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Home My WebLink About5/22/1996MINUTES ATTACHED Joint Meeting of Board of County Commissioners and Hospital Taxing District WORKSHOP ON MEDICAL SERVICES Wednesday, May 22, 1996 5:00 P.M. .Board of County Commission Chambers County Administration Building 1840 25th Street Vero Beach Call to Order (Fran Adams) Introduction (Carolyn Eggert) Description of Public Health/Primary Care Committee (Carolyn Eggert) Hospital District Programs Community Health Network (Beverly O'Neill) Partners - Maternity Program (Ginny Crandell) Community Emotional Behavior Hospital (Barbara Horn) Visiting Nurses Association (Sharon Kennedy)' Public Health (Jean Kline) Future of Medical Services (Beverly O'Neill) Questions and Answers MAY 229 1996 5 minutes 5 minutes 10 minute$, 7.5 minutes 7.5 minutes 10 minutes 25minutes 10 minutes 10 minutes 600k 9N f'ljF 150 SPECIAL MEETING eQQR 98 muuL 151 Wednesday, May 22, 1996 The Board of County Commissioners of Indian River County, Florida, met in Joint Session with the Trustees of the Indian River County Hospital Taxing District at the County Commission Chambers, 1840 25th Street, Vero Beach, Florida, on Wednesday, May 22, 1996 at 5:00 p.m. Present were Fran B. Adams, Chairman; Carolyn K. Eggert, Vice Chairman; Richard N. Bird; Kenneth R. Macht; and John W. Tippin. Also present were James E. Chandler, County Administrator; Charles P. Vitunac, County Attorney; and Barbara Bonnah, Deputy Clerk. Present for the IRC Hospital District Board of Trustees were: Vincent Montuoro, Chairman Beverly O'Neill, R.N. Margaret Ingram Alan Polackwich, Attorney Absent were: Very Reverend David C. Lord Joyce Smith Broadus Sowell, M.D. Heidi Gorsuch, M.D. Chairman Adams called the meeting to order and turned it over to Vice Chairman Eggert who announced that the purpose of this workshop meeting is to inform the Hospital District Board of Trustees and the Board of County Commissioners of the services that are available outside the hospital in Indian River County, services that are funded either by the County or the Hospital District. Vice Chairman Eggert also announced that what we are not going to talk about tonight is the hospital or IRMH, Inc. and the Boards will not entertain any questions on those subjects. Vice Chairman Eggert and Trustee Beverly O'Neill wished to give the Boards a broad view of how the County Commission and the 1 MAY 229 1996 Hospital District are serving the public in an attempt to make medical services more cost effective. We all know how expensive it is to go into the hospital, especially when treatment has been delayed and the situation has become very serious. We are looking for programs that will provide preventive medicine that will bring. the ability to help someone with a problem as quickly as possible. - This is pre -budget time for the County and we are particularly interested in being able to spread our dollars as far as we can and still give quality medical service. COUNTY EXPENDITURES ON MEDICAL SERVICE State Agency 101 New Horizons Mental Health/Substance Abuse $ 351,740 106 Public Health Department Physical/Environmental Non -Profit Organizations 110 Alpha Health Services Substance Abuse/Pregnant Women General Fund Grants 111 Medicaid Substance Abuse Programs TOTAL Safespace/Spouse Abuse 635,335 16,400 340,000 36,204 $1,379,679 15,000 $1,394,679 2 MAY 229 1996 Boos 98 i,�u 152 BOOK , 98 PAuak 153 Vice Chairman Eggert noted that we are equally interested in eliminating duplication, which is the reason for a number of committees that communicate well with each other. Within the county, we have a Primary Care Public Health Committee, which is composed of the following persons: Commissioner Carolyn K. Eggert, chairman Beverly O'Neill, R.N., Hospital District Trustee Jim Judge, Emergency Services Cindy Harris Panning, Hospice Health Services Joyce Johnston, County Welfare Dept. Gerry Koziel, IRMH, Inc. Victor Hart from Gifford Jean Kline, Public Health Carol Molloy, Public Health Joan Kostenbader from Sebastian Dr. Syed Kalamuddin, Fellsmere Health Clinic Kathy Nall, Healthy Start Coalition HOSPITAL DISTRICT PROGRAMS, COMMXjN= HEALTH NETWORK - BEVERLY O'NEILL, TRUSTEE Trustee Beverly O'Neill led off the health program presentations by giving a brief history of the IRC Hospital Taxing District, its