Lake County Community Health Center Governing Council met June 8.
Here are the minutes provided by the council:
1. Call to Order
Acting Chair Brown called the meeting to order at 5:39 p.m.
Attendance Notes:
Member Argueta joined the meeting at 6:05 p.m. and left the meeting at 6:15 p.m.
Present 7 - Member Fornero, Vice Chair Brown, Member Tarter, Member Bejster, Member Cunningham, Secretary Argueta and Member Lara
Absent 3 - Member Washington, Chair Smith-Taylor and Member Vargas
2. Pledge of Allegiance
Acting Chair Brown called on Member Ross-Cunningham to lead the pledge of allegiance.
3. Approval of Minutes
3.1 May 11, 2021 Meeting Minutes
A motion was made by Member Ross-Cunningham, seconded by Member Fornero, that the minutes of the May 11, 2021 meeting be approved. Roll call vote taken, all in favor, motion carried.
Aye: 6 - Member Fornero, Vice Chair Brown, Member Tarter, Member Bejster, Member Cunningham and Member Lara
Absent: 3 - Member Washington, Chair Smith-Taylor and Member Vargas
Not Present: 1 - Secretary Argueta
4. Public Comment to the Council
None
5. Executive Director's Report
Executive Director Mark Pfister informed the Council of the following:
- We have had 61,744 cases of COVID-19 in Lake County and 1,009 deaths. The County Board, at their meeting this morning, held a moment of remembrance for those that have lost their life to this disease and pandemic.
- COVID-19 vaccinations have been extremely effective. The death rate has been dropping dramatically, with very few deaths in the last few weeks. And the new case rate is down to less than 3 per 100,000 per day. At this point in time we are in moderate community transmission and hope to get down to 1 per 100,000 cases per day. We are at the lowest positivity rate and case rate since June 2020.
- In Lake County, there have been 656,323 doses administered to residents with 44.04% of the population fully vaccinated. Of the age 65 and above population, over 82% have received at least one dose and 77.61% have been fully vaccinated. There are many more in that age group that were vaccinated in other states (Florida, Indiana, Wisconsin) but we don't have that data in our system.
- He received a response from Member Vargas on May 12, 2021, with regard to her resignation. She stated she would be submitting her formal letter of resignation by the end of that week but to-date he has not received it. He, the Council Chair, and Lisa Kroeger again attempted to follow up with Member Vargas but no response was received. He then sent another email to Member Vargas stating that she need only submit a two line email and that would be acceptable as her formal resignation. Since she has confirmed that she is going to resign, he and the Chair are giving her a little bit more time to submit her formal resignation. Therefore, at this point he is not asking the Council to take any action on Member Vargas, but if her formal resignation is not received by the July 13, 2021 meeting, he is going to recommend to the Council that they take formal action and remove her from the Governing Council as her attendance has not been good and there is no indication that she will ever attend in the future.
- He will be on vacation through July 14, 2021, and therefore will not be in attendance at the July 13, 2021 meeting. He will ask Director Kim Burke to be his delegate to represent him at that meeting.
Acting Chair Brown asked if the matter pertaining to Member Vargas would be a discussion item or an action item on the next agenda. Mark stated that, if needed, it would be an action item.
6. Action items
6.1 Provider Reappointment - Dr. Zun
Dr. Les Zun, Medical Director, presented the two providers for reappointment, Susan Felsenthal, MD, and Carlie Terchin, APRN, and turned the floor over to Member Ross-Cunningham, Chair of the Personnel Committee. Member Ross-Cunningham informed the Council that the Personnel Committee met just prior to this regular meeting to review and discuss the matter and the committee recommends reappointment.
A motion was made by Member Bejster, seconded by Member Fornero, that Susan Felsenthal, MD, and Carlie Terchin, APRN, be approved for reappointment. Roll call vote taken, all in favor, motion carried.
