[00:00:01]
UH, TAKE A ROLL CALL.THE AFFIDAVIT OF POSTING WAS ACCURATE.
WILL RISE FOR A MOMENT OF SILENT PRAYER AND THE PLEDGE OF ALLEGIANCE.
I PLEDGE ALLEGIANCE TO THE FLAG OF THE UNITED STATES OF AMERICA AND TO THE REPUBLIC FOR WHICH IT STANDS, ONE NATION UNDER GOD, INDIVISIBLE, WITH LIBERTY AND JUSTICE FOR ALL.
ALRIGHT, UM, JUST A SIDE NOTE THAT WE'LL REVIEW THE, UH, ARPA REPORT AT THE MEETING IN MARCH.
UM, SO IF I COULD GET A MOTION AND A SECOND TO APPROVE THE CONSENT AGENDA.
NOT ALLOWED TO KEEP TRACK OF THEM.
UM, AND OUR FIRST, OH, WE GOT A VOTE.
OPPOSED? ALRIGHT, I JUST GUESS I'M ON A RACETRACK HERE.
SO OUR FIRST, UM, ITEM OF, UH, BUSINESS IS THE, UH, HSD ADMINISTRATIVE QUARTERLY REPORT.
WE HAVE ANITA AND LEE, WHO IS FIRST
SO IN JUNE OF 2022, I STARTED MY FIRST EOS INITIATIVE, WHICH WAS TO, UM, CREATE
[a. HSD Administration Quarterly Report]
EFFICIENT BILLING SYSTEM, UM, FOR OUR CHILDREN AND FAMILIES.TODAY, I'M PLEASED TO REPORT THAT IT'S COMPLETE.
UM, THE NEW INVOICING SYSTEM IS FULLY OPERATIONAL, UM, AND ONLY IN PLACE A VERY SHORT TIME.
IT'S VERY EFFICIENT AND NICE, SO A SUCCESS.
SO I'M GLAD TO REPORT THAT IS FINALLY COMPLETED.
THE NEXT ONE I'M, I'M WORKING ON IN 2024 IS, UM, TO ENHANCE OUR ACCURACY AND STREAMLINE THE BILLING PROCESS IN MY UNIT.
UM, FIND WAYS TO FURTHER ENHANCE EFFICIENCY THROUGH AUTOMATION AND EXPLORE OPPORTUNITIES TO POTENTIALLY INCREASE REVENUES IN THE CLINIC.
UM, WITH US BEING IN THE FULL REIMPLEMENTATION WITH JACKSONVILLE, I THOUGHT IT WOULD BE A PERFECT TIME TO LOOK AT HOW WE'RE DOING THINGS.
UM, LAST FALL I HIRED A MEDICAL CODING ASSISTANT.
THEY ADDED ONE TO MY TEAM AND, UM, SHE'S ALREADY IDENTIFIED INSTANCES WHERE SOME OF OUR PRESCRIBERS WERE UNDER CODING FOR SERVICES, WHICH MEANS LESS REVENUE TO THE CLINIC.
SO SHE'S IDENTIFYING THOSE AND GOING BACK TO THE PRESCRIBER AND, UM, HAVING THEM CORRECTED SO THAT WE GET THE, UM, CORRECT REVENUE DUE TO THE CLINIC, WHICH IS REALLY NICE ADDITION TO OUR TEAM.
UM, AND THE OTHER THING THAT I'M WORKING WITH, I'M WORKING WITH, UM, JEL TO FURTHER AUTOMATE OUR, UM, ELECTRONIC, UM, UH, INSURANCE ELIGIBILITY FUNCTION.
CURRENTLY WE DO IT MANUALLY AND THERE'S ALWAYS INSTANCES WHERE IT MIGHT BE AN ERROR OR SOMETHING.
SO BY AUTOMATING IT, WE'LL JUST STREAMLINE IT AND MAKE IT MORE EFFICIENT.
SO THAT'S WHAT I'M WORKING ON RIGHT NOW.
UM, SO AS FAR AS THE CODING SPECIALIST AND THE ADDITIONAL REVENUES YOU'VE REALIZED, UM, DO YOU HAVE SOME KIND OF DATA THAT YOU CAN SHOW US OR IS THAT COMING, LIKE THE INCREASE IN REVENUE? YEAH, I THINK THROUGHOUT 2024 WE WILL, WE'LL LOOK AT ALL THAT AND THEN COME BACK EARLY 2025 AND LOOK AT 2024 REVENUES AND SEE THE DIFFERENCE AND EVERYTHING WE'RE, I'M GONNA COLLABORATE WITH, UH, DOUG BRI TOO, BECAUSE HE'S REALLY INTERESTED IN, UH, DIGGING INTO THE REVENUES AND SEEING WHERE WE CAN INCREASE AND, AND ALL THAT.
YEAH, LOOK FORWARD TO HEARING THIS.
IT'S SMALL GROUP TODAY, HUH? YEAH.
LEMME JUST GET THIS, GIMME ONE SECOND HERE.
I'M LEE ANDERSON, THE OFFICE MANAGER OF HEALTH AND HUMAN SERVICES.
SO I'VE BEEN REPORTING TO YOU THROUGH THE MONTHS AND WHEN WE STARTED THE EOS INITIATIVES, UM, ON IMPROVING OUR EXTERNAL PROVIDER BILLING.
UM, SO I DID, I DID HAVE THAT AS AN INITIATIVE PREVIOUSLY AND THEN I'VE CARRIED IT FORWARD 'CAUSE WE'RE STILL WORKING ON IT.
UM, BUT I HAVE GOTTEN QUITE A BIT OF WORK DONE ON IT.
UM, THE LAST TIME I REPORTED TO YOU, WE WERE, I WAS, UM, TRANSITIONING OUR EXTERNAL PROVIDERS WHERE ALL OF THEIR BILLING IS MANUAL, UM, TO, FROM A SHARE FILE SYSTEM TO A SHAREPOINT SYSTEM, WHICH IS MORE EFFICIENT, IT'S MORE USER
[00:05:01]
FRIENDLY, UM, AND WE'RE ABLE TO PROCESS THINGS EVEN QUICKER.UM, SO I'VE BEEN ABLE TO KEEP TRANSITIONING THESE PROVIDERS ONTO THIS DIFFERENT PLATFORM.
