17 Aug Regular Monthly Meeting Minutes: July 25, 2018
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
Regular Monthly Meeting Minutes
July 25, 2018
TRUSTEES: Marybeth Cunningham Allen Jones
Ann Marie McCrystal Tracey Zudans
VIA TELEPHONE: Barbara Bodnar
STAFF: Jennifer Frederick Kate Voss
Ann Marie Suriano
OTHER ATTENDEES: Angela Dickens Kathy Orton
Gerri Smith Andrea Berry
Miranda Hawker Joelle Tinney
Vicki Soule Val Zudans
Michelle Genz Father Chris Rodriguez
Kristen Crocker Karen Davis
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- Father Chris Rodriguez provided the invocation.
Consent Agenda- Marybeth Cunningham, Chairwoman IRCHD
Mrs. Cunningham asked for a motion to approve the Chairman’s meeting minutes dated June 20, regular monthly meeting minutes dated June 21 and a July disbursement of $1,352,921.41. Ms. Deigl made the motion to approve which was seconded by Mrs. McCrystal. The motion carried unanimously.
Mrs. Cunningham sated that at this morning’s Chairman’s meeting the board had discussion relative to IRMC’s request to implement a co-pay for non-emergency visits to the hospital emergency department, concerning indigent patients. Mrs. Zudans requested that the board seek an additional opinion from outside counsel separate from the memorandum that Mrs. Peshke prepared on the same matter. Mrs. Suriano reached out to GrayRobinson, the District’s outside counsel with Mrs. Zudans’ request, but they indicated they would like to conduct further research on the matter before preparing an opinion. Mrs. Cunningham explained that since this request is outside the scope of work that GrayRobinson was originally hired to conduct, there will be an additional expense incurred. She asked the board to either approve moving forward with the second opinion or move to accept the opinion of in house counsel Mrs. Peshke. Ms. Deigl indicated that she felt comfortable with the opinion prepared by Mrs. Peshke. Mrs. Zudans stated that the interpretation prepared by Mrs. Peshke did not fully address the issue and she was not in agreement. She further indicated that she would not vote for implementation of a co-pay based on Mrs. Peshke’s summary. She clarified that she does agree with the process of implementing a co-pay but wants surety that the District is legally allowed. Mrs. Cunningham mentioned that it is technically the hospital that is implementing the co-pay, not the District and many other District funded agencies collect co-pays from patients as well. She believes this is a policy change at the hospital and that they are seeking District approval of the same. Mrs. McCrystal recommended that the hospital present the exact policy language to the District for review and approval and Mrs. Zudans indicated she would be comfortable with that method. Mr. Jones stated that, ultimately, the hospital belongs to the residents of Indian River County and that if a Trustee has a serious concern, he supports obtaining a second opinion. Mrs. Cunningham requested that outside counsel provide a second opinion as to whether IRMC implementing a co-pay is a District issue and if they are legally able to approve the implementation of a co-pay. Mrs. Suriano indicated that the District would need to update their policy and procedure manual with language reflecting the policy change, should it be deemed legal by counsel. Pending the results from outside legal counsel, the board will discuss and vote on this matter at next month’s meeting. Mr. Jones made a motion to request a second opinion from District outside counsel which was seconded by Mrs. McCrystal. The motion carried.
Mrs. Cunningham provided an update concerning the Cleveland Clinic partnership and stated that the process is moving forward and Cleveland Clinic is about to complete their due diligence work at IRMC. She hopes by the month of August that they will have agreements to review.
Financial Statement Review- Allen Jones, Treasurer
Mr. Jones provided the financial statement review and stated that the District finances remain sound, however as noted previously, there will be little excess funds at the end of the year beyond the reserves. However, the reserves will be sufficient to manage through the beginning of the next fiscal year until the District begins to receive it tax revenues in November.
As of June 30, the District bank balances totaled a $7.6 million and with the approval of this month’s disbursements of $1.4 million, the balance remains at approximately $6.2 million. According to the budget, he projects about $4.5 million in funds left to distribute leaving approximately $1.7 million in the bank. Since the maintained reserves total a little over $2.2 million, the District must invade the reserves by approximately $500,000 by fiscal year end.
Mr. Jones noted that the figures outlined include reimbursing IMRC approximately $1.2 million for indigent volumes that have swelled beyond the amount budgeted. However, the District will have enough money to support that expense if they chose, which they have always done in the past. Mr. Jones explained that with no tax revenues coming in during the first few months of the new fiscal year, the District will likely draw down reserves further for October expenses. He further stated that in the three years he has been Treasurer, this is the first time the reserves will be utilized.
Lastly, Mr. Jones stated that this year’s results reflect two things, the first being that the current fiscal year budget minimized the millage rate on behalf of the taxpayer because the District carried over as little excess cash possible coming into the 2017-2018 fiscal year. Second was the increase in indigent volumes at IRMC. In his opinion the principle cause of the volume increase is that fewer low income residents are being covered by the Affordable Care Act. On balance, the District has sufficient funds to fully meet all funding obligations through November, when the new tax revenues will replenish the District accounts.
