Sep 24 IRCHD/We Care Joint Meeting- August 10, 2021
IRCHD/We Care Joint Meeting
Indian River County Hospital District Conference Room/ Zoom
August 10, 2021
ATTENDEES: Marybeth Cunningham Barbara Bodnar
Ann Marie McCrystal Allen Jones
Michael Weiss Kerry Bartlett
Jennifer Frederick Jennifer Peshke, Esq.
Kate Voss Robi Robinson
Miranda Hawker Nancy Baker, M.D.
Joe Coakley Michaela Scott, M.D.
Convene Meeting – Marybeth Cunningham, Chairwoman
Mrs. Cunningham convened the special joint meeting of the IRCHD Board of Trustees and the We Care Foundation Board of Directors at 4:00 PM. She welcomed everyone and asked that there be introductions for all in attendance. To start, Mrs. Cunningham acknowledged Dr. Saver’s untimely passing and shared her condolences on behalf of the District Trustees and staff.
District Support of We Care Specialty Referral Program- All
Mrs. Cunningham stated that the District has had many discussions with Dr. Saver over the years about We Care and its operations. She explained that the District recognizes that there is a need for a specialty referral service process through We Care and the funding that the District provides is to support that purpose. Now that Cleveland Clinic Indian River (“CCIRH”) is in the community, the process has changed and there is a need to revaluate how to best streamline this process. Mrs. Cunningham explained that the District requires all funded agencies to submit metrics, which are evaluated by the board semiannually. In the past, it has been challenging to obtain these same types of metrics from We Care, due to a number of factors. These metrics that the board receives from the funded agencies are critical in showing the effectiveness of the tax dollars being spent. Moving forward, the District will now be required through Florida Legislation to submit an in-depth performance review audit, which reviews all Special Districts to ensure that their tax dollars are being spent efficiently on sustainable and impactful programs and services. Therefore, as We Care moves to restructure and the District will need to reevaluate how they fit into that funding model and how they can best support those venerable patients.
Mr. Jones addressed the group and echoed Mrs. Cunningham’s comments and stated that the District has supported We Care for many years and admires their work done in the community. The goal of these discussions is to make this process as efficient as possible and close any gaps in coverage for the patient. Mr. Jones clarified that his comments, along with any other comments made by an individual Trustee, are their personal feelings and opinions. The Trustees are not able to speak outside of public meetings and discuss these matters, therefore these discussions allow each Trustee to voice their personal opinions. He believes that most District Trustees are more comfortable supporting patient care, rather than salaries at We Care, and would like to see if there is a way to transform that structure.
We Care Talking Point- All
Mr. Robinson stated that he was surprised by the mention of the District potentially not continuing to pay salaries for the We Care clinic moving forward. Mrs. Suriano stated that as a reminder, the District always paid for We Care salaries and then a few years ago transitioned to a hybrid model that supported salaries and fee for service. Last year, Dr. Saver submitted their funding request which requested funding support salaries only and explained that the hybrid model was not able to support their operations. It was further explained that the District currently pays for Dr. Fountains’ salary, along with 2 nurses. There was group discussion surrounding the necessity of paying a doctor or a nurse’s salary, for a job that could potentially be supported by someone at an administration level. Dr. Baker stated that in many cases, the personal relationship Dr. Fountain and Dr. Saver have with community physicians helps facilitate the referral process more quickly. There were discussions surrounding the referral process for a We Care patient to a specialty service at CCIRH. Mrs. Cunningham stated that TCCH, Whole Family Health, the District and We Care have had discussions surrounding this process and how to accurately track those referrals. Currently there are issues with obtaining data from We Care that shows the full picture of the referral process from beginning to end, and how many patients are currently either in the process or have received that specialty service care and have been discharged. It also appears that there is still a large back log of patients waiting to been seen for specialty services. There was further group discussion and Dr. Baker spoke to the fact that CCIRH does not have all specialty lines of service, so there are some instances where CCIRH is unable to support We Care in caring for that patient. It was also discussed that many insured and self-pay patients are also experiencing delays in getting connected with a specialist and this is also a problem nationally.
Mr. Robinson stated that We Care is still requesting their full budget request for FY 21-22, with the expectation that they would come to the District in January with a proposal of a new operating model, taking into consideration the many discussions that have taken place over the last few months. This new model could show a transition of staff and location, which may reduce the amount of funding they are requesting from the District. However, he is requesting from the board that they are given the time between now and January to develop this plan. There was further group discussion surrounding the potential funding structures for the clinic, while providing the most effective care and support to the patient. The Trustees have requested and still do not feel like they have received data outlining the full referral process and the average amount of time it takes a patient to been seen and treated. Ms. Bartlett stated that she would like to see a 5 to 10-year strategic direction plan for We Care, so the Trustees may see if it is in line with the District’s strategic direction as well. Mr. Robinson indicated that he has met with Jeff Pickering from the Community Foundation and that he will be facilitating that process for We Care. Ms. Bartlett asked how soon this process was to begin and that she would also like to hear from the board as to what they envision this timeline to look like. Mr. Robinson stated that this meeting was their main focus currently and that after they receive direction from this board, they will begin to move forward with the process immediately, looking first for a short-term plan for sustainability. Ms. Hawker addressed the group and stated that the We Care board has discussed how this process has changed with the addition of Cleveland Clinic. However, We Care still relies on many private physicians within the community to volunteer their time. It is their goal to make this process as easy as possible for the physician volunteering their time. She believes this is what We Care is about, facilitating the transfer of the patient to a specialist and making that experience as best as possible. She stated that Dr. Fountain has always been able to see the patient and make sure everything is taken care of before they are sent to the specialist. Therefore, she believes that over the next 6 to 12 months, the board will work to firm up what that process looks like and the personnel needed to complete that mission and identifying what the We Care Mission is concerning that part of the referrals they used to make, are now done directly to CCIRH by TCCH or WFHC. There was further group discussion surrounding this process and Mrs. Cunningham stated that she believes currently many board members are not comfortable funding We Care at their requested amount for FY 21-22. Therefore, the District is requesting that within the next 3-6 months, We Care bring a proposal to the District concerning their structure moving forward and what financial support would be needed from the District. Additionally, the District is also requesting monthly updates with metrics-driven data. Mrs. Cunningham also instructed them to contact her or Mrs. Suriano concerning any issues in the referral process with Cleveland Clinic. She reiterated that the District wants to work collaboratively with We Care to find the best solution for the agencies and the patients, and that the District is here to support them in this process.
Public Comment & Adjourn
Mrs. Cunningham thanked the group for their participation in this important meeting and looks forward to finding a resolution to fit everyone’s comfort level. There was no further discussion and the meeting was adjourned at 5:30 PM.