AND I'M ABOUT, I'M A LITTLE OVER HALFWAY DONE WITH OUR, UM, CCS PROVIDERS, AND SO THAT'S GOING REALLY WELL.
UM, I'VE BEEN GOING AND MEETING WITH THEM ONE-ON-ONE, AND THEY ARE VERY RECEPTIVE TO THE CHANGE.
THEY LIKE THE NEW PROCESS THAT WE'RE DOING.
I'VE GOTTEN, I HAVEN'T GOTTEN ANY NEGATIVE FEEDBACK ON IT, SO
SO I'M GONNA CONTINUE TO DO THAT.
UM, THE END GOAL THAT YOU'LL SEE IN MY, UM, REPORT IS JUST THAT WE'RE GONNA MOVE AWAY FROM THAT OLD OLDER SYSTEM TO THE NEWER SYSTEM.
SO I'M JUST TRANSITIONING THESE PROVIDERS OVER AND IT, AND IT'S GOING WELL.
SO THAT'S IN A NUTSHELL OF WHAT, WHAT MY REPORT IS.
UM, THE SECOND ONE, I ADDED ANOTHER INITIATIVE THIS YEAR, UM, TO IMPROVE THE PROCESS FOR REPORTING WISCONSIN MEDICAID COST REPORTING.
SO THIS IS AN ANNUAL REPORT THAT WE, UH, FILE WITH THE STATE AND I, I'M JUST GONNA GIVE YOU A LITTLE A BACKGROUND ON IT.
IT'S A COST-BASED PROGRAM OR COST-BASED PAYMENT SYSTEM FOR COUNTIES THAT ARE CERTIFIED IN AS MEDICAID PROVIDERS OF COMMUNITY-BASED SERVICES.
IT'S ADMINISTERED THROUGH THE DIVISION OF HEALTHCARE ACCESS AND ACCOUNTABILITY IN THE WISCONSIN DEPARTMENT OF HEALTH SERVICES.
COUNTY PROVIDERS PARTICIPATING IN THIS PROGRAM RECEIVE A MEDICAID PAYMENT FROM DHS BASED ON ACTUAL COSTS INCURRED AS REPORTED ON AN ANNUAL BASIS OR ON ANNUAL COST REPORTS.
SO, I MEAN, THAT'S A LOT OF WORDS, BUT BASICALLY MY, MY UNIT, UH, WE VERIFY THAT ALL OF THE, THE SERVICES WE BILL TO MEDICAID, UM, THAT WE HAVE PAID FOR THEM, UM, WE ALSO REPORT THOSE, UH, UNITS OF SERVICE THAT WE PAID FOR, UM, BY PROVIDERS.
SO, UM, WE, WE GIVE THEM A DETAILED ACCOUNT OF, OF WHERE ALL THAT MONEY, UH, WAS PAID, AND THEN WE VER AND, AND BILL TO MEDICAID.
SO IT'S A PRETTY LABOR INTENSIVE PROCESS, AND WE'VE HAD TROUBLE IN THE PAST JUST GETTING THE DATA TOGETHER TO REPORT IT TO, TO THE STATE.
UM, IT, IT TAKES QUITE A WHILE, SO I NEED TO COME UP WITH A BETTER PROCESS TO BE MORE EFFICIENT.
UH, I DON'T, I, I'M ON TRACK WITH, UM, MY GOALS WITH THIS.
I'VE ALREADY, UH, TAKEN INVENTORY OF ALL THE SOURCES OF THE DATA THAT I NEED TO COLLECT.
SO THE NEXT, UH, THING THAT I'M WORKING ON IS TRYING TO EXTRACT THAT DATA OUT OF OUR ELECTRONIC HEALTH RECORD, AND WE'RE WORKING WITH THE JSEL GROUP TO DO THAT.
SO IT, IT'S JUST AN ONGOING, UM, PROJECT THAT I'M WORKING ON, BUT IT'S ON TARGET.
I SHOULD HAVE MORE TO REPORT TO YOU HOPEFULLY THE NEXT TIME THAT I REPORT.
SO, BUT IT'S A NEW INITIATIVE, SO I'M JUST GETTING, GETTING THE, YOU KNOW, GETTING IT STARTED.
SO, DO YOU HAVE ANY QUESTIONS? NO.
ALL RIGHT, UP NEXT WE HAVE DOUG AND THE BEHAVIORAL HEALTH QUARTERLY REPORT.
UM, THE FIRST, UH, UH, PILLAR THAT I'M ADDRESSING IS TO INCREASE THE BEHAVIORAL HEALTH DIVISION REVENUE, WHICH IS SIMILAR TO WHAT ANITA MENTIONED.
SO THERE ISN'T A WHOLE LOT IN PLACE YET AS WE GO FORWARD WITH RE-IMPLEMENTING OUR ELECTRONIC HEALTH RECORD.
UM, WE'RE, WE'RE NOT QUITE PULLING DATA
[b. HSD Behavioral Health Quarterly Report]
OUT OF THE SYSTEM YET, BUT OUR GO LIVE DATE WITH THAT IS APRIL 1ST.SO ONCE THAT'S IN PLACE AND WE HAVE A BETTER, YOU KNOW, BETTER PROCESSES TO PULL THAT INFORMATION OUTTA THE SYSTEM, WE'LL BE ABLE TO TRACK THAT REVENUE.
UM, MORE TO YOUR POINT, JODY, ABOUT, YOU KNOW, LOOKING AT THE CODING SPECIALIST AND HOW THAT'S CHANGED FROM 23 TO 24 AND LOOKING AT THAT AND THEN HAVE MORE DATA BY THE END OF THE YEAR.
SO IT'S ON TRACK, BUT WE'RE KIND OF WAITING AND HOLDING PATTERN AS WE GET OUR, OUR ELECTRONIC HEALTH RECORD, UM, IMPROVED WITH JSEL.
UM, THE OTHER, UH, UM, INITIATIVE WAS TO INCREASE, UM, COMPLIANCE, UH, BI-ANNUALLY.
WE HAVE ALL MY PROGRAMS GET RECERTIFIED BY THE STATE, SO WE WANNA BRING IN MORE COMPLIANCE AND AUDITING FEATURES.
