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HomeMy WebLinkAboutHealth & Human Services 04-11-03 MARY LOUISE OLSON WILL REVIEW VOUCHERS AT 8:00 AM REVISED ST. CROIX COUNTY REVISED NOTICE OF COMMITTEE MEETING TO: Clarence Malick, Chairman St. Croix County Board FROM: Tom Dorsey (John Borup, 246-8223) COMMITTEE TITLE: St. Croix County Health and Human Services Board DATE: 04/11/03 TIME: 8:30 a.m. LOCATION: St. Croix County Health and Human Services Complex, New Richmond CALL TO ORDER ROLL CALL ADOPTION OF AGENDA DATE OF NEXT MEETING: 04/24/03 OR 05/09/03 ACTION ON PREVIOUS MINUTES: 03/27/03 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Resolution to downsize Nursing Home licensed bed capacity NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Presentation of 2002 Annual Report 4. Action on bids to purchase 12-passenger van 5. Personnel Issues a. Request to contract for Mental Health Therapist b. Review of Financial Assistant Position to Lead Worker 6. Equipment/shelving needs for centralized medical records 7. Reappointments and Privileges of the Medical Staff for 2003 8. Preparation for County Board Goal Setting Session ANNOUNCEMENTS & CORRESPONDENCE POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT (Agenda not necessarily presented in this order) SUBMITTED BY: John M. Borup DATE: COPIES TO: COUNTY BOARD OFFICE COUNTY CLERK NEWS MEDIA/NOTICE ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD April 11, 2003 The St. Croix County Health and Human Services Board met on April 11, 2003 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Leon Berenschot Lois Burri Dr. James Craig Mary Louise Olson Ralph Swenson Esther Wentz MEMBERS ABSENT: Chris Bethke, excused Fern Johnson-Schmidt, excused STAFF PRESENT: John M. Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Judy Ziegler, Accounting Supervisor Ron Kiesler, AODA/Mental Health Coordinator Steve Kirt, Mental Health/AODA Clinical Services Supervisor Kristie Tellijohn, Director of Nursing-Nursing Home Malva Berg, Secretary OTHERS PRESENT: Clarence Malick, County Board Chair Deb Kathan, Personnel Director Chair Dorsey called the meeting to order at 8:30 AM noting the meeting was properly and legally publicized. NEXT MEETING: The next Health and Human Services Board meeting is scheduled for Friday, May 9th at 8:30 AM. Wentz will review vouchers at 8:00 AM. AGENDA: Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: That the agenda be approved as circulated. MINUTES: Motion: A motion was introduced by Wentz, seconded by Berenschot, and unanimously adopted: That the minutes of the 03/27/03 Health and Human Services Board meeting be approved as distributed. APPOINTMENTS: The three-year terms for the citizen members appointed to the Health and Human Services Board expire in April. Malick asked that citizen members continue to serve until reappointments are made and hopefully that will be done in May. RESOLUTION TO DOWNSIZE NURSING HOME LICENSED BED CAPACITY: The issue to downsize is being pushed by our empty beds, reduced IGT monies and the State's penalty to tax licensed beds beginning 07/01/03. The estimated net effect of that bed tax will be (-$38,000) per Brian Schoeneck. The resolution presented today does not have a number on it but administration is recommending 84 and to discuss a long-range plan to possibly decrease down to 50 beds. The IGT funds will be cut in 2004 and possibly will be gone in 2005. St. Croix County Health and Human Services Board Page 2 April 11, 2003 Malick questioned the possibility to divide the nursing home and make two facilities under 50 beds. Corporation Counsel said the idea should be carefully considered and outside expert, legal counsel as well as financial and tax consultants should be obtained to determine if it is possible. Krieger said it would be difficult to divide the nursing home into two facilities because dietary and other support services would be shared, making it difficult to separate two separate operations. The goal of the facility was questioned. Is the goal to take care of as many residents as we can or to have as low as a levy as possible? Swenson questioned if there were plateaus as to the best staffing levels/resident needs. Krieger said according to David Lund 50 would be the most efficient facility and staffing should be in eight-bed increments. With more staff, there is more cost. 88 is the average