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DeKalb County, Illinois |
Minutes of the
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PRINTABLE DOCUMENT
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BOARD OF HEALTH MEMBERS PRESENT: Scott Starkweather, President; Jean Gastiger, R.N., N.P., Vice President; Linda Liston, M.D., Secretary; David Diemer, D.V.M.; Julia Fauci; Todd Latham; John B. Olson, D.D.S.; Sue Thompson, R.N.
BOARD MEMBERS ABSENT: Kevin Buick; David Phillips, M.D.; Jesus Romero
Board members and staff introduced themselves.
MINUTES
On a motion by Mr. Latham, seconded by Ms. Fauci, the minutes of the Board of Health meeting of January 22, 2008, were approved. Motion carried.
On a motion by Dr. Olson, seconded by Ms. Gastiger, the minutes of the Executive Session of the Board of Health meeting of January 22, 2008, were approved. Motion carried.
DIVISION REPORTS
Mrs. Grush reported that the months of January and February were spent in closing out the financial books for FY 2007 and working with Sikich, L.L.P., the county’s auditing firm.
The Medicare Cost Report for the Home Care Program was completed and submitted to Health Management Associates, who completes the report for Palmetto GBA, our Medicare intermediary. Significant additional work was required in the preparation of the information as Medicare did not accept the change in the county’s fiscal year for 2007 from that of a 12-month period to 13 months. Medicare did accept the change in fiscal year for FY2008.
Work on the Community Outreach Building has restarted, and there is no delay anticipated in the move-in date. Kevin Poorten, CEO of KishHealth System, inquired about our plans, and Mrs. Grush reported that the Health Department would not be renewing the lease in February 2009. This was acceptable to Mr. Poorten.
Since the shooting incident at Northern Illinois University, the county has held meetings for department heads to look at all county buildings in terms of security measures and procedures. Mrs. Grush pointed out that some offices in Sycamore that deal with unhappy customers are very accessible to the public and could be open to some major security issues. Health Department staff has also asked that procedures that are simple to follow be implemented within our buildings.
Dr. Olson asked if the Health Department had a satellite telephone for use in a disaster as cell phones may not be available, as experienced at the NIU incident. Mrs. Grush responded that the agency does have some phones that connect with county law enforcement and fire departments. Mr. Drake, Director of Environmental Health, indicated that the agency has two Starcom systems, which will work when other systems are down, allowing agency staff to communicate statewide and with the Illinois State Police. One of the Starcom phones can be plugged into a vehicle so can be recharged. Mr. Drake added that the agency also has two radios for contacting the DeKalb County Sheriff’s office.
Mr. Latham asked if the Health Department has a backup generator. Mrs. Grush responded that there is a generator that serves the multi-purpose room and the Health Department. She also stated that the Nursing Home has a generator for some areas. She added that the new Community Outreach Building is not slated to have a backup generator at this time because of cost.
Mrs. Grush stated that the NIU experience showed her how quickly the media responds to an event, which requires those in key positions to react immediately. Ms. Fauci stated that she thought NIU did a fabulous job. Mrs. Grush agreed, and added that it was to their benefit that they were able to shut down for a few days and plan a strategy for return of the students and faculty. She pointed out that not all emergencies provide that opportunity, and that would be the difficult task in a medication distribution event in that it would need to be implemented and completed in 48 hours.
Mr. Drake reported that a smoking complaint on a tavern in Genoa was received recently. After reasoning with the owner, agreement was reached. He added that both veterans clubs in DeKalb are upset about the Smoke-free Illinois Act. Mr. Drake feels that the law will be rewritten in the near future as there is no way for a violator to get due process under the current rules and regulations. Mrs. Grush stated that there are a couple pieces of legislation to exempt private clubs, but so far, no such legislation has been considered.
Ms. Fauci asked if the Environmental Health Division inspects geothermal wells. Mr. Drake responded that they do not at this time as there are no State regulations. He added that these are becoming an alternative source and pointed out that the new Community Outreach Building is geothermal. The Division is not allowed to issue permits for shallow geothermal wells, but can for deep ones.