IN BETWEEN THOSE, UM, AUDITS, THEY ALWAYS GO VERY WELL.
UM, OUR RECERTIFICATIONS DON'T COME BACK WITH ANY EGREGIOUS ERRORS.
THERE'S ALWAYS GONNA BE A MISSING SIGNATURE OR MAYBE A MISSING FORM, BUT BY AND LARGE, THEY'RE NOT PROBLEMATIC.
THIS INITIATIVE TIES IN REALLY WELL WITH SOMETHING THE SOUTHEAST REGION IS DOING WITH THE STATE RIGHT NOW TOO, OF, OF COMPLIANT COMPILING ALL OF THE COMPLIANCE FORMS AND, AND PAPERWORK THAT THE
[00:10:01]
FOUR COUNTY OR FIVE COUNTY REGION USES AND SHARING THOSE SO THAT WE CAN SORT OF STREAMLINE OUR, OUR, UM, AUDITING PROCESSES IN HOUSE TO JUST MAKE THOSE RECERTIFICATION PROCESSES EVEN QUICKER.WE'RE DEVELOPING THOSE PROCESSES RIGHT NOW, AND THEN WE'LL DEVELOP A SORT OF A PLAN OF CORRECTION THAT WILL LIVE WITH THE TEAM SO THAT WHENEVER THEY FIND THESE ERRORS, WE'LL HAVE A PLAN OF HOW WE'RE GONNA REPLACE THEM AND HOW TO AVOID THEM GOING FORWARD.
SO IT'S, IT, ALL THOSE THINGS ARE UNDER DEVELOPMENT.
UM, THE LAST ONE WAS THIS, THE SOBER LIVING FACILITY.
UM, THAT WAS A CARRYOVER FROM LAST YEAR.
UM, PRIOR TO, UM, OR I'M SORRY, AFTER THIS WAS PRINTED, WE DID GET A, THE PROPOSAL FROM MAITA HOUSE THAT I, THAT JULIE SENT TO ME, I REVIEWED TO JUST SORT OF GIVE US THEIR OVERVIEW AND THEIR OUTLINE OF WHAT THEY WANTED TO DO NEXT.
SO I KNOW THAT THAT'S IN PROCESS, SO WE'RE BACK ON TRACK WITH THAT.
THE NEXT STEP WILL BE DEVELOPING THE RFP WITH 'EM AND THEN HOPEFULLY GETTING THAT OUT BY THE END OF THE, THIS FIRST QUARTER, WHICH IS OUR HOPE.
ANY QUESTIONS? ALRIGHT, LOOKS GOOD.
UM, SO THE NEXT ITEM ON OUR AGENDA IS A DISCUSSION REGARDING THE FUTURE OF SAMARITAN HEALTH CENTER.
AND IN LIGHT OF THE FACT THAT, UH, TRILOGY HEALTH SERVICES DECIDED NOT TO SIGN THE FINAL CONTRACT AFTER 10 MONTHS OF LOTS OF WORK AND NEGOTIATIONS, UM,
[c. Discussion Regarding the Future of Samaritan Health Center]
SURPRISES US ALL.UM, NOW THAT WE'VE HAD A CHANCE TO KIND OF PROCESS THAT AND THINK THROUGH IT AND THINK ABOUT IT, IT MAKES SOME SENSE TO HAVE A, A DISCUSSION.
UM, UH, YOU KNOW, WE, WE, THE COUNTY BOARD RESOLUTION FROM LAST APRIL IS, IS REALLY CLEAR.
IT, IT APPROVES THE SALE, UM, APPROVING THE SALE, AND IT ALLOWS THE COUNTY TO CONTINUE TO WORK WITH A BROKER TO FIND A NEW BUYER.
UM, AS COUNTY EXECUTIVE SHOWMAN SAID, OUR NUMBER ONE PRIORITY IS, HAS ALWAYS BEEN, IS THE RESIDENTS AND THE STAFF.
UM, AND WE NEED TO TAKE CARE OF THEM.
SO WE WILL FIND A QUALIFIED BUYER WHO CAN BEST ACCOMPLISH THAT.
BUT, UM, WOULD LIKE TO TAKE AN OPPORTUNITY TO HEAR FROM YOU IF YOU HAVE ANY, ANY COMMENTS? YEAH, I, FOR DISCUSSION, MATT IS HERE TO ANSWER ANY QUESTIONS.
YEAH, AND I TALKED TO MIKE A. LITTLE EARLIER TOO ABOUT ONE OF THE QUESTIONS THAT I HAD, I REVIEWED THE SALE CONTRACT YES.
AND, UH, THE SALE CONTRACT ACTUALLY SHOWED 181 SKILLED NURSING, BUT IT'S 131.
YEAH, THAT WAS THE TYPO THAT WE CORRECTED SEVERAL MONTHS AGO.
THEN I THINK IT POPPED BACK IN.
SO, AND THEN, UM, SO THE 31 FOR CBRF? THAT'S CORRECT, YES.
JUST SO WE HAVE THAT ALL CLEAR.
AND THEN, SO NOW WITH SELLING THOSE LICENSES WITH THE DEAL THAT DIDN'T, UM, WORK OUT, THEY WERE GOING TO SPLIT THEM RIGHT.
UM, WITH A FACILITY HERE AND THEN TAKE SOME OF THOSE LICENSES AND USE THEM SOMEPLACE ELSE.
WOULD THEY HAVE TO, WHEN THEY SPLIT THEM LIKE THAT, WOULD THEY HAVE TO USE THEM WITHIN A CERTAIN GEOGRAPHIC AREA OF HERE? WELL, TECHNICALLY YES.
YET THE STATE HAS ALLOWED SOME LATITUDE IN THAT.
SO, UM, THE WAY IT'S WRITTEN, THEY SHOULD STAY WITHIN A REGIONAL AREA, WHICH IS, UH, SOMEWHERE BETWEEN FIVE AND SEVEN COUNTIES.
BUT, UH, THERE HAVE BEEN TIMES THAT THEY'VE ALLOWED EXCEPTIONS, ESPECIALLY AREAS WHERE THEY FEEL THAT THERE'S A LOW, UH, NUMBER OF SKILLED NURSING BEDS IN A GIVEN COUNTY.
