In the second post, I said we’d take a look at the budgeteers for DeKalb County Rehab & Nursing Center (DCRNC). While the DCRNC Operating Board, the Health & Human Services Committee of the county board, and DeKalb County Board itself vet the budgets, none of these bodies prepares the budget. That’s left to a private company called Management Performance Associates, Inc. In other words, the facility is publicly owned and privately managed.
DeKalb County signed a contract with MPA in 1997 for management services for three years, at a cost of $65,000 per year, with provisions for renewal. Among the original provisions were that the manager, MPA, would provide a qualified health care executive at MPA’s expense to serve as administrator.
However, the agreement was amended in 2003 to have DCRNC provide the administrator at DCRNC’s expense. There is no explanation given for the change, but it probably came about because Illinois law requires a licensed administrator of a skilled nursing facility to work on the premises 40 hours per week. MPA personnel live in St. Louis. While I can’t speak to what was happening in 2003, I have looked at MPA travel reimbursements going back several years and the MPA manager typically travels to DeKalb twice per month. It seems unlikely the administrator spent 40 hours every week at the facility until DCRNC took on the responsibility for providing that person.
Broadly speaking, the role of the MPA manager is financial, while the administrator’s is clinical. Documents I’ve looked at don’t make clear whether one position is subordinate to the other or if both answer equally to the operating board. But MPA has the contractual obligation to prepare and submit an annual capital expenditure and operating budget, which in the last post I identified as problematic when it comes to budgeting for temporary CNAs.
Now twenty-four years into its tenure, MPA provides the DeKalb County Board more services than it did at the start. In 2007, a county resolution expanded MPA’s role to “include the operating board’s responsibilities for the DeKalb Supportive Living Not-For-Profit Corporation.” Beginning in 2012, MPA helped the county start a compliance program required by the Affordable Care Act, which it oversees to this day. And, finally, MPA has advised the county in the DCRNC renovation and expansion project.
Let’s get a picture of the costs of services. Here’s the invoice for this month:2021-oct-latest-invoice
Not including payments for construction-related services, the county will pay MPA about $275,000 this year.
The DCRNC’s operating board meeting agenda last month included the item “Authorization to Seek Proposals for DCRNC Management Agreement.” Considering DeKalb County’s ongoing three-year contract cycle with MPA, this is probably a routine Request for Proposal situation but the time has arrived under financial circumstances that are anything but ordinary. I hope the county takes this opportunity to assess DCRNC’s relationship with MPA, its management and governing structures, policies, communication protocols, and any other factors that prevented the county board from understanding the extent of the financial issues and retrenching when they were easier to address.
Below is the original contract between DeKalb County and MPA without the amendments:county-mpa-orig-contract-19pgs
Total vendor payments to MPA 2018:2018-vendor-payments-to-MPA-1pg
Total vendor payments to MPA 2019:2019-vendor-payments-to-MPA-1pg