BOT Regular Monthly Meeting: July 21, 2022

BOT Regular Monthly Meeting: July 21, 2022

County Commissioner Chambers/ Zoom
July 21, 2022 @ 4:00 PM

TRUSTEES: Allen Jones Barb Bodnar
Marybeth Cunningham Ann Marie McCrystal

ABSENT: Karen Deigl

STAFF: Kate Voss Jennifer Frederick
Ann Marie Suriano Dawn Carboni

ZOOM: Kerry Bartlett Jennifer Peshke, Esq
Elizabeth Appleton

ATTENDEES: Samantha Messina Philip Cromer
Liz Bruner Angela Guzenski
William J. Mallon, M.D. Gerald Pierone, M.D.
Randy Riley Wilfred Hart
Vicki Soule Michael Kint
Jad Shalhoub Marie Andress

Convene Meeting & Approval of Consent Agenda– Marybeth Cunningham, Chair

Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM by welcoming those in attendance and via Zoom. Rabbi Michael Birnholz provided the invocation and Ms. Cunningham led the group in the Pledge of Allegiance. Ms. Cunningham then asked for a motion to approve the budget presentation meeting minutes dated June 7, regular monthly meeting minutes dated June 14, Chairman’s meeting minutes dated June 15, strategic planning meeting dated June 28, and a July disbursement of $837,793.09. The motion was made by Mrs. McCrystal and seconded by Ms. Bondar, which carried unanimously.

Chairman’s Report- Marybeth Cunningham, Chair

Ms. Cunningham stated that she met with Dr. Rosencrance this week who provided her with an update concerning CCIRH. She stated that CCIRH has been recognized by the Florida Department of Health as one of 26 hospitals in the state that has the lowest C-Section rate and has lowered the rate further over this past year from 30% to 20%. Additionally, CCIRH has completed a sports medicine service agreement with the Sebastian River high school and will now be the preferred provider for their students. Lastly, CCIRH has hired two employees to their executive staff which includes Daniel Finn as the Director of plant operations, who has 30 years of experience in this field, and Larry McGill who will serve as the Scully Welsh Cancer Center administrator.

District Counsel Report- Jennifer Peshke, Esq.

Unfortunately, due to an issue with Zoom, the group was not able to hear Ms. Peshke provide her report. However, a copy of Ms. Peshke’s written report was included within the meeting packet for review.

Financial Statement Review- Allen Jones, Treasurer

Mr. Jones provided his treasurer’s report and stated that the District is in excellent financial condition. As of June 30, the District had investments and bank deposits totaling about $12.7 million. Less the expenditures approved earlier of $838,000, there is a balance of $11.8 million remaining in the accounts. He explained that the District’s funded agencies are budgeted to receive around $4.3 million, along with the District operating expenses of a little over $200,000 which equals District budgeted expenses of only $4.5 million, and will conclude the year with a carryover of $7.3 million. Lastly, he stated that despite the changing nature of healthcare needs and the uncertainty of inflationary costs, these carry-over funds will allow the District to prudently plan for any future needs, and it is probable that the Trustees will return some of these excess funds to taxpayers when the next fiscal year’s budget and proposed millage is announced.

Executive Director Report- Ann Marie Suriano, Executive Director

Ms. Suriano provided her report and stated that she has distributed to the Trustees the final version of the amended strategic plan for their approval. She discussed the changes that were made and stated the final version of the document is available on the District’s website for review. She asked for a motion to approve the Strategic Framework which was made by Ms. Cunningham and seconded by Mrs. McCrystal. The motion carried unanimously. She then stated that the next steps will begin on how to best put this plan to action and communicate the same to the community and funded partners.

GlobeChek Update- William J. Mallon, M.D. & Gerald Pierone, M.D.

