Indian River County Hospital District

Chairman’s Meeting Minutes: May 16, 2018

SUMMARY MINUTES

Chairman’s Meeting

Indian River County Hospital District

Hospital District Conference Room

May 16, 2018

10:00 AM

 

 

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

EXCUSED:                            Dr. Michael Weiss

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

OTHER ATTENDEES:          Morgan Libbey;  Mike Swan;  Annabel Robertson; Trip Snelson

 

Convene Meeting- Marybeth Cunningham, Chairwoman

Mrs. Cunningham convened the monthly chairman’s meeting of the IRCHD at 10:00 AM by welcoming those in attendance.

 

Funded Agency Quarterly Update- Morgan Libbey, Executive Director  

Ms. Morgan Libbey of the Public Guardianship program provided a quarterly update to the Trustees. She gave a review of the program and stated that the Public Guardianship program provides legal and professional guardianship services for individuals who have been deemed unable to care for their personal affairs. Through the guardians and case workers appointed to each case, an individualized needs assessment is conducted and a care plan to meet the ward’s needs for medical and mental health treatment is established.  Ms. Libbey stated that with the District funding in fiscal year 2017-2018, the program was able to serve three additional wards. Further, the program continues to evaluate the effectiveness of the program utilizing the following factors:

  1. Utilization of best practices standards of the National Guardianship Association;
  2. Compliance with Florida Statutes; and
  3. Constituent’s satisfaction through case management discussion.

Lastly, Ms. Libbey reviewed some of the cases of wards who have been stabilized through the program. One particular case was assisted with help through the McCabe Connections Center. The patient, who abused the 911 emergency systems frequently for non-emergency issues, has now been placed into a secure living environment and is no longer misusing the county resources. There was further Trustees discussion and they agreed that the program was a vital asset to the community.

 

United Against Poverty Update- Annabel Robertson, Executive Director at Up

 Ms. Robertson, Executive Director and Trip Snelson, Program Director at United Against Poverty provided the Trustees with a presentation on the program in Indian River County. Mr. Snelson explained how the program supports members in Indian River County with a “Hand Up” not a hand out, to those in need. Their purpose is to inspire and empower those in poverty to achieve economic self-sufficiency. Ms. Robertson reviewed the building blocks for success which the program uses as its foundation for the path to self-sufficiency. She further reviewed data concerning the positive impact “UP” has made on the community. Since 2016, 141 community members have been lifted out of poverty and 216 members completed the STEP graduate program and obtained gainful employment. Ms. Robertson further discussed the recent purchase of a new 42,000 sq. /ft. building, which will be completed by fall, 2018. With the new building they will be able to triple the amount of students who participate in the STEP program, double the member share grocery program and improve outcomes through collaborations with local partners. Mr. Snelson invited the Trustees to tour the facility and the new building in the next few weeks.

 

Increase of District Income Qualifications- Allen Jones, Treasurer  

Mr. Jones explained that a few months ago, the Trustees discussed the possibility of raising the District’s eligibility guideline from 150% of the Federal Poverty level to 200%, and what impact financially it would have on the District, along with the number of patients who would be now eligible for care. As a review, Mr. Jones stated that currently the District reimburses health care agencies in the county that provide certain medical services for individuals and families that:

  1. Are residents of Indian River County for at least six months;
  2. Have an annual income at or below 150% of the Federal Poverty Level; and
  3. Are uninsured, which includes Medicare and Medicaid.

Mr. Jones stated that over the last few months he, Mrs. Suriano and Mrs. Frederick gathered and reviewed data from the U.S. Census bureau and the District database. They concluded that at the current Federal Poverty standards, there are approximately 4,500 eligible residents in the county who qualify for indigent care coverage. The census bureau data estimates that there are approximately 3,000 additional residents who may be eligible if the Federal Poverty Guideline was raised to 200%. He provided further review of the projected cost of additional care and stated that based on current experience with indigent patients, it is reasonable to project a cost of $2.4 million.

