Visiting Nurse Merger Stalls

Talks Between Two Key Agencies to Form One Nursing Service Approach Time of Decision After Thirteen Months

By JULIA WELLS

Talks about a potential merger between the Island's two visiting nurse agencies have reached a critical juncture, and the next few weeks will determine whether the merger becomes reality or falls apart, leaders from both agencies said this week.

"We continue to talk," said Robert Tonti, the chief executive officer of the Vineyard Nursing Association. "But we are probably going to get to a point very soon where we decide whether we are going to finish this - or not," he added.

"It is still quite up in the air, but I think everyone is in agreement that we have to come to some definitive understanding," said Susan Wasserman, president of the board of directors of Martha's Vineyard Community Services, the parent organization for the Visiting Nurse Service.

The two agencies have been discussing a merger since January 2005. Both are nonprofits; the Vineyard Nursing Association stands alone, while the Visiting Nurse Service functions under the social services umbrella of Community Services.

Both agencies lose large sums of money on an operating basis, and depend on fund-raising to meet their annual budgets; the proposed merger is aimed at creating efficiencies by reducing administrative costs. Neither agency releases its financial statements to the public, although each depends heavily on private donors to contribute nearly $300,000 each year, which is used to close the gap in annual operating deficits.

Although there is some overlap, each agency also provides different services in the community. The Vineyard Nursing Association provides home health care almost exclusively, both skilled and unskilled. The Visiting Nurse Service provides some health care; it also has contracts with the Island towns to provide health services, including flu shot clinics, and it provides home visits for mothers of newborn babies.

Mr. Tonti said this week that the talks between the two nursing agencies had progressed to the point where a pro forma was developed on paper; the idea is to create a single, independent nursing agency, as opposed to one agency taking over the other.

But it is no longer clear whether that is possible, in part because the two nursing agencies are at markedly different places when it comes to their own internal business affairs.

The Vineyard Nursing Association, with Mr. Tonti at the helm, is pursuing a forward-thinking business plan that includes, among other things, a formal appeal of its Medicare reimbursement rates and specialty training for its health care workers in pain management techniques. The training is aimed at meeting the anticipated needs of the Vineyard community as its population ages. By contrast, future business planning for the Visiting Nurse Service effectively has been put on hold during a period of administrative changes at the top at Community Services, where a new executive director is set to take over in late February.

Mrs. Wasserman said this week that the merger talks have been useful and productive, but she admitted that Community Services simply may not be ready to commit to the merger.

"I would say that everything is very cordial and we have learned a great deal - there has been no defensiveness and we have shared a lot of information and I think that has been terrific. I think that probably it has been two steps forward and one step back, because I took over [as president recently] and we haven't had this executive leadership," she said, adding: "We are very much in the process of talking, and I don't think we have changed our mind that a single agency would be a very good idea, but how it would get from the two agencies to one, we haven't really figured out yet.

"I'd say we have learned a lot about the similarities in the organization and come to appreciate the differences. We are really coming to a place where we are going to be able to make a decision, but I don't have a specific time frame. We need to bring Julia Burgess [the new executive director who takes over Feb. 27] up to speed on all of this."

Mr. Tonti said his agency has a number of issues that require immediate attention, including recent changes in federal Medicare reimbursements that will eliminate about $180,000 in operating revenues if they are allowed to stand. Mr. Tonti writes about the Medicare reimbursement problem in an op-ed piece which is published on the Commentary Page in today's Gazette.

In addition, the nursing agency, which is housed at the Martha's Vineyard Community Hospital, must move out in June to make way for the start of the hospital building project.

"We have had a very tough year, financially," Mr. Tonti said. He said staff members will not receive a pay raise this year unless some extra money is found, and he praised them for their dedication and professionalism.

"Home health care is different from hospital care. It is really a calling and our people are extremely dedicated to their work," he said.

Meanwhile, he said the merger would benefit both agencies, and also the Vineyard community over the long term.

"I think it is something we should be doing - it helps the agencies, and financially it makes some sense," Mr. Tonti said, concluding: "There is a pony in there somewhere. I think there is a model that would give an agency a more stable financial footing going forward yet give it the autonomy. There is a way."