Ms. Fauci asked about the humane issues reported in Mr. Drake’s report of dogs left outside in winter. Mr. Drake responded that the humane issues do take a lot of staff time in the winter months, and if there is no good result, the dog is removed from the home.
Ms. Fauci asked if it had been decided which apartment buildings would be participating in the pilot program for recycling. Mr. Drake indicated that he has some ideas, one of them being a large apartment complex with a mixture of students and families and one that is totally students. Two additional complexes will be selected to participate in this project.
Mrs. Chilton, Director of Personal Health Services, stated that site reviews have continued over the past two months, and agency staff and programs do very well. A new pediatric nurse practitioner has been hired. Sharon Coyer is a professor in the School of Nursing at NIU, and has previously worked as a pediatric nurse practitioner. Mrs. Chilton added that Ms. Coyer saw 14 new babies in the month of February.
Ms. Fauci asked Mrs. Rolf, Director of Home Care, if staff would do home visits in the new residential facility being constructed on this complex. Mrs. Rolf responded that they do have a nurse on-site and their administrator is a nurse, but Medicare will cover our program to do home visits there, which will be similar to those made to Barb City Manor in DeKalb and Grand Victoria in Sycamore.
Mrs. Zanellato, Director of Health Education, is working on getting the Coordinated Approach to School Health (CATCH) program operating in both Sycamore and DeKalb. There are two grants, one to implement a program in Sycamore and one to expand the program in the DeKalb School District. The contract was signed three months ago, but no additional information has since been received. Another major change is some shifts in the emergency planning team of the Health Department. In the past, grant deliverables have determined planning by the agency; however, when looking at planning and the goal of treating all county residents within 48 hours, it is necessary to establish a direction that will focus toward this end result. Mrs. Zanellato indicated that the need is for a very efficient plan with more workers and communication pieces in place. While she feels substantial progress can be made, fewer deliverables of the grant may be met.
FINANCIAL DATA
On a motion by Ms. Thompson, seconded by Dr. Liston, the Financial Statements for the months of December 2007 and January and February 2008 and the Claims for the months of February and March 2008 were approved. Motion carried.
NEW BUSINESS
2007 Year-end Financial Statement
Mrs. Grush presented the 2007 Financial Statement. She pointed out that it is for a 13-month period as the County moves to the new January 1 fiscal year. Revenue was $6,352,421.62. Expenditures were $7,447,688.53. Included in expenditures was a $1.3 million payment towards the new Community Outreach Building. Mrs. Grush presented a chart showing Home Care revenue at $2,700,815 and expenses at $2,556,032, a difference of $144,783. Public Health revenue was $3,538,875 with expenses at $3,591,656, resulting in a deficit of $52,781. Mrs. Grush stated that, generally, Public Health meets its expenses and Home Care generates some revenue. With the 2007 fiscal year having two Decembers, typically low revenue months, this affected the Public Health side of operations. Interest income was $112,731. Interest income is typically not used for operations, but rather for building the reserve fund. Mrs. Grush stated that the good news is that revenue was $204,733 over expenditures. She indicated that this will help the agency to meet the remaining $500,000 obligation on the new building as only $250,000 was budgeted in an effort to keep the agency’s reserve funds at three to four months of operating expenses. Mrs. Grush reported that the agency’s financial situation is strong; however, there are some flags that need to be monitored:
· Home Care revenue was up 2%; expenditures were up 11%. · It is anticipated that facility expenses in the new building will be more than is currently being paid. · In Public Health, $40,000 of the revenue was one-time supplemental funding or the result of changes in billing mechanisms that cannot be counted on in the future. · There is the possibility that the Comprehensive School Health Grant of $30,000 will not be renewed. · Interest income will reduce as the Fund Balance has been significantly reduced to meet building obligations, and interest rates are currently low.
Mrs. Grush reported that the agency’s projected Fund Balance for 2007 is $2,295,811. Actual cash on hand at the end of December 2007 was $1,709,453.11, the difference being in accounts receivable. After paying the remaining $500,000 for the new building, the agency’s Fund Balance will be around $1.2 million.
