McLean County Health Committee met Nov. 4.
Here is the minutes provided by the committee:
The Health Committee of the McLean County Board met on Monday, November 4, 2019 at 4:30 p.m. at the Government Center Building 115 E. Washington Street, Room 400 Bloomington, IL.
Members Present: Chairman Susan Schafer, Members: George Wendt, Carlo Robustelli, George Gordon, Catherine Metsker (4:34) and Sharon Chung
Members Absent: Member Randall Martin
Other Members Present: None
Staff Present: Ms. Camille Rodriguez, County Administrator; Mr. Eric Schmitt
Assistant County Administrator; Ms. Cassy Taylor, Assistant
County Administrator; Ms. Jessica Woods, First Assistant State’s
Attorney – Civil Division, Ms. Julie Morlock, Recording Secretary
Elected Officials Present: Ms. Tammy Brooks, Interim Administrator Health Department; Mr.
Mike Donovan, Director Court Services; Mr. Jason Tabb, Juvenile Detention Center Director; Ms. Cindy Wegner, Nursing Home
Chairman Schafer called the meeting to order at 4:30 p.m. and declared a quorum.
Chairman Schafer presented the minutes from the September 30, 2019 regular meeting for approval.
Motion by Chung/Gordon to approve the minutes from the September 30, 2019 regular meeting.
Chairman Schafer confirmed there were no members of the public to appear before the Committee.
Ms. Cindy Wegner, Director, Nursing Home presented for action a request to approve a First Amendment to Agreement between McLean County Nursing Home and Symbria Rehab Inc. Ms. Wegner indicated this reflects change in Medicare reimbursement with our current company. She stated this contract would go for RFP as it ends February 1, 2020. Ms. Schafer asked if she could explain the new payment model. Ms. Wegner indicated it is called PDPM Patient Driven Payment Model that adds a nursing component so therapy does not drive the entire payment and they pay less money to the therapy company with this model.
Motion by Gordon/Chung to recommend approval of a First Amendment to Agreement between McLean County Nursing Home and Symbria Rehab Inc./ Motion Carried.
Ms. Metsker joined the meeting.
Ms. Wegner presented for action a request to approve an Amendment to the Medline Post- Acute Corporate Sales Supply and Program Agreement. Ms. Wegner indicated we buy medical supplies through this company, so they are offering us a program to educate nursing staff on skin treatment programs. Mr. Gordon asked her to confirm contract will end in April. Ms. Wegner confirmed.
Motion by Robustelli/Wendt to recommend approval of an Amendment to the Medline Post-Acute Corporate Sales Supply and Program Agreement.
Ms. Wegner presented for action a request to approve Merchant Agreement between McLean County (Nursing Home), Worldpay, LLC and Government Payment Services d/b/a GovPayNet. Ms. Wegner stated this would allow them to take credit cards for payment. Ms. Schafer asked if this is for monthly charges or incidentals. Ms. Wegner confirmed for monthly statements.
Motion by Robustelli/Chung to recommend approval of Merchant Agreement between McLean County (Nursing Home), Worldpay, LLC and Government Payment Services d/b/a GovPayNet.
Ms. Wegner presented for action a request to approve the Nursing Home 2020 Private Pay Rate. Ms. Wegener indicated this has a 3% increase that keeps our rates in the middle of what other facilities in the area are charging.
Motion by Metsker/Robustelli to recommend approval of the Nursing Home 2020 Private Pay Rate.
Ms. Wegner presented her monthly reports. Ms. Schafer asked about why there were only four admits. Ms. Wegner indicated there was a federal survey in the facility in September and survey window is still open, so there is a possibility we would not be reimbursed for Medicare or Medicaid patients, therefore we are not taking any of those patients until survey window closes. Ms. Schafer asked when window closes. Ms. Wegner stated it closes when they come back in. Ms. Schafer asked about tags they found. Ms. Wegner indicated they found structure issues such as firewalls and generator. She stated they had a life safety code professional organization come in and give recommendations. Ms. Wegner indicated they have submitted plan of correction so could come back any day. She stated they asked for an extension in the plan of correction but extension does not affect when they come back and close the survey window. Mr. Gordon asked if we have an idea of their time frame. Ms. Wegner indicated the federal government reviews the plan of correction and contacts the State and the State comes back out. Ms. Metsker asked about budgeting the corrections to the nursing home. Mr. Schmitt indicated they have been working with Farnsworth group for the design work to get the tags corrected and would bid out construction and bring budget amendment to them once they have more information. Mr. Robustelli asked if these were tagged previously. Ms. Wegner indicated these had not been pointed out before. Ms. Schafer asked if Federal reviews the State survey. Ms. Wegner indicated they do not and they are separate surveys. Mr. Wendt asked about getting a second opinion on the inspection. Ms. Wegner stated that was why they had the professional group in Chicago made up of former life safety surveyors come in. Ms. Schafer asked if there was an appeal process for the federal inspection. Ms. Wegner indicated used to be able to ask for an ongoing waiver, but do not allow that anymore, but they will allow extensions. Mr. Wendt asked about code inspection was based on. Ms. Wegner indicated this is based on fire safety code. Ms. Schafer asked if we consult with Town of Normal. Ms. Wegner indicated that they do not do these types of reviews and recommendations.
