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DeKalb County, Illinois |
Minutes of the
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BOARD
MEMBERS PRESENT: Fred Peltz, D.D.S.,
President; Glenda Pecka, R.N., M.S., Vice President; Steve Kuhn, P.A.,
Secretary; James Cole, M.D.; Sonja Conway, Ph.D.; Carl Heinisch; Darrell Wiley,
M.D.; Steve Wolf, R.N.
BOARD
MEMBERS ABSENT: Russell
Bishop, Psy.D.; Mike Groark, J.D.;
Debra Schelkopf, D.V.M.
On
a motion by Mr. Wolf, seconded by Mrs. Pecka, the minutes of the Board of Health
meeting of January 22, 2002, were approved, as presented.
Motion carried.
Mrs.
Grush stated that the biggest issue currently is the effect of the State Budget
on local health departments. She
indicated that public health, thus far, is doing better than many other
departments in the state. Mrs.
Grush reviewed the proposed cuts to date, but indicated a lot could change
between now and July 1. Mrs. Grush
is concerned about tobacco funding, with a recommendation in the budget to cut
funding to local health departments by as much as 40 percent, with other
grantees not being cut nearly as much. She
indicated that, while a cut is inevitable, she hopes that it is spread fairly
among all grantees.
Mrs.
Grush continues to attend meetings on bioterrorism. The September 11 incident forced agencies to realize how ill
prepared they were for a major event. Mrs.
Grush reported the Department has submitted a Bioterrorism Medication
Distribution Plan to the State Health Department that was required of all county
health departments.
Mrs.
Grush reported she continued with placing the furniture order following her memo
to Board of Health members on February 12, 2002. This allows for a redesign of the Animal Control area to
accommodate the new warden and secretary and add four additional cubicles to the
growth area. Furniture will also be
purchased for the new Support Staff Coordinator and an additional intake room.
Extra shelving and dividers were also ordered.
Neilly
Berger has been hired as the new Animal Control warden and joined the agency on
the 4th of March. She
comes to us with three years of experience in Indiana. It is anticipated she will be on her own by spring and
working the 1 p.m. to 9 p.m. shift. By
that time, the new Animal Control van should also have been received.
Dr.
Peltz asked if many Animal Control calls are received from the southern part of
the county. Mr. Drake responded
that there are not many calls from Sandwich because the police department there
is very good. Calls are received
from the Somonauk and Shabbona areas. He
added that there is currently a serious problem in the Hinckley area with two
Rottweilers that are allowed to run.
Mr.
Drake, Director of Environmental Health, reported that a few restaurants have
voluntarily closed over the past couple months and three have been closed by the
Division for violations.
Mr.
Drake called attention to the recycling rate of 64 percent which includes
construction demolition. With the
construction and demolition materials removed, the rate drops to 44 percent,
indicating that the people of DeKalb County continue to do an excellent job of
recycling. He added that it is a
goal of the program to raise that rate even more.
Mr.
Kuhn asked about the Household Hazardous Waste Day scheduled for April 27 from 8
a.m. to 3 p.m. at the Farm Bureau. Mrs.
Grush stated that 40,000 flyers would be included in newspapers throughout the
county in the next couple weeks at a cost of around $4,000.
She pointed out that the reason DeKalb County is able to cosponsor this
day is because the Health Department agreed to give the Environmental Protection
Agency (EPA) $25,000 to help cover the expenses, which will run approximately
$100,000 for the day. The fliers
will indicate what can and cannot be brought to the event, and also the fact
that businesses are not included. Mr.
Drake stated that also included on the flier is the fact that this recycling
event does not happen every year so residents should take advantage of it. The next closest site is Naperville or Rockford, and they do
not want to accept it but are mandated to because of grant funding.
Dr. Peltz remarked that he recently heard on national public radio a
discussion on the environmental impacts of recycling and the reaching of the
point where it does not pay for itself any more.
Mr. Drake stated that there is no money in the recycling of paper, glass
or commingled products as there was years ago.
Mrs.
Lux, Director of Personal Health Services, stated that her division has been
attempting to hire a public health nurse and has been advertising for over a
month. She added that she is
pleased that some of the grants are receiving increases. Mrs. Grush pointed out that there was an article in the Chicago
Tribune last Sunday on the national shortage of nurses, pharmacists and
radiology technicians. Mr. Kuhn
stated that radiologists tend to branch off into specialty areas such as CAT
scans, ultrasounds, and MRIs.
