Apr 26 Regular Monthly Meeting; March 21, 2019
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
Regular Monthly Meeting Minutes
March 21, 2019
TRUSTEES: Marybeth Cunningham Tracey Zudans
Ann Marie McCrystal Barbara Bodnar
Michael Weiss Allen Jones
EXCUSED: Karen Deigl
STAFF: Jennifer Frederick Kate Voss
OTHER ATTENDEES: Rev. Derek West Carol Kanerak
Pat Knipper Lundy Fields
Vicki Soule Carrie Lester
Wayne Creelman Morgan Libbey
Marie Andress Michelle Genz
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. Reverend West provided the invocation for the meeting and Dr. Weiss led the group in the pledge of allegiance.
Consent Agenda- Marybeth Cunningham, Chairwoman IRCHD
Mrs. Cunningham asked for a motion for approval of special meeting minutes dated February 19, Chairman’s meeting minutes dated February 20, regular monthly meeting minutes dated February 21; special meeting minutes dated February 27, and a March disbursement of $1,104,572.98. Dr. Weiss made the motion which was seconded by Mrs. McCrystal. The motion carried unanimously.
Financial Statement Review – Allen Jones, Treasurer
Mr. Jones stated the District is in sound financial condition. After the February disbursements, the Districts bank accounts held approximately $9.8 million and there are a projected $8.2 million in remaining budgeted expenses for the remainder of the fiscal year. Therefore, that will leave approximately $1.9 million to cover operations at the beginning of fiscal year 2019-2020. Mr. Jones stated that the District balance sheet shows $2 million as negative retained earnings. This came about three years ago after the District board approved a budget that reduced their amount of maintained excess reserves. Excess reserves are accumulated over the years when the District spent less than was budgeted and the funds were placed into reserve account for unanticipated expenses. After analyzing years of operations, the board voted to reduce those reserves on the principal that the District shouldn’t accumulate tax dollars in excess of the annual spending needs. Since this action, the District has been able to reduce the millage rate for most of the years prior to 2015, despite the fact that there were costly one-time expenses related to the transaction with Cleveland Clinic. Additionally, in the most recent calculation from fiscal year 2017-2018, the Districts taxes represent about 5.7% of the total property tax bill, which is a relatively small and puts little impact on the tax payer. However, most of the population that is supported by the District’s tax proceeds would be impacted severely, if the District’s could no longer receive tax proceeds. A few examples being that two thirds of the births in Indian River county are supported with prenatal care funded entirely by the District. The District also provides one fourth of the Health Departments total annual budget, and additional financial support to multiple other health care agencies in the county. He believed the residents should be proud knowing that the District is able to achieve balance by minimizing the tax payer’s exposure and burdens, while still providing support to a population who needs it.
Funded Agency Quarterly Report- University of Florida Department of Psychiatry – Wayne Creelman, M.D. – Medical Director
Dr. Creelman provided the Trustees with a review of UF’s first quarter data in which they saw a total of 150 patients, a volume slightly higher than last fiscal year. He discussed the centers suboxone program which provides the drug to patients who are suffering from opioid abuse and addiction issues. He further stated that UF continues to work collaboratively with the McCabe Connections Center to provide mental health services and counseling for residents of Indian River County. Additionally, he informed the Trustees that the financial position has improved for the center since last fiscal year and thanked the board for the bridge funding which helped support their stainability. Lastly, he stated that he has met with Dr. Rosencrantz the new CEO of Cleveland Clinic Indian River, and looks forward to working with the hospital collaboratively to provide mental health services in the county.