purpose, scope of services funded by the District, and the community health network. PARTNERS IN WOMEN'S HEALTH - MATERNITY PROGRAM - GINNY CRANDELL 3 MAY 229 1996 S ORIC P CTIVE 198 99 M Irio ■ 85 GOAL E L A PROG T E Q ITY OB C ARE TO IGE F S ■ CURRE PROG P ES PRO QUALITY ■ CUSTOMERS SFACTI ■ 1996 GOAL TO CO TINUE T O QUALITY CARE WITH IN THE NT O IC CLIMATE X ■ e the s er's Hea are c 'tt6d to Effects a Care r r advocate roily to we provide a in a fe environment. ough c our patients will re eive t Care throughout the ME I E eprogr .c ent ■ Lo Birth i t 0te 1 transp s ■ C- Section tes ■ Documented g U ■ Women No Pren 1 Care ■ Total Service Delive 'es ■ Newborn Transfers 4 MAY 229 1996 lth in hic upporti e ducation, Primary eriod. 198 94-9. % 6.0 ° 1.0 % 8 % 9.0 % 9 . 19.0 68 506 2.6 % 2.0 % BOOK. 98 F%L 15.4 BOOK P RS WO ALTH NT S ISF N 199 ( l 5 ■ A L BY OB IAN 9 0 o EXC ENT O VE A RA ■ CNM C AT E OF,,, DELIVERY 6% E TO ABOVE AVE GE ■QUESTIONS AN RE /o RV .QW1,1i ■CV.,0PERA PR WITH IRC ■ NM & OB P ALL P RY P AL CARE ■ MEDICAL PECTS OF O DER AD S 1 OF IRMH ■ IRCPHU CON S EDUCA ON E S CA COORDINATION ■ IRMH CASE MANAGE WORKS P S, COMMUNITY AGENC D IRCP TO O TOWARD A SEAMLESS PERINATAL ALTH CA SY TEM ■ WORK WITH THE HEALTNY S T CO TION TO CONTINUE TO IMPROVE CO SERVICES. NATOL ■ gram Ne,,Worn Uar W nI con ' ues the i ality C e pro i e the P ers pr a ■ Improved are for i ' k Babie bo in Indian Riv Coun ■ Stable consisten are for di n newborns ■ Ability to accept ba ' s back om High Risk Centers earlier to o to contact with their families 5 MAY 229 1996 COMMUNITY EMOTIONAL BEHAVIOR HOSPITAL - Vision Statement: The Center for Emotional and Behavioral Health is committed to providing excellence in mental health care to individuals and families while responding to the needs of the changing community. Our patients can expect quality care given with dignity and professionalism through the collaborative efforts of the multi- disciplinary team. We will continue to support the Quality First process while working together as a team. Changing Community: 1993 - Hospital took over management of mental health directors. - Length of stay, 30 days. - Homebound teacher - school district employee. - 3 -hour school instruction 1 day. - Books and homework assignments from schools. - School members attended tx team 1-2x during stay and multiple phone calls. - Discharged to home/back to school. 1996 - Average length of stay, 8.3 days. 2-4 day stays not unusual. - No homebound teachers from district. - Generic learning experience, addressing more social skill issues than academics. - School representatives not typically attending tx team. - Calls to school to determine placement issues/need no testing. Hospital and schools are working to collaborate to meet the needs of children with special mental health issues. Joint venture with CollaBorative Schools - Devereux/CEPH - To provide effective services to SED and EH students making the best utilization of resources - parental involvement - therapist - increased parental compliance - success notes Devereux The Devereux proposal being negotiated. (overview family piece) In the existing reimbursement system, there is no resource to fund the family component for children covered by Medicaid or funded through HRS. 90% of children in existing Devereux programs are funded through Medicaid. Met with Dr. Gayor, Asst. Superintendent for Special Services, and discussed the need to support _what is done for children by providing a family component. He concurred that family involvement is crucial to the degree of success experienced by the child. 6 MAY 229 1996 BOOK 98 �-Au 156 DEVEREUX DAY TREATMENT PROGRAM FACT SHEET Clients to be served: BOOK 98 PAU157 Children and adolescents (Kindergarten through Grade 12) who have had difficulties progressing in school-based emotionally handicapped and severely emotionally disturbed classes, and who require an intensive, highly structured environment. These children may be experiencing problems at school or at home, or have other problems with those in authority. They may experience depression, impulsiveness, hyperactivity, distractibility, withdrawal, school -refusing behavior, or severe learning problems. Who can refer children to the Devereux PU School? School guidance counselors, social workers and psychologists; other mental