Aye: 6 - Member Fornero, Vice Chair Brown, Member Tarter, Member Bejster, Member Cunningham and Member Lara
Absent: 3 - Member Washington, Chair Smith-Taylor and Member Vargas
Not Present: 1 - Secretary Argueta
6.2 FY2021 Health Resources and Services Administration (HRSA) American Rescue Plan (ARP) Health Center Construction and Capital Improvements (C8E) - $927,053 - Grant Application Approval - Nordstrom
Jerry Nordstrom, Director of Business Operations, reviewed with the Council the information provided in the agenda packet. Mark Pfister clarified that this item is for the approval of the grant application and once received it will be brought back to the Council for approval of the funds.
A motion was made by Member Fornero, seconded by Member Tarter, that the application for grant funding be approved. Roll call vote taken, all in favor, motion carried.
Aye: 6 - Member Fornero, Vice Chair Brown, Member Tarter, Member Bejster, Member Cunningham and Member Lara
Absent: 3 - Member Washington, Chair Smith-Taylor and Member Vargas
Not Present: 1 - Secretary Argueta
6.3 Evaluation of Sliding Fee Discount Schedules for Medical, Behavioral Health and Dental Services - Riley
Pam Riley, Director of Finance, thanked the Governing Council Task Force, comprised of Chair Smith-Taylor, Member Tarter, Member Argueta, and Member Lara, for meeting with her, Diane Pelli, and Kim Burke to review the evaluation of the sliding fee discount program which is a key component of being an FQHC and must be reviewed every three (3) years. She then turned the floor over to Diane Pelli, Business Manager, who reviewed with the Council the information provided in the agenda packet. Diane noted one correction needed to the statement at the bottom of the attachment titled, "Market Survey of Provider Charges for Uninsured Patients." It states, "Last time medical fees have been increased was on July 1, 2014," but that is actually the last time the nominal fee was increased.
Member Bejster asked if the "No Income" line on the attachments meant that no income information was provided by the patient/client. Diane stated that is correct. Member Bejster noted that those are fairly high numbers and that the collection rate on them is fairly low and asked if there has been any discussion around providing easier ways for the patient/client to submit their paperwork. Diane explained that, historically, getting patients/clients to supply their proof of income has been difficult and that those on the lower end of our scale have been able to pay and those without income have the lower collection rate. Training of front desk staff has been looked at and it was mentioned during the Task Force meeting that efforts will be made to reinforce with staff the importance of obtaining that paperwork to help increase patient/client response. We also need to look at best practices for that same day in an attempt to get additional payment.
A motion was made by Member Tarter, seconded by Member Lara, to approve the recommendation of the Task Force that no changes be made to the existing sliding fee discount schedules. Roll call vote taken, all in favor, motion carried.
Aye: 6 - Member Fornero, Vice Chair Brown, Member Tarter, Member Bejster, Member Cunningham and Member Lara
Absent: 3 - Member Washington, Chair Smith-Taylor and Member Vargas
Not Present: 1 - Secretary Argueta
6.4 Evaluation of Sliding Fee Discount Schedules - School-Based Health Center (SBHC) - Riley Attachments: Summary SBHC Med and BH 2019-2021
Pam Riley explained that the SBHC sliding fee schedule is separate from the FQHC and that this data was not yet in hand for the Task Force to review. She then turned the floor over to Diane Pelli who reviewed with the Council the information provided in the agenda packet.
Member Fornero asked if it is currently only the Round Lake school district that has the SBHC. Diane confirmed that it is. Member Fornero then noted that he thought there was talk at one time that Waukegan would have a SBHC. Mark stated that there have been several meetings over the last multiple years with the last one being about a year ago. He then reminded the Council that the Healthcare Foundation of Lake County, along with the Health Department, has recommended that the Waukegan School District hire a consultant because SBHC's are based on volume and when you don't have the needed volume you can't pay the bills. When a consultant came in to look at the possibility of doing a SBHC for North Chicago they were able to demonstrate that there was not going to be enough volume to support it. So it has been left with the Waukegan School District to hire a consultant to do the analysis and determine if it is a viable option for them.
A motion was made by Member Ross-Cunningham, seconded by Member Bejster, to approve the recommendation that no changes be made to the existing sliding fee discount schedule for the School-Based Health Center. Roll call vote taken, all in favor, motion carried.
