Loading...
HomeMy WebLinkAbout11 November JEFFERSON COUNTY BOARD OF HEALTH MINUTES Tuesday, November 23,1999 Board l,Iember.r: Dan I {apole, Member - County CommzJ,ioner District # 1 Glen Hzmtingftrd, Member - County Commissioner Dirtrict #2 Richard Wojt, Chairman - County Commissioner Distrzd #3 GerifJrey Masci, l'vlember - Port Townsend City Council jill Bubier, Member - Hospital Commissioner Dirtrid #2 Sheila Westerman, Citizen at Latge (City) RiJberta Frisse/~ Vice-Chairman, Citizen at La')!.e (County) StaffAlembers: jean Baldwin, Nursing S em<Yis Director Larry Ftry, Environmental Health Director Thomas Locke, MD, Health Officer Vice Chairman Frissell called the meeting to order at 1: 1 0 p.m. All Board and staff members were present with the exception of Commissioner Harpole and Member Westerman. APPROVAL OF MINUTES Member Masci moved to approve the minutes of the October 21, 1999 meeting. Member Buhler seconded the motion. Vice Chairman Frissell noted that a correction needs to be made to the minutes on page 6, paragraph 5, sentence 1. The sentence reads Jefferson General has dropped their contract to do mammograms lor the Breast and Cervical Cancer Women and the Soroptomists. It should read Jefferson General has dropped their contract to do mammograms lor the Breast and Cervical Cancer Women. Member Masci amended his motion to approve the minutes of the October 21, 1999 meeting as corrected, Member Buhler seconded the motion which carried by unanimous vote. OLD BUSINESS - None NEW BUSINESS MYSTERY BAY SHELLFISH & MOORING BUOYS UPDATE: Larry Fay distributed procedures from the Planning Department, for issuing mooring buoy permits. Dave Christensen explained that the State Department of Health records any changes or concerns to shellfish growing areas annually. The Department noted that the number of boats moored in Mystery Bay is approaching that which might be classified as a marina. A change in classification would impact commercial shellfish !,>Towers. The State is reviewing the impacts of the number of boats moored in the bay. Visitors to these boats dump sewage in the bay. Chairman Wojt said he and Commissioner Huntingford asked the DNR to investigate how well they are monitoring the buoy leases. Dave Christensen said there are many players involved in buoy permitting. The Planning Department issues a shoreline permit, Fish and Wildlife issue permits to install buoys, and the DNR provides a HEALTH BOARD MINUTES - November 23, 1999 Page: 4 in the Medicare program that were part of the Balanced Budget Act. Many rural physicians are on the verge of bankruptcy. While costs continue to rise, reimbursements have been static or declining. Also there are growing complaints of a lack of choice of plans. The second problem identified is the collapse of the individual insurance plan. Individual insurance policies are still being sold in Jefferson County by KPS. However, the big three insurance groups: Regents, Group Health and Primera have pulled out of rural areas. The goal of the summit was to look at solutions. A report is forthcoming which summarizes different projects underway. Some of which include: . Community partnership schemes (communities getting together, pooling resources, reorganizing to keep doors open and keep providers afloat); . Demonstration projects for the "post insurance environment." Rural health financing that is not based on insurance companies but direct contracting with state agencies. Providers directly contract with the Medical Assistance Administrations. The potential benefit of this, without increasing money involved, is that it increases reimbursement. The difficulty is who bears the risk for cost overruns; . Single payer systems. As in the Canadian model, these involve government as financier of all health care; and . Initiative Healthcare 2000 Single-fund system. A nongovernmental, not-for-profit agency that becomes a provider of health insurance to all residents of the state. Commissioner Huntingford asked how setting up a new entity would help pay for and provide better service? Dr. Tom Locke replied that it is complex and you have to consider where the money is going now and where it would be going under this revised system. The short answer from advocates is that currently about 23% of the money is going to fund the administrative overhead and the health insurance infrastructure. The goal is to reduce costs from 23% to 6% and use the difference to fund higher reimbursements and expanded access. Vice Chairman Frissell said this is the program the State uses called the Uniform Medical Plan. It is a self-insured preferred provider plan for State employees and retirees. Reimbursement comes from the State and premiums are adjusted to cover the costs. The feedback she has received from providers is very positive. Member Buhler said there is a cost efficiency benefit when physicians have one entity to deal with in billing. HEALTH CARE ACCESS - JEFFERSON COUNTY: Health Nurse Julia Danskin reported that she primarily works with the outreach project focused on the Medical Assistance Administration (MAA) which makes sure that people who can qualify for medical assistance get it. Many of those people are children up to age 19 from families that can be up to 200% ofthe federal poverty level. Washington State's plan was to contract with insurance plans to provide coverage for the MAA people. The federal HEALTH BOARD MINUTES - November 23, 1999 Page: 3 Commissioner Huntingford asked how the County will estimate and pay for costs to enforce inspections? Larry Fay explained that the action could be as simple as a notice to title that says they