SUMMARY MINUTES
CHAIRMAN’S MEETING
Indian River County Hospital District
July 25, 2018
TRUSTEES: Marybeth Cunningham Tracey Zudans
Ann Marie McCrystal Dr. Michael Weiss
Allen Jones
EXCUSED: Barbara Bodnar
STAFF: Ann Marie Suriano Jennifer Frederick
Kate Voss
OTHER ATTENDEES: Miranda Hawker Joelle Tinney
Kathy Orton Karen Davis
George Eighmy Robert Brugnoli
Jeanne Shepard Janet Begley
Michelle Genz Vicki Soule
Convene Meeting – Marybeth Cunningham, Chairwoman
Mrs. Cunningham convened the Chairman’s meeting of the IRCHD at 2:00 PM by welcoming those in attendance.
IRMC Emergency Department Co-Pay Process- Ann Marie Suriano, Executive Director & George Eighmy, IRMC CFO
Mrs. Suriano stated that through multiple community health improvement plan meetings, the collaborative group recognized the issue of high volumes in the emergency department. It was determined that many indigent patients were utilizing the hospital’s emergency department for non-emergent issues. This form of care is more costly and does not provide a continuum of care for the patient. Additionally, it affects the time it takes to treat those with medical emergency issues. The group had multiple discussion on this matter and agreed that a process should be implemented to assist patients in finding a long-term primary care resource to treat their medical issues, instead of utilizing the emergency department. However, this process must abide by federal EMTALA laws, which govern emergency treatment in hospitals.
Mrs. Suriano explained there has been much discussion in the collaborative group meetings concerning the implementation of a co-pay to those indigent patients presenting to the emergency room with non-emergent issues. Mrs. Suriano further explained that this matter was also discussed among the District Trustees and, last month, Mrs. Zudans questioned whether the District was legally permitted to request some form of payment from an indigent patient and requested legal clarification on the matter. Through her review of the District Special Act, Mrs. Peshke prepared a memorandum on the matter as requested and has indicated that the District has the authority to approve a co-pay, being collected by the current operator of the hospital. This is an administrative function of the operating entity of the hospital, which the District has been requested to approve. Mrs. Suriano further stated that the District would need to update their policy and procedure manual to reflect the change. She stated that many hospitals, along with local District funded agencies, also implement some form of co-pay to its patients. Additionally, private insurance companies have the same policy or may even deny non-emergent claims completely. Mrs. Zudans stated that while she agrees with the idea of implementing a co-pay, she disagrees with Mrs. Peshke’s interpretation in her memorandum. Mrs. Cunningham acknowledged Mrs. Zudans statements and indicated that perhaps outside counsel could review review this matter as well. The board agreed with her recommendation. She asked Mr. Eighmy to review with the board, the hospitals proposal concerning the implementation of a co-pay for non-emergent visits at the emergency department.
Mr. Eighmy stated that, from the discussions with the collaborative group, the hospital has developed a process to manage the high patient volumes in the emergency department. He explained that when a patient presents at the emergency department, they will immediately go through a medical screening performed by a physician to determine if their issue is emergent or non-emergent. If the issue is an emergency, the patient will be given treatment immediately. If the issue is determined to be non-emergent, the patient will speak with a financial counselor to discuss their medical coverage options. If the patient has no medical insurance, they will complete a questionnaire to determine if they are indigent or eligible for Medicaid. The patient is then given the option to seek care at another local provider who could address their needs or continue care through the emergency department. If the patient chooses to remain at the emergency department, they will be required to pay a $50 co-pay and be responsible for any additional ancillary or physician fees incurred through their treatment. Mr. Eighmy also stated that they plan to expand and hire additional emergency department navigators to provide more direct patient support and ultimately get the patient the most appropriate care.
There was further Trustee discussion on this matter and Mrs. Cunningham stated that the District would contact outside counsel to further review and they would revisit the item at tonight’s regular monthly meeting.
MHA School Violence Prevention/Intervention Discussion- Robert Brugnoil, Ph.D.
Dr. Brugnoil explained that at a past regular monthly meeting, the District Trustees invited the Mental Health Association (“MHA”) to submit a grant for new services addressing violence prevention in Indian River County schools. Subsequently, there were discussions between the MHA and Dr. Lillian Torres-Martinez, director of student services for the School District of Indian River County, and they identified the need for this program at two local high schools. This program would include prevention intervention with all ninth-grade students and a more intensive intervention for at-risk students at all high school grade levels. This program would also be one program among many others in response to Senate Bill 7026, which is to enhance school safety in light of the mass shooting which took place in February, 2018, at Stoneman Douglas Highschool in Parkland, Florida.
Dr. Brugnoli provided a review of the High School Violence Prevention and Intervention Program. He stated that using research about evidence-based interventions and best care practices for violence prevention, the cost to provide the program case is estimated at $75,905, which would include adding one masters degree level mental health professional on a full-time basis. They believe this program will impact students by the development of improved skills for emotional health and well being. Mrs. Shepard, Clinical Director at MHA, reviewed statistics and data relative to the success of the program. She explained that MHA will also work with other local organizations, such as the Health Department, on this initiative. There was further discussion among the Trustees and they requested to see the blue print of the program with the school boards input.
FY 2018-2019 Budget Review- Ann Marie Suriano, Executive Director
Mrs. Suriano stated that she and Mrs. Frederick prepared a document clarifying some items relative to the 2018-2019 funding requests for Tykes & Teens; UF Suboxone program; and the Healthy Start Nurse Family Partnership program. There was further Trustee discussion concerning the same. Additionally, Mrs. Suriano stated that with the updates from the last budget discussion meeting, the proposed tentative millage rate would be .9330.
Mr. Jones discussed his efforts to enhance the utilization of the District owned Gifford Health Center. He informed the Trustees that he attended the Gifford Health Council meeting on July 24 and received a list of the current needs for the community. Those include primary care, extended clinic hours and mental health services. There has been discussion about moving the VNA’s mobile unit to the Gifford Health Center on Saturday mornings, as an alternate place for residents of the area to seek care. The Council further discussed the initiative to have staff from Healthy Start and Partners in Women’s Health to provide additional support and services. Mr. Jones stated that the Gifford Health Council expressed their desire to keep the Health Department as the main health agency in the area, due to their strong relationship with the community. They felt placing an alternative agency in the area would be disruptive to the community. Mr. Jones and the Council agreed that a stronger relationship between the District and those working in their Gifford community needs to be established. Currently Ms. Hawker is putting together a proposal for the future utilization of the Gifford Health Center. As an estimate, they believe the project will cost approximately $1 million and project to receive $400,000 in revenues. Mr. Jones stated that he will be following up with the Trustees for discussion and feedback once more information becomes available.
Other Business-
Mrs. Cunningham requested the availability of the Trustees for the month of August. She stated that there is potential that the District and IRMC Board of Directors will hold a joint meeting to discuss the terms of the Cleveland Clinic partnership. Additionally, the Trustees may hold a special meeting to also review and discuss the terms of the lease agreement with Cleveland Clinic.
Public Comment- There was no public comment.
Adjourn- The meeting was adjourned at 3:45 PM
