Jul 21 Regular Monthly Meeting- June 15, 2023
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
June 15, 2023 @ 4:00 PM
TRUSTEES: Paul Westcott Michael Kint
Marybeth Cunningham Kerry Bartlett
Barb Bodnar Karen Deigl
William Cooney, M.D.
STAFF: Kate Voss Jennifer Frederick
Ann Marie Suriano Jennifer Peshke, Esq. (zoom)
Sebastian De Maio
ZOOM: Anne Posey
ATTENDEES: Vicki Soule Marie Andress
Lundy Fields Pat Knipper
Tara Beard Tracey Griffis
Shannon Bowman Jackie Keville
Elizabeth Adams Bill Stengle
William Stewart Carol Kanerak
David Solvin Bruce Curran
Convene Meeting, Invocation, Pledge & Consent Agenda– Marybeth Cunningham, Chair
Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM. Reverend Dr. Anna V. Copeland of the Community Church of Vero Beach provided the invocation and Ms. Bartlett led the group in the Pledge of Allegiance. Ms. Cunningham asked for a motion to approve the May meeting minutes and a June disbursement of $898,770.09 Mr. Kint made the motion to approve which was seconded by Ms. Bartlett. The motion carried unanimously. Ms. Cunningham stated that there is an addition to the agenda under new business, which will be the approval of the recommendation from Ms. Suriano to hire BJM Group, to conduct the District performance audit. She stated that Ms. Suriano will speak more to this matter during her executive director report.
Chairmans Report- Marybeth Cunningham, Chair
Ms. Cunningham stated that the District has two proclamations for adoption at tonight’s meeting. The first recognizing Andrea Berry for her work and dedication as the CEO of Heathy Start for the last seven years. Ms. Cunningham read the proclamation aloud for the record and presented Ms. Berry with a plaque of recognition. Next, she read aloud the second proclamation into the record, which recognized National Nurses week, which took place in May.
District Counsel Report- Sebastian DeMaio, Esq.
Mr. DeMaio provided the District counsel report on behalf of Ms. Peshke who was out of town. He stated that the District received the VNA’s Notice to Exercise its Option to Purchase the real property described as the “Hospice House Parcel” and will be voting on Board Resolution 2023-02 which pertains to the sale, later in tonight’s meeting. Next, he stated that the Trustees discussed the value of creating a Finance and Audit Committee for the District. Resolution 2023-01 has since been drafted to establish this committee, which will also be brought forth for adoption later in tonight’s meeting. Additionally, the District’s budget review and funding cycle is underway and they have participated in several budget funding sessions this past month. Their office will remain available to the District staff and to each of the trustees should questions arise throughout this process. Lastly, he stated that their office has responded to questions from the recruiter that the District has hired to find candidates for the open Executive Director position, and will continue to do so as the need arises.
Financial Statement Review- Michael Kint, Treasurer
Mr. Kint provided his report and stated the District is in a healthy fiscal position eight months into the fiscal year. The District received additional tax revenues in the last month, bringing the collection against budget to 98% and District expenses for program and administrative needs continue to be under budget. He explained that the Trustees will have further opportunity to review spending relative to this fiscal year’s budget at the upcoming budget discussion meeting in July. He stated that it is clear that some agencies may not utilize all of their budgeted funds this fiscal year and knowing this may impact future funding allocation. Lastly, he stated that the Districts investments total $8.6 million with DeepBlue and an additional $4.5 million with Treasury Direct. He further explained that one of the Districts T-bills matured and those funds, which equal $1.2 million, be deposited into the Districts operating account to cover expenses.
Executive Director Report- Ann Marie Suriano, Executive Director
Ms. Suriano provided her report and discussed House Bill 1130 which was passed in 2022, requiring all special districts to conduct a performance review every five years, beginning October 1, 2023. She explained that over the last several months Ms. Voss has conducted research and due diligence on qualified firms to conduct the Performance Review for the District and submitted four proposals to her for review and consideration. She reviewed the same and has made the recommendation to engage with BJM Group based on their experience and expertise in conducting these audits. She further stated that Dave Solvin from BJM and Bruce Curran from their partner The Surgicalist Group, were present at todays meeting to answer any questions. Ms. Cunningham asked that Mr. Solvin provide a brief introduction of their firm and work history with conducting these performance audits for the Trustees benefit. Mr. Solvin stated that BJM Group is a network of accounting firms and has a dedicated audit division, with 40 years’ experience in conducting performance audit. To date, they have completed performance audits for 27 Special Fire Districts in Florida and those clients have been very satisfied with the work product. They have also partnered with the Surgicalist Group who will help assist with performance audits for Hospital Districts. Additionally, he explained that they have firms based in Florida and Georgia, but the team working on the District account will be based in Tampa. He then discussed the process of conducting the performance audit review and stated that the main objectives will be to look at the District operations and finances, to see how well they are performing in those areas and where there can be improvements. The report will then be provided to the District Trustees and staff for review, prior to it being submitted to the state. Mr. Westcott asked if there will be opportunity for the individuals Trustees to participate in the process. Ms. Solvin stated that they primarily work with the District staff to obtain the requested information and data, however if a Trustee wanted to be a part of the kickoff call they would be welcome. They will also have opportunity to review the report before it is finalized to provide any feedback. Mr. Solvin further stated that the whole process will take around 20 weeks to complete.
