The first order of business at the Aug. 23 Macon County Board of Health meeting was to recognize two individuals for outstanding achievements. Health Director Jim Bruckner recognized Missy Boston and Melissa Leatherman for their efforts in improving the health department’s quality of care.
Boston accepted a certificate from the North Carolina Immunization Branch on behalf of the entire department for ensuring that more than 90 percent of Macon County children have received age-appropriate immunization by the age of two.
Leatherman could not be at the meeting. She was giving a presentation to the monthly Ladies Night Out at Angel Medical Center. She was recognized for compiling an extensive report to the SNS Preparedness Audit Review in Asheville. Bruckner commented that “getting a 97 percent out of a possible 100 percent was a huge thing,” therefore the board wanted to say a special thanks to her. Bruckner said that Leatherman has also passed her CPR instructor certification. “We only have a couple of those in the health department and now that she has moved to health education ... we are happy,” Bruckner said.
Macon County Board of Health chair Roberta Swank spoke directly to Boston, but was speaking of both accomplishments when she added, “I remember thinking that these little things that sometimes the community, and even as board members, get a lot of things going because we expect perfection ... but we appreciate the work that goes into it. Thank you.”
Flu vaccine is in
Since flu season is just around the corner, Jimmy Villiard focused the attention of the board to a flu vaccination plan.
“The good news is that we have the flu vaccine in, which is kind of unusual because last year we did not get it until late,” said Villiard. He also said that they will be trying something new this year by adding a vaccination clinic at the Macon County fair. Flu shots will be given at an outside station at the fairgrounds Friday and Saturday, Sept. 16 and 17 from 9 a.m. to 9 p.m. while supplies last. The shots will be available for adults and children at a cost of $25. No appointment is necessary. Organizers ask people to bring their BCBS, Medicare, Medicaid, Tri-Care, Crescent and Medicare replacement cards with them in order to file the insurance. Villiard said that there is more competition this year for places to receive the vaccination, but they are expecting the same kind of success at the fair as they had at the Pumpkinfest last year. For more information about the vaccinations, call (828)349-2081.
Another thing that will be new for Macon County this year is the Fluzone High-Dose Seasonal Influenza Vaccine, a vaccination of a higher dose which will be offered to persons 65 and older. Research shows that the immune system grows weaker with age, and the body does not have the same ability to properly respond to the influenza vaccine. This places people 65 and older at a greater risk of contracting influenza even though they received the vaccination. According to the Centers for Disease Control and Prevention (CDC) “the Fluzone High-Dose vaccine contains four times the amount of antigen (the part of the vaccine that prompts the body to make antibodies) contained in regular flu shots.”
In December of 2009, the Food and Drug Administration (FDA) and the Center for Disease Control (CDC) approved the higher dose vaccination as safe for the general public. In a study comparing the high dose vaccination with the regular Fluzone vaccination, a higher number of people reported adverse effects after receiving the shot. The CDC reported that “the most common adverse events experienced during clinical studies were mild and temporary and included pain, redness and swelling at the injection site and headache, muscle aches, fever and malaise.” The FDA and the CDC approved the higher dose of the vaccination because, in their estimation, the effects were not serious enough or wide spread enough that it would be deemed unsafe.
Villiard said most assuredly that the higher dose vaccine “has been approved by the FDA and it has been proven safe.”
Adult dental clinic
Tammy Keezer explained to the board that the adult dental clinic is still experiencing difficulty in finding a full-time, state licensed dentist. On the board’s recommendation at the last meeting, the search for a dentist was expanded. Letters were sent to all active and retired dentists in Macon and Jackson counties. There has been some response to those letters. Advertisements were also placed in the Atlanta and Knoxville papers. The committee is working to get Dr. Brinner, a local dentist, contracted to work a couple of Fridays. One other dentist from Candler has showed interest in the position and the committee is currently trying to make contact with that candidate and open negotiations with him.
A major problem that arises from not having a contracted dentist for the clinic is the cost of keeping the operation running as much as possible. Villiard pointedly asked the board, “How long can we maintain the clinic in its current operation?” As it stands, the clinic is only open two days a week. For July, the clinic managed to generate close to $27,000 in total revenue for the month, but Villiard states that that isn’t enough and they are looking at cutting the already reduced services in half.
Villiard also presented the board with another option. He said that they could “mothball” the clinic and basically shut down operations “because we do not have a dentist and we cannot provide the service.”
Villiard said that there were enough funds available to continue the clinic as is for another month. It was the decision of the board to wait one more month and see if they could get the dentist from Candler to come on board and solve the problem of possibly shutting down the program.
Strategic health plan
Kathy McGaha presented the board with an update on the Health Department strategic plan. According to McGaha, her staff that has been working on the plan had condensed a 35- page document from last year down to two pages. McGaha said that this was due in large part to a redirection of focus on two main goals: The leadership team trying to make the plan smaller and “easier to absorb and understand,” and to get employees within the facility to relate their particular job to the strategic plan. Four divisions are charged to come up with workable objectives for each priority, personal health, population health, environmental health and operations. The deadline for the staff to bring their ideas to the table is Sept. 6.
McGaha focused on three priorities recommended by the leadership team.
The first priority is to improve communication within the system and to “develop/refine communication strategies that target key stakeholders.” The team rated various organizations according to their interest and influence in the Health Department and looked for ways to communicate with those organizations “more efficiently and more effectively.” For example, the Department of Social Services (DSS) would have a considerable amount of interest in the Health Department, but would not have as much influence. Therefore, the DSS stakeholder rating was not very high as far as a priority target for improving communication strategies. The Board of Health or other county officials would have a greater influence, therefore, they would have a higher priority of communication.
A second priority that McGaha presented was to maximize their partnerships with hospitals and other community stakeholders to work together at “improving the health of the population; improving the experience of care (access, efficiency, and quality of health services); and contain or reduce healthcare costs.” This comes directly from the Institute for Healthcare Improvements Triple AIM. It is the plan of the Health Department to adopt this philosophy.
The third priority that McGaha presented was to improve the utilization of technology to generate revenue and reduce costs within the Health Department.
Tonya Hodgins was asked to update the board on the status of the budget. According to Hodgins, the expenditures for the past two months is right at 11.9 percent, which is below the anticipated mark of 16.66 percent. Hodgins explained that, on paper, the revenue figures do not look good, but some Medicaid (about $69,000) and state funds (a total of about $115,000) have not been recorded into the county budget yet. When all of that is totaled, Hodgins projects that the budget revenue would be up to almost 8 percent, which is the level it should be for the month of August.