Nursing

Fee for Service is contracts with other agencies for services.  The only contract we currently have is with the Behavioral Health Board to support the C-Harmed clinic to provide a counselor and some supplies.

State or Federal is MAC (Medicaid Administrative Claiming) and CMH (Children with Medical Handicaps).

Fund 2025 is the COVID Vaccine grant and the revenue it generates.

Fund 2003 is the Public Health Nursing Fund.

Comparison of Nursing Fund expenditures over the past several years.

Much of the nursing revenue is generated by giving vaccines and billing insurance for them.  Immunization activity is seasonal in nature, with predictable patterns.  School shot season begins in July and goes through August.  Flu shot season can begin as early as August, peaks in October and winds down in November.  Revenue should trend along the same lines, allowing for insurance billing lag.  This graph shows that the revenue is not predictable, indicating billing issues.

Immunization data is uploaded into the State immunization registry, ImpactSIIS.  According to the ImpactSIIS data, this is the number of shots given through the Health Department each month from 2017 through the present.  As the blue line shows, there are predictable spikes in activity in September and October, coinciding with flu shot season.

The red line is COVID vaccinations.  

This is the nursing revenue by month for the fiscal years 2017 through the present.  The expectation would be that this line would follow the same trends as the vaccinations given line, but lag about 3 to 5 weeks behind for the billing cycle to be completed.  This shows unpredicted spikes, indicating a billing process that is inconsistent.

The CMH Program is a care coordination program for families of children with specialized medical needs.  The CMH nurse helps families enroll in the program that helps fill any medical coverage gaps not covered by traditional insurance or the medical card. 

Recruitment and retention for this position are incredibly difficult.  The nurse must be an RN, and a BSN is preferred.  Due to the nature of the medical complications these children and families face, it is crucial that this nurse be well versed in pediatric medicine and challenging medical conditions.

Over the past 10 years the department has had multiple nurses come and go, and has had gaps in service many times.

The C-Harm-Ed program is a County Harm Reduction and Education outreach program that focuses on reaching disenfranchised county residents who are suffering from SUDs and related consequences. 

The goals for the program are to reduce HIV and Hep-C infections in Washington County by reducing exposure to dirty needles, and to help people break free from the cycle of addiction and harm done to themselves and their families.

The program if funded by the Washington County Behavioral Health Board.  The contract runs from July 1, 2023 through June 30, 2024.