Dr. Pierone addressed the board and provided an update to the Trustees on the status of the GlobeChek pilot program. He began by discussing the GlobeChek workflow and how the service is administered to the patients at Whole Family Health Center. He explained patients are offered examinations in conjunction with scheduled or walk-in medical visits. Then the patient is screened by a GlobeChek staff member and the results of the scan are sent to the ophthalmologist for review. Patients with urgent, semi-urgent or significant findings are referred for follow-up with an ophthalmologist. Records from that follow up visit are obtained to maintain a continuum of care for the patient. Next, he reviewed data concerning the number of patients screened which was 982, and their payor source, which was mixed. Around 13% of the patients were qualified under the District Financial Assistance Guidelines and the others maintained private insurance, Medicare, Medicaid, or were uninsured. He also reviewed data concerning concurrent medical conditions of screened patients. Next, he discussed the findings from the scans which were broken into categories which included urgent, semi-urgent, significant, secondary, and normal. Through the triage findings it was shown that 40% of patients screened needed additional follow-up care and there were six patients that needed urgent immediate care. He discussed an instance where a patient was screened and it was discovered during the screening that without immediate intervention, he would have lost his vision completely. Further, the discussed the challenges and opportunities that have come from this opportunity to place GlobeChek at Whole Family Health Center and how they can continue this program in a sustainable manner. Dr. Mallon addressed the board and said he could not have picked a better partner than Whole Family Health Center to begin this pilot program and that the agencies have worked very well together. He explained that next steps will be how they can properly bill for this service through primary care avenues, which would help offset the cost to the District. Mr. Jones volunteered to work with Dr. Mallon and Dr. Pierone, to discuss a funding structure moving forward. The Trustees had discussion and they were pleased with the outcome of the program thus far and look forward to seeing the formal proposal for the continuation of the services, for their consideration. Lastly, Ms. Andress spoke to the board and explained that Whole Family Health Center has incurred cost for follow up care and glasses for some District qualified patients, and asked if the board would be willing to reimburse them for the cost. There was Trustee discussion and Ms. Cunningham made a motion to approve the request, which was seconded by Ms. Bodnar. The motion carried unanimously. Ms. Andress stated that she would submit the formal request to District for review and processing.

Funded Agencies Semi Annual Reports-

The Mental Health Association- Angela Guzenski, COO & Philip Cromer, CEO

Ms. Guzenski addressed the board and stated that the Mental Health Association submitted its semiannual update to the Trustees prior to today’s meeting, and asked if there were any questions concerning the report. There were none so Dr. Cromer began by discussing the current issues facing the agency which include the increase of acuity and severity of symptoms they are seeing in their clients. He stated that post pandemic, inflation and the current housing crisis have taken a drastic toll on the community’s mental health and the effect is has on people is severe. Therefore, the walk-in center has become a much-needed service which offers immediate support with a mental health screening, free of cost. They have also seen a drastic increase in children and adolescents needing mental health services. Therefore, they have added psychiatric services for children to help assist in combating this increase. They have also added a teen support group and are working to develop a center for parents and children, to provide additional support to families. Ms. Guzenski stated that they continue to work collaboratively with the IRC School District and the summer months, which usually are a slower time, have been overwhelmed with a need for services. There was also discussion surrounding the need for further prevention services which would be helpful in preventing the issues from becoming so severe. Ms. Cunningham questioned why they were unable to utilize all the funding in their budget specifically allocated for therapy services. Ms. Guzenski explained that many times, a patient will have insurance which covers very little or has a high co-pay, which would disqualify them from District financial assistance. Additionally, there are patients who are just over the 200% Federal Poverty Guideline which also disqualifies them from District financial assistance. Therefore, there are instances where they are providing services for free, so a patient is able to receive care. There was Trustee discussion surrounding this and how it also effects other agencies as well, and how best the District can move forward with supporting these agencies and still be fiscally responsible with tax dollars. Ms. Guzenski explained that MHA has explored every avenue in obtaining additional funding to support increased costs from salary increases and operations costs. Dr. Cromer ended the discussion by stating that even though there is much doom and gloom surrounding the increased need for mental health services, MHA is making a meaningful impact in the community by saving and changing lives for the better.