Aye: 7 - Member Fornero, Vice Chair Brown, Member Tarter, Member Bejster, Member Cunningham, Secretary Argueta and Member Lara
Absent: 3 - Member Washington, Chair Smith-Taylor and Member Vargas
6.5 Change in FQHC Hours of Operation - Burke
Kim Burke, Director of Healthcare Operations, reviewed with the Council the information provided in the agenda packet. She reminded the Council that in March they approved a change in FQHC hours of operation for the Belvidere Medical Building due to the start of the ceiling construction. That construction will be completed by the end of June 2021, so the Council is now being asked to approve the resumption of regular hours at that health center at that time.
A motion was made by Member Tarter, seconded by Member Fornero, to approve the revised hours of operation for the FQHC sites as presented. Roll call vote taken, all in favor, motion carried.
Aye: 7 - Member Fornero, Vice Chair Brown, Member Tarter, Member Bejster, Member Cunningham, Secretary Argueta and Member Lara
Absent: 3 - Member Washington, Chair Smith-Taylor and Member Vargas
7. Presentations
7.1 Human Resources Recruitment Efforts - Harris
Lorraine Harris, Human Resources Director, turned the floor over to Elliott Hanna, Human Resources Recruiter, who shared his screen with the Council for a PowerPoint presentation. The PowerPoint was not provided prior to the meeting for inclusion in the agenda packet, so it is attached to these minutes as documentation of the information provided. The presentation focused only on the current vacancies within the FQHC's and the efforts made and resources utilized to recruit for them. There are currently 19 vacant FQHC positions out of a total 79 vacant positions for the entire agency. Prior to COVID-19, the average number of agency-wide vacancies was 50-60. Lorraine added that during the COVID-19 pandemic a hiring freeze was put in place but was lifted in September 2020. Now that the job market has reopened, good qualified candidates are in high demand so higher salaries are being offered making it difficult to attract candidates and retain some existing staff. Health Department exit interviews have also shown that some staff have left due to issues with finding childcare during the pandemic. Member Ross-Cunningham asked if the vacancies have left the FQHC's short-staffed. Lorraine stated that Kim Burke and Dr. Zun have become creative with shifting health center staff where needed to cover those gaps so that our patients and clients are not impacted but it does make it difficult for them to maintain clinic operations. Acting Chair Brown noted that this is a topic that Chair Smith-Taylor would be very interested in based on comments she has made and has ideas and contacts related to recruiting efforts with some of the Chicago medical schools. Lorraine stated she will contact Chair Smith-Taylor for her input. Mark informed the Council that this item is on the agenda at Chair Smith-Taylor's request, which makes it even more unfortunate that she could not be in attendance, but that this information will definitely be shared with her. Member Ross-Cunningham asked if the reason for reaching out to schools outside of Lake County is because there are no qualified candidates in Lake County. Lorraine explained that there may be qualified candidates in Lake County and elsewhere but if they don't apply for the posted positions, we can't interview and potentially hire them. Vacant positions are posted on the Health Department website as well as the County website, and that outreach is done with College of Lake County in addition to outreach with colleges and universities throughout the state, but that outreach to other colleges and universities is going to be for the higher level positions. And we are going to hire the most qualified applicant, whether they live in Lake County or not, because we have a responsibility to our patients and clients to provide them with the best care and services possible. Lorraine added that the Health Department is going to be utilizing a new applicant tracking system as of July 1, 2021, and that Elliott is at the midpoint of transitioning from the old system to the new one. She asked Council members to wait until after July 1, 2021 to share vacant position links within the community so that potential applicants will be utilizing that new system. Member Bejster asked if there was a more detailed flyer outlining the positions available and stating why the Health Department is an employer individuals should seriously consider that Council members could share. Lorraine stated that is something that could be provided, but it would have to wait until after the part-time recruiter position is filled so that Elliott will have some support and assistance. Dr. Zun commended Member Ross-Cunningham on her assistance in the efforts to recruit a physician candidate. Unfortunately, the candidate did not accept the Health Department's offer. Member Fornero asked how many individuals are employed by the Health Department. Lorraine stated there are approximately 875.
