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HomeMy WebLinkAboutBOH minutes 102418MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 24, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ October Page 1 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON October 24, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore – Chair, Timothy Smith –Vice- Chair, Keith Bagby, Bruce Baldwin, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Jennifer Deyo, Liska Lackey and Sam Lasris. BOARD OF HEALTH MEMBERS ABSENT: Jessica Frega. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Victoria Hudson, Interim Environmental Health Director; Carla Julian, Dental Clinic & Compliance Manager; Donna King, Health Promotion & Education Services Director; Pam McCall, Public Health Nursing Director; Kristin Prelipp, Communications Manager; Ashley Rawlinson, Healthy Carolinians Coordinator; Beverly Scurry, BOH Strategic Plan Manager; and La Toya Strange, Administrative Assistant II. GUESTS PRESENT: None. I. Welcome New Employees Susan Elmore, Chair, called the meeting to order. There were no new employees in attendance. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the October 24, 2018 Agenda Motion was made by Liska Lackey to approve the agenda, seconded by Bruce Baldwin and carried without dissent. IV. Action Items (Consent) A. Minutes of September 26, 2018 Meeting Motion was made by Sam Lasris to approve the minutes of September 2018, seconded by Jennifer Deyo and carried without dissent. V. Educational Sessions A. Customer Satisfaction Survey Environmental Health (EH) Services (Interim EH Director, Victoria Hudson), Dental Health MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 24, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ October Page 2 (Dental Clinic Manager, Carla Julian) and Personal Health (Personal Health Services Director, Pam McCall) reported their results of patient and client input surveys and improvement plans. EH Services has used the same feedback tool since 2007. The survey has been in an electronic survey link on every outgoing signature line from EH staff since September 2009. There is also a link on the EH webpage. The survey consisted of 18 questions and allowed an opportunity for free form comments on services and staff recognition. It was collected from September 2017 to September 2018. There were 178 responses. Some of their results include: • Food, Lodging & Institutions had 75% of clients that reported an overall satisfaction with services received; while Onsite Well & Wastewater section had a little less than 70% express their overall satisfaction. • It was reported that about 75% of clients responding rated field staff’s knowledge as excellent; while the 65% rated the office staff’s knowledge as excellent. • From the free form section, comments received were very complementary and spoke of helpfulness and attentiveness. Ms. Hudson stated that the comments are used as opportunities for quality improvement when it’s critical of professionalism or response times. She also spoke of the limitations of the survey, proposing adding a way for return contact when the client’s comment(s) requires clarification. Lastly, she remarked that she’d like all results (overall satisfaction, knowledge and response time) to be at a minimum of 80%. Since July 2017, the Dental Health Services patient satisfaction surveys have automatically been sent electronically to the patient after their appointment via Solutionreach; however, Solutionreach does not have the surveys available in Spanish. Spanish and English paper versions of the surveys were distributed in October 2017. Below are some of the results from the October 2017 English/Spanish surveys. There were 60 respondents. • 78.3% of clients were satisfied with their overall experience and reported that the location of the clinic was convenient. 3% of clients disagreed. • 83.3% rated staff as courteous and responsive to their needs. • 90% rated their dental hygienist/assistant as courteous and responsive to their needs. • 91.2% rated their dentist as courteous and responsive to their needs. Below are some of the results from the Solutionreach surveys that were collected from June to October 2018. There were 73 respondents. • 97% responded good to excellent for dentist explanations, how well the provider listened, and appropriate amount of time spent with patient. • 7% (5 respondents) said ease of scheduling urgent appointments was poor to fair. Clients also reported that they liked the punctuality, attentiveness, feeling of comfort, and staff’s friendly attitudes. Areas for improvement included having the dentist explain problems better, how long it takes to get an appointment, and hiring more hygienists. Ms. Julian stated that most of the