Sunday, July 5, 2015

Why Aren't I Excited Yet?

When I first started working at the Mid-Michigan District Health Department I was alarmed to see that it had experienced five years of steadily decreasing budgets. This meant decreasing staffing levels, too, since our only large expenditure category is for personnel. As I visited the branch offices and spoke with staff I made a point of showing them a chart of the budget (like the first five bars of the chart below) and explained to them that this trend was a threat to their jobs. I said that we needed to work together to reverse this by expanding our programming and increasing our efficiency. My wife called it my “straight talk” tour. In fairness, staff knew this already and were already working hard on quality improvement projects and expanding billing, so the foundation for a turnaround was well laid.

I am happy to say that the trend has been reversed. During the 2012-13 fiscal year, we bottomed out with 68 FTEs. This year we have 72 FTEs. This year for the first time in several years we are giving staff raises, which are long overdue. And we are proposing to the Board of Health a budget over 6 million dollars for the first time in five years.

MMDHD Revenue and Expenditures FY 2008-15. Up at last! 

So why aren’t I excited yet?

The reason is that our traditional environmental and personal health programs are still underfunded and understaffed. Funding from the Michigan Department of Health and Human Services will be flat again this year and we expect the same from County appropriations. This means that with every year that passes, inflation eats into our ability to run these programs. Meanwhile, the workload continues to increase. We have new minimum program requirements in environmental health and Children’s Special Healthcare Services, for example. We have been hit with major new requirements in Emergency Preparedness.

Look at the chart, above. In 2013-14 and 2014-15 Revenues and Expenditures were right around 5.8 million dollars. In 2015-16 we expect to spend and earn 6.1 million. All of the increase is due to new programming including Community Health Workers, Drug Free Communities and other activities that have their own funding streams. The dollars they bring in cannot be directed to support other underfunded activities. This is really a double whammy, because as we add programs we increase the pressure on the administration and supervisors. We need to add at least two supervisors to cope with the workload, but our overhead budget has not increased at all.

Imagine how this looks to the average Michigander: Your budget is going up but I still can't get a well permit on time? The reason is the new money we have brought in is not for the well program.

We don’t have many friends out there. For example, the Michigan Restaurant Association is on a tear to get the legislature to cut the fees we charge for restaurant inspections. This move would effectively bring restaurant inspections in Michigan to a halt. The result, predictably, would be an increase in communicable disease outbreak investigations, which is also flat funded.

One friend is the Ingham Health Plan Corporation. In January the work of our Community Health Workers will become billable to Medicaid Health Plans. The Corporation is trying to help us figure out how to price the services of the Health Workers so that the overhead costs of supervision and technology are fully covered. We need a lot more of this business-like thinking.