Ms. Wegner presented an updated report on the Blue Ribbon. Ms. Metsker asked if recommendations have been implemented. Ms. Wegner confirmed they have been implemented. Ms. Metsker asked about outcomes on things implemented and provided example of food changes. Ms. Wegner indicated they added food options and families and residents have been pleased with changes. Ms. Metsker asked about staff satisfaction and the partners in care committees. Ms. Wegner went over members and topics. Ms. Metsker asked who determines topic. Ms. Wegner indicated the family asks for other information. Ms. Metsker stated she would like to see in the future more information about how the satisfaction committee looks to achieve their objectives.
Ms. Metsker stated it looked like they saved money with agency, and asked how they are attracting employees. Ms. Wegner indicated that in the report are suggestions of ways to attract staff. Ms. Metsker indicated she was glad to see they are working with local colleges to gain staff. Ms. Wegner indicated that they have been fortunate in getting CNA students from Heartland. Ms. Schafer asked if the hospital liaison was located at the nursing home. Ms. Wegner indicated they are at the hospitals, doctor offices, and different senior agencies but does have a place at the nursing home. Ms. Schafer asked how not being able to take Medicare residents has affected that job. Ms. Wegner indicated they still check with private and senior locations. Ms. Schafer asked if they would be willing to have board members attend the resident committee meeting. Ms. Wegner stated she thought that would be possible. Ms. Schafer asked about strategic planning committee. Ms. Wegner went over action plans they are working on.
Mr. Robustelli asked about memory care and hospice units. Ms. Wegner went over estimate on cost and rates for the unit to incorporate a memory unit. Mr. Robustelli asked if wages include healthcare and retirement costs and to confirm rates and capacity. Ms. Wegner went over numbers she estimated. Mr. Robustelli indicated he would recommend a more conservative projection. Mr. Wendt agreed that a more realistic estimate based on needs of community and census was needed. Ms. Schafer also agreed and indicated she would like information on costs for training. Ms. Schafer said she wanted to move cautiously into memory care to make sure are prepared for it as she felt there other things that were a priority. Mr. Robustelli said he agreed need to take care of facility needs but felt facility is underutilized. He stated they needed to consider suggestions because he did not feel it was sufficient to do things we have been doing, but need to do new things and utilize space to bring in new revenue to help make the nursing home sustainable. Ms. Schafer agreed but stated she wants to do it well and not rush forward. Ms. Chung stated she met with Ms. Wegner a couple of years ago and discussed memory care and agreed it is time to move it forward. Ms. Chung left the meeting at 5:15
Mr. Jason Tabb, Juvenile Detention Center came forward and presented his report. Chairman Schafer indicated that Ms. Welch was not present but her report was in the packet. Chairman Schafer asked about tour of Jail Medical at the end of the meeting. Chairman Schafer asked if there were questions; hearing none, she thanked him.
Ms. Tammy Brooks, Health Department Interim Administrator presented her monthly reports to the Committee. Ms. Metsker asked about innovative ways to replace dental supervisor. Ms. Brooks indicated the president of the dental society had been in discussions with an advanced practice dental school in Peoria, who have their dental degrees but are going back for advanced training, to do rotations in agencies in our area and has added McLean County Health Department. Chairman Schafer ask if there were any questions or comments for Ms. Brooks, hearing none, she thanked her.
Ms. Rodriguez presented for review and approval the Tort Judgement – Risk Management/Juvenile Detention Program (0135-0077-0022) budget. Mr. Tabb indicated a similar budget to previous years, but pointed out they have been sharing a nursing with the Health Department since March but have a part-time nurse now. Mr. Gordon asked if costs are increasing for vaccines. Mr. Tabb indicated costs are not increasing but number of clients are increasing, so he increased this amount. Ms. Schafer asked if they are finding children without immunizations. Mr. Tabb stated it is not immunizations but prescription medication they are supposed to be on.
Motion by Gordon/Robustelli to recommend approval of the Tort Judgement – Risk Management/Juvenile Detention Program (0135-0077-0022) budget. Motion Carried.
Ms. Rodriguez presented for review and approval the Tort Judgement Fund 0135, Tort Judgement Department 0077, Risk Management / Correctional Health Services Program 0073 (Revision). Mr. Schmitt indicated they passed this budget last month and went over the change staff is recommending to that budget. Mr. Gordon asked about increase. Mr. Schmitt indicated that registered nurse salary amount went up to allow it to be more competitive.