On a motion by Ms. Fauci, seconded by Ms. Gastiger, the 2007 Financial Statement was approved. Motion carried. 2007 Solid Waste Annual Report
Mrs. Grush presented the 2007 Solid Waste Annual Report. She explained that the DeKalb County Board gave authority of the Solid Waste Management Program to the Health Department to administer in March 1995, and an annual report is a requirement. The program is funded by a $1.27 per ton tipping fee imposed on waste deposited in the landfill. After approval by the Board of Health, the report will be submitted to the DeKalb County Board.
One area that is an issue is recycling in apartment complexes. According to haulers, recycling in this area is hard to accomplish. Mrs. Grush indicated that the agency has plans to conduct some pilot programs toward this effort, as presented previously by Mr. Drake.
Mrs. Grush pointed out that the Solid Waste Management Program has a larger fund balance than normal because the tipping fee was increased in 2007. Also, $30,000 was budgeted for mini-grants, and after running ads in the local newspapers, only one application was received. In addition, an auditing change to include five quarters in the Financial Statement was made to coincide with the County’s new fiscal year. Because of these excess funds, it may be possible to hold a household hazardous waste recycling event sooner than the usual every two to three years.
Major program achievements for 2007 were presented and included one used motor oil collection, two electronic recycling collections, printer cartridge and lead acid battery recycling, education to 5,018 DeKalb County children and adult students, the loaning of event recycling containers, and miscellaneous other administrative duties.
Dr. Diemer asked where recyclables could be taken in Mayfield Township and questioned why the Township could not open a site. Mr. Drake responded that, currently, DeKalb was the closest site for Mayfield Township residents. Mrs. Grush added that trucks do not want to pick up recyclables in rural areas because of the distance between pickups. Dr. Diemer pointed out that the easier recycling is made for people, the better response there would be. Mrs. Grush explained about the recycling site that was in Sycamore, which was closed because there was no control on what was taken there. Mr. Drake added that the county paid the full price of the facility for three years and then half-price for three years. After that, it was turned over to Sycamore Township. He pointed out that the program did pay for pickup of special items that were left there, such as couches. Ms. Fauci suggested a pilot program using a township building as a recycling site. Dr. Diemer pointed out that the township building on Church Road would be an easy place to access. Mr. Drake indicated that he would investigate this possibility again. Ms. Fauci suggested having an organization, such as the Boy Scouts, having a rural drop-off of aluminum cans as a fundraiser. Mrs. Grush stated that such a program was funded in Fairdale, and the Boy Scouts were in charge of the collection of metal and cans. Mr. Drake stated that the Esmond School District has a big cart for the collection of aluminum. He added that recycling of paper is a good idea, but people don’t want to keep it until a pickup time. He pointed out that small batteries are also a great item to recycle, but most people would not save them for pickup once or twice a year.
On a motion by Dr. Olson, seconded by Mr. Latham, the Annual Report of the Solid Waste Management Program was approved. Motion carried.
2007 Home Care Administrative Review
Mrs. Grush reported that the Home Care Program is required by the federal government to annually conduct an administrative review. A review of Home Care revenue shows an increase of 2% as compared to last year, with an increase in expenses of 11%. Cost per visit is determined by completion of the Medicare Cost Report, and these costs are in line with the limits per visit that is allowed by Medicare. Mrs. Grush explained that the methodology used for computing the cost report by Health Management Associates is completely different than hers, as she uses actual expenses of the program while the Medicare methodology uses percentages of all agency costs in a number of categories.
Visits by payor and patients increased by approximately 2%, and more females are served than males. Of significance this past year is that far more people were seen in the 70 to 100 year old age group than in 2006. The 2007 Clinical Record Evaluation Summary was conducted in December 2007, and showed few deficiencies.