YEAH, I WAS JUST CURIOUS ABOUT THAT.
UM, AND THERE'S NO PROBLEM WITH SPLITTING IT.
LIKE COULD IT BE SPLIT, YOU KNOW, AND ARE THERE RULES LIKE HALF OR CAN YOU DO EITHER LIKE THREE? NO, IT, IT COULD BE ANYTHING.
AND BETWEEN, BUT ALL WITHIN ONE ENTITY.
LIKE IF WE HAVE, UM, A NEW BUYER THAT COMES ALONG AND UM, THEY WANNA DO SOMETHING SIMILAR TO, UM, TRILOGY, CAN THEY, CAN THEY DO THAT? OR COULD WE POTENTIALLY FIND A BUYER? TWO BUYERS? NO, NO.
IT HAS TO BE ONE BUYER, ONE T FOR THE WHOLE THING.
AND THEY CAN, THEY CAN'T SELL THEM, BUT THEY CAN USE THEM IN TWO DIFFERENT
[00:15:01]
PLACES.THEY CAN'T SELL 'EM BECAUSE THERE'S ONE LICENSE NOW IT, WITHIN THE SAME COMPANY, THEY WILL ALLOW A SPLIT WITH LICENSES, BUT THEY CAN'T SELL A PORTION.
AND WE CAN'T SPLIT IT FOR A DEAL FOR THE TWO COMPANIES.
UM, YEAH, THAT'S WHAT I WAS WONDERING.
AND THEN I DUNNO IF YOU HAVE, I HAVE SOME QUESTIONS.
ARE ARE, I MEAN, MAYBE YOU CAN'T ANSWER SOME OF THESE, BUT ARE THERE ANY INTERESTED BUYERS THAT WE ARE AWARE OF? NO, BUT, UH, THE GOOD NEWS IS JOSH JUST SIGNED THIS AFTERNOON, THE AGREEMENT, UH, FOR A BROKER, EXCLUSIVE LISTING AGREEMENT, AND HE JUST SIGNED IT AND IT WILL BE EVANS E-V-A-N-S.
AND THEY'RE OUTTA CHICAGO AND THEY DO A NATIONWIDE SEARCH.
THEY ARE ACTUALLY THE BROKER THAT WE WERE BEGINNING TO WORK WITH SOMEWHERE BETWEEN, WELL, IT WAS MAY, UH, 23RD OF, OF 2022, WE WORKED WITH THEM AND UNTIL THIS DEAL CAME THROUGH WITH THE POSSIBILITY OF TRILOGY, THEN THAT WAS PUT ON THE BACK BURNER.
SO NOW WE RESTARTED THAT WE'RE WORKING WITH FOLEY EN LARDNER AND WORKING WITH THEM, AND IT'S BEEN GOING VERY, VERY WELL.
CAN YOU EXPAND ON THE DEFINITION OF EXCLUSIVE? YES.
THAT MEANS THAT, UM, NOW THAT IT'S SIGNED, ANYONE INTERESTED WOULD GO THROUGH THEM FOR THE NEXT SIX MONTHS AND THEY WOULD BROKERAGE THE WHOLE THING.
BUT WE CAN'T HAVE TWO BROKERS.
SO WHAT IS THE BROKER LIKE GOING, HOW ARE THEY GOING TO THEN, THEY'RE DOING A NATIONWIDE SEARCH, SO THEY'RE GOING TO FIND A BUYER BY ADVERTISING.
UM, HOW DO THEY DO THAT? WELL, YEAH, BECAUSE BECAUSE THIS COMPANY HAS BEEN IN BUSINESS FOR A, A LONG PERIOD OF TIME, THEY HAVE A LOT OF THE PLAYERS THEY KNOW AND THEY WILL GO OUT AND ADVERTISE NATIONWIDE AS WELL AS LOCALLY.
IN, IN LIKE MAGAZINES THAT THEY SEND OUT OR IN, I MEAN, HOW DO, WHAT DO THEY ADVERTISE? WELL, NOWADAYS EVERYTHING'S SO ELECTRONIC, SO I'M SURE THEY HAVE BUYER LISTS AND COMPANIES LISTS, BUT THERE MAY BE ALSO IN MAGAZINES, TRADE MAGAZINES, UM, WHAT IS THE TERM OF THE CONTRACT WITH THE SIX MONTHS? SIX MONTHS.
SO THEN, UM, IN THE UNLIKELY EVENT THAT THE BOARD WOULD VOTE TO END THE CONTRACT WITH THE BROKER TO PURSUE ANOTHER OPTION, CA CAN WE CANCEL THE CONTRACT WITHOUT PENALTY OR OH, THERE'D BE A PENALTY OF, YEAH.
AND, AND THAT'S BASICALLY WHAT WE BELIEVE THE INTENT OF THE COUNTY BOARD WAS TO GO OUT AND MARKET AND SELL.
SO, AND SIX MONTHS IS NOT AN OVERLY LONG TERM.
UM, CAN WE REVIEW THE CONTRACT AT ALL? UM, IT'S SIGNED.
I'M SURE YOU COULD, BUT, UH, BRAD'S NOT HERE TODAY OR DOES HE NOT NORMALLY COME? UM, SOMETIMES HE COMES SOMETIMES.
UH, WE, WE'D HAVE TO CHECK WITH BRAD TO SEE, BUT I DON'T THINK ONCE IT'S SIGNED, I DON'T THINK THAT'S A PROBLEM.
BRAD STERN IS WHO YOU WANT TO TALK TO, REVIEW IT IF I CAN.
UM, SO I, I HEARD AT THE MEETING THAT SOME PEOPLE SAID WE SHOULD FIND OUT THE POSITIVES AND NEGATIVES.
AND I THINK JEFF SCH LIFE SAID, WELL, WE'RE CERTAINLY GOING TO BE DOING THAT.
