SUMMARY MINUTES
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
October 17, 2024
TRUSTEES: Karen Deigl Michael Kint
Marybeth Cunningham Paul Westcott
Barb Bodnar Kerry Bartlett
William Cooney, M.D.
STAFF: Kate Voss Jennifer Peshke, Esq.
Frank Isele Kaytlin Dickens Dawn Carboni Jennifer Frederick
ATTENDEES: Vicki Soule Michael Hammes
Richard Rothman, M.D. Joe Iannucci
Linda Walton
ZOOM: Marie Andress Anne Posey Pat Knipper Megan McFall Lisa Zahner David Christian Lauretta Farrell Wayne Creelman
Convene Meeting, Invocation, Pledge & Consent Agenda
Ms. Cunningham convened the regular monthly meeting of the Indian River County Hospital District at 5:15 PM. She asked for a motion to approve the September meeting minutes and an October disbursement of $1,493,029.93. The motion was made by Ms. Deigl and seconded by Ms. Bartlett. The motion carried unanimously.
Ms. Cunningham addressed the board and took a moment to reflect on the devastation Indian River County has suffered due to Hurricane Milton. She thanked the Trustees for their support and approving the funding to United Way for the Hurricane Relief Fund.
Annual Verbal Report- Cleveland Clinic Indian River Hospital- Richard Rothman, M.D., Vice President & Chief Medical Officer
Dr. Rothman stated that he was here to present the annual verbal report for CCIRH with data related to 2023. He first addressed the hospital’s resilience in maintaining services during Hurricane Milton, when the facility lost power and two of their generators failed. He explained that they were able to locate two replacement generators within 8 hours of the failures and there was minimal disruption to patient care.
Next, he reviewed data relative to outpatient and emergency department visits and stated that the hospital performed over 230,222 outpatient visits and nearly 55,000 emergency department visits in 2023. He then provided a review of the scope of services and stated that all service lines offered in 2022 were continued into 2023 and have expanded services within oncology and minimally invasive cardiac procedures. Additionally, CCIRH remains the only facility within Indian River County that delivers babies. He then discussed the hospital’s financial challenges and their commitment to the community. Dr. Rothman stated that they have already spent $100 million on capital improvements, outside of CCIRH philanthropic support, which includes a $7 million renovation to the labor and delivery unit. Next, he discussed the hospitals operating loss of over $60 million, which was attributed to national healthcare trends and local service demands. However, despite those financial challenges, the hospital remains committed to expanding services that meet community needs, including the support of charity care. He further discussed staff and retention issues and noted that staffing turnover is affecting healthcare systems nationally. However, CCIRH attrition rates have decreased, and efforts are being made to improve caregiving engagement and address the affordable housing challenges for staff. There was also discussion surrounding payor mix and Medicare/Medicaid payment comparison. He stated that the hospitals Medicare and Medicare Advantage patient percentage in Indian River County is approximately 70%, and traditional Medicare is easier to manage compared to Medicare Advantage, which has more authorization challenges. Further, Government reimbursement generally yields lower payments than commercial reimbursement, with 70% of hospital income coming from government sources. Lastly there was discussion surrounding the need for community engagement from CCIRH and additional understanding of the Ombudsman program from the public. There was Trustee discussion and questions for Dr. Rothman. Also, suggestions were made to enhance the Ombudsman Program to improve public relations and community engagement, including training staff to direct concerns to the Ombudsman.
District Counsel Report- Jennifer Peshke, Esq.
Ms. Peshke provided her report and stated that she continues to review the annual deadlines and deliverables due to the District under the Lease with CCIRH and has responded with questions as they arise. Further, under the leadership of Ms. Deigl, the District has submitted an offer to purchase the CHS property to house a future women’s sober living program. Additionally, the District and VCOM have entered into a lease agreement for the Human Services Building. Ms. Peshke has also completed the last phase of this process which is to confirm CCIRH will grant a waiver of the Right of First Refusal they hold on the parcel and CCIRH has provided a letter advising the same and this will be maintained in the District files. Further, she has participated and assisted with the Trustee’s Strategic Planning efforts and continues to remain available for support. She also has worked with Ms. Frederick to finalize the agency funding agreements for the new fiscal year 2024-2025. Lastly, she stated that she attended the taxpayers’ association luncheon on October 4th, where Ms. Cunningham and Mr. Isele both addressed its members.
Financial Statement Review – Michael Kint, Treasurer
Mr. Kint stated that after twelve months of the fiscal year, the District is in strong financial condition. He provided a review of the year-to-date budget items and investment and cash holdings. He explained that the District’s net ad valorem tax receipts for last fiscal year totaled $12,946,443, less commissions and uncollectibles. He further explained this amount is 102% of budgeted tax revenue and shows the district income was over budget by $258,383. This was due to back taxes that were paid which is noted in Mr. Isele’s financial snapshot report. Next, he reviewed the investment accounts and cash holdings which total $10,759,932. He then reviewed the year to date budget items and stated that most programs were expensed at 100% of their budget with the exception of a few who requested midyear funding, to cover their shortfalls. He further stated that the total for all program expenses through the end of the fiscal year was $16,077,602, which computes to 98.7% of the total program budget approved for last fiscal year. Total administrative expenses were slightly over budget and totaled $1,280,732. Combined, administrative and program expenses totaled $17,358,333, which is 99.4% of budget for fiscal year 23-24.