Executive Director- Ann Marie Suriano
Mrs. Suriano stated she has been working with IRMC in discussions concerning the emergency department co-pay. Additionally, she has worked with Mr. Jones on the District tentative budget and has been available to the Trustees for their input concerning the same.
Funded Agency Quarterly Report- VNA- Kathy Orton, VP Clinical Services
Ms. Orton provided a quarterly update concerning the VNA. She reviewed data concerning the areas of service which included home health and hospice. Additionally, she discussed patient volumes concerning the mobile unit. Ms. Orton indicated that it is still very difficult for the mobile unit staff to collect qualification data from its patients and to date, the unit has suffered a loss of $200,000. Further, the Medicaid billing number they received has not been as beneficial as they had hoped, due to the fact that many patients are covered under a Medicaid HMO and not traditional Medicaid. Therefore, they are unable to collect reimbursement for the services rendered. Ms. Orton further discussed the VNA’s plan to increase the scope of the mobile unit in a county wide health education and patient care initiative localized by zip code areas in Indian River County. She explained that VNA will work collaboratively with other local health partners to connect residents to the care they need. Mr. Lundy Fields, VNA’s CEO will address the Trustees next month to discuss this initiative in greater detail.
Funded Agency Quarterly Report- Healthy Start
Ms. Berry provided a quarterly update concerning Healthy Start. She stated that Healthy Start has implemented a statewide Coordinated Intake and Referral process. This policy solidified Healthy Start as the launching point for all mothers and infants to receive any services they need to ensure a healthy start. Further, Healthy Start works in close connection with local partner agencies to build a system that allows for each mother in the county to find services they need. In addition, Ms. Berry explained that they have added the Nurse Family Partnership program to their system of care. This program is an evidence-based program proven to decrease poor birth outcomes by addressing the social determinants of health and directly addressing these issues through a home-based clinical process. The program will launch in August, 2018. Ms. Berry further reviewed infant mortality data for the county. Ms. Crocker provided a few patient testimonies relative to the services they received through Healthy Start.
New Business- Approval of Fiscal Year 2018-2019 Tentative Budget
Mr. Jones explained that the District is required to approve a tentative budget for fiscal year 2018-2019. The millage rate approved at tonight’s meeting is the maximum millage to be assessed and unable to be increased. However, the District has the authority to decrease the millage and approve a final lower millage rate in September. The budget, as presented, would represent a millage rate of .9405. He explained that the main reason for the increase is due to the hospital’s funding request which increased by $1.2 million from last year. If the board agrees to fund the hospital at a lesser amount, it would reduce the millage significantly. The board will have the next two months to further review and trim down the budget before voting on the final millage on September 20. Mr. Jones made the motion to approve the tentative budget with the millage rate of .9405, which was seconded by Mrs. McCrystal. Mrs. Zudans stated that since there has been an increase to property values in Indian River County, she does not support the increase in millage rate. She suggested keeping the millage at its current level of .8894 which would provide the District with an excess of $1 million in tax revenues. Mrs. Cunningham indicated that she believed there will be enough information concerning Cleveland Clinic and their support of indigent care, to know exactly how much will need to be budgeted. Further, she indicated that the hospital’s funding request is the same amount as the projected year end figure for the current fiscal year. Mrs. Bodnar stated that she felt the millage rate was high but believes the board will work to decrease the rate over the next coming months. Mrs. Cunningham asked for public comment.
Val Zudans, public member, stated there was about a 3.8% decrease to ACA enrollment and does not feel that was a significant driver to the increased indigent volumes at IRMC. He believes the increase was caused by the large backlog of patients who received expensive surgical care at IRMC. Additionally, the District is set to receive approximately $980,000 in additional tax revenue from the increase in property values. Also, the District budgeted $1 million for the Partnership process and stated that amount of funding is not projected to be included for the upcoming year which should decrease the millage as well, and an increase in the rate is not necessary. He indicated that no other local government agencies have indicated that they are raising their millage and encouraged the District consider the taxpayer.
Mrs. Cunningham called the question and the motion carried 5 to 2, with Dr. Weiss and Mrs. Zudans in opposition.
Hospital Parcel Property Split Approval- Ann Marie Suriano, Executive Director
Mrs. Suriano explained that the District owned parcel that the hospital campus is located on is currently one parcel, however, the VNA Hospice House and Human Services Building are also located on this parcel but are separate entities. During this partnership process, it was suggested by legal counsel to split up the parcel and each property obtain their own parcel number with the county. She asked for a motion to approve to have the hospital parcel split. Dr. Weiss made a motion which was seconded by Mr. Jones. The motion carried unanimously.
Public Comment- There was no additional public comment.
Adjourn- The meeting was adjourned at 6:45 PM