HAVE WE FOUND OUT, YOU KNOW, IT WAS SO LONG THAT WE WERE WITH TRILOGY AND THEN TO HAVE IT HAPPEN AFTER SIGNING, DO WE KNOW WHAT HAPPENED BEYOND, BEYOND THEIR, A DIFFERENT
[00:20:01]
BOARD CHANGING THEIR BOARD? YEAH, WE REALLY, WE REALLY DON'T HAVE ANY ADDITIONAL INFORMATION, BUT IT REALLY, THE STATEMENT BEYOND SIGNING, WE DIDN'T SIGN, UH, JOSH SIGNED, BUT IT TAKES TWO PARTIES MM-HMM.SO THEY DID NOT SIGN THAT DAY.
WE ANTICIPATED, AND IT'S INTERESTING TRILOGY, UH, STAFF ANTICIPATED SIGNING.
SO IT WAS, UM, BUT BECAUSE OF A NEW SET OF INVESTORS, THEY DECIDED THAT THEY'RE REFOCUSING ON DIRECTION.
SO WHAT DOES THAT MEAN? WE DON'T KNOW.
SO, SO IN THE, IN, YOU KNOW, UH, IN THE NEGOTIATIONS, WHAT WERE SOME OF THE THINGS THAT, OR DID THEY SAY, YOU KNOW, INDICATE, UH, SOME THINGS THAT THEY REALLY DIDN'T LIKE ABOUT, UM, HOW WE HAD PUT UP THE PARAMETERS FOR THE SALE? NO, THEY WERE TOTALLY SATISFIED WITH EVERYTHING.
IN FACT, UH, THREE WEEKS PRIOR, THE VICE PRESIDENT THAT I'VE BEEN WORKING WITH, HE BROUGHT WITH HIM HIS, UH, ENGINEER AND HIS DEVELOPMENT PERSON.
AND EVEN THOUGH THE AGREEMENT WAS FOR THREE YEARS WITH A POSSIBLE EXTENSION OF ONE MORE YEAR, THEY DECIDED THAT DAY THEY'D LIKE TO BREAK GROUND IN SPRING OF 2025.
DID, DID THEY INDICATE THAT STAFFING WAS AN ISSUE? I MEAN, WAS THERE, DO YOU KNOW, WERE YOU ANY KIND OF PART OF THE NEGOTIATIONS AT ALL, OR? OH, YEAH.
AND, AND, UH, THEY CERTAINLY UNDERSTAND THEY HAVE MULTIPLE FACILITIES AND NATIONWIDE.
UH, JUST THIS MONTH, 19.1% ARE IMMIGRANTS OR COMING FROM ANOTHER COUNTRY TO, FOR THE STAFFING ISSUE, WHICH WAS, UH, PRETTY SURPRISING TO ME IS, IS THAT NATIONWIDE? THIS WAS, YES.
THIS WAS FROM MCKNIGHT NEWS, LONG-TERM CARE NEWS.
AND THEY STATED 19.1% OF THE US NURSING HOME AND NURSING WORKFORCE IS, UM, OUT OF THE COUNTRY COMING FROM OUT OF THE COUNTRY.
SO THIS IS DEFINITELY A NATIONWIDE ISSUE.
AND I THINK DURING THE TASK FORCE WAY BACK IN 21, UM, THERE WAS A LOT OF DISCUSSION ABOUT UTILIZATION WITHIN THE COUNTY, OUR COUNTY, WASHINGTON COUNTY.
DO YOU KNOW IF ANY OF THAT HAS CHANGED NOW? I THINK, DID THEY SAY WE WERE UNDERUTILIZED? I'M NOT SURE YOUR QUESTION.
I WOULD HOW THAT, THAT THERE'S MORE BEDS THAN PEOPLE.
UM, AND I THOUGHT THAT THAT WAS ONE OF THE, THE ISSUES WE DEFINITELY HAVE.
IT'S HARD TO JUDGE THAT TODAY I HAVE 131 LICENSED BEDS, AND AS OF TODAY'S CENSUS, I HAVE ONLY 42.
NOW, PART OF THAT IS LACK OF DEMAND.
THE LARGER PART IS THAT WE CAN'T AFFORD, BECAUSE I'M AVERAGING A HUNDRED THOUSAND DOLLARS A MONTH ON AGENCY STAFF.
SO IT'S VERY DIFFICULT TO, UM, LOOK AT, I NEED A SAFE ENVIRONMENT, OF COURSE.
SO I NEED, I NEED A NUMBER OF EMPLOYEES TO SERVE OUR RESIDENT POPULATION.
SO, UM, I THINK THAT WITH THE CURRENT STATE, WE COULD PROBABLY GO UP TO 50 AT THE HIGHEST AT THIS POINT.
SO THE CENSUS IS NOW DEPENDENT ON THE STAFF THAT YOU CAN GET? IS THAT THE MAJORITY? YEAH, THE MAJORITY WE'RE, WE'RE NOT RECEIVING AS MANY REQUESTS FOR LONG-TERM CARE.
AND I ATTRIBUTE THAT TO, IN PART THAT EV WE'RE IN THE NEWS ALL THE TIME THAT MM-HMM.
IT, IT ACTUALLY, IF YOU'RE LOOKING AT JUST WHAT HAPPENED, THE PICTURE TODAY AND LAST MONTH, AND, UH, SINCE COVID IT, IT'S EXASPERATED BY THE FACT THAT WE'RE SELLING OR AT THAT, THAT DECISION HAS BEEN MADE.
SO IT'S HARD TO GET EM A FULL-TIME EMPLOYEE TO SIGN ON.
[00:25:01]
FACT, I'M WORKING ON, UH, NEW INCENTIVES THAT I'LL BRING TO THIS COMMITTEE POSSIBLY IN MARCH.BUT YES, WE ARE, WE ARE DOING THAT.
UM, THE LATEST TRADE JOURNALS TALK ABOUT 31% OF THE STAFF NURSING HOME AND HOSPITAL STAFF HAVE LEFT THE FIELD SINCE COVID.
BUT THAT WAS NOT AN ISSUE WITH TRILOGY STAFFING WAS NOT SOMETHING THAT, THAT THEY SAID WERE REALLY WORRIED ABOUT STAFFING HERE IN THE WASHINGTON COUNTY AREA.
I I DID NOT HEAR THEM SAY THAT, UH, WASHINGTON COUNTY WAS ANY MORE DIFFICULT FOR STAFFING THAN ANY PLACE WHERE THEY EXIST.
