Nov 18 Regular Monthly Meeting: October 20, 2022
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
October 20, 2022 @ 4:00 PM
TRUSTEES: Allen Jones Barb Bodnar- via Zoom
Ann Marie McCrystal Marybeth Cunningham
ABSENT: Kerry Bartlett
STAFF: Kate Voss Jennifer Frederick
Ann Marie Suriano Dawn Carboni
Jennifer Peshke, Esq
ZOOM: William Wims Cathy Whitaker
Marie Andress Vicki Soule
ATTENDEES: Pam Burchell Alex Greenwood
Greg Rosencrance Roxanne Hall
Charles Mackett Megan McFall
Brett Hall Daniel Peter
Igor Kromov Matt Reiser
Convene Meeting & Approval of Consent Agenda– Marybeth Cunningham, Chair
Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM. Deacon Dave Hankel, St. Helens Catholic Church provided the invocation and Ms. Cunningham led the group in the Pledge of Allegiance. She then asked for a motion to approve the consent agenda which was made by Mrs. McCrystal and seconded by Ms. Bartlett. The motion carried unanimously.
Chairmans Report- Marybeth Cunningham, Chair
Ms. Cunningham explained that she attended, on behalf of the District, a recent meeting of the Board of Directors at CCIRH. She had been asked by the other Trustees to provide an update of what was discussed at the meeting, but given the fact the CCIRH will be providing their semi-annual report tonight, she will forgo providing that update.
District Counsel Report- Jennifer Peshke, Esq.
Ms. Peshke provided her report and stated that she continues to review the annual deadlines and deliverables due to the District under the Lease with CCIRH. She is also actively following the current legislative session for bills related to Hospital Districts, with regard to the sunshine law and public records act and there are no new updates at this time. Additionally, the District is currently on hold with this matter with how a potential county ordinance change regarding stormwater retention may impact the IRC floodplain and stormwater code changes, as it relates to the property the Hospital District owns with regard to the hospital campus. Lastly, she is preparing for the annual compensation committee meeting, and will be sending the trustees more on that as it is available for their review.
Financial Statement Review- Allen Jones, Treasurer
Mr. Jones provided his Treasurer’s report and stated that the District has begun its new fiscal year with the lowest millage rate in the last several years, but the most cash on hand to support and improve health care needs for Indian River County. He explained that it is important to invest these extra funds and made a motion to approve the purchase of a 1-year US Treasury Bill in the amount 2 million dollars to mature next October. The return rate should amount to $440,000, and the District current investments have yielded approximately $289,000. Mrs. McCrystal seconded Mr. Jones motion, which carried unanimously.
Executive Director Report- Ann Marie Suriano, Executive Director
Ms. Suriano stated that her written report was provided to the Trustees with the meeting materials but she will highlight a few separate items. Today she attended the First Annual Meeting and Awards presentation for the Senior Collaborative. She is also a current Board member for the Senior Collaborative. At the presentation, many District funded agencies were recognized for their support and work within the community. Additionally, she has sets up some meetings to convene individuals to have further discussions surrounding detox and aftercare services and will update the Trustees on the progress of those discussions.
Semi Annual Report- Cleveland Clinic Indian River Hospital- Gregory Rosencrance M.D., President CCIRH
Dr. Rosencrance addressed the board and thanked them for their continued partnership and support. He explained that with hi, today is the CCIRH executive team, including the new COO Alex Greenwood. Dr. Rosencrance stated that his report today will review a number of items which include scope of services, quality benchmarks, capital spending, indigent care services, and an integration update. He began by discussing the scope of services at CCIRH which continue to focus on cardiovascular care, oncology, neurosciences, orthopedics, complex surgeries and digestive diseases, along with primary care. CCIRH has a five-year recruitment goal to bring in 64 net new physicians into the community. Their head and neck oncology program continues to grow, with the addition of a second surgeon added to the team. They have also added a fourth oncologist who will be the director of medical oncology. They have also added three full time laborists to provide on site patient coverage for expectant mothers. They also continue to provide MFM services to high-risk mothers in the community. He reviewed data concerning physician recruitment and the departure of some long-term physicians, and that in 2022 they will onboard 41 new physicians. He stated that all medical staff is vetted and approved by the CCIRH Board of Directors, medical executive committee and the credentials committee of the medical staff. He then reviewed the additional employed physician group specialists that have been added to the staff. They will also continue to grow and expand their heart and oncology programs.
Next, he provided an update concerning imaging services at CCIRH. He explained that Radiology Physicians of Indian River, which is the contracted diagnostic and interventional imaging group, is dissolving its organization on December 31, 2022. A number of the physicians in the group are in discussion to transition into the Cleveland Clinic imaging institute, while others are choosing to retire, relocate, or seek employment elsewhere. He explained that Cleveland Clinic Imaging Institute since day one has provided imaging support to CCIRH and will continue to do so, during this transition. He invited Dr. George Puskar, who is a founding member of Radiology Physicians of Indian River to address the board and answer any questions they may have. He also provided a brief review of why the physicians of the organization decided to dissolve the corporation. He explained that due to financial and internal contractual obligations to each other, the members felt it best to dissolve the corporation and that it was in no way due to their relationship with Cleveland Clinic. Many members had chosen to retire or work from home. He stated that his presence at today’s meeting is to dispel any rumors suggesting anything other than the information that has been discussed today.
