18 Jan Regular Monthly Meeting Minutes January 18, 2018
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
Regular Monthly Meeting
Indian River County Commission Chambers
January 18, 2018 @ 4:30 p.m.
Dr. Michael Weiss
Ann Marie McCrystal
Ann Marie Suriano
Jennifer Peshke, Esq.
Val Zudans, M.D.
Felix Begay, M.D.
Convene Meeting – Marybeth Cunningham, Vice Chairwoman IRCHD
Mrs. Cunningham convened the regular monthly meeting of the Indian River County Hospital District (“IRCHD”) at 4:30 p.m.
Mrs. Cunningham stated that the first order of business was the election of officers. Mrs. Peshke explained that the Hospital District Bylaws require that the District reorganize at the first meeting of each year and elect five officers. Any board member may make a nomination for the five offices, which include Chairman, Vice Chair, Treasurer, Secretary, and Assistant Secretary. Each office will be elected by calling for a nomination, and a second.
Mrs. Peshke called for a nomination for Chairman. Mr. Jones made a motion to nominate Mrs. Cunningham as Chairwoman, which was seconded by Mrs. McCrystal. The motion carried unanimously.
Mrs. Peshke called for a nomination for Vice Chair. Mrs. McCrystal made a motion to nominate Dr. Weiss as Vice Chair, which was seconded by Mrs. Cunningham. The motion carried unanimously.
Mrs. Peshke called for a nomination for Treasurer. Ms. Deigl made a motion to nominate Mr. Jones as Treasurer, which was seconded by Mrs. Zudans. The motion carried unanimously.
Mrs. Peshke called for a nomination for Secretary. Mrs. Cunningham made a motion to elect Mrs. McCrystal as Secretary, which was seconded by Mr. Jones. The motion carried unanimously.
Mrs. Peshke called for a nomination for Assistant Secretary. Mrs. McCrystal made a motion to nominate Ms. Deigl as Assistant Secretary, which was seconded by Mr. Jones. The motion carried unanimously. Mrs. Peshke stated that the election process was complete.
Mrs. Cunningham stated that the board must agree and approve a meeting schedule for 2018. She indicated that Mrs. Suriano is now participating in the Community Leadership program through the Indian River County Chamber of Commerce. Their monthly meetings also take place on the third Thursday of the month and end at 5:00 PM. In order for Mrs. Suriano to attend her Leadership meeting and the District regular monthly meeting, she asked the board to approve moving the District meetings to 5:00 PM. The board agreed to the change. Additionally there was discussion concerning the monthly Chairman meeting and the board agreed to move the start time to 10:00 AM, on the third Wednesday of each month.
Consent Agenda – Marybeth Cunningham, Chairwoman
Mrs. Cunningham asked for a motion to approve the Special Meeting Minutes dated December 5th, 7th, 8th, 9th; Chairman Meeting Minutes dated December 13; Regular Monthly Meeting Minutes dated December 14; and a January disbursement of $1,303,585.15. Mr. Jones indicated that there we are few bills received late after the publication of the agenda therefore; the disbursement amount may be different on some copies of the agenda. Mrs. Deigl made the motion to approve, which was seconded by Mrs. McCrystal. The motion carried unanimously.
Mrs. Cunningham indicated that the District staff will be sending out a list of IRMC Committees in which the District Trustee may participate. She asked the Trustees to choose their preferred committee and return the list to the District office for review.
District Counsel Report, Jennifer Peshke, Esq.-
Mrs. Peshke stated that she continues to work with the District’s retained special transactional counsel, Gray Robinson, as the District is now in phase two of this collaborative process with the Hospital.
Financial Statement Review- Allen Jones, Treasurer
Mr. Jones provided the monthly financial statement review and stated that the District is in sound financial shape. As of December 31, the combined bank accounts totaled approximately $13.8 million, including reserves. He explained that program expenditures are running slightly below budgeted numbers and same hold true for administrative expenses. Therefore, through the first three months of the fiscal year, District expenses are running below budgeted amounts.
Mr. Jones explained that in the last fiscal year, the District budgeted amount for indigent care at IRMC was $5,763,036. The actual expense incurred totaled $6,337,961. Therefore, the hospital has requested reimbursement for this cost of providing treatment for District eligible indigent patients. In the interim, Mrs. Suriano reviewed with hospital administration the billings of each patient and verified that each patient met District definition of eligibility for indigent care. In total, it is recommended that Trustees approve reimbursement for these services for $574,925. However, he explained that that the Partners in Women’s Health program operated below the budgeted amount for fiscal year 16-17 by $204,107. In addition, the District has already approved an incentive payment earned by the program of $55,000, which has not yet been paid. Therefore, Mr. Jones made a motion to approve a payment to IRMC for the net amount of $425,823. This amount is included in the budget for this fiscal year and is well within the anticipated expenses for the current fiscal year. Mrs. McCrystal seconded the motion and there was Trustee discussion. Mr. Jones clarified that the Partners incentive bonus goes directly toward supporting the program, not IRMC’s general accounts. The motion carried.
