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HomeMy WebLinkAboutM031810JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 18, 2010 2:30 PM — 4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District #1 Thomas Locke, MD, Health Officer David Sullivan, County Commissioner, District #2 Jean Baldwin, Public Health Services Director John Austin, County Commissioner, District #3 Julia Danskin, Nursing Services Director Kristen Nelson, Vice Chair, Port Townsend City Council Sheila Westerman, Citizen at large (City) Chuck Russell, Chair, Hospital Commissioner, District #2 Roberta Frissell, Citizen at large (County) Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:32 PM. A quorum was established at 2:36 PM. Members Present: John Austin, Roberta Frissell, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Phil Johnson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw Guest: Frances Joswick, SAAB APPROVAL OF AGENDA Member Nelson moved and Member Austin seconded for approval of the agenda. The agenda was approved unanimously, as written. (The order of business was altered during the meeting to accommodate the schedules of presenters.) APPROVAL OF MINUTES Member Austin moved for approval of the February 28 minutes; Member Frissell seconded. Member Nelson suggested that, on page 3, member names of those opposed to the motion be listed. Dr. Locke stated that the names were edited out from the draft minutes, and that this is an option under Robert's Rules. After a brief discussion, members agreed to consider the matter further at a future meeting. (Ms. Baldwin reported that the letter that was subject to the motion had not been sent because of the Governor's letter the day following the BOH meeting.) Dr. Locke suggested that, in the future, members could make a separate motion that the full details of a vote be recorded when they so desire. The minutes of February 28, 2010, as submitted, were approved unanimously. Jefferson County Board of Health — March 18, 2010 - 1 - PUBLIC COMMENTS (None) OLD BUSINESS AND INFORMATIONAL ITEMS National Estimates of the Cost of Foodborne Illness Dr. Locke pointed out the article in the packet, which announces a new web site called `Make Our Food Safe" and information from the Produce Safety Project. He noted the very high cost associated with food borne illness. The web site presents information by state on various economic measures. Kiwanis Club of Port Townsend Team Leaders Award Program Jean Baldwin explained that it is the practice of the Health Department to nominate youth for awards when they display initiative in community service. She said that Nathaniel Christiansen had stepped forward for the Chimacum School Based Clinic and other school endeavors. For his volunteer efforts he had received the 2009 Thomas J. Majhan Team Leaders Award. He then donated his prize money to the school based clinic. A letter from the Kiwanis Club to the Chimacum School Based Health Clinic is included in the packet. Substance Abuse Advisory Board's Recidivism Reduction Grant Application to Department of Justice Francis Joswick reported that the SAAB has submitted a grant application to the Department of Justice on behalf of the Sheriff's Department. The amount requested, $417, 861, is to fully implement existing programs and institute the new comprehensive program for reduction of recidivism rate of mental health/substance abuse offenders in the County Jail. She was very pleased that all three congressional representatives provided written support of the application. Ms. Joswick indicated that the SAAB and those involved are optimistic that the full treatment program will be funded at the jail. Member Austin noted that Ms. Joswick was highly instrumental in guiding this effort and thanked her for her leadership. The awards will be announced after July 1. She said that the cost of this problem is extremely high; Jefferson County has one of the highest recidivism rates in the State. Ms. Shaw inquired whether the recidivism rate had changed since the Drug Court had been instituted; Ms. Joswick said that it had not changed. Jefferson County Board of Health —March 18, 2010 - 2 - NEW BUSINESS Family Planning Cost Analysis Veronica Shaw presented the Clinical Fee Analysis process and fee schedule update. She noted that by ordinance the Health Department is required to provide a fee analysis annually. Based on the 2007 analysis, fees were raised to include 100% of the suggested cost adjustment. Ms. Shaw said that she had completed the 2009 analysis, but was recommending no actual increase in fees this year. The analysis reveals that, with the implementation of the previous increase, there has been a 178% increase in delinquent accounts. However, the write-offs have decreased — as a result of working with clients to allow them to pay when and as much as possible for them. She clarified that a sliding scale, not shown in the packet materials, is still being applied. Member Westerman asked if delaying the increase actually threatens the ability to provide the services. Ms. Shaw said that services are not threatened and that the 2007 increase is sufficient for the time being. Jean Baldwin noted that the 2009 fees are still considerably below market price, but are closer to insurers' reimbursement rates. Members Sullivan, Austin and Nelson expressed concerns about the true costs, the cost of collections, and the de facto sources of "gap" funds. There was acknowledgement that a portion of the shortfall comes from the General Fund. Member Westerman inquired about the history of fee increases. Ms. Baldwin said that fee increases have not occurred each year. Also, prior to last year, they were not based on this level of analysis, but on what Medicaid would pay. Currently, it is permissible to increase charges for medications, for example, when the cost of medications increase. Ms. Shaw referred to the complexity of the analysis model that the department is using, noting its embedded formulas, RVUs (relative value units), COLA, and estimates of nursing/provider time for particular procedures or services. She said that the derived figures are still estimates and cannot be interpreted as the absolutely accurate and actual