AND THEN THEY GO, UH, OUTTA STATE AFTER THAT.
JUST CLARIFY, WHEN YOU SAID 42 BEDS, IS THAT HOW MANY PEOPLE THEN? THAT'S OUR CENSUS FOR SKILLED IT IS 42 SKILLED NURSING.
FOR, UM, FOR SKILLED NURSING, IT'S 42 FOR THE RCAC, IT'S 19 OUT OF 24.
SO, AND I, I TALKED TO MIKE EARLIER ABOUT, UM, I WAS ASKING HOW MUCH ARPA MONEY WE HAVE LEFT, AND HE SAID ABOUT ONE POINT 29 MILLION.
AND, UM, I GUESS HOW LONG DO YOU EXPECT THAT TO LAST? I'M ASSUMING THAT'S TO BE THAT WE COULD USE FOR INCENTIVES.
SO HOW LONG WOULD THAT LAST? UM, DID YOU WANT TO YEAH, YEAH, I CAN ADDRESS THAT.
SO THE 1.29 NUMBER, UH, IS INCLUSIVE OF, UH, COMMITTED ARPA FUNDS THROUGH MARCH.
SO WE'VE GOT ARPA FUNDS COMMITTED, BAKED INTO THAT NUMBER ALREADY.
UM, THROUGH MARCH FOR THOSE INCENTIVES.
SO, UH, AT THIS POINT, WE'RE USING ABOUT JUST OVER A HUNDRED THOUSAND A MONTH, UH, IN ARPA FOR, FOR INCENTIVES IS KIND OF THE WAY THE NUMBERS WORK ON THAT.
SO, UM, THE, I MEAN, ASSUMING THE $1.29 MILLION WOULD BE COMPLETELY DEDICATED TO THE STAFFING ISSUE, UM, YOU KNOW, YOU CAN DO THE MATH ON THAT, ON THAT, BUT THAT'LL, THAT'LL CERTAINLY LAST THE REMAINDER OF THE YEAR AND THEN SOME.
BUT, UM, AGAIN, THAT, THAT IS OBVIOUSLY SUBJECT TO APPROVALS AND DIFFERENT THINGS LIKE THAT.
SO, SO WHAT DO, WHAT DO WE DO WHEN THE MONEY RUNS OUT? THAT'S WHAT HE'S GONNA TALK TO US ABOUT IN MARCH.
WELL, WELL, I'M GONNA TALK ABOUT NEW INCENTIVES OR AN EX, UH, EXTENDING THE CURRENT INCENTIVES.
UM, SO IF WE DON'T CONCURRENTLY LOOK AT OTHER OPTIONS, GENERAL FUNDS, I'M ASSUMING WON'T BE SOMETHING THE FULL COUNTY BOARD WOULD AGREE TO INDEFINITELY, UM, FOR OR FOR A UNKNOWN LONG PERIOD OF TIME.
SO, UM, AND THE LISTING CONTRACT ENDS ENDS IN SIX MONTHS.
SO IF WE DON'T HAVE A BUYER IN THAT TIME AND WE RUN OUT OF THESE ARPA FUNDS AND WE'RE INTO THE GENERAL FUND, UM, WHAT HAPPENS NEXT? I THINK YOU NEED TO TALK TO YOUR CHAIR AND THE CHAIRMAN OF THE BOARD,
BUT I THINK THAT'LL, WELL SEE, THIS IS WHY I FEEL THAT WE NEED TO BRING BACK THE AD HOC COMMITTEE AND WE NEED TO BE UPDATING THE INFORMATION THAT WE HAD, BECAUSE I THINK IN EVERYTHING ELSE THAT THE, THE COUNTY DOES, I BELIEVE THERE ARE, THERE'S A PLAN B OR THERE'S, YOU KNOW, SOME WAY TO ASSURE THAT WE'RE NOT HITTING A WALL AND WE HAVE NO PLAN.
UM, AND UNLESS WE START PLANNING, UH, FOR THAT POINT IN TIME, I MEAN, YEAH, BUYER COULD COME UP AND IF THAT COULD ALL WORK OUT AND YOU KNOW, UM,
[00:30:01]
BUT THAT MAY NOT HAPPEN.YOU CAN'T COUNT ON THAT HAPPENING AS WE'VE SEEN.
UM, SO, UH, THAT'S WHY I'M LOOKING FOR, TO BRING BACK THE AD HOC COMMITTEE.
AND DID YOU READ MY LETTER TO THE EDITOR THAT I HAD? NO, IT WAS IN TUESDAY'S PAPER.
UM, SO, AND I REALLY DIDN'T HAVE TO WRITE A WHOLE LOT BECAUSE I QUOTED A LOT FROM THE COUNTY.
UM, SUCH AS UNDER OUR, UH, STRATEGIC PRIORITIES UNDER THE HEADING OF ACCESS TO BASIC PHYSICAL, BEHAVIORAL, AND SOCIOECONOMIC NEEDS.
UM, WE HAVE TWO ITEMS THAT I THOUGHT REALLY PERTAINED.
ONE PRO PROVIDES FOR THE PHYSICAL, EMOTIONAL, AND SOCIAL WELLBEING OF ITS SENIOR POPULATION, ENSURING THEY ARE INDEPENDENT, SAFE, AND INCLUDED IN THE COMMUNITY.
UM, AND THEN THE OTHER ONE PARTNERS TO ENSURE THE COMMUNITY'S BASIC SOCIOECONOMIC NEEDS ARE BEING MET AND PROVIDING CARE AND ASSISTANCE TO IMPROVE THE CIRCUMSTANCES OF THOSE AT RISK.
SO I MEAN, WE ARE, WE'RE STATING RIGHT IN THERE THAT WE'RE GOING TO BE TAKING CARE OF SENIORS, AND WE DON'T MEAN SENIORS IN HIGH SCHOOL, WE MEAN SENIOR CITIZENS
UM, SO, UM, ALSO UNDER THE COUNTY'S ORGANIZATION VALUES, IT STATES OUR SUCCESS IS ROOTED IN INNOVATION.
WHAT COMES FROM OUR, OUR CREATIVITY WILLINGNESS TO TAKE RISKS AND DEDICATION TO NEW IDEAS.