census for the last few weeks. Krieger said beds that are delicensed are not retrievable. Board members were concerned that having too low of a number, services to a portion of the population would be eliminated if the goal is to create a waiting list. Berenschot said we need to serve people who are out there whether or not it costs money (county levy). If this is the case, St. Croix County residents will have to foot the bill for services. Dorsey said we may need to look at the census every year. Borup said 50 is too dramatic of a cut now. He said there are no settled union contracts and administration has no control over salaries. Borup encouraged Board members to consider a freeze on salaries. Krieger said there would be a cost savings in management and supervisory positions if the beds were lowered from 124 to 84. She said adjustments have already been done in staffing through attrition, etc. She said some positions can't be cut but the hours could be cut as some work still needs to be done. The new computer software for the Nursing Home is still being implemented; staff are still in the training process. David Lund from the state's financial department has offered an incentive to guarantee our Medicaid rate through the downsizing period up to 18 months. If a decision is made as to the facility number before June 30, 2003, the board will not need to bank or unbank beds since we will be in the process of downsizing. Additionally, the option to switch beds from one wing to another after they are delicensed can be done so the facility is not stuck with a delicensed bedroom that may later be needed during remodeling. The longer it takes to downsize, the more money we get as the State will guarantee our Medicaid rate until we reach the number we downsize to. The census today is 83. Krieger said the building design discourages a niche market for Alzheimer's. She said behavior management is the focus of our facility and we receive referrals from area facilities for behavior management residents. She said if the facility specializes in behavior management only, we would lose more money as it takes more staff to take care of behavior management clients. She suggested a cooperative effort with Dunn, Polk and St. Croix County due to specific needs of residents as each county has their own specialty. Swenson would like to see a cooperative effort with Dunn, Polk and St. Croix Counties to care for the residents of this area in the form of a possible regional center as to where it makes sense to do this, specialization and managerial St. Croix County Health and Human Services Board Page 3 April 11, 2003 interests and the possibility of sharing residents. The Board would support funding to cooperate with others to develop a market for the cooperative effort. Malick said this effort should not wait until 2004. Motion: A motion was introduced by Wentz, seconded by Burri, That the resolution to downsize be at 84 at this time and in a year's time this may need to be a lower number. The resolution is as follows: RESOLUTION AUTHORIZING THE ST. CROIX COUNTY NURSING HOME TO DOWNSIZE TO 84 BEDS RESOLUTION WHEREAS, the St. Croix County Nursing Home is responsible for caring for those needing nursing home care; and has experienced a declining census; and WHEREAS, the State of Wisconsin has recognized the declining census statewide and imposed a penalty on the Medicaid rate if occupancy drops below 90.5%; and WHEREAS, declining Intergovernmental Transfer Dollars (I.G.T.) will significantly increase costs for County Nursing Homes; and WHEREAS, St. Croix County can reduce county expenditures by downsizing the Nursing Home's capacity, as of July 1, 2003. NOW, THEREFORE, be it resolved by the St. Croix County Board that the St. Croix County Nursing Home will proceed with downsizing the Nursing Home's licensed bed capacity from 124 beds to 84 beds, effective July 1, 2003, with a letter to the State of Wisconsin dated by June 30, 2003. Dated this 11th day of April, 2003. Offered by: St. Croix County Health and Human Services Board. Roll call vote: Thomas Dorsey-yes Leon Berenschot-no Chris Bethke-absent Lois Burri-yes James Craig-yes Fern Johnson-Schmidt-absent Mary Louise Olson-no Ralph Swenson-no Esther Wentz-yes Four yes, three no, two absent, motion passed. Dorsey said the Board members should go before the full County Board in a unified effort. Krieger