dissatisfaction regarding the wait time for an appointment, which was 8-9 months, was MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 24, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ October Page 3 before a 3rd hygienist was hired. The Dental Health Improvement Plan Services strategies to improve include: • Continuing to utilize UNC Dental School hygiene students on Tuesdays and Thursdays. • Investigating the possibility of one late clinic per week and include questions about hours of operation in the survey. • Including a question regarding the likelihood of patients going to Chapel Hill clinic location if offered. • Upload Spanish-language surveys to Solutionreach. Personal Health Services (PHS) collected paper patient satisfaction surveys that were distributed during one week in August. Surveys were available in English and Spanish. There were a total of 29 surveys collected at SHSC and 32 surveys at WHSC respondents. The decreased response rate was attributed to the transition to Epic which also caused clinics to see fewer patients. Not all respondents answered all of the questions. The results included: • Satisfaction with location convenience was 100% at both locations. • The rate at which respondents agreed on the ease of making an appointment was 94% at WHSC and 93% at SHSC. • Overall satisfaction rate was 78% at WHSC and 97% at SHSC • Satisfaction with interpreter services was high at both clinical sites with 100% at WHSC (with 10 out of 10 clients responding) and 88% at SHSC (with 7 out of 8 clients responding). There was a space for open comments. Only positive comments were received. They included: • The phlebotomist was lovely. • Nothing at all – I’m very pleased with the services. • I have found this office to be extremely professional at all visits! Well done and kudos to the staff. Ms. McCall stated that the goal is to have efficient, effective, and patient-centered care. The PHS plan for improvement includes: • Continuing to assess customer satisfaction as the challenge is getting people to respond. • Investigating approaches for continuous patient feedback data – possibly via text surveys. The BOH had questions that were addressed by Ms. Hudson, Ms. Julian and Ms. McCall. B. 1st Quarter Financial Reports & Billing Dashboard Reports Rebecca Crawford, Financial and Administrative Services Director, gave a report on the 1st quarter revenue and billing accuracy. Her report is as follows: • Total Health Department Revenue: Average YTD monthly revenue in FY19 after the first quarter is $157k/month or $471k YTD, representing 13.6% of our overall budgeted revenue for the year. Multiple factors MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 24, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ October Page 4 contribute to the lower than normal revenue: Electronic Medical Record (EMR) change to Epic, provider on maternity leave in Dental, and departmental closures due to hurricane Florence. As usual though, the total first quarter revenue is also skewed down due to the majority of state funds not eligible to be drawn in July (this is typical) and allocations of Medicaid Max funds will not be transferred into our budget until the end of the fiscal year. Expenses are higher than revenues, but on trend, at 20.5% of the total, overall budget. • Total Billing Accuracy: Billing Accuracy is under construction due to the change in EMR. The Informatics team is working diligently to have this measure for both medical and dental back by the second quarter financial report. • Dental Earned Revenue by Source: The FY 18-19 average monthly revenue ($39.5k/month) for the first quarter is below our budget projection ($45k/month) and our FY 17-18 average of $42.6k/month due to having a dentist on maternity leave. Also, we projected and budgeted to receive a higher level of revenue for FY 18-19 than in FY 17-18 because of the additional Dental Hygienist we received for this fiscal year. Our new Hygienist was hired mid-quarter so we will not begin seeing increased revenues until second quarter. FY 18-19 dental earned revenue totaled $118k at the end of the first quarter. • Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 18-19 ($55.6k/month) at $16.3k/month due to provider turnover (2 new providers started seeing patients in late July and August) and as clinic staff continue to work through issues with the new EMR, improved customer service during the EMR transition with longer appointment times (meaning we saw fewer patients), and have dealt with clinic closures due to hurricane Florence. We anticipated these issues as they arise in all new automation projects and have staff dedicated to fixes by increased training for providers, weekly workflow meetings, a Quality Improvement team called the “Epic