failed to have an inspection completed. In the absence of an indication of a public health threat, it would not be discovered until the property owner sells or refinances the property. Linda Atkins indicated that the resident signs a contract with the PUD before the system is final. It is on the title and it passes with the title. On occasion, there have been people who have refused the PUD access to their system. Commissioner Huntingford said his concern is systems where there is no contract. What will happen with someone who has a failing system and does not have the money to fix it? Linda Atkins responded that although she did not apply for grant funding during this cycle, loan funds are available for on-site sewage systems from First Federal Bank. Quimper Credit Union is the financial agent for the County on any collections. Larry Fay noted that a few brokers have stated that alternative systems in the PUD inspection program are able to get financing, including VA and FHA financing if they can document they are current with their PUD inspections. Member Masci moved that staff revise the O&M section using the PUD as the monitoring contractor and submit a draft of this revision to the BOH for review and comment. Vice Chairman Frissell seconded the motion which carried by unanimous vote. Member Buhler asked about septic systems on the shoreline and why are systems on bluffs subject to yearly inspections? Linda Atkins responded that waste water moves vertically and horizontally and one of the problems is that it comes out of the bluff. The same problems apply whether it is a low or high bank. Linda Atkins announced the Small Flows Clearinghouse has requested a proposal from the County to provide monitoring data collected over the past 13 years. This information is not available anywhere else in the nation. Additionally, she and other Special On-Site Demonstration grant participants will make presentations at LaQuinta in Tacoma on December 1. This day-long session will review the results and share findings on the operation and efficacy of sand filters, mounds, treatment devices, and disinfection units. Larry Fay complimented Linda's efforts. The feedback he has received is that the Jefferson County report is professionally and scientifically superior to others. The results of the study will be presented to the Board of Health at an upcoming meeting. HEALTH CARE ACCESS - STATE: Dr. Tom Locke reviewed the information generated from the Rural Health Summit on November 9. There was good attendance from Jefferson County and the County's issues figured prominently into the discussions. Of the problems occurring throughout the state, the impact is the heaviest on rural areas. Increasingly the problems are seen as a failure of the urban- based health financing mechanisms to work in rural areas. Others in danger of going out of business are home health agencies and pharmacies. Problems in hospitals are due to the cuts in excess of $100 billion HEALTH BOARD MINUTES - November 23,1999 Page: 2 renewable lease of the tide land. The State plans to continue to monitor bay usage over the next one to two years. As the data warrants, they will investigate further. Commissioner Huntingford said it would be good to know the contamination threshold that requires closure. Member Buhler asked what action the Board of Health can take to implement a pump-out facility? Dave Christensen said there is a pump-out in the state park and a seasonal closure at the dock when numbers are high. Larry Fay said a question still to be answered by the State is where the County stands if another half dozen permit applications are approved in the next year. He will keep the Board updated on the situation in the event a policy recommendation is needed. Member Masci asked who samples the water for quality? Dave Christensen said that shellfish growers conduct water quality tests. It is an important distinction to make, however, that the water quality in Mystery Bay does not warrant closure. It is the potential for degradation due to the number of boats and the usage of the boats that is of concern. BRIEFING PUBLIC WORKSHOPS ON DRAFT ON-SITE SEWAGE RULES: Linda Atkins provided an update on the workshops held in the Tri-Area, Brinnon and Quilcene early this fall. Most of the issues raised related to third party operations and monitoring. Comments were that contractors would have a vested interest in finding system problems, that the frequency of inspections was felt to be appropriate, and that there is a need to ensure all systems are checked and failures identified early. Other comments were that the utility approach seems to be looked at favorably as long as inspections are done and reported consistently. Linda Atkins reviewed the revisions. She asked if the BOH would be willing to support the staff recommendation to revise the O&M section with the PUD as the monitoring contractor? Linda Atkins said that with the use of private contractors, there are significant development costs including testing, licensing, and training. The only place the County has relied on a private sector quality inspection program is the monitoring of aerobic treatment systems through the National Sanitation Foundation. In this case, factory-authorized technicians conduct the unit inspections. The experience has been that when the reports are requested, they have been done, however, the reports do not appear. If a licensing program for inspections is created, how can inspections be confirmed and assure quality? Vice Chairman Frissell asked about the quality of the PUD inspections? Larry Fay responded the quality of the PUD inspections has