NEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 25, REGULAR MEETING, APRIL 21, 1997 PAGE 938 Purpose: To budget greater than anticipated animal control fees and dog/cat tag revenve to cover the additional cost of mailings, processing summons for Small Claims Court, and’ pure protective equipment APPROVAL OF CONSENT AGENDA ITEM 5, COMMUNITY BASED ALTERNATIVES (CBA) FUNDING RECOMMENDATIONS FROM THE HUMAN SERVICES ALLOCATION ADVISORY COMMITTEE Commissioner Davisaskedifthe items presented werejust recommendations fromthe Human Services Allocation Advisory Committee? ‘Budget Director Cam Grifin explained the Board was not being asked to approve funding from the General Fund for outside agencies; however, the grant application for CBA funding must be submitted to the State in order to receive State funding for these agencies. She reported that no County funds were allocated forthe CBA agencies, ‘Motion: Vice-Chairman Caster MOVED, SECONDED by Commissioner Howell t approve the funding tecommendation for the Community Based Alternatives agencies as recommended by the Human Services Allocation Advisory Committee. Upon vote. the MOTION CARRIED. UNANIMOUSLY, PRESENTATION OF HOSPITAL STUDY COMMITTEE REPORT ‘Mr. Claude OShicls, Carman ofthe Hospital Stuly Cormier, expressed appreciation ‘othe Boa forfavng an opportnty to present he report fom te losptl Stay Commitee. He introduce the Plowing members of the Comite tat were preset. Ms, Joyce Femando, Vice-Chairman Mr. Adair Graham Me. Truman MeCastand Ms. Roberta Clark Mr. Jim Pierce Mr. O’Shields expressed appreciation to Ms, Pat Melvin, Assistant to the County Manager, and Dr. Don Latham, UNC Wilmington, Cameron Schoo! of Busines, forthe support given f0 the Hospital Study Comittee during the performance of the study. ‘The following report was presented: ‘The Hospital Study Committee was charged to study the reorganization of New Hanover ‘Regional Medical Center's current operating structure from “not for profit” public hospital toa “not for profit” Community General Hospital as allowed by North Carolina Lav. The Committee was requested to study thoroughly and provide the Board of County Commissionersa non-binding written recommendation to either approve the request ffom the Medical Center to become a Community, ‘General Hospital or consider any options deemed appropriate by the Hospital Study Committe tht ‘would maintain and not compromise the excellent healthcare provided to the fegion as well as improve @ mote efficient operation “The charge to the Committee further stated thatthe Medical Center must remain a benefit to both public and private sectors of New Hanover County and facilitate future economic growth and development. Sine the citizens are the County's most important resource, te New Hanover County Board of Commissioners charyed the Committee wth ensuring protection of the insured, uninsured, and indigent populations. The final charge to the Committee was to prepare a non-binding recommendation and provide reasonable alternatives by March 24, 1997, After review of the above charges to the Committee, the group established a format thet ‘ould allow the charge to be met within certain time constraints “Major changes have occurred inthe provision of healthcare. More changes are coming, and the hospital business appears tobe one with constant changes, A major movement at this time s theNEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 2s REGULAR MEETING, APRIL 21, 1997 PAGE 939 ‘eduction of inpatient days in the hospital. According to national trends, hospital occupancy has Giopped 1% in four years with dovnard movement expected to come ove the ex derade Major savings in health care costs ean be obtained by keeping patients out ofthe hospital or by gee reducing he numberof ay of inpatient care, Therefore the rend Real mnasement ‘n* wellness” to help keep people out ofthe hospital. Reducing the number of hospital beds needed will eventually reduce the eumber of hospitals. As he reduction in hospital bedsneeded accelerates, providers, ie, hospitals, both public and private seramble to develop survival plans. New Hanover Regional Medical Center finds self inthe same predicament Health care costs have almost doubled in the past 10 years as represented in the Gross National Product, from 7% in 1984 o 12% in 1904. In an attempt to lower costs on the pat of the consumer, new demands are being made on providers at all levels in the healthcare field. Cost shifting is occurring. Where federal, state and local funding is reduced for Medicare/Medicaid and the aisured the costo roidng at car sto the rate ayers The Medical Cena faces the same hurdies with 63% ofthe patients served being Medicaid and Medicare patients representing '8244,000,000. Regardless of the organization structure of New Hanover Regional Medical Centr, layofls will continue to occur based on the fact that fewer beds will be needed due to the emphasis on outpatient care Bocause of the changing health care envionment, New Hanover Regional Medical Center seeks to become a Community General Hospital to insure is ability to continue to provide quality care to the citizens of the community and region. ‘The Medical Center believes the benefits of @ Community General Hospital area follows 1, ‘The provision of continued eate for al 2, Enhances the Medical Center's competitive position, 3. Increases non-patient related income investments 4, Decreases cost of operation. 5. Balances local control and provides flexi 6 Resolves the issue concerning competitive information. 