Indian River County Hospital District

Budget Workshop Meeting Minutes: May 21, 2018


Budget Workshop: Public Guardianship Program IRC; IRMC; VNA

Indian River County Hospital District

May 21, 2018


TRUSTEES:                           Marybeth Cunningham ; Allen Jones; Ann Marie McCrystal; Tracey Zudans;  Barbara Bodnar; Karen Deigl


EXCUSED:                             Dr. Michael Weiss


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


OTHER ATTENDEES:     Morgan Libbey; Mike Swan; Warren Fuller; Chet Kaletkowski; Lundy Fields; Mary Macintosh;  Kathy Orton;  Steve Smith; Susan Strader ;

Vicki Soule


Convene Meeting- Marybeth Cunningham, Chairwoman-     

Mrs. Cunningham convened the monthly chairman’s meeting of the IRCHD at 1:00 PM by welcoming those in attendance.


 Funding Requests-

Public Guardianship Program of Indian River County- Mike Swan, President & Morgan Libbey, Executive Director-

Ms. Libbey provided a review of the Public Guardianship programs funding request for FY 2018-2019. The total funding request is $28,000, which is $8,000 more than the previous year. She explained that because of District funding in FY 2017-2018, the program was able to serve three additional wards. Further, they plan to expand the program to help assist two additional wards during this next fiscal year. As a historical review Ms. Libbey explained that the Public Guardianship program provides legal and professional guardianship services to community members who have been deemed incapable of caring for themselves due to health or mental illness issues. Through trained guardians and case workers appointed to each ward, an assessment is conducted and a care plan is created to meet each individual’s needs. There was further Trustee discussion concerning the program and Ms. Deigl recommended that they reach out to the Senior Resource Center for additional support concerning this program.


Indian River Medical Center- Warren Fuller, VP CFO

Mr. Fuller provided a review of Indian River Medical Center’s FY 2018-2019 funding request. The full request of $7,560,224 is inclusive of acute inpatient, psychiatric inpatient, outpatient services and the emergency department. The hospital is also requesting $1,682,520 for the Partners program, which brings the total funding request to $9,242,743, an increase of approximately $400,000 from the previous fiscal year. Mr. Fuller explained that the funding request for indigent care reimbursement is based on the FY 2017-2018 projected utilization for qualifying client inpatient acute days, inpatient psychiatric days, outpatient visits/revenues, and emergency room visits/revenues. This fiscal year budget reflects a 3% increase from the projected current fiscal year end and is 18% from actual FY 17-18 for the combined categories of service. Additionally, the 3% increase is due to higher reimbursement rates which were calculated with assistance from the District consultant Ken Conner. The 18% increase from FY 17-18 is a combination of volume and rate increases. In addition, there is a $152,950 reduction to the funding for the ED due to the patient co-pay program, which is scheduled to begin this upcoming fiscal year.


Mr. Fuller further reviewed the Partners in Women’s Health funding request. He explained that the request will ultimately be the amount recommended by a collaborative workgroup that will develop the District’s Partner’s program goals and financial place for the upcoming fiscal year. Their expectation will be that the Districts funding, plus Partners collections will be sufficient to cover the total cost. In addition, the funding request has increased by $357,520 from last fiscal year due to the following:

  1. Salary market adjustments;
  2. Adding a physican to help fill the community shortage in OB/GYN services; and
  3. Adding a Nurse Practitioner to provide prenatal services at the Gifford Health Center.

There was Trustee discussion concerning the request and the pending partnership with Cleveland Clinic. They discussed the fact that although it is yet to be determined at what level, Cleveland Clinic will be taking over the operations at the hospital and be responsible for the cost associated with treating the patients. This was discussed when they first approached IRMC about a partnership and she stated that they would not seek any additional funding from the District, over the current amount provided. However, since the deal is not complete and an agreement is not in place, the Trustees agreed that they must fund the hospital at its current level, to maintain the current standard of care.  Only once an agreement is in place and a charity policy has been written, can they look at reducing or altering indigent care funding at the hospital, which may ultimately lead to a lower millage rate. There is currently an agreement for payment of indigent care in place between the District and IRMC which must be followed by both parties. There was also Trustee discussion concerning the reimbursement the District provides to the hospital for patients that come in through the ED and the hospitals requirements through EMTALA.

As a follow up to the request, the Trustee asked for Mr. Fuller to provide a response and supporting data concerning the following:

  1. Provide a breakdown of the ED patients and their payor source (i.e Medicaid, Indigent);
  2. Provide a breakdown of the charge for an outpatient services; and
  3. Provide a breakdown of the number of low acuity visits to ED.


