Special Meeting- Budget Discussion: August 17, 2022

Special Meeting- Budget Discussion: August 17, 2022

SPECIAL MEETING- FY 22-23 Budget Discussion
Indian River County Hospital District Conference Room/ Zoom
August 17, 2022
10:00 AM

TRUSTEES: Barbara Bodnar Kerry Bartlett
Allen Jones Ann Marie McCrystal

ABSENT: Karen Deigl

STAFF: Jennifer Frederick Kate Voss
Dawn Carboni Ann Marie Suriano
Jennifer Peshke, Esq.

ZOOM: Andrea Berry Bill Cooney
William Winns Marie Andress
Sabby Hightower Michael Kint
Marybeth Cunningham

ATTENDEES: Pat Knipper Lundy Fields
Ed Love Daniel Gatins
Mary Silva Linda Kloss
Alethia Dupont Moreen Burkard
Elizabeth Appleton Randy Riley
Elizabeth Adams Brett Hall
Jeffery Zipper Maiti Soria
Marty Mercado

Convene Meeting – Kerry Bartlett, Vice Chairman

Ms. Bartlett convened the budget discussion meeting of the IRCHD Board of Trustees at 10:00 AM by welcoming those participating via Zoom and in person. She also extended her thanks to all the funded agencies who were present at today’s meeting.

FY 22-23 Agency Funding Request Follow Up & Budget Discussion- Ann Marie Suriano, Executive Director

Ms. Suriano stated that the board met on July 12 for their first budget discussion meeting and, at that time, additional information was requested from the funded agencies regarding their funding requests. Therefore, Ms. Frederick submitted those questions to the funded agencies for follow up and prepared a detailed sheet with the responses as well as an outline of the requests separated into program and fee for service requests. Ms. Suriano explained that she would go through each item with the Trustees to see if there were any additional questions, and would also provide opportunity for the funded agency to respond as well. First, she began by addressing the Healthy Start request to support the Program Data & Sustainability Coordinator. She informed the Trustees that Healthy Start has obtained revenues from another funding source for this program and that they are withdrawing their request.

Next, there was discussion concerning the Hope for Families request and some Trustees asked for more clarification concerning the funding for the administrative and equipment cost. Ms. Frederick stated that Hope for Families submitted follow up data concerning the request which included a breakdown of expenses. It was also clarified that this request was not going towards any type of capital expense.

The discussion continued surrounding the new funding request from iRecovery. Many of the Trustees asked for further understanding of the referral process and wanted to see proven outcomes. Ms. Suriano stated that she and Ms. Carboni conducted a meeting with iRecovery to discuss their for-profit status and what would be required of them to disclose during the Districts’ annual audit of the funded agencies. Dr. Zipper, CEO of iRecovery was in attendance and provided an update to the Trustees concerning the status of the creation of their Foundation entity. He explained that the Foundation has been created and they are currently in the probationary period awaiting their final licensing from DCF. Therefore, if the Trustees felt more comfortable with providing funding directly to the Foundation, in lieu of the for-profit entity, they would be happy to partner under that direction. Next, there was discussion surrounding the effectiveness of detox and substance abuse treatment via telehealth and Dr. Zipper stated that there was a recent CMS study supporting this method of treatment. Additionally, many patients find this method to be more comfortable and supportive, as it takes place in their home. Lastly, Mr. Hall from the McCabe Connections Center addressed the group and stated that he has referred three patients to iRecovery for services and they had very positive things to say about their experience.

Next, there was discussion concerning Senior Collaborative and Mr. Riley was in attendance to answer any questions. It was discussed that supplemental information was provided to the Trustees yesterday, and many still needed time to review the same. There were no additional questions at this time. They also discussed the follow up information they received from Substance Awareness Center and were satisfied with their response and had no further questions.

Ms. Suriano stated that the next item up for discussion was the new funding request from Sunshine Physical Therapy. She explained that the agency provided supplemental information for the Trustees to review and consider. Additionally, Ms. Carboni prepared a report for the Trustees which outlined their responses to the Pre-Audit Questionnaire. Ms. Frederick informed the Trustees and she and Ms. Carboni conducted an on-site visit at Sunshine and were very impressed with their facilities and operations. There were no further questions at this time from the Trustees.

Next there was lengthy discussion concerning Tykes & Teens, and the interim Executive Director Linda Kloss asked to address the board. She thanked the Trustees for their support during this transition period and provided an update concerning their search for a new CEO, which should be completed by end of September. She then discussed that the organization has been able to remain stable through these uncertain times and have only lost two employees. Additionally, they are working with an attorney to address and correct the Audit findings from Ms. Carboni’s report. Dr. Dupont, Director of Outpatient Services addressed the board and provided a review of data and outcomes metrics from their Martin and St. Lucie County sites. Mr. Jones voiced his concerns regarding the fact that the two other programs Tykes & Teens operated in Indian River County were not sustainable and questions how this outpatient program they are requesting substantial funding for, will be more successful. Ms. Kloss explained that they are already operating the program successfully in Martin and St. Lucie County and would be utilizing the same method and proven outcomes. The program would treat 6–17-year old’s and is a needed service within the community to help combat the increased need for therapy services. There were no further questions at this time.

