Sep 24 Special Meeting- August 26, 2021
IRCHD Special Meeting via Zoom
August 26, 2021
ATTENDEES: Marybeth Cunningham Ann Marie Suriano
Ann Marie McCrystal Allen Jones
Jennifer Frederick Vicki Soule
Kate Voss Robi Robinson
Jamie Merritt Marie Andress
Charles Mackett, M.D. Karen Deigl
Convene Meeting – Allen Jones Treasurer
Mr. Jones convened the special meeting of the Indian River County Hospital District at 2:00 PM via Zoom. He explained that the purpose of this meeting is to explore ideas that would make the District’s expenditures more impactful on improving the health of the community, particularly for those eligible under the District’s financial assistance guidelines. Mr. Jones stated that as the District moves toward the conclusion of its budget preparation for the upcoming fiscal year, the board is seeking ways to improve the impact of the healthcare support currently being provided.
Accessibility to Healthcare Services Talking Points- Allen Jones, Treasurer
Mr. Jones stated that Marie Andress of Whole Family Health Center and Vicki Soule of Treasure Coast Community Health had some preliminary discussions. In an email, Ms. Andress suggested Trustees might consider funding these few areas:
1. Helping underinsured individuals with co-pays
2. Help fund non-Covid vaccinations like Shingles or Pneumonia
3. Help patients in the “donut hole” of prescription drug reimbursement
4. Help with Vero Radiology costs
Mr. Jones would like today’s discussion to be the catalyst of developing some meaningful solutions to support these gaps and barriers to care. He believes there should be no limit on the concepts considered as long as they are financially responsible and will have an impact on improving the health the of Indian River County residents. He asked Dr. Mackett to provide his thoughts and recommendations first. Dr. Mackett indicated that one barrier to care is not everyone is eligible for Medicaid, and it can be difficult to acquire due to the lack of Medicaid expansion in the state. He also believes there is an opportunity to provide a safety net for underinsured residents in the community. Additionally, further community outreach by TCCH and WFHC may be needed, to spread the word that health services are available through their organizations. Dr. Mackett also stated that an additional barrier is an access to specialty services. In some cases, CCIRH does not provide the specialty service needed or there is a backlog of patients waiting to receive that particular service. He also agreed with supporting preventative vaccination distribution. He explained that there are many preventative vaccines available and it would be beneficial to provide those immunizations to adults in the underserved populations. Some of those vaccines include flu; HPV; hepatitis A&B; TDAP; and other preventative vaccines that are proven to reduce morbidity and mortality. Further, Dr. Mackett stated that metrics to measure these outcomes could be tracking the number of individuals who are getting vaccinated each year. Additionally, he believes there is an opportunity for the District to support other services which aren’t currently covered such as:
1. Smoking Cessation
2. Colorectal Cancer Screenings
3. Women’s Health Services
4. TB Screenings; and
5. Low Dose CT Lung Cancer Screening
He stated that these preventative services have been shown by the US Services Preventative Task Force, to reduce morbidity and mortality. Lastly, he discussed that when the State of Oregon reimburses Medicaid and supplements underserved/underinsured, they review their budget to see how much will be spent that year and rank the services by which are most efficacious and cost-effective. He believes it would be beneficial to look into this structure as a guide.
Mr. Jones asked for additional input and Ms. Andress addressed the board. She explained that she invited Ms. Jamie Merritt, the Vice President at WFHC who is an expert on FQHC billing rules, to be a part of the discussion today. They have had prior discussions concerning the underinsured and she asked that Ms. Merritt speaks to that matter. Ms. Merritt indicated that within WFHC social services department, they have identified some areas that need additional support. One main area is regarding underinsured patients and Medicaid. Many times, those patients have limited coverage and are often only covered for specific services such as family planning. Medicaid also puts limitations on services such a behavioral health. She further explained that there are also issues with patients obtaining durable medical equipment (“DME”). In other instances, patients are opting to obtain low monthly premium plans which require them to pay sometimes 40% of their healthcare cost and have relatively no coverage for specialty services. There are also individual circumstances where a patient is just above the threshold for Hospital District financial assistance, so parents must obtain alternative coverage for their children if they are unable to afford Medicaid. Lastly, she discussed the issues with patients in the “donut hole” of prescription drug reimbursement. Many times, patients are not notified that they have reached their maximum coverage threshold and are forced to pay out of pocket for their prescriptions that historically have been covered. She further recommended that it may be beneficial to start tracking those underinsured patients to get an idea of the volume of patients who may need additional assistance. Mrs. Frederick indicated that the Hospital District does make some exceptions to provide coverage to patients who may have extenuating circumstances or are just above the financial qualification guideline. However, the District cannot provide support unless they are notified of the circumstances and she encouraged WFHC and TCCH to contact her to discuss how best to support the need. There was further group discussion concerning this matter and how best to keep track of this data. Mrs. Soule indicated that many times if a patient is in need of additional services like a preventative vaccine, TCCH will provide the service and absorb that cost. She also agreed that many patients have low coverage insurance or catastrophic coverage only, which does not cover primary care. She would like to look further into providing assistance with co-pays for those who are uninsured. She understands that will take work to develop, but she believes it is a justified expense to help bring further healthcare support to the community. There was further group discussion surrounding the underinsured and Ms. Deigl feels that this is not a one size fits all situation and it will take some work on the District’s part to find a meaningful solution.
Mr. Jones thanked everyone for this meaningful discussion and stated that there will need to be some sort of mechanism for reviewing these outstanding needs. He informed the group that currently CCIRH provides free care to any individual who is 250% or below the Federal Poverty Guidelines. However, after having a prior discussion with Dr. Saver, he was informed that when a patient needs radiology services, they are billed directly for those services regardless if they qualify under the 250% threshold. This is due to a contractual agreement between CCIRH and Vero Radiology. He explained that this agreement was originally between IRMC and Vero Radiology and through the CCIRH transition, CCIRH is obligated to complete the terms of the agreement. He stated that he would like to further look into how the District could better support the patients, until the agreement can be renegotiated in a few years. Mr. Robinson indicated that We Care pays for all of its patient’s radiology costs and they have a contract with Perkins to help assist with prescriptions and DME. Ms. Deigl indicated that Senior Resource Association also has a plethora of DME and would be happy to assist collaboratively with other agencies in getting that equipment to their vulnerable patients.
In closing, Mr. Jones stated that from today’s discussion he heard that there are a number of opportunities for the District to consider and make their expenditures more impactful to the health of the community. He hopes these discussions will continue and that the District budget will accommodate those areas of most importance.
Public Comment & Adjourn
Mr. Jones thanked the group for their participation in this important meeting and looks forward to working collaboratively on these matters. There was no further discussion and the meeting was adjourned at 3:00 PM.