said the Nursing Home will lose revenues if admissions are no longer accepted. Krieger said bedhold, which is 85% of the Medicaid rate, is granted if the facility is at 95% occupancy. The occupancy penalty for less than 91% occupancy is being eliminated and will be gone by 07/10/05 St. Croix County Health and Human Services Board Page 4 April 11, 2003 The Board recessed from 9:55 to 10:05. Malick left the meeting. REQUEST TO CONTRACT FOR MENTAL HEALTH THERAPIST: Administration is proposing that we seek an additional Mental Health therapist for 2004 and meet current demands by contracting for a Mental Health therapist (non-county employee) for the rest of 2003. Borup said he is supportive of this concept that it is essentially a financial push to contract for this position. Kiesler said a contracted position is typically more costly than to hire a regular St. Croix County employee. Kiesler said there are no direct dollar figures as to what it would cost to contract for this position as a contract will need to be negotiated. Motion: A motion was introduced by Berenschot, seconded by Swenson, and unanimously adopted: That the Board approves to contract time for additional therapy time through 2003. Olson questioned what would happen to this position if there was a freeze across the County. REVIEW OF FINANCIAL ASSISTANT POSITION TO LEAD WORKER: Administration is requesting to upgrade this position to a lead worker. This position would provide daily supervision for five bookkeeping staff to free up time for Judy Ziegler for financial monitoring. Borup said the staff in this position currently works four days per week. Kathan said this position will need to go to the Personnel Committee for approval if approved by the Health and Human Services Board and the position would not necessarily be increased one full level. Swenson questioned whether the expectations of this position raised the bar enough that the position would be able to perform tasks required and providing training for programs used. Motion: A motion was introduced by Wentz, seconded by Olson, and unanimously adopted: That the Board approves upgrading the Financial Assistant position to Lead Worker position and that the position be forwarded to the Personnel Committee. CONSIDERATION OF CLAIMS: The following reports were distributed to the Board: March cash report and March fixed asset report. Health and Human Services Board member, Olson, reviewed the following vouchers: HUMAN SERVICES: 18431: $300.00, emergency assistance. Payment to a landlord to prevent a family from becoming homeless. Emergency assistance-Homeless is a fully funded State program. 18764: Cumberland Memorial Hospital, $5,120.00, cost for one client for eight days of service. Cost is $640 per day at Cumberland. 18790: J.C. Chauffeur Service, $532.00, transportation. Costs for a Long Term Support client for the month of March. Trips include grocery shopping, doctor appointments, appointments at Human Services facility. 18858: University of CA-Berkeley, $28.00, Public Health subscription. One-year subscription to "Wellness Newsletter." St. Croix County Health and Human Services Board Page 5 April 11, 2003 Motion: A motion was introduced by Olson, seconded by Wentz, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 18355 through 18457, dated March 20, 2003 in the amount of $145,177.80. Human Services vouchers 18458 through 18510, dated March 27, 2003 in the amount of $278,075.24. Human Services vouchers 18511 through 18573, dated April 03, 2003 in the amount of $57,585.19. Human Services vouchers 18574 through 18741, dated April 11, 2003 in the amount of $115,762.15. Human Services vouchers 18745 through 18871, dated April 11, 2003 in the amount of $349,855.74. Nursing Home vouchers 2605 through 2611, dated March 20, 2003 in the amount of $3,372.94. Nursing Home vouchers 2612 through 2616, dated March 27, 2003 in the amount of $749.08. Nursing Home vouchers 2617 through 2620, dated April 03, 2003 in the amount of $19,245.32. Nursing Home vouchers 2622 through 2659, dated April 11, 2003 in the amount of $45,140.47. Human Services, Workshop, Public Health, Social Services vouchers 109 through 139, dated March 06, 2003 in the amount of $322,626.30. Human Services and Nursing Home vouchers 109 through 138, dated March 11, 2003 in the amount of $186,684.86. Human Services, Workshop, Public Health, Social