 

Next Mr. Jones reviewed how other healthcare District’s in Florida structure their indigent policies. All have some sort of sliding fee scale depending on income relative to the Federal Poverty Guideline. Additionally, Mr. Jones stated that the IMRC has an obligation to abide by the Emergency Medical Treatment and Labor Act (EMTALA) which requires anyone, regardless of citizenship who presents at the emergency department, to receive a medical screening examination to determine if an emergency medical circumstance does or does not exist. If an emergency medical condition exists as defined by EMTALA, the patient must be stabilized and treated, regardless of their insurance status or ability to pay. He clarified that hospitals, private or public, have no obligation under EMTALA to provide uncompensated care beyond the medical screening exam. There was further Trustee discussion regarding EMTALA and the possibility of implementing a co-pay to uninsured individuals who present at the ED with a non-emergent complaint. There was further Trustee discussion concerning Cleveland Clinic’s Charity guidelines and what is covered under that policy. Mrs. Cunningham stated that this matter will be discussed with Cleveland Clinic at the appropriate time during negotiations and that nothing has been drafted yet for review or consideration. She further explained that Cleveland Clinic will develop its own Florida Charity Care policy through this process.

 

Lastly, Mr. Jones reviewed his recommendations with the Trustees and stated that he recommends leaving the income guideline at 150% of the Federal Poverty Level. Additionally, the District should continue to reimburse providers non-emergency care and/or specialty care of eligible indigent patients. Mr. Jones also recommended that the Trustees consider soliciting a request for proposal from a qualified healthcare provider in the county to provide non-emergency healthcare option for uninsured residents. This could be a program modeled after Partners in Women’s Health with guidelines to be determined. Lastly, he would like the board to investigate in “Kid Care” insurance policies that may be available for the 500 children in the county that are estimated to have no insurance, including Medicaid.

 

There was further Trustee discussion surrounding Mr. Jones recommendations and the board agreed to not raise the Federal Poverty Guidelines to 200% at this time. They feel there needs to be more research and data collected on the various impacts it would have on the District and community. There was also discussion surrounding the idea of forming a committee to lead this effort and research Mr. Jones’ recommendations further.

 

Report on the Business of Healthcare Seminar- Ann Marie Suriano 

Mrs. Suriano stated that she attended the Business of Healthcare seminar at the University of Miami. At the seminar, the presenters discussed mergers and acquisitions of hospitals, along with the trend of volume to value based care and pay structure concerning healthcare. She found this information to be very valuable concerning the current pending partnership with Cleveland Clinic.

 

Other Business-

 Mrs. Cunningham stated that Mrs. Suriano gave a tour of the District owned properties to the representatives from Stout. Stout is working with IRMC to evaluate the asset value which is important in this transaction with Cleveland Clinic. Futher, she explained that Cleveland Clinic recently conducted a five day tour of the hospital campus conducting their own valuation. Further, the firm Price Waterhouse will also be conducting due diligence on IRMC and the District, over the next month. Additionally, attorneys for the District will be working towards parceling out the land that the VNA sits on for the benefit of potentially selling the land later on and not including it in the Cleveland Clinic deal. Further, Mrs. Cunningham stated that due diligence is still under way in the Partnership Process with Cleveland Clinic and she hope to have a draft agreement to the Trustees in June for their review and comment.

 

Public Comment- There was no public comment.

Adjourn- The meeting was adjourned at 11:30 AM

WILLIAM COONEY, M.D.

SEAT 7

William P Cooney M.D. 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   |   1/24-12/29

Origination: Elected (2 OC)

Occupation: Retired Surgeon

Email: w.cooney@irchd.com

Address: 1705 19th Pl Suite G3, Vero Beach, FL 32960

KERRY BARTLETT

SEAT 6

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

Email: k.bartlett@irchd.com

Address: 1705 19th Pl Suite G3, Vero Beach, FL 32960

KAREN DEIGL

SEAT 5

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   |   1/24-12/29

Origination: Elected 1 OC | Elected NOC

Occupation: President/CEO

Email: k.deigl@irchd.com

Address: 1705 19th Pl Suite G3, Vero Beach, FL 32960

PAUL WESTCOTT

SEAT 4

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.


