MAYOR AND COUNCIL
JULY 20, 2015
Mayor Cerino called the meeting to order at 7:45 p.m. In attendance were Council members Liz Gross, Linda Kuiper and Samuel T. Shoge, W. S. Ingersoll, Town Manager, Jennifer Mulligan, Town Clerk and guests.
Mayor Cerino asked if there were any additions or corrections to the minutes of the Mayor and Council Meeting of July 6, 2015. Ms. Gross moved to approve the Mayor and Council meetings as presented, was seconded by Mr. Shoge and carried unanimously.
Mayor Cerino stated that operating funds on hand for unrestricted use was $1,322,054.67 and there was a balance from the Washington College donation of $192,740.00, bringing total operating funds to $1,514,794.67.
Mr. Ingersoll stated that report of funds on hand this month was by staff under the supervision of a temporary accountant who in years past was with the auditor for the Town. He said that she was working with the financial staff to assess their knowledge and experience with Town financial operations (in the absence of a financial director) and to consider the idea of some restructuring to insure more office-wide familiarity with the financial operations.
Mayor Cerino asked for a motion to pay bills. Ms. Kuiper moved to pay the bills as presented, was seconded by Mr. Shoge and carried unanimously.
Mr. Ken Kozell was present on behalf of the University of Maryland Shore Regional Health to discuss the process that UMMS was going through regarding services offered at each of their locations. Mr. Kozell thanked the Mayor and Council for the invitation to the meeting.
Mr. Kozell stated that the health care world was now operating on a national level since the Affordable Care Act was passed. He said that the Act makes sure that those patients who previously did not have insurance have access to services other than using a hospital’s emergency room for service. He said that a patient’s entire wellness was being taken into a consideration rather than their need for services in the event of an emergency.
Mr. Kozell stated that changes reflected quality and cost, noting that quality was paramount in the industry. The federal government was now enforcing that hospitals focus on quality care by reimbursing based on the level of care they provide (rewarding them with high quality outcomes or penalizing for outcomes that were not high quality).
Mr. Kozell stated that there were physician shortages in a variety of specialties all over the country, the largest of which is in the primary care field. There were not enough primary care physicians to meet the needs of the nation, especially as more patients are added to the insured field. He said that Shore Regional Health was looking at opportunities to expand the primary care services, such as allied health care officials. Mr. Kozell stated that Maryland was especially tough when it came to physician recruitment and retention, especially in rural areas.
Mr. Kozell stated that the State has a unique way of managing healthcare and UMMS has been granted a waiver allowing for a regulated agency that controls what can be charged for hospital payment. He said that Maryland was comparable, if not better, than other states when comparing quality and costs, but that benefit was deteriorating with a shortage of primary care physicians and increasing costs of providing care. He said that there was a modification to the waiver in January 2014 to continue to operate on the regulatory payment system, but it had specific initiatives as follows:
1) Hospitals Expanding the Scope of their Responsibility.
• In the past the focus was mainly on sick care provided in a hospital environment. Hospitals are now responsible for focusing on sick care and well care, such as insuring primary care physicians are seen outside of the hospital system and diagnostic testing performed when needed.
2) Shift from Volume to Value.
• Hospitals before January 2014 were incentivized based on the amount of work they did; the more work they did the more they were paid without a focus on the value that was provided to the patient. Now, there has to be higher quality care at a much lower cost.
3) Reduce the Cost of Health Care in the State of Maryland.
• There are specific dollars associated with reducing the cost of Medicare and Medicaid services at the National level and hospitals are held accountable to that as a part of the new waiver.
Mr. Kozell stated that these changes were a significant paradigm shift from what hospitals were used to working with in the past and these challenges were trying to be viewed as opportunities to improve.
Mr. Kozell stated that Shore Regional Health now has some very clear guidelines for how to operate a health care industry in the State of Maryland as a result of the Federal Affordable Care Act and as a result of the new waiver. He said that Shore Regional Health System was now investigating how to provide the best quality care at the lowest affordable cost.
Mr. Kozell stated that since the merge with Chester River Hospital in 2013, Shore Health was now a 5 county, 3 hospital system that covered 370 square miles and treated 175,000 patients within a 5 county region ranging from northern Kent County to Southern Dorchester County.
