Chairman’s Meeting: October 19, 2022

Chairman’s Meeting: October 19, 2022

Indian River County Hospital District Conference Room/ Zoom
October 19, 2022
10:00 AM

TRUSTEES: Marybeth Cunningham Karen Deigl
Ann Marie McCrystal Barb Bodnar
Allen Jones Kerry Bartlett

ZOOM: Ed Lowe Marie Andress
William Winns Vicki Soule
Dr. Mallon Caleigh Hansen

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

ATTENDEES: Lundy Fields Bill Stewart
Pat Knipper Bill Stengel
Igor Kromov Megan McFall
Robi Robinson Jennifer Jones

Convene Meeting – Marybeth Cunningham, Chairwoman

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

Strategic Planning Discussion

Ms. Suriano addressed the board and stated that as part of the continued work to implement the strategic plan framework, she asked the Trustees to come together to move forward with creating definitions and funding criteria. She believes the staff and Trustees need further direction on how to best move forward with this process. She has reached out to other hospital districts in the state to discuss how they implemented their strategic and community efforts, but has received little to no response from those Districts. She will however, continue to work on making contact with them. It was further discussed that the strategic framework that was approved is a working document and can be amended as the Trustees move through this process. Mr. Jones stated he would like to add a fourth priority which states that the District commits to being transparent and fiscally responsible for tax dollars spent or invested. This would include establishing and monitoring performance metrics consistent with the healthcare providers patient care objectives, and conducting audits as appropriate to verify the validity of reported metrics and financial numbers of supported healthcare providers. There was further Trustee discussion and the group agreed to add this priority. Therefore, Mr. Jones made a motion to approve the addition of the fourth priority, which was seconded by Ms. Deigl. The motion carried unanimously.

Next, Ms. Bartlett stated she had a meeting with Brett Hall to discuss the Indian River Indicators data concerning mental health and substance misuse. The data is outlined by color, which indicate the level of capacity for Indian River County’s System of Care. Green indicates adequate, yellow indicates insufficient, and red indicates no capacity. She explained that during her meeting she asked Mr. Hall if there was a supportive role for the District to help achieve better outcomes for the continuum of care concerning mental health and substance misuse. Mr. Hall was asked to provide some additional recommendations or action steps for the District to consider, in order to move the needle for sustainable change. There was then group discussion surrounding the need for detox services and how the District can support this initiative. Some Trustees suggested there be a formal RFP process, others suggested having a round table discussion with other entities who provide detox services within the state, to see how their operations are supported.

Lastly, Ms. Suriano stated that she would like to have this information presented to the public and the District funded agencies. However, some Trustees felt that the District needed to further define its goals and action steps, along with developing funding criteria, before the plan could be distributed to the public. There was also discussion concerning the District funding application to reflect the funding criteria changes. It was also suggested that Ms. Suriano meet with other funded agency CEOs, to discuss their strategic planning process to obtain feedback on best implementation practices.

VNA Funding Request Discussion

Ms. Suriano stated that the full funding request for the mobile health unit has been included in the final fiscal year 2022-2023 budget, but some Trustees had further questions concerning the breakdown of expenses for the cost of operations. Those Trustees questions were sent to the VNA, who provided responses and additional data outlining their request. Ms. Suriano asked if the Trustees were satisfied with the information they received, or if they would like to have further discussion, as many of the VNA representative are present at today’s meeting. There was lengthy Trustee discussion concerning the mobile health clinic and its impact on the community. The Trustees agreed that they are not questioning its effectiveness but more so the cost to operate it and that the fact the 95% of the total funding requested is from the District. Next there was discussion surrounding the question at to why the VNA doesn’t obtain Medicare or Medicaid credentials in order to bill for visits to the mobile health clinic. Dan Bach, CFO at the VNA explained that because the clinic is “mobile” it doesn’t meet the requirements for Medicare or Medicaid credentialing. Additionally, most of the patients seen at the mobile clinic are not insured. It was discovered that most patients visiting the mobile health clinic are unable to obtain an appointment at one of the local FQHC’s and would otherwise go to the emergency room for care. After further Trustee discussion it was decided that Distict would support the total funding request but would reimburse for supply costs on an as used monthly basis, instead of at 1/12th of the budget. Ms. Bartlett made a motion to approve the change in funding which was seconded by Mrs. McCrystal. The motion carried unanimously. It was discussed that Ms. Frederick would add this change to their funding agreement, which had not yet been finalized. Additionally, it was requested that a copy of the VNA revised budget be provided to Dawn which outlined their allocated costs.

GlobeChek Funding Request Discussion

Ms. Suriano stated that the District has received the funding requests from Whole Family Health, TCCH, and GlobeChek, to support the continuation and expansion of GlobeChek services. She first discussed and reviewed the request from TCCH and explained that the request is based on projections of staff time and patient visits. It was further discussed that the Globe would travel weekly to 5 different TCCH locations. Next there was discussion concerning the WFHC request, which would have a stationary Globe at their Vero Beach office. All three funding requests outline their actual costs and what is being proposed for reimbursement from the District. Mr. Jones addressed the group and stated that this proposal was higher than what he had initially worked on with the parties, and was not in favor of the increased request. It was explained that initially, the parties were requested to not exceed a certain threshold of funding, so their initial funding request was based on this instruction during their discussions with Mr. Jones. However, after presenting that information to the entire Board of Trustees last month, the parties were instructed to prepare their funding request with actual cost, so it would accurately reflect what it would take to operate the program fully, for all three agencies. Based on this explanation most of the Trustees were in favor of the larger proposal and Ms. Cunningham made a motion to approve the requests, which was seconded by Ms. McCrystal. The motion carried 5-1, with Mr. Jones is opposition.

Public Comment & Adjourn

Mr. Kint addressed the board and asked what the projected number of visits were for the GlobeChek. Mr. Jones indicated it was approximately 8,050.

Mr. Shalhoub stated that he is in agreement that the Strategic Plan should have more detail in its action steps. Additionally, he stated that he believes there is a way GlobeChek could bill for the eye services they provide. Ms. Soule responded and stated that the service GlobeChek provides is not considered an eye exam, but an eye scan, and is not billable through insurance.

Ms. Posey was present on Zoom and it was announced that she has stepped down from her position at the BHC with CCIRH, and has been hired as the new CEO at Tykes & Teens. The Trustees congratulated her on her new role.

The meeting was adjourned at 11:45 AM