health professionals and family members. What services are offered to clients and their families in this program? The program will operate during normal school hours, with emphasis on both academic and behavioral development. The program will utilize several areas to elicit change: -A structured behavior management level system. Psycho -educational activities to develop emotional and social coping skills. Individual, group, and family therapies. Psychiatric and psychological consultation. -Academic curricula approved by referring school districts. -Art, music, and recreational activities specifically designed for EH/SED populations. -Speech, language, and occupational therapies. School Counselors: The school system requesting behavior specialist 1/school. Currently 7 FTE's shy of 1/school. Behavior specialists are educators trained to deal with behavior problems within schools. Dr. Gaylor is supportive of a collaborative effort between the School System and the mental health system to fill the gap for students in need of services. Adding LOSW and/or psychology doctoral students to provide group, individual, family therapy for those youngsters identified by _behavior specialist. Carolyn Sheppard and teachers' union. VA MAY 229 1996 � r � VISITING NURSES ASSOCIATION - SHARON KENNEDY Visiting Nurse Association & Hospice VNA has been providing home health services to Indian River County residents for over 20 years, including intermittent in-home visits by RN's, LPN's, Social Workers, Therapists such as Physical Therapy, Occupational Therapy, and Speech Therapy, and Certified Nurse Assistants. The VNA was the first home health agency in Indian River County and remains the only non-profit home health agency in the county. Governed by a voluntary board of up to 30 Directors, the VNA provides home health visits to all ages, ranging from tiny premature infants, women and children, adults with acute and chronic disorders, to the elderly and the terminally ill. The VNA is recognized as providing high quality specialty care, including a large IV team, specialized wound care, pediatrics, ostomy care, and has well-developed teams serving people with special needs such as mental health, cardiac and respiratory care, orthopedics, and other unique needs. The VNA offers a full spectrum of services and focuses on prevention, wellness, and education through our commitment to serve all people in need, regardless of their ability to pay for their care, while keeping the costs of care to our community as low as possible. Our private duty program, companion services, and programs such as the flu shot program help to keep patients well, independent in their homes, and out of hospitals and nursing homes whenever possible. Our mission is to identify unmet community needs and to develop programs and services to meet these needs. The VNA is accredited by the Joint Commission for Accreditation of Healthcare Organizations, with commendations. In 1995, the VNA provided 97,000 visits to over 3000 patients in IRC. The Indian River Hospital District will fund care through the VNA to apx. 140 patients in the 1995-96 budget period. Hospice joined the VNA in 1986 and ours is the only agency in the county providing licensed Hospice care. Providing a whole family approach to caring for patients that are living with life -limiting illnesses, Hospice cares for over 350 families a year in Indian River County. By providing the patient and family with a full team of health 8 MAY 22 1996 p �uf, rr4�tij BOOK F'AG 159 professionals, such as RN's, Counselors, Certified Nurse Assistants, Chaplain services, Bereavement Support, and a large volunteer component, The VNA Hospice helps patients stay in their home during this crucial time, again, regardless of their ability to pay for their care. The services of the VNA & Hospice are reimbursed by Medicare, Medicaid, private insurance, worker's compensation, private pay, Hospital District funding, and contributions by private donors. In 1995, the VNA and Hospice provided over $.5mil of services to patients who could not pay for their own care. Last year, the Hospital District provided $163,712 reimbursement for patients who qualified under this pay source and the VNA and Hospice Foundation subsidized the rest. The Hospital District is the payor of last resort. The visits are billed