Oct 18 Joint Meeting IRCHD & We Care Foundation:
Joint Meeting of IRCHD Trustees & We Care Foundation Board
Hospital District Conference Room
September 18, 2019
PRESENT: Marybeth Cunningham Karen Deigl
Dr. Michael Weiss Ann Marie Suriano
Kate Voss Jennifer Frederick
Jennifer Peshke Allen Jones (via telephone)
Tracey Zudans Ann Marie McCrystal (via telephone)
Joe Coakley Robi Robinson
Ralph Turner Charles Mackett
Miranda Hawker Dennis Saver
Laurie Welton Marie Andress
Michelle Genz Shelly Stuven
Convene Meeting – Marybeth Cunningham, Chairwoman IRCHD
Mrs. Cunningham convened the joint meeting of the boards at 11:00 AM and asked for group introductions. She provided a brief summary of the history between the District and We Care, along with how the former IMRC, now Cleveland Clinic Indian River, relationship has changed over the years. She asked Mr. Turner to provide the group with a review of the current Cleveland Clinic financial assistant policy. Mr. Turner stated that if a patient does not have insurance, CCIR provides financial assistance for emergency and other medically necessary care, at a discount from the normal charges if your family income does not exceed four times the Federal Poverty Guideline (“FPG”). All applicants are initially screened for Medicaid coverage and must cooperate with the Medicaid representatives to be considered for financial assistance. If eligible for financial assistance under the Policy, the patient will receive free or discounted assistance according to the following income criteria:
1. If your annual family income is up to 250% of the FPG, you will receive free care;
2. If your annual family income is between 251% and 400% of the FPG, you will receive care discounted to the amount we generally bill insured patients for such services; and
3. Uninsured patients who do not otherwise qualify for financial assistance, are eligible for a discount of 50% off gross charges.
He further explained that in some instances a patient may receive a bill for services rendered by a hospitalist not associated with Cleveland Clinic, however, they normally do not try and collect those fees from low income patients. There was further discussion regarding the coordination of scheduling of We Care patients for specialty services at CCIR and how that process has become much more efficient since CCIR inception.
We Care Services Today and Future
Dr. Fountain and Dr. Saver spoke to the current We Care structure and operations. Dr. Fountain stated that the element of care coordination for these patients is time consuming and may need ongoing case management through We Care. There was group discussion surrounding the matter of primary care services being rendered at We Care. Many District Trustee felt that providing primary services at We Care is inconstant with the purpose of We Care, which they believe to be providing coordination of specialty services for patients. Ms. Stuven indicated that primary care services make up only 14% of their care and that the care rendered is mainly coordination to specialty services for patients, provided by volunteer doctors. There was further group discussion surrounding the issue of We Care providing free primary care services out of their clinic, located at the Gifford Health Center, which is now under the operation of TCCH, a Federal Qualified Health Agency that provides primary care. Many Trustees felt those patients receiving primary care services through We Care, should be seen at TCCH, which would give them a patient home with a true primary care doctor. Additionally, Federal Qualified Health Agencies are the preferred health home for lower income individuals.
Sublease Requirement/language between TCCH and We Care Foundation
The group had discussion concerning the sublease requirements and language in the agreement between TCCH and the We Care Foundation. The following amendments were made to the agreement:
Term; Termination – adding language that in the event the IRC Hospital District denies We Care’s request to renew this sublease they will have 90 days from the expiration date of the lease to vacate the premises. With the 30-day notification requirement, this gives 120 days from notice of the non-renewal to be fully vacated.
Use of Subleased Space – “or be in competition with” will be removed from the third paragraph of this section, reading: The Sublessee agrees that its occupation and use of the Subleased Space shall not interfere with TCCH’s use, occupation or operations. It was stated and agreed that We Care would NOT recruit or add new Primary Care patients. This was to recognize and safeguard the continuity of care for the current primary care patients of Dr. saver and Dr. Baker only.
Ms. Peshke indicated that she is also working with Dr. Saver on subsequent language relative to the sovereign immunity, which is given to the volunteer physicians through their affiliation with the Indian River County Health Department.
District Budget to Support We Care Specialty Coordination of Services-
Lastly, the group had robust discussion surrounding the allocation of District funding to support the We Care program. Ms. Suriano explained that the We Care Foundation has requested $ 357,376.42 in program funding to cover salaries and benefits for 1- .8FTE physician, 2- 1.0 FTE RN Coordinators, and the addition of 1 – .9FTE OPS RN Coordinator. These are employees of the Florida Department of Health Indian River County and the We Care Foundation contracts with the DOH to obtain these employees for the We Care Clinic at the Gifford Health Center. As discussed earlier this staffing level provides for 86% support of coordinating patients to specialty services and 14% support to volunteer physicians providing Primary Care.
As a historical background, the District transitioned from program funding of $314,506 FY 2016-2017, to a combination of program and fee for services funding in fiscal year 2017-2018. The budget request for program funding of $143,058 (1.0 FTE physician salary) and fee for service request of $203,248 for direct patient visits, was approved for a total of $346,306 in funding. In fiscal year 2018-2019 the request approved for program funding was $131,822 (.9 FTE physician salary) and the fee for service for patient visits was $187,944, for a total of $319,766 in funding. The decrease in funding was due to a decline in District qualified patient volumes.
Currently, We Care patient visit volumes have declined again slightly this year, and many other changes have occurred in healthcare services and access to specialty care within Indian River that have affected the 2019-2020 funding model. Therefore, the District has proposed to continue the combined funding model at the following levels:
1. Maintain the program(salaries) funding of $131,822 and Fee for Service funding based upon the same projected year end volume as this year, increasing the reimbursed amount per visit from $130.31 to $155 for a budget amount of $170,000 for a total budget of $301,822.
Additionally, We Care is proposing total program funding for the salaries of 2 RN’s and .8 of Dr. Fountain’s salary for a total $292,219, plus an additional 1-.9 FTE OPS RN to be paid out on a 1/12 basis. This would assure them of the ability to maintain staff if the volume continues to decline. The District did not support the funding of the addition of another OPS RN Coordinator, which was requested in the FY 19-20 funding request. Ms. Suriano explained that if the District Trustees were to support this option, consideration would have to be made to continue to report “Qualified” patients, volumes and type of care ie. specialty or primary care, as well as, time and salary audits. Lastly, it was agreed to by the Board of Trustees that the release of this funding is contingent upon receiving a fully executed Sublease between TCCH and We Care Foundation, for the We Care Clinic space in the Gifford Health Center. Also, all funding will be made payable to the We Care Foundation, and not the Department of Health.
Adjourn- The meeting was adjourned at 1:30 PM