Mrs.
Baj, Director of Home Care, hired a full-time home health nurse that started in
March and also a part-time nurse who will begin in April.
The new part-time nurse lives in the southern part of the county and Mrs.
Baj is hopeful this will help decrease travel time and the associated expenses.
She added that she has noticed a gradual growth in that area of the
county with the closing of Allen Home Health a couple of years ago.
On
a motion by Mr. Kuhn, seconded by Mrs. Conway, the Financial Statements for the
months of January and February 2002 and Claims for the months of February and
March 2002 were approved. Motion
carried.
Mrs.
Grush stated that the development of policies and procedures for the agency’s
fiscal management activities were a requirement as a result of the Department of
Human Services audit of the agency last year. She stated that she wanted to amend the proposed document
presented to read, “The Department’s financial goal will be to pay all
general expenditures from current revenue” instead of “the Department will
pay all general expenditures from current revenue.”
She stated there are times of the year when monthly expenses are more
than revenue coming in because of various payment cycles.
While this has not been a major problem in the past couple years, it
could well be this year as we have noticed a slowdown in state payments.
On
a motion by Mr. Heinisch, seconded by Dr. Wiley, the Financial Management Policy
and Procedure Manual was approved, as amended. Motion carried.
Mrs.
Gush stated that, in spite of a year of bad economy, the Health Department did
very well financially. She stated
that this extra cushion is necessary when there are years of decreased revenue,
which may occur in 2002. She added
that it seems during years of lean revenue are also years of a greater demand on
agency services.
Mrs.
Grush stated that revenue budgeted was $3,385,100 in July 2000, revised revenue
was $3,892,000 and total revenue received for FY2001 is actually $4,077,144.
Expenses were budgeted at $3,607,600, revised to $3,646,200, with actual
total expenses at $3,533,750. An
area that was under spent in FY2001 was the Salary line item, which was
attributable to the difficulty in recruiting staff.
A
Revenue Comparison from 1993 to 2001 was presented. This chart shows Revenue at $4,078,516, which is 15% higher
than FY2000, and Expenditures at $3,533,750, an increase of 13% over FY2000.
She attributes part of this to being the first full year under the
Perspective Payment System (PPS) versus the cost per visit reimbursement in the
Home Care Program. She added that a
reason our agency has done so well with this payment system is that it has
always been the program’s philosophy not to over-visit just to gain revenue
under the cost-based system. A total of $375,000 more revenue was received in FY2001 as
compared with FY2000. Of this, an
estimated $110,000 is FY2000 money for home care visits done in 2000.
As the program was changing from cost-based to Perspective Payment at the
end of our year, we were not fully aware of the revenue to be received in 2000.
$100,000 more in grants was received in FY2001 and also $67,000 more in
fees. Increased payments from
Public Aid have also been realized for the Well Child and Immunizations
Programs, which she attributes to the implementation of KidCare and staff
signing up clients for that program. Mrs.
Grush reported that the agency is funded by 54 sources of revenue, all with
their own regulations, requirements and rules.
Revenue,
Expenses and Fund Balance by Year from 1982 through 2001 was presented.
Mrs. Grush pointed out that the difference in FY2001 Revenue and Expenses
was $544,766, with approximately $290,000 being from Home Care.
Mrs. Grush stated that this revenue is remarkable considering the fact
that a number of home care agencies have gone out of business.
Other areas to be noted were the receipt of over $62,000 in interest and
$80,000 in additional grants received. She
added that it was possible to claim overhead on these grants and not necessarily
add staff. The Fund Balance
for FY2001 shows $2,063,408, but as of November 30, 2001, the fund had only $1.5
million actual cash with the rest as receivables.
Dr.
Cole asked if the Home Care Program could handle more work since they are doing
so well. Mrs. Baj responded that it
would be possible with more nurses and more space. Mrs. Grush pointed out that there is not much room for growth
in the current building and recruitment of nurses is very difficult.
She added that more could not be done because of the demands on staff, as
well as the fact that she feels the program is meeting the needs of the
residents of DeKalb County and does not wish to expand into other counties.
Dr. Cole stated that, from an outpatient standpoint, he ends up caring
for a lot of wound care patients because the family is not capable of providing
that care. Mrs. Grush pointed out
that the patient does need to be considered homebound to qualify for services.
Mrs. Baj explained that the definition of homebound under Medicare and
Medicaid is a considerable and taxing effort to leave the home, with infrequent
trips and of short duration that may require assistance.
