Jul 26 Regular Monthly Meeting Minutes: June 21, 2018
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
Regular Monthly Meeting Minutes
June 21, 2018
TRUSTEES: Marybeth Cunningham Allen Jones
Ann Marie McCrystal Tracey Zudans
Karen Deigl Dr. Michael Weiss
EXCUSED: Barbara Bodnar
STAFF: Jennifer Frederick Kate Voss
Ann Marie Suriano Jennifer Peshke, Esq.
OTHER ATTENDEES: Carol Kanarek Gerri Smith
Miranda Hawker Angela Dickens
Vick Soule Michelle Genz
Janet Begley George Eighmy
Karen Davis Richard Van Lith
Val Zudans Rabbi Michael Birnholz
Convene Meeting – Marybeth Cunningham, Chairwoman IRCHD
Mrs. Cunningham convened the regular monthly meeting of the IRCHD at 5:00 PM by welcoming those in attendance.
Invocation- Invocation- Rabbi Michael Birnholz of Temple Beth Shalom provided the invocation for the meeting.
Consent Agenda- Marybeth Cunningham, Chairwoman IRCHD
Mrs. Cunningham asked for a motion to approve Budget Workshop Minutes dated May 7,14, 21, 25; Chairman’s Meeting Minutes dated May 16; Regular Monthly Meeting Minutes dated May 17, and a June disbursement of $1,221,874.50. Mrs. Zudans made the motion, which was seconded by Mrs. McCrystal. The motion carried unanimously.
Mrs. Cunningham stated that the District board will meet on July 11 to discuss the 2018-2019 FY budget. The meeting is open to the public.
District Counsel Report- Jennifer Peshke, Esq.
Mrs. Peshke stated that she has been working with the District concerning the 2018-2019 FY budget and has attended all the budget workshop meetings. She continues to work on matters concerning the Cleveland Clinic partnership and the due diligence associated with that process.
Financial Statement Review- Allen Jones, Treasurer
Mr. Jones provided the financial statement review. He stated that the District remains in sound financial condition and through May, the bank accounts totaled $8.6 million which included $2.3 million for special operating reserves and $6.2 million for budgeted operating items. Budgeted expenses projected to be spent at the current rate between now and the fiscal year-end total $5.8 million, which leaves some additional funds left over. However, he explained that if IRMC continues to operate at its current level, which is approximately $1.2 million over their budget for indigent care services, they may request additional funding from the District to cover those expenses. He further explained that this increase is driven by a 14.4% increase in patient volumes and 11.2% of that increase accounts for inpatient care services, which is costlier. Mr. Jones stated that the District has discretion over reimbursing IRMC for these expenses and they may need to draw from the reserve funds to reimburse IRMC for the indigent services it provided. He asked that the Trustees keep this in mind while proceeding through the current budget cycle.
Executive Director- Ann Marie Suriano
Mrs. Suriano stated that she met with the Indian River County Metropolitan Planning Organization to further discuss the expansion concerning 37th street and 11th court. She indicated that they would like to come before the board again to discuss the same. Additionally, she stated that she met with Ms. Davis and the Envison group from IRMC to discuss the charges implemented by Envison for physician services in the ED. Currently the District does not reimburse the physician service fee to the hospital. There was discussion surrounding the creation of a plan to address this matter. Lastly, she stated that the District Trustees agreed to revisit their strategic plan which was completed in 2017. Ms. Suriano received confirmation from the board to contact Mr. Michael Felix who conducted the last plan, to assist moving forward with an updated plan. She will follow up with the board once she speaks to him.
Funded Agency Quarterly Report- IRMC ER Navigator Program – Rick Van Lith, VP Strategic Planning
Mr. Van Lith provided an update concerning the ER Navigator Program along with a historical review of the inception of the program. He explained that through the community health needs assessment, it was discovered there was a high usage of the emergency department for non-emergency issues. The community organization who participated in this initiative included VNA, TCCH, Health Department, and Whole Family Health. The program stated in March 2017 and to date they have had 8,196 patient interactions. He further explained the role of the ER Navigator, which is to help educate patients presenting at the IRMC emergency department with better options for continuum of primary care. They also assist the patients by helping them coordinate a follow up appointment with a primary care physician. He further discussed the referrals process and reviewed some of the program’s major issues. Additionally, he reviewed cases of individuals who were frequent users of the ED who had non-emergency issues. He also reviewed data concerning the reasons behind the patient visits to the ED and many individuals who presented had low acuity issues which are deemed non-emergent. Lastly, Mr. Van Lith discussed the next steps concerning the ED navigator program. He explained that IRMC plans to implement proactive interactions by modifying the navigator’s role to work directly with primary care providers(“PCP”) to proactively monitor and address patients that need to have continuity of care. Further, they want to ensure access by continuing to work with the PCP providers collaboratively to ensure routine and timely access. There was further Trustee discussion concerning this matter.