Motion by Metsker/Gordon to recommend approval of the revised budget for Tort Judgement Fund 0135, Tort Judgement Department 0077, Risk Management / Correctional Health Services Program 0073.
(58:48) Ms. Rodriguez presented for review and approval the Nursing Home Fund 0401, Nursing Home Department Budget. Ms. Wegner indicated there were no major changes except budgeting for a new small transportation van. Mr. Schmitt indicated that was another change, as the communication specialist time would be divided with the Nursing Home where the nursing home pays 20% of that salary. (1:02:05) Mr. Gordon asked about employee full time salary increase. Ms. Wegner indicated that was for merits and across the board. Mr. Schmitt added there was a pay rate change for nurses to be competitive with the market. (1:03:20) Mr. Robustelli questioned the revenue projections as there was about an extra million in projected revenue and where that increase was coming from. Mr. Robustelli asked if numbers based on memory care unit. Ms. Wegner stated they were not but enhanced programing did factor in. He asked if Illinois Public Aid is a reliable source of revenue. Ms. Wegner confirmed it was. Mr. Robustelli asked if they were doing something different than in the past to attract Public Aid clients. Ms. Wegner said they were not looking to attract more but did take into account conversions of patients to Medicaid as well as referrals from hospitals and the fact that one of the facilities in the area decertified their Medicaid beds.
Mr. Wendt asked her to confirm increased reimbursement rate. Ms. Wegner confirmed the increased amount. Ms. Schafer asked her to confirm they cannot take Medicare or Medicaid right now. Ms. Wegner confirmed only taking private pay and VA. Ms. Schafer asked if that was taken into account with the budget. Ms. Wegner stated should be resolved in the next couple of weeks. Ms. Wegner stated she based budget on 115 average daily census, which was lower than budget census used last year. (1:09:28) Mr. Gordon asked about census for year before and Ms. Wegner stated it was either 120 or 125.
Mr. Wendt stated he felt they should base revenue on average census from last year. Ms. Wegner indicated they took into account the liaison and increased marketing. Mr. Robustelli indicated that nursing homes are struggling nationwide so he too felt we should be conservative, which he knew would mean budgeting more unappropriated fund balance. (1:14:32) Ms. Schafer agreed and commented on seeing a more realistic temporary agency usage amount. Mr. Gordon agreed with Ms. Schafer about budget for the agency services. Mr. Robustelli stated he was aware that we cannot turn the situation at the Nursing Home around right away, but he felt continued loss supports case for more dramatic action for revenue enhancements at the Nursing Home. He asked if they could make changes to the budget at this point in the process. Ms. Schafer agreed, and asked staff if they could adjust budget based on lower census numbers and realistic expenses especially for agency services. Mr. Schmitt indicated they could but asked for clarification on census number Committee wanted to utilize. (1:20:08) Discussion among members regarding census numbers to be utilized for revenue and expense lines. (1:31:28) Discussion about timing to approve budget and continued discussion about numbers to be utilized. (1:37:08) Mr. Robustelli suggested a special meeting of the Committee on Friday to discuss a budget based on average census from last 22 months and adjusted expense numbers for temporary staffing. Discussion about timing and possible special meeting.
Motion by Robustelli/Metsker to recommend approval of the Nursing Home Fund 0401 Department budget.
Motion by Gordon/Wendt to table to date and time determined by the Administrator. (Determined at meeting Friday, November 8th at 3:30 p.m.) Motion Carried.
Ms. Rodriguez went over the new positions hired. Ms. Schafer asked if there were any other questions; hearing none, she thanked Ms. Rodriguez.
Ms. Schafer indicated the next meet would be on Friday, November 8th at 3:30 p.m. and the next regularly scheduled meeting would be Monday, December 2, 2019 at 4:30 p.m. She also went over proposed meeting dates for 2020.
Chairman Schafer presented for approval Nursing Home bills with a prepaid total $575,085.38.
Motion by Robustelli/Gordon to approve prepaid bills for the Nursing Home as presented.
Chairman Schafer presented the bills for the Developmental Disability Board with a prepaid total of $63,671.25.
Motion by Gordon/Wendt to approve prepaid bills for the Developmental Disability Board as presented.
Chairman Schafer presented for approval bills for Jail Medical and JDC Medical with a prepaid total of $74,307.22.
Motion by Metsker/Gordon to approve prepaid bills for Jail Medical and JDC Medical as presented.
Chairman Schafer presented for approval bills for the Board of Health with a prepaid total of $245,927.33.
Motion by Robustelli/Metsker to approve prepaid bills for the Board of Health as presented.
Chairman Schafer asked if there was any additional business to come before the Committee; hearing nothing, she adjourned the meeting at 6:19 p.m.