SO, UM, IF WE DON'T HAVE A BUYER THAT COMES FORWARD, I DON'T THINK WE SHOULD BE, UM, FOLLOWING, WE LIKE TO BE LEADERS.
WE DON'T WANNA BE FOLLOWING SO MANY OTHER CO COUNTIES IN GETTING OUT OF THE BUSINESS.
UM, SO WE NEED TO BE INNOVATIVE AND CREATIVE AND PREPARED.
AND, UM, SO THERE ARE COUNTIES THAT HAVE DECIDED TO STAY IN THE BUSINESS AND MEET THEIR COMMITMENTS TO THE TITLE 19 SENIOR POPULATION IN THEIR AREA.
UM, I PLAN ON TALKING TO A FEW OF THEM TO GET MORE INFORMATION, BUT I KNOW THERE ARE, I KNOW A COUPLE OF THEM I HAVE IN MIND TO TALK TO.
AND IF THEY CAN DO IT, WE CAN DO IT.
UM, THE PROJECTIONS THAT WERE PREPARED BY THE OUTSIDE CPA FIRM BASED ON OUR HISTORICAL DATA WITH THE SAMARITAN AND THE ASSUMPTIONS GIVEN TO THEM BY THE COUNTY, PROVE THAT WE CAN HAVE A FINANCIALLY SUSTAINABLE COUNTY OWNED OPERATION.
AND IF WE ADD INDEPENDENT LIVING, WE JUST ENHANCE THAT AND MAKE IT EVEN MORE SOUNDLY SUSTAINABLE GOING INTO THE FUTURE.
THAT WOULD BE THE CREATIVE INNOVATIVE PART.
UM, SO THE, THE NEXT OBJECTION WAS THE STAFFING SHORTAGES.
AND IT'S INTERESTING THAT 19.1% OF THE NURSING HOME STAFFING ACROSS THE NATION IS FROM ANOTHER COUNTRY BECAUSE THAT IS, UM, DEFINITELY THAT WOULD BE AN OPTION IF WE HAVE, IF WE STABILIZE THIS SITUATION, UM, AND DECIDE TO, FOR EXAMPLE, BUILD A NEW BUILDING THAT WOULD GIVE STABILITY TO OUR CURRENT EMPLOYEES, WHICH WOULD HELP YOU RETAIN OR ATTRACT FULL-TIME EMPLOYEES, WHICH YOU'RE HAVING THE BIGGEST PROBLEM GETTING RIGHT NOW.
UM, AND UM, I THINK THERE'S A NUMBER OF PEOPLE WHO HAVE LEFT THAT WOULD PROBABLY COME BACK BECAUSE SOME OF THE PEOPLE COME BACK NOW THAT RETIRE OR LEAVE.
SO THEY WOULD BE EVEN MORE LIKELY TO, UM, IF WE CAN GIVE THEM A STABLE WORK ENVIRONMENT.
SO, AND THEN IF THAT'S NOT ENOUGH, OUR BACKUP PLAN, 'CAUSE YOU ALWAYS NEED ONE, IS TO BRING IN PEOPLE FROM THE PHILIPPINES.
AND WHEN YOU DO THAT, THAT YOU COULD GET SOMEBODY POSSIBLY, UM, WHO'S AT, AT AN LIKE AN RN STATUS OVER THERE, BUT COMES IN HERE AS LIKE A NURSING AIDE AND THEN THEY HAVE TO GO THROUGH OUR EDUCATIONAL PROCESS TO WORK UP THE LADDER.
HOWEVER, THEY DO HAVE A TWO YEAR COMMITMENT TO THE COMPANY THAT BRINGS OR ORGANIZATION THAT BRINGS THEM IN.
AND IF THEY LIKE WHERE THEY'RE WORKING, THEY COULD STAY WELL BEYOND THE TWO YEARS.
SO, UM, THIS, TO ME, THIS IS VERY DOABLE AND I KNOW WE DO HAVE THE, THE RESOLUTION TO SELL AND THERE'S NO TIME LIMIT ON THAT.
UM, HOWEVER, THERE WILL BE A TIME LIMIT BECAUSE THERE WILL BE A TIME WHEN THE COUNTY BOARD SAYS ENOUGH IS ENOUGH.
AND, UM, SO THAT'S WHERE I THINK WE NEED TO UPDATE
[00:35:01]
THE INFORMATION THAT WE, THAT THE AD HOC COMMITTEE AND YOU MOSTLY YOUMEDICAID RATES ARE COMING OUT SOON.
AND UM, SO WE NEED TO UPDATE THAT AND WE NEED TO BE PREPARED WITH A PLAN B.
SO IN BASED ON THAT, WE, I KNOW I DON'T, CAN'T HAVE AN ACTIONABLE ITEM, BUT I REALLY WANT TO MOVE THAT THIS TOPIC BE PUT ON THE MARCH, 2024 COUNTY BOARD AGENDA, UM, TO VOTE ON BRINGING BACK THE AD HOC COMMITTEE TO UPDATE THAT WORK SO THAT WE'RE PREPARED.
I THINK THAT'S WHERE YOU WOULD MAKE THE MOTION AT THE BOARD MEETING.
THE OTHER ADDITIONAL THOUGHTS OR COMMENTS SUPERVISOR BAILEY? NO, I'M JUST WORRIED IF WE ONLY HAVE SIX MONTHS AND THEY DON'T FIND A BUYER, YOU KNOW, AND WHAT ARE WE GOING TO DO? YOU COMMENT ON PREPAREDNESS THEN? YES, WE SHOULD BE, YES.
I'M SURE THE STAFF IS, I'M A HUNDRED PERCENT SURE THEY'RE VERY AWARE OF THAT AND MM-HMM.
I MEAN, WE'RE NOT STAYING SAYING STAY IN BUSINESS THROUGH ETERNITY.
UM, BUT FOR WHATEVER, YOU KNOW, WHAT MAKES SENSE? UM, AND UM, BECAUSE IF WE DON'T HAVE A BUYER AND WE RUN OUTTA MONEY AND WE HIT THIS WALL, THE OTHER ALTERNATIVE IS NOT ONE THAT ANYBODY WANTS.