Dr. Rosencrance continued his presentation with a review of information concerning the BHC and stated that CCIRH has invested in updating the facilities, safety, and increased staff at the center. He discussed patient care data which showed an increase in admissions from 2021. The staff at BHC continues to work closely with the CCIRH Emergency Department to develop a rapid Behavioral Health Response Team, to assist behavioral health admissions at the emergency room. He then discussed the updates that have been done to the facilities, along with safety measures to keep patients and staff safer.
He then provided an update concerning the phone systems at the hospital and stated call abandonment rate is back on target, and they are working to improve the VRA scheduling system. They have also done various IT updates throughout the hospital and the full transition to the EPIC system will be complete on October 29th. He further discussed additional security updates which include metal detectors that will be installed at emergency department entrance, along with stadium pat downs conducted by a security officer if needed. With visiting hours having returned to normal, they now are seeing an increase of individuals visiting the hospital.
Next there was discussion concerning the hospitals benchmark goals and he provided a review of data on the same. One area to note was their mortality index which was better than the target average, which is a high-quality achievement. He then discussed construction projects capital expenditures. He stated that there are a number of projects underway and total spent this year is projected at 43 million. Year to date in 2022, they have spent 20.9 million and some of the highlighted projects include the interventional radiology room, construction of the laboratory chemicalizer, roof repair, heat and air conditioning units, and the refreshment of 100 patient rooms. Additionally, two major projects are submitted for the 22-23 capital budget which include the mother/baby unit for 15 million and the replacement of the entire central energy plant which is expected to cost around 40 million. He then provided a review of the hospital financials and stated that the revenues were at 7.2 million, however the hospitals expenses were 78.6 million over budget which left an operating income of negative 69 million. He discussed the various contributions to the deficit which included labor costs, traveler costs, merit and salary increases, and market adjustment. He discussed their efforts to lessen the use of traveling staff and stated their peak number in April was 244, and are now currently at 154.
Next, he discussed indigent care spending and emergency department visits. To date CCIRH has spent 10.1 million on indigent care, which was an increase of $700,00 from 2021. However, they are seeing fewer indigent visits at the ED and attributes that decrease to availably of services the local FQHC’s who help serve that population. Additionally, ED visits have decreased overall and there have been 56,000 visits so far this year. Inpatient visits are projected to track around 22,000, which is greater than the prior year.
Lastly, he discussed some of the awards and accomplishments achieved over the last year, which included the US News rating of 18th best hospital in Florida. They are also near completion and have consultants reviewing the graduate medical program and have expanded their undergraduate program and continue to have Florida State medical students working within the hospital. They have requested feedback from a caregiver’s preference survey to better understand the needs of their providers and staff. Additionally, Cleveland Clinic has been a member of the American Hospital Association for 75 years. Dr. Rosencrance thanked the Trustees for their continued support and partnership. There was Trustee discussion and they expressed their gratitude for the work Cleveland Clinic has done, despite their revenue loss.
Funded Agencies Semi Annual Reports-
The Mental Health Collaborative- Brett Hall, Executive Director
Mr. Hall stated that before he begins his presentation, he would like to acknowledge the CCIRH Intensive Outpatient Adolescence Mental Health program. He explained that they are using dialectic behavioral health therapy which is the gold standard for that level of care, and are truly implementing this type treatment. He began his update by stating that mental health continues to be in the forefront of discussion throughout our community and nationally. 2 out of 5 people, which equates to 40% of the population, are in need of treatment for mental health issues. Indian River County continues to see a need for additional mental health providers and there is a waitlist for people waiting to receive treatment. The Connections Center is working with those individuals to provide temporary services until they are able to be seen, to provide immediate help. They are also seeing an increased need for adolescent and children therapy services. One positive partnership that the Connection Center entered into with Tykes & Teens, who is now utilizing office space within their center, to provide therapy to children. Next, he discussed the continued work to bring detox services to Indian River County and that they are now seeing an increase of adults needing detox from benzodiazepines. Lastly, he stated that the Unstruggle campaign had its kick off launch, which was well attended and that the website is up and running. This site can be used as a connection tool for residents to get connected to mental health services.
New Horizons- William Wims, CEO
Mr. Wims provided the semi-annual update for New Horizons and reviewed data concerning patients served which included children and adults. New Horizons has also seen an increase in children and adolescent visits and have hired an additional ARNP to help with the case load. Additionally, they have filed with AHCA to expand their license to expand services for short term residential treatment. They continue to focus on employee retention and have hired 5 new nurses. They are also working to complete items within their strategic plan, which include much needed upgrades to the center.
There was no public comment and the meeting was adjourned at 6:30 PM