VNA- Lundy Fields, CEO


Mr. Fields introduced the VNA staff that joined him for today’s presentation which included Kathy Orton, Vice President of Clinical Services; Mary MacIntosh, Interim CFO; Steve Smith, Director of Marketing and Communication; and Susan Strader, Nurse Practitioner on the Mobile Unit. Mr. Fields explained that he was recently hired as VNA’s new CEO.

He explained that for over 40 years the VNA has served the home health and hospice needs of thousands of patients and has built a high level of trust within the community. The Mobile Unit has been on the road for over 15 years and brings health and wellness services to the people in their communities. Mr. Field shared his perspective on how the VNA sees leadership within the organization and its future goals. He reviewed the funding request concerning home health and hospice needs, along with the Mobile Healthcare on Wheels program. The VNA projects that maintaining the current funding structure would result in a need for $382,000 in funding for the 2018-2019 FY.  The District also asked the VNA to project how much funding would be required to cover the incremental indigents that would be added if indigent eligibility criteria were raised to 200% of the Federal Poverty level. He explained that changing the eligibility criteria would increase the program funding from $340,000 to $724,000.  The third funding level option would be to move forward with expanded indigent criteria and funding a strategic community health wellness initiative that will include the Mobile Healthcare on Wheels program.

Mr. Fields stated the first step of developing goals and objectives for the community has already been accomplished by the work of the District, in conjunction with others key leaders in the community. As a result of all this work completed over the past several years, leaders know what the specific health goals, objectives and needs are for Indian River County. The VNA’s plan is to launch a community-wide health education and patient care initiative localized by zip code areas within Indian River County. He explained that the first key initiative is to focus a dedicated VNA team responsible for overall campaign execution. The second is to create a yearlong health & wellness calendar, and the marketing plan to support the calendar. He provided a sample of what the proposed calendar would look like for the Trustees review. The next key initiative involves the mobile unit to deliver patient care and refer patients, when appropriate, to various community partners like TCCH, the Health Department and Partners in Women’s Health. Finally they want to identify champions in several local communities to be the voice for the health and wellness needs in that particular area. He further stated that they plan on measuring a wide range of metrics to estimate the efficiency and effectiveness of this campaign. There was further Trustee discussion concerning Mr. Field’s request, specifically his ideas concerning the mobile unit.


Public Comment- There was no public comment.

 Adjourn- The meeting was adjourned at 1:00 PM



William P Cooney MD is an orthopedic surgeon (retired) who has been a resident of Vero Beach since 2004. He practiced orthopedic surgery at Indian River Medical Center from 2006-2015 within the orthopedic practice of Prosports. He served on the IRMC Foundation for four years. Prior to this, he was a Professor of Orthopedics at Mayo Clinic in Rochester Minnesota, Chair of the Division of Hand Surgery and Vice president of the Department of Orthopedic Surgery. He served as the Vice Chairman of the Mayo Clinic Development Department. He has been President of the American Society for Surgery of the Hand, Orthopedic Research and Education Foundation, Consultant at Shrine Hospital systems. He was editor in chief of the Journal of Orthopedic Surgery and co-editor of the Journal of Hand Surgery. He held grants in hand and wrist surgery sponsored by National Institute of Health (NIH) and Stryker Orthopedics and has over 250 publications in the field of orthopedic surgery, hand, wrist and elbow surgery and microsurgery- free tissue transfers. Within Indian River County, he has served as Chairman of the Board and President of the Hope for Families Homeless Center, Board of the Indian River Hospital Foundation, We Care and Whole Family Health Center medical practices.

Term:  1/23-12/24

Origination: Elected (2 OC)

Occupation: Retired Surgeon



Kerry Bartlett,  of Vero Beach, has more than 30 years experience in philanthropy, including as vice president of the VNA & Hospice Foundation; VNA chief advancement officer from 2001-2007; and executive director of the Indian River Community Foundation from 2008-2014. Kerry is the founder of The Bartlett Company, which focuses on nonprofit and philanthropic consulting. She also is a managing director for Carter, a Vero Beach company that specializes in advancing philanthropy worldwide. Kerry has spent more than 25 years in the nonprofit sector as a fund development professional and has particular expertise in annual funds, major gifts, endowment campaigns and legacy giving. Kerry is also known for creating and implementing effective donor-centered stewardship programs that build, maintain and strengthen nonprofits’ relationships.

Term:  3/21-12/22   |   1/23-12/26

Origination: Appointed by Governor Ron DeSantis
Elected NOC

Occupation: Philanthropic Consultant/Managing Director



Karen has been President and CEO of Senior Resource Association, where she successfully advocates for older adults and their families, since 2006. In that role, she helps provide activities, education and services benefiting older and disabled adults in Indian River County. In addition, Karen provides oversight of the community mass transit system for residents and visitors of the county. As CEO, Karen is responsible for a $7 million operational annual budget and managing more than 100 employees. She ensures that fiscally sound and responsible solutions are created to provide healthcare and a better quality of life for all Indian River County residents. Karen earned a BS in Health Administration from Florida Atlantic University and an MHA from the University of Florida. She was elected to the Indian River County Hospital District Board of Trustees in 2016, and joined the Board in January 2017.