Mrs. Grush presented several bar graphs, which shows how patients are evaluated when discharged. As a result, data also shows that patients are frailer and sicker resulting in lower recovery. Of importance is the national indicators of acute care hospitalization and emergent care that are being looked at by the federal government, such as if our services are keeping people out of the hospital or keeping them from being readmitted. The program did make improvements in this area this year. Mrs. Grush pointed out that this will come into play because the federal government is talking about paying for performance, which would be determined from these two indicators.
Mr. Latham moved to approve the 2007 Home Care Administrative Review, seconded by Ms. Fauci. Motion carried.
2008 Home Care Policies and Procedures
Mrs. Grush explained that a professional committee was appointed to review the policies and procedures of the Home Care Program, which is a requirement of the federal government. The committee consisted of Mr. Starkweather, Mrs. Gastiger, and Dr. Thornton (the agency’s medical director). Mrs. Rolf, Director of Home Care and Mrs. Grush initially reviews all policies and procedures and revises or creates as needed. They are then given to the committee, who approves the policies and procedures and signs off on them. A statement is needed in the minutes of the governing board of the Home Care Program that this has been satisfactorily completed.
On a motion by Ms. Thompson, seconded by Dr. Olson, the Home Care Policies and Procedures were approved. Motion carried.
HIPAA Privacy and Security Update
Mrs. Grush indicated that the HIPAA Privacy and Security Policies must be reviewed annually by the HIPAA Security Team of the Health Department. Any changes are made at that time and presented to the Board of Health for approval. This year, no changes were recommended by the Committee.
Also an annual requirement is the appointment of HIPAA Security Officer(s) and members of the HIPAA Security Team.
On a motion by Ms. Fauci, seconded by Mrs. Gastiger, Karen Hills was appointed as Security Officer for Public Health and Tammy Pieroni for Home Care, and members of the Security Team approved, as presented. Motion carried.
UNFINISHED BUSINESS
Ms. Fauci announced that she was in Washington, D.C. earlier this month regarding a couple of key health issues. The first was regarding Medicare reimbursements and the other was a system of technology whereby health records of an individual would be shared across state lines and to other providers. She explained that the candidates running for president already have this in their budgets, and the issues were talked about at the policy level in Washington. She also brought back articles on obesity.
Ms. Fauci also presented the spay/neuter issue discussed at previous Board of Health meetings. She stated that the DeKalb County Board has appropriated $15,000 for a trial spay/neuter program. A task force to discuss problems and determine how best to deliver the services was discussed, including what the services are, and recruiting volunteers and obtaining donations. The group is looking for a way to deliver the service to those that do not have money to get such services. Mrs. Grush stated that she and Ms. Fauci will solicit input from stakeholders and prepare a proposal for the May Board of Health meeting.
Mr. Diemer stated that the county already has low-cost programs in the county to screen people, and they are working with the trapping of feral cats. He added that TAILS is very involved in that program and suggested having Beth Drake on the spay/neuter committee as he feels that organization should be an integral part of this project. He pointed out that TAILS is already helping in screening people that need financial help in getting their pets spayed or neutered.
Executive Session
At 8:45 p.m., Dr. Olson moved to enter executive session for the purpose of discussion on the Union and a personnel issue, seconded by Dr. Liston. On a roll call vote, those voting yes included Mr. Starkweather, Mrs. Gastiger, Dr. Liston, Dr. Diemer, Ms. Fauci, Mr. Latham, Dr. Olson, and Ms. Thompson.
At 9:05 p.m., Mr. Latham moved to reconvene to regular session, seconded by Ms. Fauci. On a roll call vote, those voting yes included Mr. Starkweather, Mrs. Gastiger, Dr. Liston, Dr. Diemer, Ms. Fauci, Mr. Latham, Dr. Olson, and Ms. Thompson.
CORRESPONDENCE AND ANNOUNCEMENTS
Newspaper articles for the months of January and February 2008 included the creation of layettes for low-income mothers by the women of the First Congregational Church and keeping warm in the frigid temperatures.
ADJOURNMENT
On a motion by Ms. Thompson, seconded by Dr. Olson, the Board of Health meeting adjourned at 9:08 p.m.
Linda K. Liston, M.D., Secretary DeKalb County Board of Health |
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