Public Guardianship Program IRC- Morgan Libbey, Esq.- Executive Director
Ms. Libbey provided the Trustees with an update concerning the Public Guardianship program of Indian River County. She stated that currently there are 16 active cases and 4 individuals that are on the waiting list. She stated that the program continues to work collaboratively with the Mental Health Association and the UF Center, to provide those clients with mental health care. Further, Ms. Libbey stated that the program participated in the cost per ward study developed by the Department of Elder Affairs, which had not been conducted in many years. She explained that the amount of funding being recommended for the governor’s budget was significantly less than what is needed to run these programs state wide. Therefore, it was recommended by the department chair that a budget of $2.4 million be allocated for statewide public guardianship programs. This budget has been approved and will allow for a $438 cost per ward increase, which will provide more comprehensive care. Lastly, Ms. Libbey stated that through strategic planning for the program, the board of directors discussed how best to collaborative to make sure they are meeting the needs to the community by reaching all clients and potential clients. Late in 2018, efforts began with the Senior Resource Association (SRA) and in January SRA decided to acquire the Public Guardianship program. Ms. Libbey explained that wonderful opportunity for PG because it will mean that more clients can be served, since SRA is a much larger organization. The Johns Island Community League, who provided financial support to PG, also supported the acquisition. The transition will be completed June 30, 2019 and during the initial transition, PG will make sure there is a mentoring program. Ms. Libbey stated that she will personally be available to assist as well. Ultimately, SRA will hire a new Executive Director and Ms. Libbey will step down from her position as the ED, which she has worked as for many years without pay. She thanked the District for their support and noted that without the District, they would have not been able to provide the services that are so desperately needed for these individuals.
Unfinished Business- VNA Community Health Education Campaign Additional
Funding Request Pat Knipper, Community Wellness Director
Ms. Knipper thanked the Trustees for their 6 months of financial support of the mobile unit and the vulnerable village community education initiative. She stated that the VNA would love to continue this work that for another six months and are requesting funding to do so. She prepared a short prestation outlining the focus moving forward for the initiative. She explained that the VNA plans to continue to support the need for same day-urgent care in the county, while also diverting patients from using the emergency department. They will also up efforts around education and prevention at community events. There will also be enhanced reporting of the data collected to the District, community collaborators, to gather more information necessary for informed decision making. Ms. Knipper further reviewed the six-month funding request which totaled $153,880. There was further Trustee discussion surrounding the community education initiative and their collaborative effort approach, which seems to be having a positive impact. The Trustees thanked Ms. Knipper for the comprehensive data which they felt provided a true representation of the work the VNA is doing. Mrs. Cunningham asked Mr. Jones if there were enough funds in the Districts budget to support this request. Mr. Jones indicated that there were and made a motion to approve the request for funding, which was seconded by Mrs. Zudans. The motion carried unanimously.
Approval of Amendments to the District Policy & Procedure Manual for Determining Eligibility for Health Care Assistance- Marybeth Cunningham, Chair
Mrs. Cunningham reviewed the proposed changes to the District’s eligibility criteria for health care assistance. She explained that at yesterday’s Chairman’s meeting, the board had robust discussion surrounding the criteria and each Trustees provided their own thoughts and recommendations on the same. Ms. Bodnar made a motion to approve to changes, which was seconded by Mrs. McCrystal. Mrs. Cunningham asked for Trustee discussion. Ms. Zudans stated that she has concerns regarding increasing the poverty level and the associated cost with that increase. She is concerned that some residents may drop their existing insurance in order to qualify for District care. Mrs. McCrystal stated that the District has historically supported those in the community that are 150% or below the poverty level, but the board was given information that approximately 40% of residents in Indian River county are considered to fall within the ALICE population. She believes that the District should raise the level to 250% to capture those additional residents that fall outside of the 200%, but will support the initial increase to 200% as a step in the right direction. Mr. Jones stated he will support the proposed changes to the eligibility criteria which are being recommended tonight however, he feels that ultimately the District should be providing grant funding as opposed to fee-for-service. He further stated that moving the poverty level up to 200% will align the District closer to the other funded agencies and their criteria. Additionally, Mr. Jones discussed future finances for the District. He explained that as part of the Cleveland Clinic transaction, the District will provide $500,000 in indigent care funding monthly to CCIR, over the next 29 months. With this, the District could see a potential savings and the board will need to decide what do to with the extra tax proceeds. Mr. Jones recommends that the District put half of the funds into a health care reserve account to fund additional services in the county and the other half back to the tax payer by reducing the millage rate, however the amount of savings it yet to be determined. Mrs. Cunningham stated that she is in favor of the increase and believe this change aligns with the Districts initiatives set out in the new strategic plan. Mrs. Cunningham called for a vote which was unanimously in favor of the increase. Mrs. Cunningham stated that the District staff with notify all current funded agencies of the change, which will take effect October 1, 2019 for the new fiscal year.
Public Comment- There was no public comment.
Adjourn- The meeting was adjourned at 6:00 PM