Senior Collaborative- Randy Riley, Executive Director

Mr. Riley addressed the board and stated that he has prepared a short PowerPoint presentation he would like to share with the board. He first provided an update concerning website database which saw in increase in users from 905 to 2,700, year to date. 45% of those visits were to obtain health & medical information. Next, he discussed information concerning their phone assessment and referral service which has seen an increase in volume and they anticipate to receive over 600 calls by the end of the calendar year. He then discussed things that are currently affecting the organization and future plans. First, he notified the board that he would be retiring effective May 1, 2023, and that they are currently looking for a replacement Executive Director. Additionally, their board has recognized the need for sustainability through fundraising campaigns, and they have two fund raising events scheduled in October and March. He then discussed some emerging issues that they are seeing which include the impact of the 60+ population growth and their need for services. This population is also suffering with isolation and lack of financial resources. Lastly, he discussed their five-year plan which includes finding a facility to operate from and the introduction of tele-health conferences, as well as tele-visit phone referrals. He thanked the Trustees for their support of the Senior Collaborative and understand that the District future funding structure may be changing, but he is hopeful that they can continue their partnership.

Approval of Tentative FY 22-23 Budget- Allen Jones, Treasurer

Mr. Jones began by providing a brief history of the millage rate, for context of this discussion. He explained that in 2017, the Hospital District began a concerted strategic shift, and after discussions between Ms. Cunningham and Dr. Hockmeyer, Board Chair of IRMC, it was decided they would work together to improve the delivery of healthcare in the county. The first step was forming a Collaborative Committee consisting of members of each board, and through those group discussions it was agreed that the U.S. system of healthcare made a standalone hospital unlikely to survive long term. After an extensive partnership search, Cleveland Clinic was chosen to take over operations of IRMC. He explained that when the that process began, the District’s millage rate for fiscal year 15-16 was .9951, and the budget being presented tonight will anticipate a maximum millage of .5774, which is a reduction of about 42%. This shows that the District is not only more efficient with tax dollars but effective in supporting care for all the residents of the county, and particularly those less advantaged. Therefore, Mr. Jones made a motion to approve the proposed budget for fiscal year 22-23, as outlined in the documents provided to the Trustees and available to the public. This budget includes a millage of .5774, which is down 19% from last year, and an ad valorem tax revenue of $13,507,002, which is down 8.3% from last year. This also constitutes a reduction in the rolled back rate of 10.2%. He further explained that this proposed budget may be adjusted downward but not upward over the next approximately 60 days after more examination by the Trustees and the receipt of comment from the public. After any adjustments that may or may not be made, the final budget will be further discussed at a public meeting on September 8, and the final vote will be taken on September 22 at the final public meeting of the fiscal year. Ms. Bodnar seconded the motion and there was no further Trustee discussion. The motion carried unanimously.

Request for Additional Funding EARS Program- Liz Bruner, Senior Resource Association

Ms. Bruner explained that with a monthly average of 6-7 qualified new EARS clients enrolled, the cases management team anticipates receiving dozens more requests for EARS services in the next 11 weeks, resulting in 16-19 qualified EARS participants seeking services. With the initial funds requested and allocated to the current fiscal year being exhausted, this would mean that SRA would have to place these high-risk seniors on a waiting list, until additional funding becomes available. Therefore, a request to obtain gap funding has come before the Trustees to support this program. She stated that the total request of $9,994 would serve up to 19 seniors at a cost of $526 each, for the remainder of the fiscal year. Funding would be requested on a monthly basis, based on actual enrollments. Mrs. McCrystal made the motion to approve, which was seconded by Mr. Jones. The motion carried unanimously.

Public Comment/Adjourn

There was no public comment and the meeting was adjourned at 5:50 PM