costs. It was also noted that this model is not being used for other departments and services. Ms. Danskin explained that Jefferson County Public Health receives federal Title X Family Planning funds, which requires use of a sliding scale; services are provided and fees are charged on the basis of a client's ability to pay, down to $0. The federal contract also requires the use this cost analysis system to set fees. Ms. Baldwin noted that Planned Parenthood of Washington has similar costs. She also noted that the Jefferson Health Department had been contacted by the State to help train other jurisdictions to improve their insurance billing processes. Similarly, Ms. Shaw has a 2010 grant to teach other health departments how to do billing for immunizations. She stressed that the methods and expertise in this area are still evolving. There was further discussion about finding the optimal balance. Issues considered included high co -pay rates and the young family client population whose credit ratings Jefferson County Board of Health —March 18, 2010 - 3 - can be adversely impacted if medical bills cannot be paid. Member Sullivan said he believes the insurance companies should be billed at the full rate, and that there should be compassionate treatment for those without adequate insurance. Ms. Danskin confirmed that the sliding scale applies up to 250% of the federal poverty level. There was agreement that insurance does not cover the full amount in any case, and 20 to 25% is paid by the client or written off, which ultimately is paid by the General Fund. Member Westerman reminded that an increase was needed in the previous year, which had been delayed for several years. She said she could agree to the "no increase" recommendation for one year, but urged that the department fees keep pace with actual costs so that clients do not see huge increases all at once. Jean Baldwin stated that the Ordinance does specify every other year, that rates are current, and that a decision is actually not needed until next year. 2009 Performance Measures Reports Jean Baldwin introduced the 2009 performance measure reports, noting that the department does a great deal of work, but sometimes does not tell its story as well as possible. The reports in the packet include data for the year ending December 2009. Staff is continuing to refine and update the summary statements and end of year analyses. Ms. Danskin briefly explained that the goals and objectives are written in July 2008 for the 2009 budget. In January 2010, staff then reported on the actual activity, outcomes and analysis for the previous 12 months. She said that considerably more detail is prepared and submitted to various funders and contractors. The appearance and content of the reports vary by team; measurements are generally those that were already in place when this planning/budgeting/reporting structure was adopted. Communicable Disease — This report shows the unusually large volume of work accomplished and the stresses on the system at the State and Federal levels. There were also considerable demands regionally, working with Clallam and Kitsap counties, because of H 1N 1 and one outbreak of foodborne illness. Family Support —Member Austin inquired about item 7 under Performance Indicators. Jean Baldwin confirmed that these are the families served by the Health Department with allocations from two contracts from CPS/DSHS (Alternative Response System and Early Family Support Services). This covers families screened by CPS that need additional services from a nurse. The others are families that are too low risk to be screened into CPS, but need support services. The future of both contracts is uncertain; DSHS is undergoing reorganization and shuffling of services, some of which may not be continued in the long term. Targeted Clinical Health Services — Staff pointed out the low STD rates and low teen pregnancy rates. There was a brief discussion about the success of the school based clinics. Ms. Baldwin said there has been excellent community collaboration and that students, including high risk individuals, are making use of all of these services. She reported on a recent Community Advisory Board meeting attended by representatives of the hospital, public health and school districts, as well as parents and community Jefferson County Board of Health — March 18, 2010 - 4 - members. She noted that the BOCC is credited with having passed the 1/10ffi of one percent funding resolution that makes drug and mental health services possible. She noted that the greatest demand in the school clinics is for mental health services; providers are seeing at least 59 youth per month. The Foot Care program continues to see a high volume of patients; with a general fund budget of about $6,000, it is almost self-sustaining. The program serves seniors across the economic spectrum and provides opportunity for other necessary referrals. The increased mobility for seniors keeps them in their homes longer. Member Nelson commented on the usefulness of the reports in general. She said she was impressed with the ability of teams to maintain service levels despite budget cuts and to read the reasons why certain goals could not be met. She noted the importance of the H 1 N 1 pandemic and its impact on the overall workload of the department. Members agreed that the Performance reports should be posted on the website for public review. Communication with City Council — Member Nelson also expressed her appreciation to Jean Baldwin and Sheila Westerman for their recent visit and presentation to City Council. She said that providing an introduction to the work of the Health Department will serve as a foundation for future communication and collaboration. Ms. Baldwin distributed copies of an update community needs that she had mailed to the City. Ms. Nelson also mentioned that the e-mail about Our Kids, Our Business had been received by City Councilors on the same day as the presentation. All agreed that establishing a regular forum for this type of communication is a very positive step. Public Health Heroes Nominations Jean Baldwin distributed an updated version of the March 12 nominations memorandum in the packet. The nominations