Health Committee

March 9, 2004 – 8:00 a.m.

DRAFT Minutes

 

Members present: Dr. Paul DiGiovanni, Chairman; Steve Dafoe; Mike McKee; Carol Tytler; Newell Willcox; Tamara Wyant

Others present: Ann Homer, Secretary to the Legislature/County Attorney; Elaine Lambert, Director, Jacobus Center for Reproductive Health; John Helgrin, Environmental Health, Bob Gardner, Family Counseling Services; Jackie Gailor, Public Health Director; Pat Mellberg, Family Counseling Services; Scott Schrader, County Administrator; MJ Uttech, Deputy Public Health Director; Scott Steve, Chairman of the Legislature; Linda Medeiros, Administrative Officer, Mental Health Clinic; Cara Hoffman, Cortland Standard

Absent: Larry Cornell

Dr. DiGiovanni called the meeting to order at 8:06 a.m.

Mr. McKee moved approval of minutes of the February 4, 2004, meeting; seconded by Mr. Willcox; all members voting in favor; none opposed; minutes approved.

RESOLUTIONS:

     

  1. Amend 2004 Budget, Health Department/ Jacobus Center for Reproductive Health (Wilkins Foundation and Anna Hilton Estate Donations). Mrs. Tytler moved adoption; seconded by Ms. Wyant. Dr. DiGiovanni spoke about the need for computer equipment to go through the Data Processing Department for review. Mrs. Tytler said that in her company, data processing must sign off on the purchase of computer equipment. Mrs. Gailor explained that the Health Department has its own Systems Administrator, who works directly with Mr. Corpora and that is where the estimate for the printer cost came from. Mr. Steve indicated that he feels when we receive "gifts" such as these, we should use the funds to enhance the program, not make one time purchases. Also, he feels we should be looking at purchasing a multi-function machine instead of laser printer. Mr. Steve also feels we should use money such as this for advertising and promotion of a program and not for things like "training and education." All members voting in favor; none opposed; motion adopted.

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  2. Authorize Data Use Agreement, All County Agencies. Mrs. Tytler moved adoption; seconded by Mr. Willcox. Mrs. Gailor explained the purpose of this agreement. Dr. DiGiovanni inquired why this was coming from Health. Mrs. Gailor explained because the groundwater issues would come through the Health Department. All members voting in favor; none opposed; motion adopted.

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  3. Authorize Agreement, Health Department/Nursing Division (J. Vanesky, CPA). Mrs. Tytler moved adoption; seconded by Mr. Willcox. Dr. DiGiovanni asked if data processing had been involved in the software purchase. Mrs. Gailor explained that this software is program specific. This is an on-going renewal of the contract. We already have the software; it is installed by our Systems Administrator. The auditor is the person who works specifically for government agencies on CHHA. Mr. Schrader indicated his experience with Mr. Vanesky has been very positive, particularly along the lines of Medicaid and Medicare. He feels we should use him more, not less. Mrs. Gailor explained that this will allow us to look at revenue and expenses during the year. All members voting in favor; none opposed; motion adopted.

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  4. Authorize Agreement, Health Department/Nursing Division (Preferred Provider Agreements). Mrs. Tytler moved adoption; seconded by Mr. Willcox. All members voting in favor; none opposed; motion adopted.

DISCUSSION/PRESENTATIONS/DISTRIBUTIONS:
  1. Robert Gardner, Family Counseling Services, Presentation. Mr. Gardner and Ms. Mellberg provided an overview of the agency and how they interact with the County and in the community. Mr. Gardner offered the FCS facility for a Health Committee Meeting, which could then include a tour of the facility