7. good busines decison hat will sport New Hanover Regions Medial Conte's mision tothe community (ne ofthe sues that has created hesitancy to change the operating structure of New Hanover Regional Medical Center i ts record of success. Sines is incorporation on May 26, 1967, the hospital has become an oustanding medial facty because of the thousands of dedicated men and women in the community who have served in many capacities. Many peopl feel the structure ofthe hospital should not be changed wih ths continued successtecocd. Astheold adage states, ita Broke, don't foci” ‘The Hospital Study Committe listened to the community concerns and recommendations fom persansatending the mezing, The ple comments and recommendations af cde athe wwtten report. With the wide variety of concer and recommendations heard from the public, there was overall concer about the delivery of quality health care tothe community [In communities that have changed the corporate structure ofa public non-profit hospital, it appears the change has worked wel for those communitiesNEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 2s REGULAR MEETING, APRIL 21, 1997 PAGE 940 Afr weeks ffitning, asking questions, seeking opinions nd conumitee deliberation, the Honpil Study Commie came to the flowing conclaons 1. Allow New Hanover Regional Medical Center to remain a non-profit public hospital, 2 Change to.a not-for-profit Community General Hospital 3. Createa Hospital Authority 4 Sell the hospital 5 Lease the hospital ficiy 6 Seok legislative rele from the General Astembiy ‘The Hospital Study Committee then denitied some needsthat were paramount for continued success of the hospitel: Availabilty of adequate finances, 2 Quality care at reasonable costs, 3. Continue to attract top professional stat 4. Be responsible to changing medical needs 5. Credit and trust within the community 6 Ability to maintain confidentiality in contracts for managed care 7. Revenue sources other than patent fees. Alter reviewing the various structures, the Hospital Study Committee voted to eliminate the establishment of an authority from consideration. It was further determined that not enough exploration into the options of leasing or sale of the hospital had been performed. On April 2, 1997, the members present (3), « majority, decide that they could not recommend a community general structure in its purest form for New Hanover Regional Medical Center. The five members present voted to recommend that New Hanover Regional Medical Center remain a non-profit public hospital sd sek lglatve reli through Senate Bil 247, I leisiive reef isnot proved within 12 ‘months, a Community General Hospital structure should be considered with the folowing caveats: 1, Removal and appointment of trustees, except medical staff representatives, 2. Theze would be no chingein the Aces of Encxporation or Bylaws witout approval ‘the Board of County Commissioners. _ 3. ‘Thehospital could negotiate mangged care contracts privately, but negotiations for purchases cof medical practices would remain public 4. Indigent care must be provided. 5. The hospital must continue to abide by the N. C. Public Bidding Law. 6. Thehospital will agree to continue paying property taxes or a specified amount to the County each year for medical practices it purchases, 7. The hospital will not unreasonabiy excde physicians or mel practitioners fom we ofNEW HANOVER COUNTY BOARD OF COMMISSIONERS BOOK 25 REGULAR MEETING, APRIL 21, 1997 PAGE 941 8. Investments will not be allowed beyond wha i permitted under public hospital status. ‘Mr. O’Shields reported the Hospital Study Committee has asked that itbe allowed to submit its Sa writen report othe Board of County Commision within the net 1wo weeks He reported a copy had beea distributed othe Board this morning bt was removed because Ms. Melvin and Dr, Latham had unforeseen medical emergencies last week that made it impossible forthe nine- member Commitee to review the final report. Mr 0” Stiis reported the Commitee hopes that its deliberations and writen repr wll provide might and dance onthe corporte estuduring of New Hanover Region Medal Renter He reported he would be gad to answer any questions Commi jr Birzenichs asked ifthe Committee placed an asset value on the hospital? Mr. O'Shields responded the Committee did not have an appraisal performed; however, the value ofthe hospital ranges from $300 million to $500 milion. Chairman Greer asked ifthe final report would change sin fall committee? bed not been reviewed by the Mr. 0'Shields responded the recommendations should not change becausethe Hospital Study ‘Committee thoroughiy reviewed and studied the recommendations as presented, ‘Vice-Chairman Caster reported that Senate Bill 247 had been passed by the N.C. Senate and was in the House of Representatives. He advised when the Legislative Coordinating Couneil meets fon Monday, Apri 28, 1997, he would inquire about the status of the bill inthe House. ‘Vice-Chairman Caster expressed appreciation to Mr, O’Shields and members ofthe Hospital Study Committee forthe time and effort given to prepare the report. He advised when serving on the Hospital Board of Trustees in 1992, the changes in health care were being discussed. Those changes are here, andthe Medical Center and Hospital Board of Trustees will have to stay ahead of these changes o continue to provide quality medical care and remain competitive. Since 1967, a $25 nillion asset has growa to. $360 million through quality leadership and cooperation from the community. Inhis opinion, ths is a tremendous success story. ‘Vice-Chairman Caster advised he looked forward to reading the ull eport, and he requested Mr. O'Shields to provide writen documentation i any of the four members that were not present when the report was adopted decide to vote in opposition tothe final recommendation. Mir, OShields stated the nine members appointed tothe Hospital Tsk Force participated and conurtdro the dzusson and loge. The repr cect the concer that were expressed to the Committee members by citizens throughout the community. He advised the report would be completed in two weeks and presented to the Board of County Commissioners ‘Commissioner Birzenioks recommended meeting, with the Hospital Study Committee to iscuss and review the report. He requested Mr. 0’ Shields to forward the report in advance so the ‘Commissioners would have ample time to study the document before the Work Session. Consensus: After further discussion, it was the consensus ofthe Board to schedule a Work Session fon Thursday, May 15, 1997, at 10.00 AM. folowing the Thursday moming Staff Meeting. The place wil be announced ata future date Chairman Greer expressed appreciation to Mr. Q’Shields forthe leadership provided to chair the Hospital Task Foree, and he thanked the members of the Task Foree forthe time given to prepare the report.