changed over the years in direct relation to the amount of time the County has spent to train management. Member Masci asked if the County has jurisdiction over the PUD, can the PUD provide an incentive to comply to higher contract standards? Larry Fay answered that the County has an agreement with the PUD as the entity to do the work and states what is expected. The question is what is the threat ifthey fail to perform and how else would the County accomplish the work? HEALTH BOARD MINUTES - November 23,1999 Page: 5 waiver for Washington State to be able to do this project says it would give people a choice. Only one insurance plan has been available in Jefferson County for the past year or so. The choice has been KPS or fee for service. Since KPS left state plans, all of the children got switched to the fee for service medical coupon. So far, there has been no word of a physician not accepting a medical coupon. Other problems are with the Healthcare Authority and the Basic Health Plan. The state set up the program so that they could only contract with insurance plans to provide the service. Although, Community Health Plan of Washington agreed to replace KPS, they had no providers contracted in Jefferson County. As of November 1, subsidized Basic Health clients got put in Community Health Plan of Washington and assigned a primary care provider in Poulsbo. One hundred and seven were able to stay with their local providers. Some subsidized Basic Health plan families whose children were on medical assistance through the Health Care Authority, were also assigned to Community Health Plan of Washington. As of today, the Health Care Authority has chosen to provide the option of going fee for service so they can continue to get coverage locally. The biggest problem is that the Basic Health Plan has decided not to take any non-subsidized Basic Health Plan as of December 31. These are the people who paid the full premium price and who chose the plan because they could not get any other insurance plan. The State found these people medically needy and costly. KPS is offering another individual plan to these people, but there are many people trying to get out of KPS because they are uncomfortable that their physician is not getting paid. Another State program, Children's Health Insurance Program (CHIP) would increase the coverage for children up to 250% ofthe federal poverty level. Dr. Tom Locke mentioned that there is individual insurance available called the High Risk Pool through the state. Premiums start at $500 per month per person which still does not cover the benefits of the program. The bulk of the cost was paid for by a tax spread out over all insurance plans. This is now becoming the only access point for people who are high risk. Julia Danskin introduced Eileen Rogers who is in the process of organizing a Health Forum on January 13 at Chimacum High School. The Democratic Central Committee, as a nonpartisan public service, is providing this forum to start a public dialogue to begin dealing with the healthcare crisis. Member Buhler said although Community Health Plan of Washington has attempted to work with the community, the physicians are reluctant to sign on with another health plan after the difficulties with KPS. The reimbursement is not covering their costs. The hospital and specialists have signed with Community Health, including the physicians the hospital employs and they will continue to see their existing Basic Health patients. The hospital is in the process of employing two local physicians and other affiliated health care providers. When the employment contract is complete, they will also continue to see their Basic Health patients. In addition, it is expected that another primary care physician will join an existing practice and it will be stipulated in their contract that they see Basic Health patients. The goal by early next year, is that all Basic Health people will have local access. A contract with Regents Blue Shield appears likely, and the contract \vith Primera Blue Cross is still in negotiations. HEALTH BOARD MINUTES - November 23, 1999 Page: 6 . BREAST AND CERVICAL CANCER UPDATE: Member Buhler explained that this public screening program is put on by the Center for Disease Control. It covers patients whose insurance will not cover a mammogram. The hospital district agreed to provide mammograms for this plan even with problems with late payments and difficulties monitoring payments. However, when the state decided to do a larger regional approach, the coordination ofthe program went to the Seattle King County Health Department. They are the regional manager and supply a mobile van to the County. Jean Baldwin said the majority oflow income women are still being referred to Bremerton and Poulsbo clinics. ANTI-SMOKING VIDEO: Vice Chairman Frissell introduced the American Cancer Society's video titled "Shake Your Butts." The video shows the Jefferson County Logo and a local access telephone number where you call to get information on how to be helped to stop smoking. This will be shown daily on the local cable access channel. AGENDA CALENDAR / ADJOURN Ii] APPEAL HEARING - WILLIAM SCHMITT - January (Larry Fay) Ii] MARY SELECKY VISIT - January Ii] MEETING WITH LEGISLATORS - (Dr. Tom Locke) Ii] LICENSING PROCEDURES - Rescheduled to December Meeting adjourned at 2:50 p.m. The next meeting will be held on Thursday, December 16 at 2:30 p.m. . COUNTY BOARD OF HEALTH Richard Wojt, Chairman ~r~ Roberta Frissell, V"ce-Chairman ~~ e ey Masci, Me~ber ~ !3{/g e~ . Buhler, Member ~-- (Excused Absence) Sheila Westerman, Member (Excused Absence) Dan Harpole, Member .