Executive Director Report- Frank Isele, Executive Director
Mr. Isele provided information on a few follow up items and stated that he and the Trustees are wrapping up strategic planning and held a productive meeting on October 2nd to further refine their five year goals. Items added were objectives, performance measures, and standards which are in compliance with state accountability standards and requirements for special districts that went into effect this year. Next, he provided an update on the mental health court and stated that the District convened all parties involved with the program to discuss the mechanics of client flow and continuum of care with the goal of truly understanding how the whole process works. The group’s next meeting is scheduled for October 22nd and he will provide the Trustees with an update next month. Lastly, he stated that the District has been working with United Way, Indian River Community Foundation and others to develop a joint funding solution to address the cut in DCF funding to preventative care programs in the county. Meetings with the key stakeholders continue and he will provide further updates when available. Mr. Isele had no further updates and Ms. Cunningham asked if there was any feedback from the state regarding the District’s Performance Review. Mr. Isele explained that the District received confirmation from the state that the report was received, but no other action or communication has been received or requested. Next Mr. Isele asked Ms. Dickens to provide the Trustees with an update and walkthrough some new items on the District’s performance dashboard. Ms. Dickens stated that she has added additional data and charts regarding the District’s funding impact for healthcare needs. She also reviewed data relative to the number of clients utilizing the District financial assistance programs through the funded agencies and new graphs have been developed to better understand the trends. She further stated that is she working to upload past years data so that the District may have a fuller picture of the needs and trends within Indian River County.
Funded Agency Semi Annual Reports- CCIRH IOP & ED- Cecelia Stalnaker-Cauwenberghs, Administrator of CCIRH Behavioral Health Center
Ms. Stalnaker began by providing an update regarding the Intensive Outpatient Program and stated that the program continues to grow and increased referrals from the community have led to serving individuals outside the initial acuity level, including those needing residential care. They continue to develop individualized treatment plans for patients with unique needs, resulting in a 91% increase in individual services over the past six months. The program has also successfully mitigated risks of hospitalization by providing timely therapy sessions. There has been a notable increase in referrals from the school district, with seven referrals received this year compared to last year. Additionally, collaboration with various local healthcare agencies has improved service provision for children in need of mental health support. Next, she discussed the Behavioral Health Zone at the ED and stated that it has recently been adjusted to accommodate fluctuating patient numbers, ensuring best use of space and resources. She further explained that there is still mental health stigma and a lack of knowledge around mental health and substance use disorders that continue to occur, not only in the community, but through our medical providers, EMS, law enforcement personnel. Additionally, a large part of this program was for the psychiatric crisis specialists to be able to provide education around those disorders. She explained that her team applied for the Cleveland Clinic caregiver catalyst grant and we subsequently awarded the funding, which enabled them to train nine facilitators in adult mental health first aid and one facilitator for teen mental health. In addition, it will provide an opportunity to train around 450 of the CCIRH caregivers in mental health first aid, recognizing the signs and symptoms of mental health and connecting, as well as a partnership with the Mental Health Collaborative. Lastly, there was discussion surrounding the increased number of patients with dementia and autism being dropped off at the ED, highlighting a gap in community resources for this population.
New Business- Request for Reallocation of Senior Collaborative Funds to Senior Resource Association- Robyn Orzel, Chief Development Officer
Ms. Orzel addressed the board and stated as of October 1st, the Senior Collaborative has dissolved, and the Senior Resource Association acquired three programs from that organization. Those programs are the Upslide Program, Patient Navigation, as well as the Senior Expo. She further explained that since the District initially approved $35,000 in funding to support the Upslide program, she is requesting those funds be transferred and allocated to Senior Resource Associations budget, to continue the support the program in this new fiscal year. Ms. Cunningham asked for a motion to approve the transition of funds which was made by Ms. Bodnar. The motion was seconded by Mr. Kint and passed. Ms. Deigl recused herself from the vote.
Public Comment/Adjourn
There was no further discussion and Ms. Cunningham asked for public comment. Mr. Ray Osborne, who submitted his public comment through the chat feature on Zoom requested additional clarification regarding virtual visits offered by CCIRH. He stated that he would prefer to have his visits happen virtually but stated that this doesn’t seem to be the preferred method by CCIRH. He would like to better understand this process and if there is a cost saving to CCIRH by having the visits in person. Ms. Voss stated that she would pass along these comments to Mr. Isele for follow up. There was no further public comment and the meeting was adjourned at 5:30 PM.
Respectfully Submitted,
Barb Bodnar, Secretary