to the district at 80% of usual and customary rates. Patients who are underinsured and the "working poor" who cannot afford the high premiums of insurance can still get home health and hospice care through our VNA. Thanks to our generous donors, and funding sources such as the Hospital District, no patient has ever been refused needed services due to their inability to pay for their care! When a person is referred to the VNA, a visit is made to the patient by an RN and/or a Social Worker to assess their needs, make recommendations for care, and at that time, a financial assessment is made to assist the patient with choices in their care. Sometimes the patient can be more appropriately served by one of the other community agencies and may be referred to that agency for follow-up, thus eliminating duplication of services or overlap. For the indigent care patients, VNA works closely with the IRCPHU, IRMH, TCCAN, the COA and many other community providers to ensure continuity, low cost and avoid duplication of services. We utilize a large pool of.volunteers to assist patients, thus further reducing the overall costs of the services.. 9 MAY 229 1996 r � � VNA Health Care on Wheels This 32 foot bluebird bus was made possible is 1992, thanks to the funding by IRC Hospital District with the goal of seeking out and serving isolated and underserved populations of our county. In 3 years, the mobile unit has served over 6,700 patients. The unit is equipped with examining rooms, special healthcare equipment, and a small computer and is staffed by Advanced Registered Nurse Practitioners to provide urgent - care services to those they serve. The Healthcare on Wheels is driven to one of 7 sites in the county, sets up clinics of 3 - 7 hours duration and provides assessment and treatment to clients who come for care. Patients are screened for residency requirements and if possible are referred to other health care providers if they have Medicaid, Medicare, or a private physician. However, the majority of our apx. 2000 patients per year are low income with no health insurance at all. Over 50% of the patients seen in 1995-96 were 10 years of age or younger. Patients can be seen quickly, with little or no barriers to their access to care, at no charge, are treated by the ARNP, receive prescriptions, health teaching and follow-up, thus reducing the number of patients who would present themselves to the emergency room or the health department at a later stage in their illness, at a higher cost to our healthcare system. Access to care at the lowest cost is the key to the mobile unit's partnership with the community. The unit can easily moved to new sites as the needs of the community change. The Indian River Citrus League donates money to the VNA each year to provide medications for migrants. The mobile unit is on the road 70 hours a week and the schedule can be obtained by calling the VNA at 567-5760. MAY 229 1996 10 BOOK 9 FA(Jf.160 BOOK 98 PAGE, 6 INDIAN RIVER PUBLIC HEALTH UNIT - IEAN KLINE tblic Health Services Link people to needed primary care service and assure the provision of health care when otherwise unavailable. ■ Assure a competent public health and u primary care workforce. ■ Evaluate effectiveness, accessibility, and quality of primary care and population -based health services. ■ Research for new insights and innovative solutions to health problems. bl is Health's Mission Monitor health status to identify community problem. ■ Diagnose and investigate health problems and health hazards in the community. ■ Develop community partnerships and action to identify and solve health problems. ■ Enforce laws and regulations that protect health and ensure safety. 11 MAY 229 1996 PRIMACY CARE • WIC and N ffi-ftfi Edxffatioi • Family Planrun�.......... WWI Ar • Healthy Stait/ -6.,e4 r r 1� •Migrant Lib` •Housing . -U' ,-an* bll* idin, 4.Safetv and -Q Sanitatio:"'. 