function for traditional public health items like Mantoux testing, B12 shots, flu shots, lice checks, blood pressures, cholesterol testing, glucose testing, foot clinics and to answer general health questions.
Option #5
The City continues to run the VN program until the last minute before invoking either options 4 or 5.
Mr. MacQueen said that this has been discussed with the nurses and they understand the concerns. At this time Medicare revenues are running lower than usual and there is no prospect that it will turn around. Councilor Ducharme confirmed that denials are resubmitted with different codes to maximize reimbursements. She also affirmed that partnering with other agencies has been dismissed as an option due to security issues.
Councilor Remillard noted that this issue was discussed last year and she asked if there has been an effort to increase business to increase revenue. Ms. Martin Giroux noted that this summer the case load was down 29% and now staff is at a full case load. She added that being busy increases revenue but it also increases costs. Medicare/Medicaid continue to increase what needs to be done by the nurses without offering reimbursement.
Councilor Remillard commented that sometimes it is no longer feasible to offer the service. Mayor Grenier stated that if the hospital was not providing the service, he would consider the expense. This is painful and staff is still looking at other alternatives. The reality is that there is a need to find an exit strategy.
Yvette Leighton stated that the Health Department is a business and she asked that the City support it like it would support other businesses. Mayor Grenier commented that there are tough decisions that need to be made. There are three agencies providing home health service in a community of 10,000 people.
Ms. Martin-Giroux explained that the Health Department would have to show meaningful use of the system by January of 2014 though Mayor Grenier noted that there may be some slack if we were making the effort. It is increasingly difficult to continue to support financially and there is a duplication of service in the community.
Councilor Rozek made it clear that the city would not be required to have the software if there were two part time nurses on board. Ms. Martin Giroux clarified that under Option 4, no insurances would be submitted by the City; it would be private pay only. Councilor Ducharme surmised that there would still be service; just scaled back.
HEAL Grant Proposal
Ms. Martin Giroux informed the Council that a resolution will be submitted at the next meeting for a HEAL grant for $10,000. Funding would be used to work with other agencies to promote healthy activities like walking and healthy meal options in the community. Coos County Family Health is willing to work the city on the effort. Councilor Ducharme asked what agency provides the funding and Ms. Giroux thought it was Health & Human Services.
Other
Councilor Otis mentioned that the High School print shop will work with students and the Public Works Department to provide the public with informational pamphlets on recycling. Mayor Grenier wanted to be sure that the City applies for funding through NH beautiful saying that the deadline is coming up, April 15.
Non-Meeting
There being no further business Councilor Rozek moved to go into non meeting per RSA 91-A:2 Collective Bargaining; Councilor Théberge seconded and the motion carried unanimously by roll call.
Respectfully Submitted,
Susan Tremblay
Administrative Assistant
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