Co-op Center™

Equal funding for healthcare rarely follows citizens into community residential settings once they leave the large facilities.  Read More....

To meet this challenge, the professionals at Pennhurst have designed a unique model for community healthcare provision that can consist of either a “virtual agency” or “bricks and mortar” approach.  Read More ...

The De-Institutionalization Penalty
Except for a handful of states with managed care programs, the community resident and/or guardian is faced with a new obstacle. That obstacle is quite substantial. Put simply that obstacle becomes having full access to healthcare.

Ironically, in every case that we are aware of, the healthcare that the state owned and operated institutions provide for institutionalized citizens is much more expensive than the healthcare that the community residential citizens have access to. While the care is not necessarily better in the institutional settings it is more expensive!

Poverty remains disproportionate amongst disabled Citizens. Census data shows those without disabilities to have poverty rates (less than $15,000/year income) one third lower than disabled persons (20.2%).

Currently, insurance reimbursement rates for providers who care for low income clientele are lower than actual costs of care. A report released by the Kaiser Family Foundation, explains how two million low-income adults ages 18-64 were denied medical care by a doctor or hospital. The main reason for denial of care, the report maintains, was the very low fees many states pay for Medicaid patients. These millions of underinsured, along with the 40 million uninsured Americans, have few health care options as hospitals shut their doors to low or no reimbursement. Unjust low income insurance reimbursement rates, both private and public, affect all medical facilities.

This trend closely follows the gross disparity in direct support staff salary in the community setting and the very large state owned and state operated centers. Perhaps a later version of MiCassa will address this very significant problem.

Ongoing studies indicate a preliminary estimate showing that some states paying five times more on a per citizen basis for direct care in an institution over that provided in the community residential setting.

While the backlash activities against the Americans with Disabilities Act (ADA) recently tagged disabled people as the "next consumer niche" estimating that "Handicapitalism", a term coined by Jonnie Tuitel, could have $1 trillion in consolidated buying power, the truth is that the decision-making power is far removed from the disabled individual.
The real buying power resides with government agencies who make purchases for disabled individuals under programs such as Social Security, Medicare, Medicaid, and other agencies, rather than the buying power being in the hands of the disabled citizens. It is no wonder that the financially successful privately owned provider organizations use lobbyists until they can effectively control government agency purchasing decisions. The Co-op Alliance Centers are designed to correct this disproportionate allocation of the interests of the disabled.

Also, low income communities are disproportionately hard hit by low reimbursement rates and the dissolution of health care facilities. Small hospitals and health clinics operating in underserved areas are forced to survive on these same reimbursement rates that force larger providers to shut down. Loss of these health care centers affect communities deeply, depriving all citizens of essential health care. These closures shift the financial burden of caring for the poor to remaining health care institutions in or near the community, creating longer waits for appointments and a decrease in the quality of care.
Access, to healthcare is a basic right, that if withheld inappropriately, can increase the costs of all other services provided to the citizens. Numerous studies show that a healthy population is much more "happy" and well adjusted. In a large institution sophisticated medial expertise is purchased (usually on a no cost barred basis). In the community the reimbursement for the direct healthcare coupled with markedly reduced access to direct medial services creates a very big problem.

A Seemingly Un-Resolvable Problem
Our organization is constantly asked for help in finding specialized or other direct healthcare staff that "understand" this area of medicine. At times support staff and guardians are faced with "dogmatic" medical professionals who do not have a clue (and do not wish any input from staff) concerning the best care for the community resident.

With the changes that healthcare is undergoing in the United States, for example, HMO growth and Medicare HMO failures, it is very important that healthcare to the citizens is maintained and not abandoned simply because they are community bound. Also, withdrawals of services by Medicare HMO's from entire communities, is a harbinger of things to come. It is no small wonder that some parents have voiced major concerns in that they consider the large state owned and state operated facility centers as the lesser of two evils in that they feel "assured" that at least direct medical services will be provided there. In the community settings, its an open question.

