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Home My WebLink About09122013 City Council Work Session Notes - CHC/Employment Status QD cyAi 14) L Q„1-7C1CrY-DNOO -1-5-)ek) Si_5\X-3 OD - CiliknDa Q C) ZS/6Q2tq, --)r) 11-1101 0.09 0L 13i1i 0)ro2ca, 00cn c..10-1 n o 002_ si--. 3 oUs ) -Z3,911 - 1-1 \-1-- sI °Vaal 1-1-1;tr d="COPIal,K)C.'") 'XD1.1-4:XV c/ -t)cwt A.pr-vel 7:7;4422,11rnwil-r% - '2rv)-1 Qr‘k-I ';;t*\*********VW>N"`Wric 2--;:" RE=k tc, .rec, ,v8 go:9 auru,---3:77-71- iii':-c'ci';; - ;31 fc-L-t - simISJdsiacituaTAT uouno3 IJ7inVip - --ral3c4 s 1 r)li ift"ttiii7U4 0V1-1- 0/'i\-4 Gn" :PS0d.ind• 11 Iclktkv.5 ri,k) wrirNU1vAxmp c" L L\10 SaLON NOTSSaS NWOM. - I suoiisanb punoJ A !D puodsad pup saapinoad DHD paellas jo luawAordwa 6uipae6aa uo!SDap e anew o� uo!lewio4ui y6noua I fl M iPunoD apinoad ;.. Sioz pue 47zoz 'Eloz J04 DHD paellas Jo' slsanbaa 6uipun j ;uasaad 1.y6isaano leiJueu4 aoj suoqdo ssnjsia • aJanos 6u!punj. pue 6u!w . uop.enouaa '}uawssasse ieuoEEeaado/aJeds ssn)si4 • uoLLeD!ldde DHDJo sn1.e4s uo IPunoD /4j atepdn • :uoissaS),io/si1p .Jo asodind Eton 'zi aagwaldas uo!ssas>poM punoJ'}!J paen' S dia.juaJ y73VdJ-C Auniuutoj p2V4t,as 4, ,Toz/z,/6 9/12/201.3 Action Items for the City Council • Decision on employment of CHC providers/staff • Decision on renovation of space • Consideration for financial oversight • Decision on appropriation to the CHC for 2013 Consideration of investment in the Seward CHC for future years The Mission of Seward CHC To identify and serve the healthcare needs of our community by providing quality, affordable services and promoting wellness, prevention and partnerships 9/12/2013 Proposed Model Responsible Receives for HRSA SS Hires operations of funding Executive clinic Director Finance and/or Seward CHC Personnel Board Administration City of Seward rant Reportin. Governs, Sets policies Patient Billing q H 5k Steps Identified in March Worksession • CHC/City of Seward infrastructure • City Council recommendation on Finance and Personnel—need to know model for grant application Complete—model was finance and employment by the City • Co-Applicant Agreement in place prior to grant application Complete—Co Applicant agreement was signed prior to grant submission • Affiliation Agreements with providers (i.e.dental,mental health,ancillary services,tribal,hospital) In Process—Preliminary agreements or verbal - discussions with potential partners Submit New Access Point grant application CorripieLL Announcement pending 3 9/12/2013 • Steps Identified in March Worksession (cont'd) • Completion of clinic efficiency and space utilization analysis Complete—final report recently received • Provider outreach and education ca* In Process - Provider attended CHC Clinical Leadership •• Conference in June. More activities to be done upon funding announcement • Meetings with PSMC staff c;,_��5 Pending—Need final decision on employment of staff New Access Point Application Status • Announcement expected any day • -450 Applications received • 25 are expected to be funded this month • Applications will remain on file for one year(indicates the likelihood of a second round of funding—similar to prior cycle) • HRSA announced that a new application cycle will be released again next year • This is highly unusual that a funding opportunity is announced this far in advance This speaks to the increased chances of Seward CHC receiving HRSA CHC funding at some point 0 • • 9/12/2013 Seward CHC Preparation Engaged and involved Board of Directors • Space/Operational assessment completed • Recommendation for renovation • Policy and Procedure development • Search for Interim (short-term) Executive Director • Strategic Planning activities in process 18 Implementation Plan in place Once funded, Seward CHC will have 120 days to be '' operational Space / Operational Assessment Guidian Healthcare Consulting Assessment Report recommends renovation of space for efficiency of stand- alone clinic. Renovation would need to be complete within 120 days of grant award. Options for Council to consider: IfUpon grant approval, accept grant funds of$150,000 for remodel. Expedite RFP and construction. = . -or- • City Council approval to move forward with renovation now, freeing up $150,000 in grant funds for equipment and operations 5 9/12/2013 Funding Requests 2013 • Consulting, Interim ED, Board Education, Public Education & Outreach, Other pre-grant activities 2014 • Operations support- Up to $700,000 2015 • Operations support- Up to $500,000 City Involvement in CHC Finance • Does the City want to retain Finance oversight and responsibility? • Is the City willing to process financial transactions for the CHC (i.e. payroll and accounts payable)? • The CHC may still retain clinic-specific financial responsibilities(i.e. Patient Billing, overall reporting) • Options: • Grant can be administered by the City • Grant can be received by the City, and "passed- throug h"to the CHC 11 6 9/12/2013 Recommendation by Seward. CHC Board t the last worksession the City Council asked for a Recommendation from the Seward CHC Board • The Seward Community Health Center recommends to the Seward City Council, that: • The City of Seward be the employer of record for the employees of the Seward CHC, • with the employment issue to be re-evaluated no later than 5 years, • where "employer of record" means the CHC employees are subject to the City of Seward personnel code, but day to day personnel decisions are made solely by the Executive Director of the Seward CHC. Discussion Documents • Public Entity CHCs in Alaska —Comparison • Compares Seward CHC to the other two public entity models in Alaska • Municipality of Skagway — Dahl Memorial Clinic • Employment is through the Municipality • Bristol Bay Borough —Camai CHC (Naknek) • Employment is through the CHC Discussion with both entities indicated that the decision is local — what works for the community. 