Thinking with your head; leading with your heart — Visiting Nurse Association

Updated: 9:45 a.m., May 12, 2009

CLEVELAND, Ohio — Claire Zangerle is restructuring the Visiting Nurse Association of Ohio to run more like a business.

“We’re such a from-the-heart business,” said Zangerle, the native Texan who took over in July as chief executive of the non-profit community health association started in 1902 primarily to vaccinate poor children. “The reality is that without being smart at business and thinking with your head, then you’re not able to give with your heart.” 

The Ohio member of the national nursing association has a staff of 768 people in three satellite offices — Lake, Lorain and Summit counties, “and we’re just about to open up in Geauga,” Zangerle said. The association also runs a mid-Ohio operation out of Mansfield.

Last year, the Ohio staffers directly or indirectly cared for 12,000 people in their homes — from diabetics struggling to control their blood sugar to patients recovering from knee replacements to dying cancer patients.

A United Way-supported agency, the Visiting Nurse Association cares for people regardless of their ability to pay, Zangerle said. Much of the care is reimbursed by insurance. Some of it’s paid for out of patients’ pockets.

“Patients do what they can,” Zangerle said, adding that the agency has had a surprisingly small amount of bad debt over the years.

Zangerle, who has master’s degrees in nursing and business, recently hired three more chiefs to head reorganized business lines at the association:

• Teresa J. Wimms, formerly director of nursing informatics at the Cleveland Clinic, joined the VNA as chief informatics officer. Wimms will be responsible for developing and leading information systems, data processing and telecommunications.
• Janette D. Petro joined as chief marketing officer. Petro has been a marketing professional for 22 years, mostly in the banking and law industries. She will be responsible for marketing and business development, including developing new relationships, and growing current strategic partnerships and referral sources.
• Susan M. Paschke is chief quality officer. Paschke spent 24 years with the Cleveland Clinic, most recently as associate chief nursing officer for operations. She will determine the strategy and put in place improvement processes for organizational quality.

Previously organized as clinical units — skilled nursing, hospice, private care assistance and others — Zangerle  put the new chiefs in charge of functions like finance, human resources, marketing information technology and marketing.

MedCity News asked Zangerle about what she sees as the opportunities and challenges for her organization, especially in light of expected health care reform and a shifting national industry.

Q. What role does home care play in the nation’s health care system?

A. Home care is part of what I call the three-legged stool of health care. What is the goal of health care but to keep somebody well? To keep them out of the hospital, to keep them out of the emergency room, to keep them out of the revolving door of the physician’s office where a visit is not necessary?

That is home care. It’s teaching people how to self-manage whatever disease process they have, whether it is acute or chronic.

Q. Given your view of the three-legged health care stool — hospital, doctor’s office and home — what do you think about the concept of the “medical home?”

A. Oh, I love that. It’s an inclusive, comprehensive, one-stop shopping. It feels like the old-time family practice where if you call one main number, you get everything you need. And that’s exactly what we do at the VNA.

We’re one of the pieces of the medical home. In fact, we’re trying to integrate with MetroHealth [Medical Center]. We’re their preferred provider for home care.

Mental health is a huge piece of what the VNA does, too. We have like 32 mental health nurses that go into the home.

Q. The Obama administration says it’s committed to health care reform. How do you think the new administration will affect home health care?

 A. Initially I was very encouraged with the new administration and the support for home health care. Well, when the 2010 budget came out — 5-percent cut of home care in Medicare, and of course, home care and Medicare are hand-in-glove. A five-percent cut is astronomical for organizations our size.

Q. Do you offer remote health monitoring?

A. We have a telemonitoring program in both our Cleveland office and in our Mansfield office. Our biggest patient base is heart failure.

Q. Why was it necessary to reorganize your nursing association?

A. Historically, the VNA has had several companies in silos. And I saw a tremendous lack of communication across those companies. To me a lack of communication was an efficiency problem.

So the managers in hospice didn’t really talk to the managers in home care. They still live in their own specialized worlds, but now they have buddies they can talk to. And we were able to get some economies-of-scale, some efficiencies.

Q. What is the biggest challenge in the home health are industry?

A. Competition. And competition with people who aren’t as good as you… basically companions, home health aids. They’re not regulated. And they’re not insured.

You’ve seen in the last quarter three new hospice companies open up. One of them is a national company that has just decided to come in and give us and [Hospice of the] Western Reserve a run for our money. This one is for-profit.

It’s tough for us. We have to keep telling folks, ‘We’ve been here, we’re still going to be here when these other companies go under or whatever.’ We’re joint-commission accredited.

Q. Is the economic recession affecting your association?

A. Our mission’s to serve anybody, whether you can pay for it or not. Well, that kind of gets you in trouble on the financial side.

So we have to look at regionalization. In order to be able to support the inner city and continue the good work that we’re doing, we have to get to the suburbs, because those of the folks who have insurance. And that’s how this agency can continue to build and to grow and meet the needs.

Q. What changes would you like to see in Ohio to help the home are industry?

A. [The proposed medical mart in Cleveland] would give us the opportunity to showcase what it is that home health care is. I would like to see some regulation of the home health care aid industry. Keep the funding intact. We don’t expect to get more. But we certainly don’t want to lose our funding.

I’d like to see nurses interested in home health care as another piece of their career. I’ve had nurses say to me, ‘This is not at all what I thought it was going to be.’ And they either fall in love with it, or they say, this is not for me.