Optimization Team”, and teams devoted to building algorithms with UNC IT to decrease errors in the billing system build (our state requirements make our billing very different from a typical UNC outpatient clinic and require much more specificity). Medical clinic revenue totals $49k for first quarter FY 18-19. • Environmental Health Earned Revenue by Source: Environmental Health earned revenue is currently below the budgeted projection for FY 18-19 ($53k/month) at $44.3k/month) although this is a seasonal trend. We typically see an increase in revenue during the spring with public pool and septic inspections. • Grants Fund Revenue: FSA has drawn $100k of the multi-year Kenan grant. Expenditures are low at this time but we anticipate these will increase once the new Social Work Supervisor II position is filled in the second quarter. The BOH had questions that were addressed by Ms. Crawford. C. Advisory Board Update Beverly Scurry, Board of Health Strategic Plan Manager, gave a brief summary of the Orange MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 24, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ October Page 5 County advisory boards’ activities as they pertained to the BOH’s strategic plan priorities. Ms. Scurry added that some boards being tracked did not have updates included because either they did not pertain to the BOH’s priorities or were not available at the time of the report. Below are a few of the updates: • EMS inititatives – o Naloxone Distribution Clean Needle Exchange o Coordinated Opioid Overdose Reduction Effort (COORE) • OUTBoard o The Bicycle Safety Subcommittee created a bicycle safety video PSA as well as will post “Drive Safely Ride Safely’ safety signs within the county’s Rural Buffer signs. • Town of Chapel Hill o Road to Zero program is the initiative to reduce the growing numbers of roadway and pedestrian fatalities and injuries. D. Healthy Carolinians of Orange County (HCOC) Ashley Mercer Rawlinson, Healthy Carolinians Coordinator, gave an update on the current and future activities of the HCOC committees regarding tackling goals that were identified in the 2016-2019 Community Action Plans. Below are some highlights. Social Determinants of Health  Since the Poverty Simulation was held in Orange County in January, the Person County Health Department and the CHCCS Pre-K Head Start staff requested to have the simulation conducted for their agencies. Ms. Rawlinson stated that they were both great experiences and the participants enjoyed and fully understood the concept.  The 211-a-Thon was held on June 26th. There were 15 agencies represented through the 2 sessions. 211 staff informed agencies about updating their information and how to market to clients.  Since hosting the first Try Transit Week and Transit Academies for OC during the week of September 17th and on October 5th, respectively, a Transportation Demand Manager was hired and has taken over the responsibility of hosting these events. They will lead efforts of placing transportation kiosks in county facilities and in the agencies frequented by residents/clients. Mental Health & Substance Abuse  The 2nd “Be the Light” Suicide Prevention Walk occurred on September 22nd with approximately 100 people present. The guest speaker was Phillip J. Roundtree. There was a presence from many community organizations that are engaged with mental health, safety and suicide prevention including El Futuro, Cardinal Innovations and Moms Demand Action. Representation from the OC community included our health director, Commissioner Renee Price, Hillsborough Chief Hampton and police officers, Mayor Tom Stevens, Hillsborough Town Commissioner Matt Hughes and Board of Health member, Timothy Smith. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 24, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ October Page 6 Physical Activity & Nutrition  The CATCH (Coordinated Approach to Child Health) program was implemented for elementary (K-5) and middle school students that encourages physical activity and nutrition among adolescents. It’s the most cost-effective means of preventing childhood obesity in an environment that’s fun and easy to sustain. Committee members will volunteer once a month to go to the schools to assist staff with implementing these activities and programs within OC schools. Upcoming Activities/Projects  Groundwater Presentation – December 4th at Whitted Human Services from 5:30- 8:30pm.  2019 Community Health Assessment (CHA) process.  