Indian River County Hospital District

Special Meeting- August 26, 2021

SUMMARY MINUTES
IRCHD Special Meeting via Zoom
August 26, 2021
2:00 PM

ATTENDEES: Marybeth Cunningham Ann Marie Suriano
Ann Marie McCrystal Allen Jones
Jennifer Frederick Vicki Soule
Kate Voss Robi Robinson
Jamie Merritt Marie Andress
Charles Mackett, M.D. Karen Deigl

Convene Meeting – Allen Jones Treasurer

Mr. Jones convened the special meeting of the Indian River County Hospital District at 2:00 PM via Zoom. He explained that the purpose of this meeting is to explore ideas that would make the District’s expenditures more impactful on improving the health of the community, particularly for those eligible under the District’s financial assistance guidelines. Mr. Jones stated that as the District moves toward the conclusion of its budget preparation for the upcoming fiscal year, the board is seeking ways to improve the impact of the healthcare support currently being provided.

Accessibility to Healthcare Services Talking Points- Allen Jones, Treasurer

Mr. Jones stated that Marie Andress of Whole Family Health Center and Vicki Soule of Treasure Coast Community Health had some preliminary discussions. In an email, Ms. Andress suggested Trustees might consider funding these few areas:

1. Helping underinsured individuals with co-pays
2. Help fund non-Covid vaccinations like Shingles or Pneumonia
3. Help patients in the “donut hole” of prescription drug reimbursement
4. Help with Vero Radiology costs

Mr. Jones would like today’s discussion to be the catalyst of developing some meaningful solutions to support these gaps and barriers to care. He believes there should be no limit on the concepts considered as long as they are financially responsible and will have an impact on improving the health the of Indian River County residents. He asked Dr. Mackett to provide his thoughts and recommendations first. Dr. Mackett indicated that one barrier to care is not everyone is eligible for Medicaid, and it can be difficult to acquire due to the lack of Medicaid expansion in the state. He also believes there is an opportunity to provide a safety net for underinsured residents in the community. Additionally, further community outreach by TCCH and WFHC may be needed, to spread the word that health services are available through their organizations. Dr. Mackett also stated that an additional barrier is an access to specialty services. In some cases, CCIRH does not provide the specialty service needed or there is a backlog of patients waiting to receive that particular service. He also agreed with supporting preventative vaccination distribution. He explained that there are many preventative vaccines available and it would be beneficial to provide those immunizations to adults in the underserved populations. Some of those vaccines include flu; HPV; hepatitis A&B; TDAP; and other preventative vaccines that are proven to reduce morbidity and mortality. Further, Dr. Mackett stated that metrics to measure these outcomes could be tracking the number of individuals who are getting vaccinated each year. Additionally, he believes there is an opportunity for the District to support other services which aren’t currently covered such as:

1. Smoking Cessation
2. Colorectal Cancer Screenings
3. Women’s Health Services
4. TB Screenings; and
5. Low Dose CT Lung Cancer Screening

He stated that these preventative services have been shown by the US Services Preventative Task Force, to reduce morbidity and mortality. Lastly, he discussed that when the State of Oregon reimburses Medicaid and supplements underserved/underinsured, they review their budget to see how much will be spent that year and rank the services by which are most efficacious and cost-effective. He believes it would be beneficial to look into this structure as a guide.

Mr. Jones asked for additional input and Ms. Andress addressed the board. She explained that she invited Ms. Jamie Merritt, the Vice President at WFHC who is an expert on FQHC billing rules, to be a part of the discussion today. They have had prior discussions concerning the underinsured and she asked that Ms. Merritt speaks to that matter. Ms. Merritt indicated that within WFHC social services department, they have identified some areas that need additional support. One main area is regarding underinsured patients and Medicaid. Many times, those patients have limited coverage and are often only covered for specific services such as family planning. Medicaid also puts limitations on services such a behavioral health. She further explained that there are also issues with patients obtaining durable medical equipment (“DME”). In other instances, patients are opting to obtain low monthly premium plans which require them to pay sometimes 40% of their healthcare cost and have relatively no coverage for specialty services. There are also individual circumstances where a patient is just above the threshold for Hospital District financial assistance, so parents must obtain alternative coverage for their children if they are unable to afford Medicaid. Lastly, she discussed the issues with patients in the “donut hole” of prescription drug reimbursement. Many times, patients are not notified that they have reached their maximum coverage threshold and are forced to pay out of pocket for their prescriptions that historically have been covered. She further recommended that it may be beneficial to start tracking those underinsured patients to get an idea of the volume of patients who may need additional assistance. Mrs. Frederick indicated that the Hospital District does make some exceptions to provide coverage to patients who may have extenuating circumstances or are just above the financial qualification guideline. However, the District cannot provide support unless they are notified of the circumstances and she encouraged WFHC and TCCH to contact her to discuss how best to support the need. There was further group discussion concerning this matter and how best to keep track of this data. Mrs. Soule indicated that many times if a patient is in need of additional services like a preventative vaccine, TCCH will provide the service and absorb that cost. She also agreed that many patients have low coverage insurance or catastrophic coverage only, which does not cover primary care. She would like to look further into providing assistance with co-pays for those who are uninsured. She understands that will take work to develop, but she believes it is a justified expense to help bring further healthcare support to the community. There was further group discussion surrounding the underinsured and Ms. Deigl feels that this is not a one size fits all situation and it will take some work on the District’s part to find a meaningful solution.

Mr. Jones thanked everyone for this meaningful discussion and stated that there will need to be some sort of mechanism for reviewing these outstanding needs. He informed the group that currently CCIRH provides free care to any individual who is 250% or below the Federal Poverty Guidelines. However, after having a prior discussion with Dr. Saver, he was informed that when a patient needs radiology services, they are billed directly for those services regardless if they qualify under the 250% threshold. This is due to a contractual agreement between CCIRH and Vero Radiology. He explained that this agreement was originally between IRMC and Vero Radiology and through the CCIRH transition, CCIRH is obligated to complete the terms of the agreement. He stated that he would like to further look into how the District could better support the patients, until the agreement can be renegotiated in a few years. Mr. Robinson indicated that We Care pays for all of its patient’s radiology costs and they have a contract with Perkins to help assist with prescriptions and DME. Ms. Deigl indicated that Senior Resource Association also has a plethora of DME and would be happy to assist collaboratively with other agencies in getting that equipment to their vulnerable patients.

In closing, Mr. Jones stated that from today’s discussion he heard that there are a number of opportunities for the District to consider and make their expenditures more impactful to the health of the community. He hopes these discussions will continue and that the District budget will accommodate those areas of most importance.

Public Comment & Adjourn

Mr. Jones thanked the group for their participation in this important meeting and looks forward to working collaboratively on these matters. There was no further discussion and the meeting was adjourned at 3:00 PM.

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