9/12/2013 • ,' Discussion Documents Benefits Comparison to other Rural AK CHCs • Comparison of Health Insurance and Retirement Plans of other rural CHCs Cost of health insurance premiums is generally for Employee only — most centers require employee to pay for spouse/dependents ' Note that the City of Seward can opt out of PERS for certain classes of employees and select a separate retirement option Employment by CHC Seward PROs C.--CC • CEO of clinic maintains control of employee issues • CHC can make all personnel policies and decisions • More flexibility in salary adjustments • More CHC control over personnel costs • Less City involvement in financial decision-making • Retirement costs are easily controlled(employer determines rate) • Lower health insurance costs(but also less attractivefor retention) 16 8 • - 9/12/2013 Employment by CHC Seward CONS C3(C • New start-up entity may not be attractive to prospective employees and healthcare providers -'i • Need to seek out health insurance,retirement and other benefit plans • Small staff size may make it difficultto access competitive healthcare and retirement plans • Due to few options,may not find affordable benefit packagesthat would entice employment • Requires additional staffing to recruit and retain quality candidates Employment by thy PROs • As community clinic,City Council maintains better financial oversight • City has more control over personnel costs of clinic • City may have better access to health and retirement plans • Providers more likelyto want to work for an established entity;assists with recruitment • Stable employer with established track record promotes retention • Personnel policies/procedures/structure in place in City Code • More budgettransparency • Collaborative relationship will promote long-term sustainability and viability of clinic,strengthening City's healthcare system • Retirement plan costs are easily controlled(employer determines rate) • Unemployment insurance rate is much lower than most employers 9 • 9/12/2013 • Employment by City (5.' iisow CONS ► • Potentially greaterpoliticalinfluenceonclinicoperations • Clinic employees may attempt to use political processto undermine governance of clinic • Potential public opposition to government/public employees • Perceived higher cost of healthcare and retirement plans in public sector • Health Plan costs are higher;benefit coverage is more attractive for recruitment and retention • Retirement costs are not higher since employees will not be PERS • May open clinic governance up to conflict between CHC board and Council as it relates to control and authority • Less flexibility of clinic to pay market rates for pay Cost Comparison Sample Example Comparison of Salary&Benefits. Assumptions. Total Sarrpie Retirement Health Insurance Workers'Comp Salary plus Salaries Rate Cost Rate Cost Rate Cost Benefits Seward 1,125,975 5%$ 56,299 1,675 $341,700 0.39%$ 4,391 1,528,365 Soldotna 1,125.975 4%$ 45,039 726 $148.104 10.00%$112,598 1,431,716 Talkeetna 1,125,975 3%$ 33,779 921 $187,884 10.00%$112,598 1.460,236 Skagway 1,125,975 22%$ 247,715 1,756 $358,224 0.39%$ 4,391 1,736,305 Assumes alt employers have equal salary costa • Health Insurance for non-pudic entitles is enptoyee-only coverage.Cost is over$2,000 per month for full family coverage Retirement Plan options are flexible as to enployer contribution rates Municipalities can elect to pay direct Unemployment claim rather than a rate.Seward's rate is less than 1%;assume same for Skagway. Health Plan comparison: Cover-•e. E • am Deductible: :0/20 Seward,$1,675 emp/farrily E • ,••use/Fanr $250[5rr-I.n Sodotna:$2,128 errpifanily -$ 2000 Talkeetna:$2,504 erre/fainly 5 5 000 _ Skagway:5,2441 errp/farrily E .1 ••use -_ Contributes to both PERS and social security I0 • 9/12/2013 Discussion / Questions 3'f 1� Recap of Action Items for the City Council • Decision on employment of CHC providers/staff • If City is employer; revisions as needed to the City Code • Decision on renovation of space • Wait for grant approval -or- • Move forward with renovation now using City funds • Decision on financial management Decision on appropriation to the CHC for 2013 of$75,000 • Consulting,Interim ED,Board Education,Public Education&Outreach Commitment to investment in the Seward CHC at startup o $700,000 Estimate 2014 ' $500,000 Estimate 2015 11 9/12/2013 6 N n;ax Resources • Health Resources & Services Administration http://bphc.hrsa.gov/ • National Assoc. of Community Health Centers www. nachc.org • Alaska Primary Care Association www.alaskapca.org North West Regional Primary Care Association www.nwrpca.org Seward CHC Board Members • Patty Beals, President • Kris Erchinger • Maya Moriarty,VP • Martha Fleming • Dick Cruse,Treasurer • Shane Hand • Jean Bardarson • Stacy Lane • Mike Craytor • Dave Paperman • Lois Daubney • NikkiThompson Joe Fong, ex-officio • James Hunt, ex-officio Providence City of Seward N\,,, I %