Term:  1/17-12/20   |   1/21-12/24

Origination: Elected 1 OC | Elected NOC

Occupation: President/CEO



Paul Westcott has been a Board Certified Workers' Compensation Attorney since 1999. In addition, Paul has earned his certification from the Florida Supreme Court as a Circuit Civil and Family Law Mediator. Receiving his Bachelor of Arts degree in both Economics and Political Science at Florida Southern College, he continued his education at Stetson University College of Law. He graduated from Stetson in 1988, having been a published member of the Stetson Law Review. Paul has been a member of the Florida Bar since 1988.  He began his practice in a combined civil litigation and transactional practice before serving as an Assistant State Attorney.  He began his career in Workers' Compensation with Rissman, Weisberg, Barrett, Hurt, Donahue & McClain P.A., where he handled Workers' Compensation cases at the trial and appellate levels.  In 1997, Paul opened the Ft. Pierce office of Hurley, Rogner, Miller, Cox, Waranch & Westcott P.A. handling workers' compensation cases at all levels throughout central and south Florida, while managing the operations of that office.  During his nearly 25 year career in Workers' Compensation, he lectured on a wide range of industry topics.

1/23-12/26   |   1/21-12/24

Origination: Elected 1 OC 

Occupation: Attorney & Mediator



Barbara has practiced physical therapy, specializing in orthopedics and sports medicine, in her hometown of Vero Beach since 1981. She was an integral part of the sports medicine team at Vero Beach High School for 35 years. Barbara completed the reserve police academy training, and served with the Vero Beach Police Department from 1982-1989. Her volunteer involvement in the community includes serving on the City of Vero Beach Recreation Committee, Arthritis Association of Indian River County, and the Senior Good Life Games. She and her husband, Michael, enjoy spending their free time traveling in their RV and training their Labradors, Gunner and Chase, in K-9 performance events, including agility and dock jumping. Barbara is a lifelong resident of Indian River County, and received her degree in physical therapy from Chattanooga State College. Barbara was elected to the Indian River County Hospital District Board of Trustees in 2016, and joined the Board in January 2017.

Term:  1/17-12/20   |   1/21-12/24

Origination: Elected 1 OC | Elected 1 OC

Occupation: Physical Therapist



Born and raised in Illinois, Michael was a Theatre and Speech Instructor at Lincoln College when he moved to Indian River County in 1984. He was the Director of Education for the Riverside Theatre for a decade, helping to build the Riverside Children’s Theatre and directing many productions. Michael is well known in the community for his 25 years of service at the United Way of Indian River County, 16 of those years as the CEO. He is very proud of his work with dozens of nonprofit agencies and his commitment to creating and strengthening community collaboratives. Michael was also an Adjunct Faculty member at Barry University for 20 years. He has served on many boards and committees over the years, including: Children’s Services Advisory Committee Needs Assessment, Chair of the Emergency Food and Shelter Program for many years, and he was a founding member of the Mental Health Collaborative, the Senior Collaborative of IRC and the IRC Executive Roundtable. As a Hospital District Trustee he is committed to serving all the citizens of our county. In particular, he hopes to see enhanced availability and affordability for behavioral/mental health for all in need.


Term: 1/23- 12/26

Origination: Elected 1 OC

Occupation: Retired CEO United Way



Marybeth’s professional career encompasses 34 years of working for GM/Delphi in a variety of positions. Starting out as a traffic claims clerk, she worked her way through the organization, with roles in Purchasing, Engineering, and Quality and Reliability. She retired in 2009 as the executive director of Global Operations for the Packard Electric Division of Delphi. In this position, she was responsible for 94 plants in 33 countries. Marybeth has served on the board of directors for numerous non-profits, including Northeast Ohio Adoption Agency; United Way of Warren Ohio, where she served as chairman of the annual campaign for two years; Up with People; Head, Heart and Hands of Indian River Club; Indian River Community Foundation, and the Indian River Mental Health Collaborative. She earned her B.A. in Political Science from Albion College. Marybeth was elected to the Indian River County Hospital District Board of Trustees in 2014, and joined the Board in January 2015. She currently serves as Chair.


Term:  1/15-12/18   |   1/19-12/22   |   1/23- 12/24

Origination: Elected 1 OC | Elected  NOC | Elected NOC

Occupation: Retired Executive GM