IRMC Monthly Report- Partners in Women’s Health Program Update- Allen Jones
Mr. Jones provided a historical review of the Partner in Women’s Health. He explained that Partners was established by the District in October, 1995, and the main purpose of the program was to provide prenatal care to indigent. At the time, infant mortality in Indian River County was 25% higher than the state average and there were eight private practice obstetricians, none of which accepted Medicaid. He further explained that the initial cost saving to the District decreased from $943,000 to $635,000 in the first fiscal year of the program. Mr. Jones further reviewed the cost associated with the program since its inception.
Mr. Jones stated that over the past year, he has been working with Ms. Kathy Hendrix, IRMC Board member, collaboratively with the Partners Program. A collaborative Advisory group was formed made up of an IRMC Board Member, District Trustee, the County Health Department, Healthy Start and Treasure Coast Community Health. Mr. Jones reviewed data concerning the program and stated that currently 75% of pregnant women receive adequate or better prenatal care in Indian River County and maternal mortality has been at zero since 2011. He further discussed data concerning neonatal mortality and the factors affecting neonatal mortality. Mr. Jones further reviewed the future steps that are being taken to keep this program successful for the community, which includes new initiatives with Healthy Start, the County Health Department and TCCH.
Additionally, Mr. Jones stated that at the beginning of the fiscal year in 2015, the District adopted a more formal approach in the agreement with IRMC that embraces serval elements included annual performance metrics. Annually, the metrics for the Partners program are recommended for approval by the Trustees. The metrics identified in the process embraced neonatal morality, first trimester prenatal care, patient satisfaction, and the Kotelchuck Index. He further reviewed the proposed metrics for program performance and ultimately a recommend bonus, if earned. Mr. Jones asked for approval of the proposed metrics and that an amount up to 10% of actual expenses be set aside which may be awarded to Partners enhance the Program, should they exceed in performance. There was further Trustee discussion concerning this matter and Dr. Weiss and Mrs. Zudans stated that they do not agree with an incentive bonus. Ms. Deigl requested that a report be prepared by Partners outlining what the bonus funds were used for. Additionally, Mrs. Peshke reviewed the terms of the Partners funding agreement with the District aloud. Mr. Jones made a motion to accept the metrics for the partners program which includes a possible incentive bonus and Mrs. McCrystal seconded the motion. The motion carried 5 to 2.
Executive Director Report- Ann Marie Suriano, Executive Director
Mrs. Suriano provided her executive director report and stated that the renovations to the District owned Human Services building which is currently leased by the VNA. Additionally, she informed the Trustees that she is now participating in the Indian River County Leadership Program through the Chamber of Commerce.
Funded Agencies Quarterly Report- IRC Health Department- Miranda Hawker, Health Administrator
Mrs. Hawker provided an update concerning the Health Department and discussed their collaboration with the Partners Program and Healthy Start. She reviewed data from July-December, 2017, concerning their main Vero Beach site, Gifford Health Center and We Care. She further addressed the issue of a back log of patients waiting to receive services through We Care. Mrs. McCrystal stated that the We Care task force would be meeting in the next few weeks to discuss the matter, along with other issues the program is facing. She stated that once the meeting has taken place, there will be a better understanding of the challenges and implementation of an action plan to address those issues.
Mrs. Zudans made the following motion to adopt a resolution (Attachment “A”). The motion was seconded by Dr. Weiss for Trustee discussion. There was Trustee discussion concerning the proposed resolution and most Trustees felt that they were comfortable with the process timeline, prepared by Juniper Advisory. Mrs. Cunningham asked for public comment regarding the proposed resolution.
Val Zudans, M.D., community member stated that he feels the Trustees do not understand what is being proposed. He explained that pursuant to Florida Law, the documents that Mrs. Zudans is requesting be made public, will become public as soon as the board’s vote on a final suitor. He does not feel that making the documents available seven days before the scheduled release date, will scare away the potential suitor. He feels that the not releasing the documents early is prohibiting the public, the press, and individuals in the community from reviewing the proposals. He also believes that Juniper Advisory only has a fiduciary responsibility to IRMC and not the District because IRMC retained Juniper. He believes that the documents should be made available to the public, before the Boards make a decision.
Mr. Jones asked for clarification as to when the proposals would be available to the public. Mr. Jamie Burgdorfer of Juniper Advisory stated that his understanding is that the proposals may be released to the public one day after a decision is reached by the Boards. Mrs. Peshke stated that the Florida Statute pertaining to this matter is 119.071, F.S. The Trustees had further discussion concerning the matter of the public viewing the proposals and Ms. Bodnar stated that throughout this process all meetings have been open to the public and there has been minimal attendance.
Mr. Burgdorfer reviewed Juniper Advisory’s responsibility to the District. He explained Juniper is an agent and their obligation is to illicit from the market a potential partner and secure the best set of terms available in the market for the community.
Mrs. Kathy Hendrix, Mr. Matt Reiser, and Mrs. Gerri Smith, who are IRMC Board of Director members, spoke to the transparency and collaboration between the District and IRMC regarding this process. They all trust and believe in the process that Juniper has set forth to find a partner for IRMC.
Mrs. Cunningham called the question on the proposed motion. The motion failed 6 to 1, with Mrs. Zudans in opposition.
Public Comment- There was no additional public comment.
Adjournment- The meeting adjourned at 6:30 PM