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  2. County Financial Impact, Discussion-Dr. DiGiovanni. Dr. DiGiovanni reminded the committee of his goal of looking at where we want to function as a Health Committee and not be merely resolution driven. He feels we should be looking at the financial aspect of the health programs, given the County’s current fiscal status. Dr. DiGiovanni spoke about the negative fiscal functioning of our CHHA. He asked Mr. Schrader if the CHHA was still functioning in such a negative fiscal status. Mr. Schrader said further information will be coming shortly and he and Mr. Steve have met with Mr. Vanesky about doing a first quarter audit to see where we stand. Mr. Vanesky feels we have a turned a profit in 2003 and should break even in 2004. Mr. Schrader said this surprised him and concerned him that our numbers and Mr. Vanesky’s members were one-half million dollars off. Mrs. Gailor explained that the numbers were hers and as she had indicated early in the process that the numbers were based on the entire nursing program, not just the CHHA. Dr. DiGiovanni indicated that we have a half million dollar deficit and this committee needs to look at how we are going to cover this deficit. Dr. DiGiovanni said there are other areas that we need to look at. He asked Mr. Schrader to address this issue. Mr. Schrader said that the EI (Early Intervention) program has experienced a retroactive rate adjustment for the Racker Center, which results in an approximate payment of $130,000 additional to the Racker Center. He indicated that the number of individuals accessing the program are higher than budgeted for in 2004. This is a concern which may result in being over budget in EI – he does not have an estimation at this time. He will be meeting with Mrs. Gailor and Ms. Feuerherm to discuss this. Dr. DiGiovanni also spoke about evaluating the Environmental Health program. This was mentioned last year and we need to look at this again. The committee needs to think about some of these items and think about how we need to move forward on this. Dr. DiGiovanni asked globally what Mr. Schrader feels about the department of health – should it be money-making or a break-even initiative. Mr. Schrader said we need to look at the program at a whole. There is not a health department in the state that is functioning in a break-even or profit-turning mode. Having a "for profit" arm, such a CHHA, certainly helps with the funding of the mandated programs that are not 100% funded. There are some optional programs we are providing, but based on a community health assessment, those are programs that have been identified as a need in the community. We need to identify mandated v. non-mandated services and put a price tag on each of those. This needs to be done for all departments, not just the Health Department. Mr. Steve said a better way to look at it is to say how we can better utilize/maximize the funding in a quality way. Mrs. Tytler said that the committee cannot make any decisions until accurate information can be provided to the committee and her sense is that we don’t have accurate information at this point in time. Mr. Schrader said, not in the form in which he’d like to see it. We need to know what we are spending and what we are spending it on. Mrs. Tytler asked Mr. Schrader what his time frame is for having this information. Mr. Schrader indicated that he should be able to have mandated v. non-mandated information in a month – that should be rather basic. He would like to then hand the mandated v. non-mandated report off to department and have them break the cost down. That should take departments about two to three months. Mr. Steve said the committee needs to realize it will be six months out before we have hard numbers that can be utilized. Dr. DiGiovanni feels we need to look at the 21 counties that do not provide Environmental Health and see how things are working in those counties to evaluate our program. The members of the subcommittee to look at Environmental Health will be Newell Willcox, Mike McKee, and Steve Dafoe.

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  3. Enforcement Notice on CHHA. Mr. Steve said he didn’t know about this until yesterday and he was on Health Committee last year. Mrs. Gailor indicated that we didn’t know about this last year. Mrs. Gailor gave an overview of this issue, stating it began in April 2003 with a State Audit of the CHHA. The State comes in unannounced and spends several days evaluating the CHHA. The State always finds something wrong and issues a compliance report. With changes in Medicare, the State comes in and finds "standards out" which identifies major areas of deficiency. In July, the State came back and found that the CHHA had improved enough to continue functioning. The State returned a couple of weeks ago and they found we were doing much better and will therefore, they will not return for a year, which is the normal cycle. In investigating the fine, Ms. Gailor found out that it is normally $2,000 per "standard out" and we had five "standard outs", so the total fine could be $10,000. The fine basis can be appealed if we feel we can prove the State was wrong on the "standard out." In speaking with the State, the State will reduce the fine to $5,000. Mr. Steve indicated that if there is money budgeted for this fine, the committee should have known it might be coming. He would like to see the State’s review and the steps we took to correct it. He would also like to see the reviews that have been done on the staff who are responsible for the CHHA. Mr. Steve is concerned that this has been going on for two months of the year and this is the first we have heard about it; he is also concerned that the letter has been sent to Dr. Gillim for approval of the settlement. Mr. Steve doesn’t feel that Dr. Gillim can make that decision. Mrs. Gailor said that Dr. Gillim doesn’t have the authority, which is why it is coming here. Mr. Steve said that the e-mail indicates that Dr. Gillim has the authority to make the final decision. Mr. Steve is disappointed that this was put in the budget and the members of the former Health Committee did not know about it. Mr. Steve wants to know what we must do to make certain this does not happen again. Mr. Steve wants to see evaluation, steps to correct evaluation, and reviews of employees handling the CHHA. Dr. DiGiovanni wants the same information. He wants the committee to receive a thorough report so they know what they need to monitor. Mr. Steve asked if Mr. Dougherty would come. Mrs. Gailor indicated that he would come, however, would the committee like to have someone come who knows more.

Mr. Willcox moved that the committee receives the State evaluation, and the plan of correction; seconded by Mr. McKee; all members voting in favor; none opposed motion adopted. Mrs. Tytler did clarify that she feels this might be a procedural issue and not a personnel-related issued.

 

Mr. McKee asked if there were any other "monsters under the bed" that the committee should know about. Dr. DiGiovanni asked Mrs. Gailor if there were any other reviews pending. Mrs. Gailor said not that she knows about. The clinic survey may be forthcoming. The last time the clinic was surveyed there were issues with the buildings and grounds department. Those issues have been corrected. It was clarified that an IPRO review has been done. Results should be available shortly.

 

5. Mr. Dafoe queried about the Preble water project and the status. Mrs. Gailor informed that she would have to check with Ms. Lewis. Mr. Dafoe asked that Mrs. Gailor pass along to Ms. Lewis the urgency of this issue.

 

Dr. DiGiovanni will check with FCS to see if the facility is available for the April 6th meeting at 8:30 a.m. Dr. DiGiovanni will notify the committee. Mrs. Tytler asked if the tour can be done first.

 

On motion of Mr. Willcox, seconded by Mr. McKee, the meeting adjourned at 9:35 a.m.

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