SUMMARY MINUTES
CHAIRMAN’S MEETING
Indian River County Hospital District Conference Room/ Zoom
November 20, 2024
10:00 AM
TRUSTEES: Marybeth Cunningham Barb Bodnar Michael Kint Paul Westcott
William Cooney (zoom) Karen Deigl
Kerry Bartlett
STAFF: Dawn Carboni Jennifer Frederick
Kate Voss Frank Isele
Jennifer Peshke, Esq. Kaytlin Dickens
ZOOM: Anne Posey Ann Marie McCrystal Marie Andress Kim Jeansome
Jeff Pickering Lisa Zahner
ATTENDEES: Matt Riser Vicki Soule Cecelia Stalnaker Kellie Hendley
Wayne Creelman
Convene Meeting
Ms. Cunningham convened the meeting of the IRCHD Board of Trustees’ at 10:00 AM by welcoming those participating via Zoom and in person. Ms. Cunningham stated that the first item of business is the discussion on the CCIRH bridge plan to support uncompensated care. She explained that she and Mr. Isele have had discussions with Dr. Rothman and Mr. Iannucci regarding this matter and Mr. Iannucci is here today to discuss the plan further with the Trustees.
CCIRH Bridge Plan Update- Frank Isele, Executive Director
Mr. Isele stated that the CCIRH bridge plan is a phased approach to support a percentage of uncompensated care at the hospital. The plan proposes contributions of 25% this year, declining to 10% by the fourth year, to address the growing uncompensated care figure CCIRH is experiencing. It was discussed that this financial support could be audited, and it was also agreed that a deeper look into patient satisfaction was needed. There was Trustee discussion surrounding what is constituted as uncompensated care and Mr. Iannucci provided the Trustees with additional information and clarification. There was also discussion surrounding the Districts ability to commit to a four year support plan due to the fact that they must approve a new millage and budget each year. Ms. Peshke stated that this agreement would need to have language reflective of that fact the Districts support was contingent upon available funds in the budget. Mr. Isele further stated that this four-year support plan would have a built in threshold which could not be exceeded. There was Trustee discussion, and many felt that they needed additional clarification and understanding of what was being requested. Additionally, there was discussion surrounding the Districts available reserves to support this request. It was agreed that each Trustee would submit their questions to Mr. Isele, who would follow up with CCIRH leadership to address those concerns. The expectation moving forward would be that in December the Trustee would regroup for further discussion and consideration, to potentially vote on an approval.
District Updates- Frank Isele, Executive Director
Ms. Carboni provided the Trustees with an updated Audit scheduled reviewing her progress. She stated that the current process for conducting the audit reviews has proved to be unsustainable due to the increase in District funded agencies, as well as the pre audit reviews she must complete on new agencies requesting funding. Therefore, she brought forth a proposal to amend the audit process to better accommodate the growth, while still maintaining the high level of accountability this process entails. The new process would provide a review of each funded agency every other year, unless their report included findings and corrective action. Additionally, all newly funded agencies would be required to have a pre audit review and post audit review after their first year on funding. The Trustees were supportive of the change and approved the request.
Ms. Frederick provided a program update and informed the board that Mike Cianic from Dynamic Life has resigned from his position as grant manager. She explained that Dynamic Life is actively looking for a replacement and more information will be provided tomorrow during their semi-annual update to the Trustees at the regular monthly. Additionally, Substance Awareness Center has officially changed its name to Thrive and they held a ground breaking ceremony at their new location with is located in downtown Vero Beach. Further, Ms. Frederick has been participating in the Health Departments community health improvement plan workshops and the first phase of the process is set to be completed soon. Next, Ms. Frederick informed the Trustees that a mental health symposium hosted by the Mental Health Collaborative has been scheduled for May 2nd and she plans to attend on behalf of the District. Mr. Isele then provided an update on the prevention programs gap funding. He explained that the total shortfall has been reduced to $144,000, which is inclusive of $32,000 provided by the Community Foundation. It was further discussed that CSAC has $130,000 in unspent funds, but they have not committed to supporting the preventive care programs and it seems unlikely that they will. The Trustees discussed the possibility of providing funds in support to help bridge the funding gap for the programs, with the hope that United Way would also contribute. The Trustees agreed to provide $94,000 in funding which would leave an excess of $50,000 still needed. Mr. Kint made a motion to approve, which was seconded by Ms. Bartlett. The motion carried unanimously.
Next, Ms. Dickens showed the Trustees some updates made to the District’s website dashboard which included data on the fee-for-service agencies. It was stated that the District is currently transitioning all its funding agencies to a fee-for-service model which will support further funding transparency and provide the District with additional data on patient and service lines being utilized.
Ms. Voss provided the Trustees with an update regarding the VCOM transition for the HSB. She stated that she and Mr. Isele had a zoom call with Dr. Rawlins and discussed several items with regard to the building and its operations. It was decided that the District will continue to manage the oversight and bill payment matters for the building while VCOM works to establish a designated representative for this project. Additionally, VCOM has committed to reimburse the District for any expenses incurred during this transition period. Further, Mr. Isele stated that Ms. Voss will be responsible for managing this project moving forward. It was further noted that VCOM is also required, per the terms of the lease, to spend $1 million in capital by the end of the District 24-25 fiscal year.
Lastly, Mr. Isele provided an update regarding the CHS property purchase. He stated that the due diligence process has closed and there were some findings within the building during the inspections that need to be addressed before closing. Therefore, the closing has now been pushed back to the end of December. He and Ms. Voss have been working with the District’s broker TP Kenndy on negotiations and will be requesting a purchase credit due to the findings discovered during the inspection of the buildings. He will provide the Trustees with more information when it becomes available.
Other Business
Mr. Kint stated that the Finance and Audit Committee met on Tuesday and had productive discussions. He explained that since Mr. Jones has been elected to the District Trustee board, he will no longer be able to serve on the Finance and Audit Committee. Therefore, the committee has discussions regarding suitable candidates and Mr. Kint brought forth the following recommendations to the Trustees for consideration. The first was Frank Schlitt who is a local CPA and long-term Vero resident. The second was Ms. Cunningham who will be finishing her term as a Trustee in December. There was board discussion, and they felt that these were strong candidates. Ms. Deigl made the motion to approve which was seconded by Ms. Bodnar. The motion carried, while Ms. Cunningham recused herself from the vote.
Mr. Westcott stated that hospital quality scores from Leapfrog were recently published. He felt the report highlighted communication issues across Cleveland Clinic facilities, which may impact local care. He also provided a handout which showed a comparison of Cleveland Clinic and their other Florida hospitals, as well as Orlando Health. He encouraged the Board to review the data and suggested that further discussions with Cleveland Clinic leadership should take place to better understand how they are addressing these issues.
Public Comment & Adjourn
There was no further business and Ms. Cunningham asked for public comment. Mr. Bob Atwater from Indian River Shores addressed the Trustees. He expressed his desire for the board to look further into CCIRH financials to verify that the losses they are reporting are accurate. He further stated that there should be better understanding of their cost allocation practices. He believes both of these items should be addressed before the board expends additional funds to support the hospital. There was no further comments or discussion. The meeting was adjourned at 11:40 AM.