It is important that this concern be addressed to help promote the orderly transfer of citizens into the community. Once good healthcare is available, all of the complications that arise due to poor health, and the markedly increased costs for dealing with them, will be contained.

Thinking Outside The Box
Well, we can leave things alone and trust that the community healthcare resources will just "show up". However, as many of our seniors who have signed up for Medicare HMO's have found in their communities, Medicare HMO's resources have simply left them high and dry. Of course, if seniors have unlimited funds, there is never a problem.

There is no dispute that the cost of institutional healthcare is higher than the cost of services provided in community-based settings. The average cost of institutional healthcare has been determined by some to be more than five times the average cost of community-based healthcare.

This healthcare cost gap along with the cost gap of providing residential services caused some states to increase spending on services provided through community-based programs for residential services, but not as yet for direct community healthcare services.
Throughout history the saying that "he who owns a thing controls a thing" has been used in a number of settings and is especially appropriate here.

If we look at examples of community living arrangements, we see that the successful models are ownership models. There the citizens OWN the residence and if the service provider contract ends, so be it. The citizen is never forced to leave because of service contractor changes.

Let’s repeat this, in those community settings where the citizens "own" the residential facility, the resident is not placed at risk of being removed from the facility should the service provider contract change. One of the basic issues in developing a model of direct healthcare is to determine the ownership of the model.

Ownership does have its advantages. Another relative of the preceding quote in the healthcare field is that "control equals responsibility".

The second basic issue in developing a permanent healthcare model becomes answering the question of who has the responsibility for the health care model.

More than 3.6 million non-institutionalized Americans have either mental retardation or developmental disabilities. Roughly one out of 10 of them lived in a residential setting in 1998, not including natural or adoptive families or psychiatric facilities. The high number of non-institutionalized people with developmental disabilities highlights the need to develop a service delivery system that does not depend upon public institutions to provide care.

Here the penultimate statement of independence can be made by declaring that citizens are responsible for their medical care. Many groups have organized and taken control of their direct healthcare. While not being physicians or nurses, they "hire them" and control access in that fashion. Just as in some states property ownership and other programs have changed the landscape in community living arrangements our group has pioneered this concept of local ownership of the local healthcare system.

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How does it work?

Background
The longest trip begins with the first step and the only obstacle we have seen in the establishment of the healthcare access model is the taking of that first step.

Pennhurst can help you take that first step. We act as facilitators to build a co-op alliance in your community. Our perspective on this is quite simple, as we anticipate that soon all healthcare will eventually be provided in community medical facilities.

The vision that we have was easy since we have over 25 years of experience in operating medical healthcare delivery systems in large state owned and operated institutions. A brief example of how some "minor" problems were solved may be helpful as background to the genesis of the Co-op Alliance Practices.

We were made aware of a serious problem, transporting patient records from the residence to the physicians office. Our staff began searching for solutions. In working with the medical providers in the community we have found that there were many unresolved issues. For example, medical records were found to be more complete when they were created under medical supervision in the larger facilities.

One community based individual died when he arrived at a community hospital without a record of a previously know allergy to medication which he received. This could have been avoided if a simple system was in place for transporting accurate medical records by staff.

Our solution was to encourage experts to establish the "paperless medical record" medical record program to resolve this problem. The design involves having these complex medical records on a secured internet access server and issuing a smart chip card to the citizen/guardian. When a visit to the emergency room is necessary the smart chip on the card accesses the records and saves lives. When a visit to the primary care physician is necessary, all the lab tests, allergy records and past medications are available in a professionally outlined format, reducing the possibility for error.

In essence each person 's data is owned by them not the state. That medical record and a data access card that provides control to the record moves with those consumers when they move into community settings. This assures that all community healthcare providers have an efficient and useable medical record.

A Primary Care Model
Throughout the country the movement to provide quality primary care services have flourished. Communities have attracted and promoted individual medical providers and small groups to setup practice in their community throughout the nation.

So too, we believe that a primary care model is needed on a local basis so that travel is limited and access to care is guaranteed.

Permanence is key.