2020-2023 Action Planning – based on CHA identified priorities in which 2-3 action plans will be developed around. VI. Action Items (Non-Consent) A. BOH Policy (Fee & Eligibility Policy) The Board of Health reviews its policy manual annually. Below are the recommended updates to the two sections of the Fee and Eligibility policy in which Rebecca Crawford, Financial and Administrative Services Director, briefly reviewed. I.E. Fee and Eligibility Policy Staff recommends making the following revisions to the Fee and Eligibility Policy for the purposes of clarification, to be in compliance with state requirements, and to update according to system changes: - Service Limitation/Denial (Section V.C.): Expanded the section stating that Family Planning patients will never be refused service due to an outstanding balance or inability to provide proof of income to include Maternal Health and Child Health patients at the recommendation of the DHHS Administrative Consultant. - Fees Collection (Section VII.E.): Clarified that clients are given a statement showing the cost of services after charges are processed upon request rather than at the time services are received since the Epic Electronic Medical Record (EMR) system is unable to produce a statement until after charges are processed, which may not occur until after the patient has left the clinic. - Fees Collection (Section VII.I.): Updated the Billing Cycle section to specify the billing statement process for the Epic Electronic Medical Record (EMR) system since it differs from both the Patagonia EMR and Eaglesoft EMR that was detailed in the previous version. Motion to update the Fee and Eligibility Policy as staff recommends was made by Liska Lackey, seconded by Barbara Chavious and carried without dissent. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 24, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ October Page 7 VII. Reports and Discussion with Possible Action A. Fluoride Ad Hoc Committee Update BOH member, Liska Lackey, provided an update on the recruitment of subject matter experts. She stated that they’ve acquired a dental expert, Dr. Lewis Lampiris, Assistant Dean for Community Engagement and Outreach at the UNC School of Dentistry. The committee is still in need of an expert in toxicology and a medical expert with a background in neurology and endocrinology. Beverly Scurry, Strategic Plan Manager, added that she will be reaching out to professional organizations. B. Presentation of 2019 Vice-Chair The Board members shall elect a Chair and Vice-Chair by majority vote each year at the last meeting of the calendar year. Jessica Frega had expressed interest in the Vice-Chair position. Prior to the BOH meeting, Timothy Smith and Liska Lackey, members of the Vice-Chair selection committee, extended an invitation to Ms. Frega for Vice-Chair which she accepted. Motion to elect Timothy Smith to Chair and Jessica Frega to Vice-Chair for the 2019 calendar year was made by Jennifer Deyo, seconded by Keith Bagby and carried without dissent. C. Health Director Report In addition to her report, some of the highlights Ms. Stewart gave are below: • October 12th - OCHD Annual Picnic. Although attendance was low (this was a day after Tropical Storm Michael occurred), a great time was had. BOH member, Keith Bagby, made an appearance. • October 15th – Attorney General Josh Stein announced that he has launched an investigation into Juul, the e-cigarette company. • October 16th – BOCC unanimously agreed with the option to alter the capital building improvement plan and replace the original plans to build a dental clinic with the mobile clinic (dental van). • NCALHD voted to support the ABC Boards to avoid privatization of alcohol sales. The NCALHD acknowledged the ABC Boards’ contributions including to Orange County. BOH member and ABC Chair, Keith Bagby, added that most people aren’t aware of what the ABC Board does outside of liquor sales regulation. Mr. Bagby continued by stating that the ABC Board contributes significantly to multiple agencies including law enforcement and mental health. • On October 25th, Ms. Stewart and April Richard, Tobacco Prevention and Control Coordinator, will be attending “Vision 2020” in Raleigh which is sponsored by the American Cancer Society. • Ms. Stewart thanked the BOH for the recommendation of taking the Municipal and County Administration course and that classes are going well. D. Media Items Kristin Prelipp, Communications Manager, briefly mentioned the article in the News of Orange regarding suicide prevention which was included in the Media Items packet. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 24, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ October Page 8 Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. VIII. Board Comments Keith Bagby mentioned that the Carrboro ABC Store has reopened. IX. Adjournment Sam Lasris moved to adjourn the meeting at 8:10pm and Paul Chelminski seconded. The next Board of Health Meeting will be held November 28, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board