SUMMARY MINUTES
CHAIRMAN’S MEETING
Indian River County Hospital District Conference Room/ Zoom
September 18, 2024
10:00 AM
TRUSTEES: Marybeth Cunningham Barb Bodnar Michael Kint Paul Westcott
William Cooney Karen Deigl
Kerry Bartlett
STAFF: Dawn Carboni Jennifer Frederick
Kate Voss Frank Isele
Jennifer Peshke, Esq. Kaytlin Dickens
ZOOM: Geroge Fyffee Barbara Del Castillo Ivy Marchesini Anne Posey Maureen Luther Lori McCormick Michael Hammes Cecelia Stalnaker Ann Marie McCrystal Katherine Hensley
ATTENDEES: Richard Rothman, M.D. Joe Iannucci
Vicki Soule Marie Andress Lauretta Farrell Rose Gustave Linda Walton
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.
Presentation from Cleveland Clinic Indian River Hospital- Richard Rothman, M.D., President CCIRH
Dr. Rothman thanked the Trustees for the opportunity to speak with them today and introduced his executive team, who was also present for today’s discussion. He explained that he would address three areas of importance today which included a general update on CCIRH, the current stated of healthcare locally and nationally, and the impact of uncompensated care on CCIRH. He emphasized the importance of the relationship between the District, CCIRH, and other not-for-profit agencies which are crucial for effective healthcare delivery within Indian River County.
He began by providing an update regarding the hospital’s emergency department and labor and delivery. He stated that the hospital is undergoing a $7 million renovation of the mother-baby units and labor and delivery services. Additionally, there is $20 million allocated for the renovation of the emergency department, which will add over 40 rooms to better serve the community. Renovations are also planned for the second-floor hemodialysis units, and procedural areas. He also discussed the importance of the District’s support of the Partners Program, which has significantly impacted health outcomes for the community. Next, he discussed community healthcare initiatives and reviewed data on outcomes for mental health, Partners in Women’s Health and their collaboration with Healthy Start. He explained that nearly 1,000 inpatients and 500 outpatients were cared for in mental health services in 2023. Additionally, the partnership with Healthy Start and Partners provided prenatal and postpartum care to over 400 families in Q1 alone. He further discussed data from the successful Hospital at Home program which has completed over 40,000 in home visits since its inception. He also discussed the current state of healthcare and its challenges which included an increase in uncompensated care; inflation outpacing governmental reimbursement; payor dynamics; essential service challenged by underpayments from public payers and loses; and cybersecurity threats.
Additionally, he discussed the economic pressures facing healthcare locally and nationally. There was also discussion surrounding the uninsured rates in the US and Florida which have seen a significant increase, especially post COVID. He explained that Medicaid enrollment in Indian River County increased during the COVID pandemic but dropped by nearly 30% in 2023 due to state-guided re-determination. This drop resulted in approximately 10,000 individuals losing Medicaid coverage, impacting access to care. There was also lengthy discussion surrounding uncompensated care or charity care at CCIRH. He reviewed the data with the Trustees and stated that charity care increased by over 25% since 2019, totaling $17.1 million in 2023. Additionally, the hospital funded an operating loss of more than $60 million last year, highlighting the unsustainable nature of current financial practices. However, Dr. Rothman indicated that despite financial losses, the hospital continues to invest in community services, including labor and delivery and emergency department expansions. Further the hospital’s commitment to providing care, irrespective of payment status, remains a priority. It was also discussed that there is a need for community discussions on how to sustain services amidst rising uncompensated care and economic challenges. They agreed that collaboration with state representatives is essential to address policy issues affecting healthcare delivery. There was further group discussion on the importance of defining the scope of strategic planning for community healthcare services, and that the hospital must engage with community providers to enhance service delivery and patient care. There was also lengthy discussion surrounding commercial payor rates being lower than competitors’, impacting financial sustainability. The hospital is also facing a significant Medicaid shortfall, estimated at $35-$40 million, impacting its ability to invest in services. There were also discussions that highlighted the importance of transparency and preparing to defend financial decisions to the public. It was further discussed the potential purchase of Sebastian River Medical Center, by Orlando Health and what impact that would have on CCIRH, with regard to another non-for-profit competitor entering the market.
Next there was Trustee discussion and concerns were raised about the hospital’s performance metrics, including appointment wait times and overall patient care quality. It was suggested that the board should request data on hospital performance to address community concerns. The Trustees further agreed that they were open to further discussions on how best to support these shortfalls that the hospital is experiencing but would like to see a strategic plan in place that would outline future sustainability actions steps. Dr. Rothman stated that he and his team would work on these items and look forward to future collaborative efforts with the District. After further Trustee discussion, Ms. Deigl made a motion to appoint Ms. Cunningham as the point person for these discussions with CCIRH. The motion was seconded by Dr. Cooney and carried unanimously.
Lastly, it was discussed that CCIRH would hold a community conversation on October 22nd which they would present the preliminary results of the community health needs assessment and asked other community leaders to participate in discussions on ways to building a healthier community. The event will take place at the Waxlax Theatre a 11:30 am and the Trustees and public were encouraged to attend.
CHS & HSB/VCOM Lease Discussion- Frank Isele, Executive Director
Mr. Isele provided an update regarding the efforts to secure the CHS property for a potential women’s sober living facility. He explained that he and Ms. Peshke have been working diligently to settle a few outstanding items before submitting an offer to purchase the property. Those include clarification on the existing land use restriction and county zoning restrictions. Also, it was discovered during the title search there is a lien on the property placed there by DCF. Ms. Peshke is optimistic that these items will be resolved, and they will provide the Trustees with an update as soon as possible.
Ms. Peshke also provided an update regarding the VCOM partnership and lease agreements. She stated that within the lease agreements with CCIRH, there is a right of first refusal (“ROFR”) clause on the HSB property. She has spoken to CCIRH legal counsel, and they are in support of the District’s partnership with VCOM and have agreed to waive their ROFR rights. Correspondence outlining the same is currently being drafted and Ms. Peshek will circulate the same to the Trustees once it is received.
Other Business-
Dr. Cooney addressed the Trustees and stated that materials were sent to the board on his behalf earlier in the week which included articles discussing Florida hospitals and health systems requirements to provide charity care. It was discussed that Florida not-for-profit hospitals have charity care responsibility of up to 2-3% of their net profits. However, CCIRH is exempt from this due to the fact that they have yet to turn a profit since taking over operations in 2018. Dr. Cooney stated that it should be noted that CCIRH has provided nearly $17 million in charity care alone in 2023 and continues to support those vulnerable populations. Mr. Westcott stated that he would still like to see additional CCIRH data with measurable outcomes. He would also like Ms. Peshke to further explore the member substitution agreement, lease and responsibilities under the Special Act with regard to charity care.
Lastly, Mr. Isele stated that he and Ms. Cunningham have been asked to give a brief presentation to the Taxpayers Association on October 4th. The other Trustees and the public were invited to attend.
Public Comment & Adjourn
There was no further business and Ms. Cunningham asked for public comment. Ms. Soule addressed the board and stated that hospitals are not the only healthcare providers who are struggling due to legislative changes and inflation. She believes there should be further education to the public as to why additional financial support is needed to support local FQHC’s. There was no further public comment, and the meeting was adjourned at 11:40 a.m.