0 Mobile Home and.RecreationalVehicle Park Services 151 I'Je ' • Conducts"' . . . . . . to public health an i0 tay lations. - • Licenses and,; insk-ats,-pollutant (grease), interceptorsunder. u,nder. county ordinance 0 Responds to citizen complaints. MAY 229 1996 12 N'A;I' 98 f'A�E 162 Budget - Revenues ■ State/Federal - $1,865,252 ■ County 956,525 ■ Medicaid/Medicare/OTP 554,917 ■ Fees- - Environmental Health 280,999 - Clinic 92,671 - Vaal Statistics 100,802 ■ Healthy Start/IPO 212,935 ■ Other grants/contracts 111,765 ■ Interest 10,357 » Total Revenue $4,186,223 800K 98 1-A6A 163 1995-1996 How County Funding is Allocated for FY 95-96 Board of County Commissioners $651,725 — Environ. Health $ 69,887 — Environ. Control Board 16,390 — Communicable Disease 114,360 — Primary Care 451,088 How County Funding is Allocated FY 95-96 Indian River Hospital District $293,800 - Primary Care (Adult/Pediatric) $198,300 — Pharmacy/Extended Hours 20,500 — Dental Program 30,000 — We Care Coordinator 45,500 13 MAY 229 1996 M M M M Future Needs Primary Care: The demands are far outstripping the resources. — 1995, IRCPHU saw 16.7% more patients through primary care programs (not including school health or adult flu programs) over 1994. — In the first 4 months of 1996, there has been another 26.7% increase from the same period 1995 or an additional 3,768 patients. — We have a six week waiting list for patients to see an adult physician. Patients are coming to us with multiple, often complex, medical problems. Future Needs (continued) — Legislative reductions the past years have negatively affected care delivery: 1995 - $124,000 1996 ,, $69,000 ♦ Needed: Primary Care Physician ♦ Needed: Increased Dental Services ♦ Needed: Pharmaceutical Support for Primary Care ♦ Needed: Improved coordination among all agencies to better meet primary care needs. ♦ Needed: Improved mental health services for children and adults. FY 96-97 Funding Request ♦ Board.of County Commissioners — $672,000 for Public Health/ Primary Care Services — Allocable 14 MAY 229 1996 ♦ Indian River County Hospital District — $240,000 Primary Care — $46,500 We Care Coordinator — $25,000 Pharmacy/ Extended Hours — $31,000 Dental Program — $150,000 Comprehensive School Health Program for South County Boar, 98 P"�bL- 164 r -I BOOK 98 165 FUTURE OF MEDICAL SERVICES - BEVERLY O'NEILL COMMISSIONER EGGERT ASKED ME TO TALK ABOUT THE FUTURE, I REALLY WISHED THAT I HAD A MARVELOUS CRYSTAL BALL TO FORESEE THE FUTURE.% MARKET REFORMS, FEDERAL AND STATE HEALTH CARE REFORM EFFORTS, WELFARE REFORM ARE PUSHING PROVIDERS, DOCTORS, HOSPITALS AND MANAGED CARE PLANS TO NEW FORMS OF COLLABORATION -CREATE SYSTEMS THAT CAN BE HELD ACCOUNTABLE FOR COST EFFECTIVE CARE AND QUALITY. THERE IS GREATER EMPHASIS ON OUTPATIENT CARE AND EXTENDED CARE. WITH THE HINT OF SOME INCENTIVES TO KEEP PEOPLE WELL. WE NEED TO SEE BEHAVIORAL CHANGE IN OUR COMMUNITY TO REDUCE SOCIETALLY - INDUCED HEALTHCARE EXPENDITURES. WE NEED TO EDUCATE AND ENCOURAGE RESIDENTS TO MAKE LIFESTYLE CHOICES IN THE AREA OF DIET, EXERCISE, DRUG ABUSE, AUTO SAFETY, TEEN PREGNANCY, DOMESTIC VIOLENCE, AND SEXUAL BEHAVIOR TO NAME A FEW. PROMOTING HEALTH AND BUILDING A HEALTHIER COMMUNITY WILL CAUSE US TO LOOK CAREFULLY AT OUR COMMUNITY HEALTH RESOURCES - PHYSICAL RESOURCES OF FACILITIES, TOOL, AND TECHNOLOGY FINANCIAL RESOURCES OF FINANCES, CASH WEALTH, ACCESS TO CAPITAL HUMAN RESOURCES OF SKILLS AND CAPABILITIES OF PEOPLE SOCIAL RESOURCES OR RELATIONS AMONG PERSONS AND ORGANIZATIONS THAT FACILITATE AND DIRECT ACTION. POPULATION BASED PLANNING FOR HEALTH STATUS IMPROVEMENT IS IMPERATIVE. THE PREVENTION AND REDUCTION FOR THE NEED OF MEDICAL INTERVENTIONS CAN OCCUR IF WE PROTECT AND PROMOTE HEALTH AND HEALTHY LIFESTYLES. WE NEED TO FORGE NEW COLLABORATIVE EFFORTS WITH THE GOAL ALWAYS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY. WE NEED TO MEASURE AND REPORT HEALTH STATUS AND ASSURE ACESS TO PRIMARY. PREVENTIVE AND EDUCATIONAL SERVICES. 15 MAY 229 1996 IN INDIAN RIVER COUNTY, THERE ARE SEVERAL AREAS THAT ARE WORTHY OF CAREFUL, ATTENTION: CHILDREN SERVICES, CHILDREN ARE OUR FUTURE THE ELDERLY FASTEST GROWING SEGMENT OF OUR POPULATION MAINTENANCE OF CHRONIC ILLNESS *" SYSTEM OF AFFORDABLE, QUALITY HEALTH CARE. WITH A NET WORK OF PRIMARY CARE AND PREVENTION CLINICS AND ESTABLISHMENT OF COMPRHENSIVE PREVENTION PROGRAMS WE CAN BUILD A HEALTHY COMMUNITY. WE HAVE THE COMMUNITY HEALTH RESOURCES AVAILABLE IN THIS COMMUNITY TO MAKE IT HAPPEN. Vice Chairman Eggert opened the meeting to questions from the audience. There being none, she closed the meeting and thanked everyone for coming. There being no further business, the Board adjourned at 6:30 p.m. ATTEST: J. arton, Clerk Minutes approved Ao Fran B. Adams, Chairman 16 MAY 229 1996 BUCK 98 PAcc 186