Chairman’s Meeting: November 18, 2020

Chairman’s Meeting: November 18, 2020



Indian River County Hospital District Conference Room

November 18, 2020

10:00 AM





TRUSTEES:                             Marybeth Cunningham             Barbara Bodnar

Ann Marie McCrystal               Allen Jones

Karen Deigl                              Tracey Zudans


STAFF:                                     Ann Marie Suriano                   Jennifer Frederick

Kate Voss                                    Jennifer Peshke, Esq.


Convene Meeting – Marybeth Cunningham, Chairwoman

Mrs. Cunningham convened the Chairman’s meeting of the IRCHD Board of Trustees at 10:00 AM by welcoming those participating via Zoom and in person.


TCCH FY 19-20 Update- Vicki Soule, CEO

Mrs. Soule prepared for the Trustees a TCCH update from October, 2019 to September, 2020. She stated that it’s been a very unusual year, not just from an operations and volume standpoint, but from a human relations and mental health viewpoint. She further reviewed data concerning their medical and behavioral health services. She also included a comparison of their Patient Satisfaction surveys from last and current year. She is pleased to report that the necessary changes TCCH had to make this year, have been overall well received. She further discussed how TCCH provides COVID-19 testing at their clinics, along with a drive thru option. Mrs. Cunningham asked for an update concerning their clinic at the UP Center. Mrs. Soule indicated that the clinic sees around 15 patients a day and are pleased with the service they receive. She is hopeful that once patients are more comfortable receiving medical care at the center, the volumes will increase.


Community Indicators Database Presentation- Jeff Pickering, IR Community Foundation CEO

Mr. Pickering provided a brief history concerning the Indian River Community Foundation. He stated that the purpose of this mySidewalk program database will be to perpetuate the IRC Community Needs Assessment in the areas of children, education, economic opportunity and employment, health, housing and seniors. Democratize community needs data and indicators, while minimizing administrative reporting burdens of participants and promoting information sharing among stakeholders; and develop collective impact and policy solutions to community challenges. There was further group discussion surrounding the implementation of this database and the challenges participating agencies may face, due to their own reporting guidelines. Unfortunately due to technical difficulties the 15 minute video overview of mySidewalk, the  platform, and Community Health Needs Assessment Dashboard was unable to be shown. He indicated that he would provide the information to the Trustees after the meeting and address the board at another time.


Phoenix Rising Update- Pedro Bernabe, CEO

Mr. Bernabe provided an update concerning Phoenix Rising and the services they offer through their centers. He provided insight to the Trustees concerning their day-to-day operations and answered questions as they arose. Mr. Bernabe offered the Trustees a tour of their facilities so that they may see first hand how the center is operated. He thanked the Trustees for their continued support.


Program Liaison Report- Jennifer Frederick

 Mrs. Frederick provided an update concerning the financial assistance program database. Over the last fiscal year, the District approved a total of 2,496 new financial assistance applications. In addition to new applications, 1,988 renewal applications were processed for a total of 4,484 for the year. For applicants who fall within 151%-200% of the FPG, the District processed just 293 applications which is relatively low. In April, following the outbreak of COVID-19, the District offered patients who qualified due to lost wages, a 90-day approval. However, only 44 approvals were approved under those guidelines.  Lastly, she stated that there was a total of 9,456 members in the database, however only 3,387 of those members are currently active. There was further group discussion surrounding the unemployment rate in Indian River County due to the impact from COVID-19. As of June, the rate was around 6.8%.


IRCHD Federal Poverty Guideline Discussion- Allen Jones, Treasurer

Mr. Jones stated that the Trustees have discussed in previous meetings an interest to align the eligibility criteria for the District, with that of Cleveland Clinic, so they are similar. The District’s criteria has evolved and now includes Indian River County resident whose income is at or below 200% of FPG. Since Cleveland Clinic offers free care to those whose income falls below 250% of Federal Poverty Income Guidelines (FPG), the question before the board is to consider adopting the same standard in District eligibility criteria. In the current fiscal year, the District budgeted a relatively low millage of .8011. This fiscal year, the District will complete its contractual obligation to CCIRH with remaining payments totaling $4.5 million. These payments represent about 30.6% of the budgeted expenditures or roughly .245 millage. Mr. Jones explained that budgeting for the next fiscal year will afford Trustees an opportunity to potentially increase the impact of healthcare support benefiting lower income residents, while not having to raise the millage on taxpayers. He further explained that in the current fiscal year, the Trustees increased eligibility from 150% to 200% FPG. Based on data provided by Ms. Frederick, there are currently 2,486 new applications in fiscal year 2019/20 with 293 falling within the range of 150-200% of FPG. It is not known how much that cost the District incrementally, from October 1, 2019, when the new range went into effect, but proportionately out of 9,456 in the database, there was an increase of 293 or 3.1%. Further, when 150-200% FPG was added, the District eligible uninsured population grew by 2,565, but only 293 (11.4%) were added to the District database. The impact was minimal on the District’s budget even in a year with the COVID impacting residents’ employment. However, this implies another 9,000+ residents could be covered if the need for medical care surges. Mr. Jones believes this could have a meaningful impact on the budget. It’s also worth noting, that expanding the eligibility criteria up to 250°/o of FPG would only add at most 592 more eligible individuals using 2016 data. At the 11.4% increase in the District’s database experienced in 2020, it is implied that only another 68 people would be added to the database suggesting a minimal impact financially. He feels the big risk financially is from the original, uninsured population in the 0-150% category, that are eligible but not claiming benefits at the moment. By Mr. Jones research and calculations, he does anticipate there will not be much of a financial risk to the District’s budget by expanding eligibility to 250% FPG. He asked for Trustees comment and there was group discussion on the same. It was decided that before increasing the level to 250%, the board would look at ways to further help the already covered population of up to 200%, with additional support and access to specialty services.


Other Business

Mrs. Cunningham provided an update on CCIRH and stated that she provided the Trustees with an outline concerning the steps they are taking to respond to calls to the Hospital regarding the new medical records system. They are currently working through those issues and will continue to do so until all matters are resolved. The hospital has freezer to store the COVID-19 vaccine at its required temperature and they hope to have the vaccine sometime in early January. As of November 16th, there were 13 COVID positive patients in the hospital with four in ICU, and this rate has been relatively consistent. Lastly, she stated that she and Mrs. Suriano, along with other community members are serving on the Intensive Outpatient RFP review committee. The committee had an RFP opening on Monday to discuss the proposals and on Friday this week, they will meet with the agencies who submitted the proposals to discuss the same.

Mrs. Peshke stated that the District will have the Amended and Restated Lease Agreement between the District and the VNA, brought before them tomorrow night for approval. She asked the Trustees to carefully review the same and contact her with any questions.


Public Comment

Mrs. Cunningham asked for additional public comment and there was none. Mr. Jones made the motion to adjourn which was seconded by Mrs. Bodnar. The meeting was adjourned at 12:10 PM.