Mrs.
Grush stated that the Board usually holds off until this meeting and receipt of
the Audited Financial Statement to establish the rate for the June merit
increase. In the FY2002 Health
Department Budget, money allowing up to a 3% increase for merit was budgeted.
Mrs. Grush stated that she is recommending a 0-3% merit this year.
The County and Health Department’s Compensation Policy provides for an
annual cost-of-living-arrangement (COLA) in December and a merit increase given
mid-year. If this 0-3% increase is
accepted, it will result in up to a 4.9% annual maximum increase.
She pointed out that $117,000 was included in the FY2002 Budget to cover
this expenditure. This year, DeKalb County is giving a 0-2% increase.
She stated, historically, the Health Department has given what the county
gives. However, she is recommending
a 0-3% because, in the past, we have given employees less than the county when
revenue was of concern. Mrs. Grush
added that the County also gives longevity pay that our agency staff does not
receive.
Mr. Wolf asked if all employees were evaluated at the same time each year. Mrs. Grush responded in the affirmative, and added that the employee must have been hired before the previous December 1 to be eligible. If the individual is at the top of their classification range, they are eligible for up to a 3% bonus, which is not tacked on to their pay rate. In management meetings this year. an evaluation tool has been revised somewhat. Mr. Heinisch stated he does not believe the business community received this large an increase this year.
Dr. Cole asked if there was a reason that certain sectors
should not be rewarded just because other areas were not doing as well
financially. Dr. Peltz pointed out
that the agency might not be in a position to give increases in future years
should State funding be cut back. Mrs.
Grush agreed that the increases should be given now since there are funds
available. Mrs. Pecka added that
the nursing shortage is becoming critical and she does not feel it would be wise
to withhold an increase for nurses at this point.
Mrs.
Pecka made a motion to award a 0 to 3 percent increase to eligible employees,
effective June 2, 2002, seconded by Mr. Wolf.
Motion carried.
Mrs.
Grush reported that the Health Department has never compensated the Animal
Control warden for being on-call evenings, weekends and holidays that has
required both going out on calls, as well as spending time on the phone
regarding animal issues. A review
of the Animal Control warden’s time was conducted showing that the current
warden had to go out 1 day on 48 of 101 weekends, and on 5 of the weekends, he
went out both days. Calls averaged
1.6 hours per call. Of the 21
holidays, the warden was called out on 6 of them.
The warden averaged 8.2 hours per day versus the standard 7.5-hour
workday for other agency staff. No
restrictions were placed on the warden to remain in the area even though he was
considered on-call.
Proposed
compensation for the Animal Control warden is as follows: hourly rate for
after-hours, holidays and weekends; hourly rate at time-and-a-half after 40
hours in the week; hourly rate at double time for holidays; on-call at $80 per
week from Monday at 8 a.m. to Monday at 8 a.m.; and the warden is to carry a
beeper and be within one hour of response when needed.
The situations warranting after-hours response will not change and
include the report of an animal bite, livestock kills, wildlife around people
and acting strangely or appearing ill and the report of an injured dog.
Dr.
Cole asked if there was a leash law. Mrs.
Grush responded that some municipalities have one, but there is not one for the
county as a whole. Mr. Drake added
that, generally, dogs cannot leave their owner’s property, and that DeKalb and
Sycamore do have leash laws.
Mr.
Kuhn made a motion to approve the proposed compensation for the Animal Control
warden, as presented, effective March 24, 2002, seconded by Mrs. Conway.
Motion carried.
Mrs.
Grush presented a history of the Home Care Program beginning with its inception
in 1966 through present day. Sources
of revenue were presented. She
indicated that the Cost Report for FY2000 has still not been completed because
the Federal Government cannot figure out what they paid us, so a settlement
payment may still need to be made. Mrs.
Grush pointed out that, under the current PPS system implemented in 2001, what
the agency is paid is what is received.
Visits
by payor were presented. Patients
increased from 825 patients in 2000 to 861 patient in 2001, a 4% increase.
Visits decreased from 16,750 to 15,470.
Home health aide visits decreased by 27%.
Mrs. Grush advised that this is what you want to see under PPS: more
patients, longer visit time, but fewer visits. Demographics reflect that more
patients are female than male, with the majority coming from hospital referrals.
The majority of discharges are due to the patient meeting their goals.
Data
on Medicare 60-day episodes was presented.