IRMC, Inc. Monthly Report- Emergency Department Triage Process- Karen Davis, IRMC Interim CEO & George Eighmy, IRMC CFO
Ms. Davis provided an update concerning the IRMC Emergency Department. She stated that they have been able to reduce wait times by 1-2 hours, due to the implementation of new processes and keeping all departments accountable. What they have discovered is that there is still an outstanding issue of indigent patients who are presenting at the ED with low acuity issues. She believes there are numerous reasons why these patients chose to utilize the ED as their primary care provider, which include convenience and lack of financial burden placed on the patient. She explained that in many cases, primary care clinics require some form of payment to receive services, where the ED does not. This has made a significant impact in visits to the ED and has made it difficult to support those patients who have a true emergency. She explained that there is a national trend now that where commercial insurance companies are now denying claims processed through the ED, for non-emergent issues. Some are also requiring higher co-pays for visits to the ED.
Ms. Davis provided the Trustees with a review of the “EMTALA” guidelines, which the hospital must follow concerning emergency treatment. The guidelines stated that in a hospital with an emergency department, an individual (whether or not eligible for Medicare benefits and regardless of the ability to pay, the hospital must-
1. Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services available, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual who is determined qualified by hospital bylaws or rules and who meets the requirements of section 482.55 of this chapter.
2. If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment as defined or appropriate transfer as defined. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends.
She further stated that IRMC will treat all patients who present at the ED but they have implemented new screening triage procedures. Currently, any patient who presents at the ED is seen immediately by a physician, who screens the patient to deem if their issue is emergent or non-emergent. In doing this, they are able to determine which patients have emergency conditions and get them treatment immediately, which has been effective. Their primary focus continues to be on direct patient interactions and following EMTALA guidelines.
Ms. Davis feels there are three options to consider regarding the emergency department. She explained that the hospital may remain at status-quo, which the trustees agreed is not option. Additionally, she stated that there could be an implementation of a co-pay or make the patient responsible for 100% of the visit, if it is deemed non-emergent. There was further Trustee discussion concerning this matter and they agreed that some form of co-pay would be effective. As clarification, Ms. Davis stated that this co-pay would apply to indigent patients only who present with non-emergent issues, as other patients presenting have to pay.
The board had further discussion and it was agreed that they should make a motion on this matter to be voted on. Ms. Deigl made a motion to support IRMC with the implementation of co-pay at IRMC ED for non-emergent visits by indigent patients. The motion was seconded by Allen Jones. Val Zudans, member of the public, requested to make a public comment. He questioned whether the District Board was allowed legally to implement a co-pay and if the Special Act allowed the same. Ms. Peshke indicated that she would research the matter further and that the board could add language in the motion to address his inquiry. Ms. Deigl amended her motion to support IRMC with the implementation of co-pay at the Emergency Department for non-emergent visits by indigent patients, pursuant to rule and regulations of the Special Act. The motion carried unanimously. Mrs. Cunningham requested that the hospital prepare a proposal of charges and follow up with the District.
Mr. Eighmy provided a review of IRMC’s second quarter financials. He explained that IRMC had income before depreciation of $7 million and had budgeted $7.9 million. After depreciation, there was an excess of $3.4 million. He explained that the volume increases in admissions are what drove those numbers up. He further reviewed total patient days and patient stays which had also increased. Additionally, he reviewed data concerning hospital and physician full time employees which increased. This can be attributed to the hospital focusing more on patient care areas over the last 3 to 4 months, as they determined there were some gaps that needed to be filled in nursing. Mr. Eighmy explained that with the increase in volume, there has been a slight decrease in revenue. This is due to the fact that there is a shift away from the commercial payors to indigent and uninsured patients, which impacts the hospitals bottom line. He further reviewed data concerning supply costs which were slightly under budget but over budget from the pervious year. He attributed that to additional high costing oncology drugs, along with more costly surgeries in orthopedic and cardiac areas. Lastly, he reviewed data concerning total expenses at IRMC, which were slightly under $77 million. He also reviewed data concerning the same information year to date.
Other Business- Request for Additional Funding- John Romano, CEO New Horizons
Mr. Romano reviewed New Horizons additional funding request to support indigent care. He explained that throughout the year patient volumes have increased causing a shortfall in funding. They are requesting an additional $20,000 to support the remaining months of this fiscal year. There was Trustee discussion and they asked Mr. Jones if there were enough funds in the District’s reserves to support this request. Mr. Jones indicated that there were sufficient funds.
Mr. Jones made a motion to approve the request, which was seconded by Mrs. Zudans. The motion carried unanimously.
Val Zudans read allowed from the Districts Special Act, Section 19, which stated “Each hospital and clinic established under this Act shall be for the use and benefit of the indigent sick who have resided in the county for not less than one-year preceding application for admission for treatment. Such residents shall be admitted to such hospital and clinic and be entitled to medical care without charge, subject to the rules and regulations prescribed by said board of Trustees. Such hospitals and clinics shall care for and treat without charge only such patients who are found by such board of Trustees to be indigent, but such board may collet from patients financially able, such charges as such board of Trustees, may from time to time, be established.” He asked the Trustees to look into the matter of implementing a charge at the emergency department.
Mr. Jones stated that he feels there is another issue concerning hours of available service for the treatment of indigent. He explained most of the District funded agencies are only open 8:00 AM to 5:00 PM, which could attribute to patients utilizing the ED for non-emergency care. He would like those agencies to research whether extending hours of operation would help support that issue.
Adjourn- The meeting was adjourned at 6:00 PM