included agencies, clinics, pharmacies, and individuals who with the Public Health Department built a community response to the H IN 1 Pandemic of 2009. Member Austin stated he would like to add the Public Health Staff who worked on this outbreak to the list of nominations. He cited several indicators from the 2009 Communicable Disease Performance Measures Report, noting that staff had done extraordinary work in preparation and management of the H IN 1 pandemic. He said that the County should be proud that HIN1 did not gain a strong foothold here, which he attributed to the excellent work of the Public Health staff. Member Austin moved that the Jefferson County Public Health staff should be included along with the other Public Health Heroes nominations. Member Frissell seconded the motion. Member Westerman initiated a discussion to clarify the placement of the nomination on the announcement memorandum; all agreed that the staff should be recognized at the top of the list. There was also agreement that the awards should be made at the April BOH meeting, possibly in a more spacious venue. The possibility of the Hospital auditorium was mentioned. Jean Baldwin and Julia Danskin Jefferson County Board of Health —March 18, 2010 -5 - suggested that a letter of invitation would be sent to all the nominated groups, asking each to send a representative. The motion was approved unanimously. Legislative Update/Wrap up Dr. Locke noted that the Washington State Legislature had gone into Special Session. He said that he is a member of a group of public health officials that tracks public health legislation. This body had a 19 page report of the bills submitted this year; 16 pages listed all the legislation that "died". Of the passed or active bills, about half remained unresolved at the end of the regular session. One very significant bill that passed set up an alternate universal purchase system for childhood vaccines. This bill was the work of a broad coalition, and had very strong bi- partisan support. As previously reported, the Pharmacy Disposal bill was not adopted. Several environmental toxin bills were sent to the legislature. One sets up a mandatory system for manufacturers of florescent light devices, which contain mercury. It requires that producers establish a disposal and recycling system, thereby preventing the mercury from entering the solid waste stream. A second toxin bill regulates the plastic agent, bisphenol A (BPA), that had been extensively used for baby bottles, sports drink bottles and the linings of metal cans. This bill bans the substance in products for children under the age of three, in sports bottles, but not within cans. He said that there is pressure from the federal government to move to alternative can lining materials. The health concern is that BPAs are chemicals that mimic hormonal effects. The pending bill that would place higher requirements for vaccine exemptions has passed through the House and gone into the Special Session. The outcomes on the remainder of the health related bills are still uncertain. Dr. Locke noted that the budget issues are significant; the gap remains at about $2.8 billion. The largest cuts in the Governor's balanced budget were in health programs, including the elimination of the Basic Health Plan which served 65,000 people, many on the Olympic Peninsula. Dr. Locke also mentioned the pending cuts in child health programs, adult Medicaid dental services, and funds for health department support for dental care for young children (ABDC program). Ultimately, the extent to which these programs can be restored depends on revenues, federal monies, and one-time fixes. Expectations are that there will be serious problems balancing the budget for at least the next two years. The fate of national health reform will have great impact on State budgets because health items are a major component of State expenditures. By 2013, federal funding will provide some relief to States for Medicaid and other programs. John Austin inquired about the likelihood of the vaccine exemption bill passing; Dr. Locke said the outcome is uncertain. After a brief discussion, Member Austin moved that the BOH direct the Chair to send an e-mail/letter to the appropriate legislators encouraging them to support the vaccine exemption requirements bill. Member Westerman seconded. The motion was approved unanimously. Jefferson County Board of Health — March 18, 2010 - 6 - ACTIVITY UPDATES Member Austin stated that the State Board of Health (SBOH) is considering issues related to on site septic systems. One question is how much monitoring will be required; the options range from virtually no monitoring to several times per year. Member Frissell inquired as to whether or not the State Board of Health had considered pleas from local jurisdictions about the septic system regulations. She recalled that this issue had been raised at the SBOH meeting in Port Hadlock, particularly the negative public response that local BOHs are experiencing. Member Austin said that the topic is on the SBOH agenda. There was a brief discussion about the ability to implement these regulations and the fact that the legislature has said that, just as in the case of school rules, there must not be any more unfunded mandates. Dr. Locke noted that he had been Chair of the SBOH when the septic system regulations were passed. He said that the language of the regulations attempts to avoid unfunded mandates. That is, to the extent that there is funding for local jurisdictions to implement, there is an obligation to do so. And if the funding is lacking, there is not that obligation. He said that the legislature had expected to provide the basic funding, which would be supplemented by permit fees. However, because of the general economic/budgetary shortfalls, that had not occurred. ADJOURNMENT Members Sullivan and Frissell moved to adjourn. Chair Russell adjourned the meeting at 4:01 PM. JEFFERSON COTY BO RD OF HEALTH huck ussell, Chai Kristen Nelson, Vice -Chair Roberta Frissell, Member ��'�' ` `o`- �►`J �'�'") lir Sheila Westerman, Member Jefferson County Board of Health — March 18, 2010 - 7 - Excused Phil Johns , Member Jo Austin, Member David u livan, ember