Local chapters of the Visiting Nurse Associations of America are linking with hospital systems in a mutual effort to control costs and attract managed-care contracts.
"A lot of the partnerships are about survival," said Lorrie Briggs, membership director for the Denver-based VNAA. "Many VNAs are finding themselves in a cut-and-dried position. If they don't line up with a larger system in the community, then they'll be cut out of referrals."
Briggs said the VNAA conducted a survey of its 207 members in September and found 72 of the 151 respondents had entered an affiliation, merger or acquisition agreement with other providers, both not-for-profit and for-profit. Another 37 respondents said they are planning some type of affiliation in the near future.
Briggs said the local visiting nurse associations are looking to lower costs, build economies of scale, increase their referrals, expand their geographic reach, and gain access to expertise and networking.
For example, the Dubuque (Iowa) Visiting Nurse Association agreed to close its home-care department and provide its private duty and community-based services as a new subsidiary of the parent organization of Finley Hospital. The hospital then opened its own home-care department.
The agreement put a more formal stamp on the organizations' existing relationship. Before the agreement, 80% to 85% of home-care referrals to the association originated at Finley. Referrals also came from physicians, other hospitals and home-care agencies.
The majority of the referrals to the hospital's new home-care department are expected to continue to come from Finley, said Julie McMahon, administrative director of home and community service at Finley and the Dubuque Visiting Nurse Association.
Referrals to the association's private duty services likely will come from Finley, other hospitals and home-care agencies, and public health agencies, she said.
The nurse association saw the deal as a natural step to gain greater leverage.
"We anticipate that by working together, we can expand our geographic service area as well as the scope of services we offer in the arena of home- and community-based services," McMahon said. "Other positive aspects of the partnership include the potential for cost savings, the addition of new employment positions, patient convenience and improved positioning for managed care."
For the hospital, the union represented a chance to develop a continuum of services in order to meet the demands of a growing elderly population in the state and to answer calls from managed-care organizations to provide a more complete delivery system.
"Our research has revealed that administering home healthcare from within the hospital will open the door for many opportunities and lend itself to a more seamless process and complete delivery of services," said Kevin Rogols, president and chief executive officer of Finley.
Jewish Hospital HealthCare Services in Louisville, Ky., and the Visiting Nurse Association of Louisville this fall agreed to merge for similar reasons.
"The home health services provided by VNA combine well with the acute care, occupational medicine, rehabilitation, and home medical equipment services of JHHS to create a comprehensive continuum of care for people in this area," said Henry C. Wagner, JHHS president.
Under the merger agreement, the visiting nurse association will retain its name and provide home-care services for the system. The financial terms of the merger between the two not-for-profit organizations were not disclosed.
JHHS includes more than 20 hospitals and other health facilities owned and managed in Kentucky and southern Indiana. The VNA made 248,309 home visits in Indiana and Kentucky last year.
Though visiting nurse associations have a long history, dating to the 1880s, of providing not-for-profit home-care services, some have been joining with for-profit companies in recent years, Briggs said.
She said a chapter in Centralia, Ill., was acquired by ServiceMaster Healthcare Management Services, Downers Grove, Ill. In addition, she said, Columbia/HCA Healthcare Corp. had snared chapters in Nashville, Tenn., and Chapel Hill, N.C.
In such cases, she said, the chapters lose their VNAA membership.
"For VNAA membership, the line in the sand is not-for-profit status," she said. "Most VNAs want to align with someone with a like mission. The ones that have gone for-profit didn't have a lot of options."