There were 168 episodes over cost and 768 episodes under cost.
Of 563 patients, there were a total of 940 episodes.
Dr.
Peltz asked if DeKalb County Hospice was serving the terminally ill patients
that our program would have seen in the past.
Mrs. Grush responded that some of our patients did go to Hospice now that
they are Medicare-certified because the patient does receive benefits from them
they could not receive from us.
Mrs.
Grush presented the revisions to the Home Health Policies.
This year, there are no new policies, but rather just cleaning up or
changing the wording of existing policies.
Mrs. Baj stated that she wanted to ensure that written policies for
procedures were in place. Mrs. Grush added that the Illinois Department of Public
Health surveyors scrutinize these policies at their accreditation visit.
Medicare regulations require that the Governing Board review these
policies annually.
Dr.
Peltz asked for an explanation of the Senior Tax Levy.
Mrs. Grush explained that $25,000 was requested from DeKalb County
Community Services approximately four years ago to provide payment for patients
who have no money for home care services or to pay the difference between the
insurance or Public Aid payment and the actual charge.
She pointed out that, at the end of the fiscal year, the difference is
billed to Community Services for the Hypertension Program, since no other
funding is received for that service. Mrs.
Baj added that this policy is a clarification of how the billing is completed.
Mrs.
Grush presented two personnel policy changes.
In the area of employee responsibilities, new employees will be provided
a listing of forms and documents required of them for their position at their
time of hire and failure to complete and submit these forms to the Director of
Office Support within 30 days of employment could result in possible
termination. Under Physical
Examination, the statement that the failure to turn in a physical exam within
thirty days of employment would result in the employee’s paycheck being held
was deleted.
There
are no changes to the DeKalb County Board of Health Bylaws at this time.
On
a motion by Mr. Heinisch, seconded by Mr. Wolf, the Personnel Policy and Home
Health Policy changes were approved, as presented. Motion carried.
Mrs.
Grush is requesting the addition of a secretarial position in the Home Care
Program with the primary function of following up or investigating reasons for
non-payments or partial payments and checking claims status for all third party
payors via verbal and/or written communication. She pointed out that this is a time consuming responsibility,
and accounts receivable has been an area of concern for some time.
A chart was presented which showed $533,714 in outstanding payments from
0-109 days and $185,579 over 474 days for a total of $719,293.
This position would most likely pay for itself in the end.
Mrs.
Grush stated that agency policy is to start an employee in this position at
$10.35 per hour, which is 10% above entry level. She is aware of several individuals in the community with
experience, and is unsure they would accept a position for $10.35.
These were long-term employees of two local organizations that recently
switched their billing to a service. She
requested authorization to hire an individual up to $11.50 an hour. She pointed
out the agency policy of not hiring a new staff person at more than the current
employees make. Dr. Wiley agreed
that this person would more than make this money back.
Mrs. Grush pointed out that this would not be an increase in pay for an
internal person because it would be a lateral move unless a new job title was
given.
Dr.
Wiley moved to approve the addition of a secretarial position in the Home Care
Program with a salary of up to $11.50 per hour, as well as the purchase of an
additional users license from HBOC for the software, seconded by Dr. Cole.
Motion carried.
Correspondence
for the past two months included a letter from George Stevens, Regional Health
Officer at IDPH, indicating that the DeKalb County Health Department National
Pharmaceutical Stockpile Plan exceeded the minimum specifications mandated by
Dr. Lumpkin. Newspaper articles
focused on bioterrorism, the presence of coyotes in the area, National Nutrition
Month in March, National Heart Health Month in February, and the offering of ESL
and Spanish GED classes at Kishwaukee College.
Two thank you letters and a donation were received from the spouses of
Home Care patients. 2000 Illinois
Selected Vital Statistics from IDPH were shared with the Board.
Dr. Cole asked if radon in public water supplies was a public health issue, adding that Sycamore’s rate exceeds levels of safety. Mr. Drake responded that it is a public health issue that is handled by the Environmental Protection Agency and not the local health department. The agency is involved in the issue by providing information to the public, but not in the policy-making as that is Federal mandate. He added that this Division does not have the expertise to deal with a 1,100 foot well.
On
a motion by Mrs. Conway, seconded by Mr. Heinisch, the Board of Health meeting
adjourned at 8:55 p.m. Motion
carried.
Steve Kuhn, P.A., Secretary
DeKalb County Board of Health
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