Ms. Suriano stated that the Trustees had follow up questions concerning the VNA’s new request for funding the community health worker and music therapy programs. She explained that VNA has reframed the community health worker program to a social worker and Ms. Knipper provided a very detailed PowerPoint presentation which was given to the Trustees prior to todays meeting for review and asked if there were any further questions. There were discussions surrounding the VNA’s request to support the social worker and some Trustees felt this was a duplicative request for service, which is already being provided by other District funded agencies and within the current funding for the home health program. Mr. Lowe ,COO at the VNA, addressed the board and stated that the VNA is asking for support of this position so they are better able to assist their home health and hospice patients. This navigator would help provide a better continuum of care for the patients and be a liaison between the patient and their families. They currently have a limited capacity with their staff, and this person would provide much needed support to those vulnerable patients. They would also be able to identify and address any additional social issues the patient may be experiencing such as food insecurity or mental health. Ms. Suriano asked for clarification on how this service would be billed to the District, and whether it would be on a fee for services basis or as a program expense. Mr. Lowe explained that it would be billed as a program expense but they would provide back up data showing the number of patients that were served and the cost per service. Next there was discussion surrounding the request for music therapy and Mr. Jones asked for data which showed outcomes measures. Ms. Burkhart provided some examples of the benefits of music therapy which help support mental and physical health. With the District support, it will help them expand their reach within the community and provide more therapy services. Additionally, the VNA is the only agency within Indian River County who provides music therapy. They also work with the Mental Health Association and work with their at-risk youth population.

Mr. Jones asked if the group could have a discussion concerning GlobeChek which was not formally included within the budget discussion materials. Ms. Suriano stated that the original request to support eyecare services was included within Whole Family’s request however through recent discussions there has been alternative funding and GlobeChek operating structures proposed and the Trustees should be updated on the same. Mr. Jones explained that as the Trustees know the pilot program with GlobeChek and Whole Family Health Center has been successful and they are looking to expand the program to provide this service to more people in the community, in the most effective and fiscally responsible way. Since March the Globe has screened 893 patients at Whole Family Health Center and 40% of those patients needed some form of follow up care. It is also worth noting that only 12% of the patients screened were District eligible patients. Therefore, the Trustees would need to be comfortable with continuing to provide this service to not just District qualified patients. He asked Dr. Mallon to provide a brief update to the Trustees on their progress so far. Dr. Mallon stated that they weren’t able to see as many patients as they had hoped which caused them a financial loss for their staff time. However, they are pleased with the results of the pilot program and have been able to assist many patients with corrective action for their eye issues. Dr. Mallon further discussed how he believes the program can move forward and right now, there are discussions surrounding how best they can work collaboratively to expand this program to reach more individuals. There were discussions surrounding the Globe being mobile and being located throughout the county at different agencies. Currently, Whole Family Health Center has amended their funding request to include additional funding to support eyecare and GlobeChek. Ms. Suriano explained that this should be a collaborative effort and there have been discussions with the partners on the best way to do this. Therefore, there could be a placeholder of approximately $300,000 in the budget to support these efforts. Ms. Andress addressed the board and stated that Whole Family Health had originally requested $49,800 for eye care back in March, and was unsure at the time how well the pilot program was going to work. After analyzing the data, they realized they needed to request a higher amount which would include cost for the GlobeChek equipment, a 5-year lease, 2.5 staff, and the ophthalmologist reading the results from the scan. Ms. Andress further stated that she believes having the GlobeChek machine at their facility and not mobile, would be more beneficial and comfortable for their patients. Mr. Jones stated that in the next few days, he Ms. Suriano, Ms. Soule, Ms. Andress, and Dr. Mallon will meet to have further discussions on how best to move forward with this program. Mr. Jones will then provide an update to the Trustees for their consideration.

Lastly, Ms. Suriano stated that the Trustees have been provided with a breakdown of the requests separated into fee-for-service and program expenses. She also provided them with a proposed FY 22-23 budget with the current projected year end for program expenses. She will make further updates from todays discussion and circulate that document to the Trustees. It was further decided that the funding matrix would be circulated again to the Trustees for their input on the few outstanding budget line items that have not been agreed upon unanimously by the Trustees. There may also be a need for the Trustees to have an additional meeting to discuss the budget prior to the September 7th First Public Budget Hearing.

Public Comment & Adjourn

Ms. Bartlett stated that there were various public comments received by the District and she read the same aloud. The first was from Mrs. Arthur White, of the City of Vero Beach who stated she strongly encourages the board to support the GlobeChek program and any future funding requests. Eyesight is a critical part of life and these services could be lifesaving to a patient. The second comment was from Ken Daige, from the City of Vero Beach who stated that the board should support Dr. Mallon and the GlobeChek program. The third comment was from Brooke Steinkamp, from the City of Vero Beach and a County resident who stated she previously utilized IRCHD financial assistance and there were long wait times for dental care at TCCH. Additionally, she supports Dr. Mallon and the care he has provided to the underserved. Lastly, there was comment from Phyllis Frey who stated please fund and support Dr. Mallon’s program for helping the blind. There was no further public comment and the meeting was adjourned at 11:55 AM.