Services vouchers 139 through 167, dated March 25, 2003 in the amount of $328,194.73. Human Services and Nursing Home vouchers 139 through 168, dated March 25, 2003 in the amount of $186,740.86. FINANCIAL REPORTS: The following financial reports through February were distributed to the Board. Borup announced that the audit may be a bit delayed due to a medical leave for Rod Paulson, CPA, but it is possible that he may attend the May 9th meeting to give the audit presentation. Borup announced Public Health received $1,500 in United way funds, the Nursing Home received $3,500 in United Way funds. There is currently a project underway through the Rotary, Lions and Kiwanis to solicit an additional $2,249 in funds for the Nursing Home. Borup said W-2 and Economic Support will be discussed at the next meeting regarding the possible dramatic downturn in the number of Economic Support/W- 2 employees across the State. St. Croix County Health and Human Services Board Page 6 April 11, 2003 ST. CROIX COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD 01/01/03 THROUGH 02/28/03 NURSING HOME 02/28/03 Cash Balance 02/28/03 $591,798.19 Add: Accounts Receivable, 02/28/03 Private Pay $60,958.97 Medicare $128,594.83 Medicaid $228,337.89 General $0.00 Accounts Payable-02/28/03 ($125,954.60) Net Current Items, 02/28/03 $883,735.28 2003 Revenue Recorded through 02/28/03 $1,021,225.28 Includes Allocations of Anticipated Revenues 2003 Expenses Recorded through 02/28/03 $1,051,208.51 Includes Allocations of Expected Expenses Net Revenues over Expenses ($29,983.23) St. Croix County Health and Human Services Board Page 7 April 11, 2003 HEALTH AND HUMAN SERVICES - 2003 SUMMARY Total OF REVENUES Jan.-Feb. Budget Balance % Administration 122,345.09 763,412.00 641,066.91 16.0% AODA Services 61,744.26 440,846.00 379,101.74 14.0% Long Term Support 2,219,188.66 12,731,125.00 10,511,936.34 17.4% Mental Health 246,949.74 2,381,245.00 2,134,295.26 10.4% Family & Children's 402,475.36 2,648,969.00 2,246,493.64 15.2% Economic Support 135,494.03 1,025,999.00 890,504.97 13.2% General Relief 85.93 18,663.00 18,577.07 0.5% REVENUES HUMAN SERVICES PROGRAMS 3 188.283 07 20.010.259 00 16.821 979 92 15.9% Public Health 204.683.29 1 347 443 00 1 142 759.71 19.2% TOTAL REVENUES HEALTH AND HUMAN SERVICES 3 392 966.36 21.357.702.00 17,964 735 64 15 9% SUMMARY Total OF EXPENDITURES Jan.-Feb. Budget Balance % Administration 129,531.90 763,412.00 633,880.10 17.0% Alcohol-Drug Abuse 72,944.90 440,846.00 367,901.10 16.5% Long Term Support 2,096,936.46 * 12,731,125.00 10,634,188.54 16.5% Mental Health 427,173.64 2,381,245.00 1,954,071.36 17.9% Family & Children's 376,762.84 * 2,648,969.00 2,272,206.16 14.2% Economic Support 184,107.10 1,025,999.00 841,891.90 17.9% General Relief 1,007.76 18,663.00 17,655.24 5.4% Accrued Payroll 322,544.37 0.00 (322,544.37) 0.0% EXPENDITURES HUMAN SERVICES PROGRAMS 3,611,008.97 20,010,259.00 16,399,250.03 18.0% Public Health 229.793.63 1.347.443.00 1.117.649.37 17-1s TOTAL EXPENDITURES HEALTH AND HUMAN SERVICES 3.840.802.60 21.357.702.00 17.516.899.40 18.0% To be on budget, percentage should be 16.67% St. Croix County Health and Human Services Board Page 8 April 11, 2003 ST CROIX HEALTH CENTER OPERATIONS REPORT JAN THROUGH FEBRUARY 2003 JAN-FEB BUDGET ACTUAL CENSUS OPERATING REVENUE: MEDICARE $ 1,254,708.00 $ 162,535.80 MEDICAID $ 2,929,061.00 $ 467,598.57 PRIVATE PAY $ 1,025,316.00 $ 138,426.46 ALL OTHER SOURCES $ 1,117.00 $ 286.45 TOTAL OPERATING REVENUE $ 5,210,202.00 $ 768,847.28 OPERATING EXPENSES: DAILY PATIENT SERVICES $ 4,252,427.00 $ 648,664.09 SPECIAL SERVICES $ 300,748.00 $ 50,102.22 GENERAL SERVICES $ 1,279,983.00 $ 194,930.02 ADMINISSTRATIVE SERVICES $ 507,779.00 $ 72,794.56 UNASSIGNED: DEPRECEIATION(%BASED) $ - $ 31,028.00 OTHERS $ 367,926.00 $ 53,689.62 TOTAL OPERATING EXEPNSES $ 6,708,863.00 $ 1,051,208.51 NET FROM OPERATIONS NON-OPERATING ITEMS: REVENUE FROM RATE APPEALS $ 14,808.00 $ 2,468.00 ITG FUNDS (%BASED) $ 798,386.00 $ 135,666.00 CO ALLOCATION (%BASED) $ 685,467.00 $ 114,244.00 TOTAL NON-OPERATING ITEMS $ 1,498,661.00 $ 252,378.00 NET FROM ALL SOURCES $ - $ (29,983.23) PERCENT SHOULD BE 16.67. FUND BALANCE 01101f03 AUDITED $ 1.68 4,566 .10 PRIOR OPERATIONS $ (29,983.23) CASH REPLENISHMENT(%$250,000) $ 41,667.00 FUND BALANCE END OF PERIOD $ 1,696,249.87 PRESENTATION OF 2002 ANNUAL REPORT: Borup gave a PowerPoint presentation