Term: 
1/23-12/26   |   1/21-12/24

Origination: Elected 1 OC 

Occupation: Attorney & Mediator

Email: p.westcott@irchd.com

Address: 1705 19th Pl Suite G3, Vero Beach, FL 32960

CHUCK MACKETT, M.D.

SEAT 3

Charles “Chuck” Mackett MD is a practicing primary care physician who has a long and storied career in military, academic and executive medicine. Dr. Mackett recently retired from Cleveland Clinic Indian River Hospital where he served for fourteen years as Chief Medical Officer, Chief of Staff and President of Indian River Medical Associates. Dr. Mackett serves on the Board of Directors of the We Care Foundation of Indian River County and the Mental Health Collaborative of Indian River County. He currently cares for patients at Treasure Coast Community Health. These experiences give Dr. Mackett a unique perspective regarding mental health, substance abuse, maternal-child care, care for veterans, preventive medicine and access to high quality medical care.

Dr. Mackett is a graduate with honors from the University of Notre Dame and is a graduate from the SUNY Upstate Medical Center in Syracuse, NY. He is a member of the Alpha Omega Alpha National Medical Honor Society and earned his Master of Medical Management degree from Carnegie Mellon University. Dr. Mackett is trained in Aerospace Medicine and is board certified in Family Medicine and Geriatrics. He is a combat veteran, former Air Force Hospital Commander and flight surgeon who served in Germany, Haiti, Japan, Korea, Romania and Iraq. His many military decorations include two Legions of Merit, a Bronze Star Medal, a Defense Meritorious Service Medal and three Air Force Meritorious Service Medals. Dr. Mackett is an Outstanding Graduate of the Air War College.

A native of Upstate New York, Dr. Mackett and his family first moved to Florida in 1996 when he served as Fight Commander and Residency Program Director at Eglin Air Force Base before later serving as Medical Group Commander at Patrick and MacDill Air Force Bases. Dr. Mackett served as Associate Professor, Executive Vice Chairman of Family Medicine and Consultant in the International and Commercial Services Division at the University of Pittsburgh Medical Center before returning permanently to Florida and Vero Beach in 2009.

As a Hospital District Trustee, Dr. Mackett plans to advocate for improved access to mental health services and access to affordable high quality primary and specialty care for all residents of Indian River County particularly mothers, children, the elderly, the underserved and veterans.

Term: 1/24-12/29

Origination: Elected NOC

Occupation:  Primary Care Physician

Email: c.mackett@irchd.com

Address: 1705 19th Pl Suite G3, Vero Beach, FL 32960

MICHAEL KINT

SEAT 2

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

Email: kintm.irchd@gmail.com

Address: 1705 19th Pl Suite G3, Vero Beach, FL 32960

ALLEN JONES

SEAT 1

In 1973, Mr. Jones began a 27 year career with Merrill Lynch, eventually becoming a senior executive of the company, Senior executive positions included Chairman and CEO of Merrill Lynch Life Insurance Company, serving on the Private Client Executive Committee and various other leadership roles including leading the effort to transition Merrill Lynch to a fee based rather than commission based business. Prior to joining Merrill Lynch, Mr. Jones’ professional career began in the United States Air Force from 1964-1968, achieving the rank of Captain. He then worked with Investment Company Dabbs, Sullivan, Trulock located in Little Rock, Arkansas rising to partner before the firm was sold and joining Merrill Lynch. Mr. Jones received his B.S.B.A in 1964 from University of Arkansas. He further completed advanced management courses at the Kellogg School of Business at Northwestern University, the Wharton School of Business at the University of Pennsylvania and Stanford University. His past community service efforts include serving on the Board of Directors for the John’s Island Club from 2008-2010; Board of Directors for the Indian River Medical Center from 2007-2010; Chairman of the Indian River Medical Center Foundation from 2006-2010; Board of Directors of the Bedens Brook Golf Club; Board of Directors of the Princeton Community Hospital from 1994-1999 and the Chairman of the American Health Association, in Houston, Texas.

Term: 1/24-12/29

Origination: Elected 2 OC

Occupation: Retired CEO

Email: a.jones@irchd.com

Address: 1705 19th Pl Suite G3, Vero Beach, FL 32960