Visiting Nurse Services of Connecticut: William Sullivan, President & CEO

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In 1909, the first visiting nurse began making rounds in Bridgeport, Connecticut, on a bicycle. Hired by a group of 80 women from 21 churches and charitable organizations, her job was to take care of homebound tuberculosis patients and to educate their families on preventing the spread of the disease. In 1910, the organization hired a second nurse. By World War I, the agency had moved its operations from private homes to an office in a building on Main Street. Within 10 years it had 17 nurses making nearly 20,000 visits to homes in Connecticut annually.

Today, Visiting Nurse Services of Connecticut (VNS) is one of the largest healthcare providers in the state. The 600 staff members of this non-profit organization provide services 24 hours a day, 7 days a week, 365 days a year with approximately 260,000 patient visits annually. VNS has five offices serving three Connecticut counties. Operating with a $32 million budget, the organization provides about $6 million in uncompensated care on an annual basis.

The Heart of VNS Services

VNS is a primarily a homecare provider. If a patient is discharged from the hospital, but still needs extensive care, a physician would refer them to VNS. Patients needing physical or occupational therapy benefit from VNS services. The organization provides speech therapy, short-term counseling, and home health aides that can assist with everything from bathing and dressing to help with other activities of daily living.

“A lot of what we do is really focused on education,” says William Sullivan, President and CEO of VNS. “We work not only with patients, but with caregivers—the family and friends of the patients—to educate them on patient safety and assure that appropriate practices are being followed.”

The difference VNS makes in a patient’s life can be the difference between a prolonged, expensive and stressful hospital stay and relaxed healing in the home environment. Over the years, VNS has introduced a number of specialty services to enhance and broaden homecare services. Specially trained nurses are available for IV therapy, wound and ostomy care, palliative care, monitoring for diabetes management and much more.

Major Challenges of a Homecare Agency

In many ways, the challenges facing VNS are no different from any other healthcare organization. Sullivan says navigating the complex and rapidly changing regulatory environment of healthcare is a major force on both the delivery of care and the financial side of the business. In a 15-year review of Medicare and Medicaid, reimbursements have increased only by about one percent and almost 75% of the organization’s revenue comes from Medicare and Medicaid reimbursements. Another 15% come from managed care providers. “I think as an industry, in general, we continue to be tested with massive and burdensome regulatory reform,” Sullivan says. “We’re seeing increasing demands for services. We’re seeing really significant and complex patient health issues. And we’re seeing shrinking and stagnant reimbursement levels.”

Sullivan also highlights staffing issues as an obstacle. “It’s a very difficult workforce market with clinical people,” he says. “There are a number of opportunities, but just not enough [clinicians] to fill them. This is presenting some long-term problems in our workforce.” The expanding technological nature of healthcare treatments is at issue, as well. Not only is the equipment to manage disease and provide services such as wound care and IV therapy important, recruiting individuals with credentialing in these areas is vital to providing best outcomes to patients. “We have made investments in new technology and services to monitor patients at home,” says Sullivan. “We also invest a lot in the education of staff so they can be well equipped to work with and address the complexities of the systems.”

As prices continue to soar, and reimbursements decline, the organization is starting to feel the impact on non-patient sources of revenue, as well. Donations from foundations and individuals are on the decline. “The economy itself is having a dramatic impact on the challenge of providing quality homecare services,” says Sullivan.

Further, as hospitals see a decline in their census, referrals tend to drop. Many homecare agencies have been forced to become selective or restrict the acceptance of referrals for certain types of payers. VNS has not succumbed to that route, yet. But Sullivan admits that it’s certainly a strategy that has been looked at and considered from the long-term survival point of view. “I think the situation is going to create access restrictions in the future if reimbursement systems continue to go in the direction that they are going,” he says. “Homecare is at the center of the strategic blueprint [of government remedies for the healthcare situation], but up to this point they are recognizing the value of the care without an appreciation of the cost of doing business to allow that care to occur.”

Finally, VNS is seeing more and more patients who, due to the economy, have deferred their healthcare needs. “What that does is lend itself to a higher acuity level and much more difficult patients to try and manage once they are forced into a situation where they finally seek medical attention,” he says.

Investing in the Future of Homecare

The bottom line is that VNS exists to create the best outcome possible for its patients. Giving patients the opportunity to stay home rather than be admitted into a hospital or nursing home is their ultimate goal. In Medicare reviews of patient outcomes, VNS consistently exceeds national standards. Sullivan is proud that the organization maintains a very low hospitalization and re-hospitalization rate. He says monitoring feedback from patients, families, doctors and staff is a continual process at VNS and they are constantly setting goals and putting action into place to address the needs of the population as they occur.

“The goal is producing the best quality outcome for the patient,” says Sullivan. “That’s really our foundation, and it’s the most important part for this organization to ensure; that we are providing the most appropriate and contemporary care that can be provided.

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