for the 2002 annual report. Board members offered some suggestions for changes in the presentation. Wentz said more than 15 minutes is needed to present the annual report as Health and Human Services is the largest entity of the County. Members requested a mission statement be included on the lead page of the presentation and that a list of accomplishments be at the end of the report. St. Croix County Health and Human Services Board Page 9 April 11, 2003 REAPPOINTMENTS AND PRIVILEGES OF THE MEDICAL STAFF FOR 2003: Motion: A motion was introduced by Wentz, seconded by Berenschot, and unanimously adopted: That the following reappointments/appointments/ privileges to the Medical staff as recommended by the Credential committee at their annual meeting January 28, 2003 meeting be approved. 1. REAPPOINTMENTS TO MEDICAL STAFF: The Credentials Committee of the Medical Staff recommends to the St. Croix County Department of Health and Human Services Board the reappointments to the Medical Staff of the following members: ACTIVE STAFF CONSULTING STAFF David DeGear, MD Pastor Colon, MD Joseph Beuning, Bruce Hanson, MD Colin Drury, MD Physician's Assistant David Olson, MD Hamid Khan, MD Cynthia Blader, Joseph Powell, MD Neal Melby, MD Physician's Assistant Clifford Tenner, MD John Simon, MD Marjorie Belisle, NP Robin Reichert, MD Mike Melby, MD Bruce Schultz, M.D. Jeng-Lu Lai, DPM 2. DELINEATION OF PRIVILEGES: The Credentials Committee of the Medical Staff recommends to the St. Croix County Department of Health and Human Services Board the approval of the Delineation of Privileges as applied for by the medical staff to include Group I privileges: 1. Care of non-critical medical and geriatric patients, and patients who are admitted for diagnostic purposes. 2. Care of terminally ill patients. 3. Care of first and second-degree burns. 4. Minor surgery, including simply lacerations, incision and drainage of superficial abscesses, removal of lightly imbedded corneal foreign bodies, and emergency tracheostomy. For: David DeGear, MD Pastor Colon, MD Bruce Hanson, MD Colin Drury, MD David Olson, MD Hamid Khan, MD Joseph Powell, MD Neal Melby, MD Clifford Tenner, MD John Simon, MD Robin Reichert, MD Anthony Hecht, MD Bruce Schultz, MD Jeng-Lu Lai, DPM And recommends Group II Specialty Privileges as applied for by: David DeGear, MD Pastor Colon, MD Bruce Hanson, MD Colin Drury, MD David Olson, MD Hamid Khan, MD Joseph Powell, MD Neal Melby, MD Clifford Tenner, MD Mike Melby, MD Robin Reichert, MD John Simon, MD Bruce Schultz, MD Joseph Beuning, PA Cynthia Blader, PA Jeng-Lu Lai, DPM Anthony Hecht, MD Marjorie Belisle, NP ' - St. Croix County Health and Human Services Board Page 10 April 11, 2003 ACTION ON BIDS TO PURCHASE 12-PASSENGER VAN: Three bids were received for a 12-passenger van. Eichstaedt said the vehicle may have to be manufactured and delivery may take 6-12 weeks. Eichstaedt distributed a spreadsheet on the vehicle specifications and prices and recommended purchasing the lowest bidder, which is Dave Holt Ford. Motion: A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: That the Board approves purchasing a van from Dave Holt Ford for $19,259 with trade in and approves allowance for additional delivery cost if any. EQUIPMENT/SHELVING NEEDS FOR CENTRALIZED MEDICAL RECORDS: Borup gave the following reasons for purchasing high-density shelving for medical records. High Density Mobile Filing and Storage Systems: ➢ HIPAA Compliance-security through centralization ➢ Save floor space ➢ Increase storage capacity ➢ Reduce access time ➢ Improve productivity ➢ Reduce operating costs ➢ Improve efficiency ➢ Lower capital outlay A spreadsheet outlining the three bids received for shelving was distributed. The Datum shelving from Offisource was the lowest bid. Borup said high- density shelving would allow Headstart to continue leasing the rest of the gym area. Motion: A motion was introduced by Berenschot, seconded by Burri and unanimously adopted: That the Board approves purchasing the high density shelving from Datum if the money can be found to do this. Borup will explore further. Dorsey asked if there were any other issues to bring before the Board. Wentz requested a round of applause for Borup for all he does for the Board. Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: that the meeting be adjourned. Time: 11:45 AM Chair: Attest: (Secretary)