Above all the access to care must be permanent. If the responsibility for healthcare is left to other parties, ie state, politicians, one individual doctor etc., it is guaranteed to change. It may not be withdrawn but it will change!

The Co-op Alliance Practice
To permanently exist the entity must be born. This is done legally by creating a "limited liability partnership". This new entity that we will call "Your Community Medical Services, LLP" is owned by two groups.

The first group is the controlling group, they control 51% of the entity. If you are reading this you would most likely be a member of this group. Parents, guardians and other interested parties will be the group that has control and has to be "satisfied" with the care that is provided. Since it is a limited liability partnership, no liability accrues to the limited partners at any time.

Quality assurance reports, scheduling of services and the availability of services is determined by this group.

The second group owns 49% of "Your Community Medical Services, LLP". This group is made up of providers, people who actually work for the "Your Community Medical Services, LLP" and are paid by the "Your Community Medical Services, LLP".

This arrangement serves a number of purposes. Firstly, this is no different than doctors or therapists who setup their own practice and want it to grow. Since they are working to build the equity in this practice there is no more dedicated provider available to the consumer.

The healthcare provider sees this as the permanent job that it was intended to be. It does not change if their employer is bought by some large hospital or gone because of some of the other changes that are occurring in the country today, including hospital bankruptcies.
Secondly, the consumers own, possess and control their own healthcare. This is the most important aspect of the model.

The community based, Co-op alliance primary care model is a blueprint in the area of cost containment, quality, and access.

Operations
Once the entity is formed the actual services must begin. In those settings where a large state owned and state operated facility is closing and conveniently our group is contracted for those services at the facility, those providers simply move into the employ of "Your Community Medical Services, LLP".

If you are not fortunate enough to have our organization involved in providing healthcare services at a facility near you or if you would like to start up this facility from scratch, we will recruit and move providers into the community and place them in the employ of "Your Community Medical Services, LLP".

Finances
Always a problem in the past as the fee schedules on a per patient visit provided in the community simply have not been as high as the expenditures that are made by the states in state owned and operated facilities.

To overcome this difficulty, a "pump the well" approach is used in the startup phase. two types of prime can be used. One is through our network of private "angel" investors, and the other is by obtaining waiver fee schedules and a pilot project status as well as community assisted facilities grants. Once operational with sufficient patient volumes, "Your Community Medical Services, LLP" becomes self sufficient...... forever.

Benefits to this arrangement include the motivation of the healthcare providers since they are not only employees but members of the partnership and are therefore willing to provide services under more reasonable salary schedules.

Material Resources
Office space, equipment leases are routinely obtainable in our medical practice start-up areas. In some areas the state is more than happy to provide already existing office space for very low rental rates ($1 per year).

In some cases there is no need for bricks and mortar. For example, nurse staffing agencies for home care are given a large fee for scheduling employees. A community owned "virtual agency" can literally operate out of a small inexpensive office setting and provide more reimbursement for each nurse employee and thereby attract more candidates and reward them appropriately.

Various newslists have examples where parents have discovered that nursing agencies have received $54,000 per nurse over and above the salary that is paid to each nurse and have received an inadequate amount of nursing coverage for their relatives. If that family uses 4 full time equivalents each year and operated thru this virtual nursing agency that we establish for you, this would free up 4 times $54,000 or $216,000 in funds that go to getting better services rather than some middleman agency's profit records!

The important issues here are to leave the "specialty" services and expensive equipment that they require to be provided by the already existing community medical facilities. It is not cost efficient to reproduce those.

The primary care and certain convenience (dental, gyn etc.) services should be available so that transportation from the group home or residence will not be an obstacle or subject citizens to long dangerous travel.

End Results
A locally owned and controlled healthcare resource is now created for you to use. Costs are decreased for everyone. Quality of care is improved for everyone. Permanence is established. There is true "control of the healthcare!

In the past it has been difficult to control the healthcare delivery system. Now this component can be guaranteed, evaluated for quality and available right there in your town.
Please contact us so that we can set this up for you today. Pennhurst is the premier healthcare provider in the MR/DD arena and we want to show you why we win awards by providing this service for you.

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