Chairman’s Meeting Minutes: May 16, 2018

Chairman’s Meeting Minutes: May 16, 2018


Chairman’s Meeting

Indian River County Hospital District

Hospital District Conference Room

May 16, 2018

10:00 AM



TRUSTEES:                           Marybeth Cunningham;  Allen Jones;  Ann Marie McCrystal; Tracey Zudans; Barbara Bodnar;  Karen Deigl

EXCUSED:                            Dr. Michael Weiss

STAFF :                                  Ann Marie Suriano; Jennifer Frederick; Jennifer Peshke, Esq.;  Kate Voss

OTHER ATTENDEES:          Morgan Libbey;  Mike Swan;  Annabel Robertson; Trip Snelson


Convene Meeting- Marybeth Cunningham, Chairwoman

Mrs. Cunningham convened the monthly chairman’s meeting of the IRCHD at 10:00 AM by welcoming those in attendance.


Funded Agency Quarterly Update- Morgan Libbey, Executive Director  

Ms. Morgan Libbey of the Public Guardianship program provided a quarterly update to the Trustees. She gave a review of the program and stated that the Public Guardianship program provides legal and professional guardianship services for individuals who have been deemed unable to care for their personal affairs. Through the guardians and case workers appointed to each case, an individualized needs assessment is conducted and a care plan to meet the ward’s needs for medical and mental health treatment is established.  Ms. Libbey stated that with the District funding in fiscal year 2017-2018, the program was able to serve three additional wards. Further, the program continues to evaluate the effectiveness of the program utilizing the following factors:

  1. Utilization of best practices standards of the National Guardianship Association;
  2. Compliance with Florida Statutes; and
  3. Constituent’s satisfaction through case management discussion.

Lastly, Ms. Libbey reviewed some of the cases of wards who have been stabilized through the program. One particular case was assisted with help through the McCabe Connections Center. The patient, who abused the 911 emergency systems frequently for non-emergency issues, has now been placed into a secure living environment and is no longer misusing the county resources. There was further Trustees discussion and they agreed that the program was a vital asset to the community.


United Against Poverty Update- Annabel Robertson, Executive Director at Up

 Ms. Robertson, Executive Director and Trip Snelson, Program Director at United Against Poverty provided the Trustees with a presentation on the program in Indian River County. Mr. Snelson explained how the program supports members in Indian River County with a “Hand Up” not a hand out, to those in need. Their purpose is to inspire and empower those in poverty to achieve economic self-sufficiency. Ms. Robertson reviewed the building blocks for success which the program uses as its foundation for the path to self-sufficiency. She further reviewed data concerning the positive impact “UP” has made on the community. Since 2016, 141 community members have been lifted out of poverty and 216 members completed the STEP graduate program and obtained gainful employment. Ms. Robertson further discussed the recent purchase of a new 42,000 sq. /ft. building, which will be completed by fall, 2018. With the new building they will be able to triple the amount of students who participate in the STEP program, double the member share grocery program and improve outcomes through collaborations with local partners. Mr. Snelson invited the Trustees to tour the facility and the new building in the next few weeks.


Increase of District Income Qualifications- Allen Jones, Treasurer  

Mr. Jones explained that a few months ago, the Trustees discussed the possibility of raising the District’s eligibility guideline from 150% of the Federal Poverty level to 200%, and what impact financially it would have on the District, along with the number of patients who would be now eligible for care. As a review, Mr. Jones stated that currently the District reimburses health care agencies in the county that provide certain medical services for individuals and families that:

  1. Are residents of Indian River County for at least six months;
  2. Have an annual income at or below 150% of the Federal Poverty Level; and
  3. Are uninsured, which includes Medicare and Medicaid.

Mr. Jones stated that over the last few months he, Mrs. Suriano and Mrs. Frederick gathered and reviewed data from the U.S. Census bureau and the District database. They concluded that at the current Federal Poverty standards, there are approximately 4,500 eligible residents in the county who qualify for indigent care coverage. The census bureau data estimates that there are approximately 3,000 additional residents who may be eligible if the Federal Poverty Guideline was raised to 200%. He provided further review of the projected cost of additional care and stated that based on current experience with indigent patients, it is reasonable to project a cost of $2.4 million.


Next Mr. Jones reviewed how other healthcare District’s in Florida structure their indigent policies. All have some sort of sliding fee scale depending on income relative to the Federal Poverty Guideline. Additionally, Mr. Jones stated that the IMRC has an obligation to abide by the Emergency Medical Treatment and Labor Act (EMTALA) which requires anyone, regardless of citizenship who presents at the emergency department, to receive a medical screening examination to determine if an emergency medical circumstance does or does not exist. If an emergency medical condition exists as defined by EMTALA, the patient must be stabilized and treated, regardless of their insurance status or ability to pay. He clarified that hospitals, private or public, have no obligation under EMTALA to provide uncompensated care beyond the medical screening exam. There was further Trustee discussion regarding EMTALA and the possibility of implementing a co-pay to uninsured individuals who present at the ED with a non-emergent complaint. There was further Trustee discussion concerning Cleveland Clinic’s Charity guidelines and what is covered under that policy. Mrs. Cunningham stated that this matter will be discussed with Cleveland Clinic at the appropriate time during negotiations and that nothing has been drafted yet for review or consideration. She further explained that Cleveland Clinic will develop its own Florida Charity Care policy through this process.


Lastly, Mr. Jones reviewed his recommendations with the Trustees and stated that he recommends leaving the income guideline at 150% of the Federal Poverty Level. Additionally, the District should continue to reimburse providers non-emergency care and/or specialty care of eligible indigent patients. Mr. Jones also recommended that the Trustees consider soliciting a request for proposal from a qualified healthcare provider in the county to provide non-emergency healthcare option for uninsured residents. This could be a program modeled after Partners in Women’s Health with guidelines to be determined. Lastly, he would like the board to investigate in “Kid Care” insurance policies that may be available for the 500 children in the county that are estimated to have no insurance, including Medicaid.


There was further Trustee discussion surrounding Mr. Jones recommendations and the board agreed to not raise the Federal Poverty Guidelines to 200% at this time. They feel there needs to be more research and data collected on the various impacts it would have on the District and community. There was also discussion surrounding the idea of forming a committee to lead this effort and research Mr. Jones’ recommendations further.


Report on the Business of Healthcare Seminar- Ann Marie Suriano 

Mrs. Suriano stated that she attended the Business of Healthcare seminar at the University of Miami. At the seminar, the presenters discussed mergers and acquisitions of hospitals, along with the trend of volume to value based care and pay structure concerning healthcare. She found this information to be very valuable concerning the current pending partnership with Cleveland Clinic.


Other Business-

 Mrs. Cunningham stated that Mrs. Suriano gave a tour of the District owned properties to the representatives from Stout. Stout is working with IRMC to evaluate the asset value which is important in this transaction with Cleveland Clinic. Futher, she explained that Cleveland Clinic recently conducted a five day tour of the hospital campus conducting their own valuation. Further, the firm Price Waterhouse will also be conducting due diligence on IRMC and the District, over the next month. Additionally, attorneys for the District will be working towards parceling out the land that the VNA sits on for the benefit of potentially selling the land later on and not including it in the Cleveland Clinic deal. Further, Mrs. Cunningham stated that due diligence is still under way in the Partnership Process with Cleveland Clinic and she hope to have a draft agreement to the Trustees in June for their review and comment.


Public Comment- There was no public comment.

Adjourn- The meeting was adjourned at 11:30 AM