SO I THINK THEY NEED TO BE OPEN TO HAVING THIS INFORMATION UPDATED AND THINKING THAT, YOU KNOW, MAYBE THIS IS SOMETHING THAT WE NEED TO SERIOUSLY CONSIDER AND WITH THE SIX MONTHS OF, FOR, YOU KNOW, FOR THE BROKER TO FIND A BUYER IN SIX MONTHS, THEN THE AD HOC COMMITTEE HAS THAT SIX MONTHS TO WORK TOO.
WHICH IS PROBABLY ABOUT, I MEAN, IT, IT TOOK A WHILE LAST TIME TO, YOU KNOW, AND SOME THINGS DON'T NEED TO BE UPDATED, BUT DEFINITELY THE NUMBERS DO WITH THE NEW MEDICAID RATES AND THINGS LIKE THAT.
SO ANY OTHER THOUGHTS OR COMMENTS? I'M COVERED WITH THAT.
WELL, I APPRECIATE, UM, WE CERTAINLY AS A, AS A COUNTY, EVEN BEFORE MY TIME, YOUR TIME, PROBABLY CLOSE TO YOUR TIME HA HAVE BEEN REVIEWING THIS AND HAVE DONE ITS DUE DILIGENCE.
SO, UM, YOU KNOW, THE DUE DILIGENCE IS DEFINITELY THERE.
UM, TWO TASK FORCES, AN AD HOC COMMITTEE, YOU KNOW, I THINK IT'S A ALMOST A WELL OILED ENGINE AT THIS POINT AS FAR AS WHAT NEEDS TO BE LOOKED AT.
AND, AND, UM, I WOULD ENCOURAGE YOU TO, TO BRING THAT MOTION FORWARD AT THE COUNTY BOARD.
IT NEEDS TO BE ON THE AGENDA, I THINK.
BUT, YOU KNOW, AND THE, AND THE OTHER THING IS THE TASK FORCE THAT HAD LOOKED AT THIS BEFORE THE AD HOC COMMITTEE AND AFTER THEIR RESULTS, UM, IT WAS ALMOST UNANIMOUS THAT THE BOARD AT THAT TIME FELT THAT WE HAVE A MORAL OBLIGATION AND A FINANCIAL OBLIGATION UP TO $500,000 A YEAR TO, UH, TAKE CARE OF OUR SENIOR CITIZENS, OUR TITLE 19 PEOPLE.
I MIGHT JUST WANT TO ADD ONE THING.
YOU KNOW, I'M NOT TRYING TO GET IN IN INTO MAKING, UH, SAYING THAT THE CELL IS A BAD DECISION, BUT I JUST WANNA POINT OUT THAT IT, BY SELLING, UM, THE LICENSES, IT'S GOING TO A PRIVATE COMPANY AND IT DOESN'T REALLY MEET, UM, WHAT THE ORIGINAL TASK FORCE SAID.
THEY'RE NOT REQUIRED, UH, TO TAKE ON TITLE 19, WHEREAS OUR GOAL AND THE TASK FORCE GOAL WAS TO HELP THOSE IN THE FINANCIAL NEED.
UM, YOU KNOW, THE REALLY WHAT WE'RE DOING BY SELLING TO PRIVATE IS COMPETITION FOR THE COMPANIES THAT ALREADY EXIST, WHICH IS ONE OF THE VALUES THAT WE DO NOT HOLD
[00:40:01]
YOU KNOW, I THINK WE SHOULD PROBABLY ALSO GO BACK AND REVIEW A, A, A LITTLE BIT OF THE INFORMATION THAT WAS DONE WITH THE ORIGINAL TASK FORCE, AND I THINK YOU DID THAT IN THE AD HOC, BUT, UM, THE CONCEPT, THE CON THE TOTAL CONCEPT THAT WE TAKE CARE OF OUR SENIOR CITIZENS, UM, 'CAUSE THE GOAL OF HAVING THE, UH, CONTINUING THE SAMARITAN IN SOME SHAPE, UH, OR FORM, EITHER BY RENOVATING OR A NEW BUILD.UM, THE CONCEPT WAS BASED ON THE FACT THAT THAT WAY WE COULD ASSURE THAT WE'RE TAKING CARE OF THE TITLE NINETEENS, WHEREAS SELLING TO PRIVATE DOESN'T REALLY MEET THAT VALUE.
AND I READ THE CONTRACT AND I AGREE
I DON'T HEAR ANY, SEE ANY OTHER COMMENTS OR FOR DISCUSSION.
APPRECIATE YOUR INPUT AND TIMING.
CAN I JUST ASK, ASK A QUESTION? YEAH.
THIS IS LONNIE HARE, I'M CHIEF OF STAFF.
UH, ARE YOU AWARE WITHOUT, UH, CHAIRMAN SCH BEING WITH US THIS EVENING, THIS AFTERNOON, ARE YOU AWARE IF HE HAS AN APPETITE TO BRING BACK THE AD HOC COMMITTEE OR IS THAT TO BE DETERMINED? I, THAT'S A GREAT QUESTION.
HOWEVER, I THINK WE SHOULD HAVE HIM REVIEW AND WATCH THE VIDEO OF THIS MEETING SINCE HE COULDN'T BE HERE.
I THINK HE SHOULD BE HIGHLY ENCOURAGED TO, UH, WATCH THE VIDEO OF THIS MEETING.
IT'LL BE HIS ULTIMATE DECISION BECAUSE IT'S HIS AGENDA.
UM, AND HIS DECISION EITHER WAY WILL MAKE A STATEMENT.
AND I JUST WILL CONCLUDE BY JUST REMINDING EVERYONE THAT WE DO HAVE THE EXISTING RESOLUTION THAT WAS SIGNED LAST APRIL.
UM, THAT REINFORCES OUR MOMENTUM GOING FORWARD TO, TO SELL.
AND AGAIN, THINKING OF THE RESIDENTS PRIMARILY AND THE STAFF, KEEPING THEM AT FIRST AND FOREMOST IN OUR MINDS, KEEPING THEM SATISFIED AND TREATED AND, AND MAYBE, UH, SELLING IS THE BEST OPTION.
SO HAVING SAID THAT, OUR NEXT MEETING WILL BE MARCH 27TH.
UH, THIS MEETING IS ADJOURNED.