Next, Ms. Suriano stated that the CSAC grants review committee spent three days listening to the funding proposals. There was $2,567,776 million available for funding however they received $3,766,993 in requests from 35 organizations, 11 of which had more than 1 program for a total of 56 programs. There were 25 of these programs that received the full request and 10 that received no funding. Additionally, the CSAC committee made a recommendation to the County Commission that any of the funds awarded which were not utilized by the entity, that they be available to the other organizations that they were initially unable to fund. Further she believes that moving forward there are ways that the District and County Commission can work together to better align their funding to reduce duplication of efforts.
Funded Agency Semi Annual Report –
Childcare Resources- Tracey Griffis, Director of Wellness & Early Intervention
Ms. Griffis introduced herself, Tara Beard Director of the Childcare Resources School and Shannon McGuire Bowman, who serves as the Executive Director. She provided an update concerning the Wellness and Early Intervention Program and stated that thanks to District funding they were able to add an Early Childhood Mental Health Therapist to their staff in February. She explained that her expertise has made a profound and immediate impact to the support they are able to offer the families who are experiencing challenging behaviors, traumatic circumstances and mental health needs, and that her caseload has already reached 80% capacity within the program. Therefore, they have hired a second mental health professional funded by the District, and the Early Childhood Mental Health & Behavioral Coach will join their Wellness and Early Intervention Team on July 1st. The coach brings a great deal of experience with behavioral analysis, extensive work with families and create appropriate interventions within the classroom to help children achieve success, and they look forward to the collaboration of these two Mental Health professionals and the impact they will make for the children and families at the school. Ms. Beard addressed the board and stated that another initiative the District funded was for professional development training for their teachers through the Florida Association of Infant Mental Health. She explained that all teachers and support staff took part in the training and she is pleased to report that once the training is complete their school is the first school in the state of Florida to have all of its staff certified with this endorsement. Lastly, there was discussion surrounding the increasing number of children needing these intervention services and stated that 30% of their students receive support for trauma, and the attributing factors which she identified was mainly domestic and substance abuse within the family. She further stated that they are currently experiencing the highest number of DCF cases the school has ever recorded. The Trustees thanked them for their continued efforts and accomplishments.
Treasure Coast Community Health- Vicki Soule, CEO
Ms. Soule addressed the board and provided an update concerning TCCH. She began by discussing some of the challenges the organization has had, and specifically with regard to indigent care reimbursement. She explained that due to COVID and the expansion of Medicaid coverage, they were under budget for medical services last year. However, those expansion are no longer in effect and they have seen an increase of uninsured patients for the current fiscal year. There was discussion surrounding their Medicaid shortfall and Ms. Soule indicated that their reimbursement from Medicaid is just slightly below their cost, however many of their patients do not qualify for Medicaid as they do not have children. She explained that a large patient population at TCCH is single working males, without children, who still meet their financial threshold for indigent or ALICE. Next, she discussed growth within the organization and stated that overall, they have seen a 3-5% growth in all service lines over the last year. However, at the Gifford Health Center, they saw a 20% increase in number of patients and she believes this was due to the increased access to pediatric visits, as well as the introduction of optometry services. Additionally, she stated that with their growth they are looking to expand space within their clinics, and are finalizing plans to purchase clinic space in the west part of the county. Their Oslo campus is also undergoing renovations and will now have a dedicated wing specifically for pediatrics and children’s dental care. Lastly, she discussed their partnership with the IRC Sheriff’s office and healthcare they are providing at the jail. She stated that they just celebrated their one-year anniversary concerning the partnership and it has been very positive. The partnership has also provided an opportunity to change the culture, for both. They are also looking to expand services to provide support for chronic care and medication assistance, and are working with Ritelife Services and Substance Awareness Center to support those initiatives.