8. Discussion Items
8.1 CQI Update - Hayes
Christina Hayes, CQI Coordinator, reviewed the information provided in the agenda packet. She noted that the depression screening PDSA is going very well. It has been rolled out to all sites except for North Chicago and BMB, but will be rolled out to those two remaining sites in July. A new PDSA to improve the childhood weight assessment and counseling process is being implemented. The role of the provider will be better clarified in the MA workflows. We will ensure everyone knows what their responsibilities are, and educate them on proper documentation and follow up with our pediatric patients. As a result, rapid improvement is anticipated within that measure. This measure is important because childhood obesity leads to obesity as an adult, diabetes, hypertension, heart disease, and numerous other conditions. Included in this month's report, at the Council's request, is information on persistent asthma medication compliance which is at 90%.
Christina stated that this information will be included in her report on a quarterly basis to keep the Council up-to-date.
9. Medical Director Report
9.1 Medical Director Report - Dr. Zun
Dr. Zun reviewed the highlights of his report as provided in the agenda packet noting that if the current candidate for the Regional Medical Director position accepts the Health Department's offer, provider positions will be fully staffed. He also pointed out that the demographics of the patients served by the Health Department is attached to his report in the agenda packet and he reviewed that information with the Council. For continuity of care assurance, he has applied for privileges with the three hospitals in Lake County that the Health Department admits to as a means to better connect with those hospitalists and other care providers and coordinate care for those Health Department patients who declare they are a LCHD patient upon admittance. He noted an update to the dental portion of his report in that the full-time dentist position at North Shore has been accepted by one of the Health Department part-time dentists. Member Tarter stated that he recalled that the unique caseload number was between 45,000 and 48,000 patients, but that it is now at 39,000 and asked if the decrease is due to the Affordable Care Act. Mark stated that the Health Department's goal is 43,156, but it has been losing 3% of its patient population per year for the last couple of years and that's fine because we are here to meet unmet needs. Some of the patients are going to private providers now accepting Medicaid and some have also moved over to Erie Family. At this point in time, at the caseload number the Health Department is at, there have been no financial ramifications but if we drop too many percentage points below the goal, that is when we could see a reduction in the 330 grant. The Health Department's goal is to find those that have unmet needs, especially medical and behavioral health care, and ensure they are coming in which is something Dr. Zun and Director Burke are working on. Member Tarter asked what the 43,156 goal is based on. Mark explained that the Service Area Competition (SAC) grant is something the Health Department applies for every three years based on the targets it has set with HRSA and that is where that number comes from. Mark noted that Member Tarter brought up a good point. The Health Department's role as a County entity is to provide care to those that don't have care or access to care.
10. Director of Healthcare Operations Report
10.1 Director of Healthcare Operations Report - Burke
Kim Burke, Director of Healthcare Operations, reviewed the highlights of her report as provided in the agenda packet.
Member Tarter asked if responses to the patient satisfaction survey can be incentivized in order to elicit a response rate better than 4-7%, such as a discount on top of the sliding fee scale discount. Kim stated that a response rate higher than 4-7% is desired and that potential opportunities to increase that rate will be explored. Acting Chair Brown noted that he receives the reminders and notifications for his appointments and really appreciates receiving those text messages. Jefferson McMillan-Wilhoit, Director of Health Informatics and Technology, noted that the national average response rate for surveys from hospitals, inpatient/outpatient is 16-20% and for just FQHC's it is 7-8%, and that this information is for context when discussing and setting goals on how to increase our response rate.
11. Director of Finance Report
11.1 Director of Finance Report - Riley
Pam Riley, Director of Finance, reviewed the information provided in the agenda packet. Chair Brown asked if some of the excess dollars is due to the large number of vacancies. Pam confirmed that it is and that it is also why expenses are lower.
12. Added to Agenda
None
13. Old Business
Acting Chair Brown asked that the Council consider issuing something similar to the President's proclamation against racism that calls upon all Americans to do all they can all of the time. This is something imbedded in society and it is a public health issue.
14. New Business
None
15. Executive Session
None
16. Adjournment
A motion was made by Member Ross-Cunningham, seconded by Member Fornero, that this meeting be adjourned. Acting Chair Brown adjourned the meeting at 6:48 p.m.
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