Visiting Nurse Association- Lundy Fields, CEO
Mr. Fields addressed the board and discussed trends they are seeing in healthcare which included the continued issue with recruiting and retaining staff. He explained that there is a national shortage of nurses and they have had to increase their sign on bonuses to stay competitive with other markets. Additionally, home health is changing and they are working to stay up to date with the latest trends and have become innovative with the utilization of artificial intelligence, where appropriate. He then introduced Kathy Orton who provided an update concerning their Hospice services. She stated that their Certificate of Need for Hospice services was challenged last year and AHCA awarded a temporary license to another Hospice entity who wanted to provide services in the County. The VNA appealed the decision and was able to show that the VNA was currently meeting the hospice needs in Indian River County through a trial that took place in September of last year. The trail ended in the favor of the VNA and subsequently an Administrative Law Judge denied the other entities Certificate of Need. However, the entity who first submitted the challenge filed an appeal and they are now waiting on a ruling for that appeal. Next, she discussed Hospice care for the last 6 months and stated that they have admitted over 1,100 patients. She then discussed their challenges with length of stay and stated that the average is 59 days and has increased 13% this last year. Therefore, they are working on their advanced care planning initiative and a community campaign to further awareness and provide education on hospice and home health services, and the value of making decision early by having a plan in place for loved ones. Lastly, she referenced their patient outcomes and stated that they are above the state and national average. Next Jackie Keville, the new VP of Home Health and Private Care addressed the board and stated that she transitioned into that role in March after the departure of Ed Lowe. She discussed their main initiative of whole patient care concerning Home Health and stated that they continue to take a collaborative approach in providing care to the patient to make sure all needs are being met. Next, she discussed the Hospital Prevention Program (HHP) and stated that with the help of their ARPN they are working to bring greater awareness of the importance of advance care planning discussions with complex patients, especially seniors. Also, they have been able to utilize additional RN’s and social service professionals to the HHP team to support increasing number of patients added to this service. She further stated that they have partnered with CCIRH on their HHP and have achieved CMS 5-Star rating in patient satisfaction. Next Elizabeth Adams provided an update concerning the Mobile Health Clinic and stated that volumes have continued to grow and they saw a 102% increase from last year in registered patients. They have provided 956 hours on the road they have provided healthcare to 1,871 registered patients which is an average of one patient every 30 minutes. They have also assisted 531 individuals with health education for disease prevention and information on medical, dental, and mental health services. She further stated that they have established two new locations serving seniors in low-income housing communities and have been working collaboratively with the Senior Resource Center on that initiative. They also continue to provide health education clinics throughout the county.
Whole Family Health Center- Marie Andress, CEO
Ms. Andress provided a brief introduction concerning WFHC and stated that they are designated as Federal Qualified Health Agency lookalike and they do not receive regular Federal grant funding, so the support from the District is very impactful. She began by discussing their utilization of District funding which was slightly under budget. She explained that visits have decreased slightly and attributed that to the fact that there was expanded Medicaid. She believes now that the extended Medicaid has ended, they will again see an increase in uninsured patients. Next, she discussed the increased utilization of their pharmacy services and explained that they are now trying to capture more of their patients due to changes to the 340b pharmacy program. Next, she discussed growth within the organization and stated that they continue to work to expand space and providers at their centers and it has been a challenge. They have seen a 15% increase in patients served from last year and have recruited four new adult medicine providers. Next, she informed the board that WFHC received an impact 100 grant which was supplemented by the Johns Island Foundation, to support the purchase of a mobile medical office. Ms. Andress met with Ms. Soule, and Ms. Knipper to talk through how best to serve the community with mobile health services, so they are not duplicating efforts. She then spoke to the request to reallocate funds in their budget to support the additional pharmacy costs they have incurred and provided a breakdown of those figures. She explained that even with the reallocation they do not project they will go over budget for this current fiscal year. Additionally, for the upcoming fiscal year, they have increased their request concerning pharmacy costs, so it will be more accurate moving forward. Next, she discussed some challenges the organization has faced and stated that with the increase in population, they continue to struggle to meet the demand for services. Additionally, the low reimbursement rates from Medicare and Medicaid continue to not cover the true cost of a patient visit. They must also meet the demand for higher staff wages due to inflation. Lastly, she provided an update concerning new initiatives and stated that they are opening a new location near the hospital and will have three providers established at the clinic. They are also working to expand behavioral health services and have hired an additional therapist and are working to hire a psychologist as well. Further she explained that HRSA will be at their facility in the next week conducting a site visit and they have been preparing for the same.
Mrs. Cunningham stated the Trustees should formally move to approve the hiring of BJM Group, to conduct the Performance Review for the District. Therefore, Ms. Bartlett made the motion, which was seconded by Ms. Deigl. The motion carried unanimously. Ms. Suriano informed the board that the median cost to conduct this review has been included in the FY 23-24 budget.
Next, Mr. Kint read resolution 2023-01 into the record, which adopted the creation of a finance and audit committee for the District. Dr. Cooney made the motion to approve which was seconded by Ms. Bartlett, and the motion carried unanimously.
Lastly, Ms. Cunningham, read resolution 2023-02 into the record, which adopted the determination that the real property described as the Hospice House parcel is deemed to be surplus property and no longer useful to the District. Ms. Bodnar made the motion to approve which was seconded by Mr. Kint, and the motion carried unanimously.
Mr. Wescott stated that he appreciates Ms. Cunninghams engagement with CCIRH leadership and coordinating them coming to address the Trustees next month. He stated that he had prepared some questions and requested follow up documentation from CCIRH a few months back and asked if those matters would be addressed and the documentation he requested be provided as well. Ms. Cunningham stated she was not aware as to what they would be addressing specifically or if they would be providing any documentation but offered to work with Ms. Suriano on following up with CCIRH, to gain further insight as to what would be addressed.
Mr. Kint stated that in connection with the newly approved finance and audit committee, he would like further Trustee input and recommendations as to the additional community members that may be appointed to the serve on the committee. Currently, it was suggested that former Trustees and Treasurer of the board Allen Jones participate, as well as Keith Morgan who is a local CPA. He asked that any additional recommendations be forwarded to Ann Marie for review and consideration
There was no public comment, and the meeting was adjourned at 6:00 PM