Mr. Kozell stated that Shore Health put together a strategic plan that gave direction under the new rules. What they were working on now was defining services that should be offered throughout the system with a Strategic Services Delivery Council, which was a Council of the Board of Directors tasked with the responsibility of identifying services that should be offered in the region for the next 5 to 10 years with the goal of services changing to meet rules he outlined earlier in the meeting. Each service line of care will be evaluated and there will be a determination of the best place to offer the pre-acute services, acute services and post-acute systems.
Mr. Kozell stated that pre-acute services include anything from education to screening, primary and specialist care, and diagnostic testing. Acute care services are the hospital services side of things such as emergency room care, observation, admissions and surgical services (inpatient and outpatient). Post-acute care encompassed home health, rehabilitative services, hospice and palliative care. He said that towns and counties in the region offer services that they need to link into for the patients such as the Department of Health, Social Services, EMS, and other health care providers to create this continuum of care that keeps patients healthy and only brings them to the hospital system when it was absolutely necessary.
Mr. Kozell stated that transportation had to be addressed in the area so that people can receive the services necessary. He said the challenge of one system in 5 counties was to integrate a transportation system to the services that were offered.
Mr. Kozell stated that the process that the Board has asked them to undertake as part of the strategic plan was now getting underway. Members of the Strategic Services Delivery Council have been identified and included 30 members, including members of the Board and physicians in the 5 county areas. Small Service Line Council Sub-Committees will be formed for input on different specialties in the area with the intent of having their first set of meetings in the early part of August 2015. Conceptual approval was to go before the Board by the end of the calendar year, at which time the Board of Directors (made up of 24 members, 22 of which were local members of the community representative of the 5 county area and 2 from the corporate office of UMMS), will decide next steps. He said that no decisions have been made but Shore Health was evaluating what the future needs should look like in the realm of National and State change in order to survive and thrive.
Mayor Cerino asked if there would be time for public comment regarding the recommendations made to the Hospital Board. Mr. Kozell stated that there was an opportunity during the process as he also thought there should be focus groups and discussions on how to evolve into a better system for the future and said that the plan would likely be vetted through the entire area before an ultimate decision was made.
Mayor Cerino stated that people were hearing rumors and he was getting calls and emails that the Hospital was closing down and asked for assurance that there would be some kind of hospital or emergency room on site in the future. Mr. Kozell stated that the Chestertown site had between 600 and 700 employees and the Shore Medical Center at Chestertown will continue to be a viable organization in Chestertown for the foreseeable future. He said that there was an obligation to the community to provide healthcare to their patients and they were trying to define what services should be offered.
Mayor Cerino stated that when the Hospital was owned by the community money would be raised to help with shortfalls and it now seemed to be a more corporate mentality. Mr. Kozell stated that Shore Regional Health was a vibrant foundation that actively solicits the community for financial support.
Ms. Gross stated that she learned there was an annual process with the State Healthcare Commission that used the data of the prior year to allocate the number of beds in each facility, noting that Chestertown’s allocation was 41. She asked what would happen to the allocations if services were moved from one area to another. Mr. Kozell stated that if services were shifted from one location to another, the beds would also shift to the hospital that absorbed the services within the Shore Health System and would continue to be allocated on an annual basis.
Ms. Kuiper stated that Anne Arundel Medical Center has satisfied 2 certificates of need for expansion and doctors from Kent and Queen Anne’s Hospital have moved there, shifting the population out of the county. She asked how a situation would be handled if a person in Rock Hall has a stroke and the stroke center was in Easton, noting that the first hour of care is critical for the patient and that was at least an hour’s ride. She said the residents were worried about receiving immediate care in the event of an emergency. Mr. Kozell stated that Anne Arundel Medical Center was a significant competitor of Shore Regional Health and a larger system but patients had choices and could choose to go to Shore Regional Health. He also said that when patients choose to go out of the system, the revenue share is lost and then it becomes harder to invest and grow services in the community. Mr. Kozell added that Shore Regional Health could not be all things to all people and the time when all services were performed at each location was far gone and said that there was a commitment to be the best at the services that they do provide.
Ms. Kuiper stated that the helicopters are used frequently and that expense was one thing to be considered and said that everyone was shipped to Baltimore. Mr. Kozell stated that helicopter transportation was necessary at times, especially when dealing with services that Shore Heath does not provide.
Ms. Kuiper stated that she knew of 2 farms that were donated to Kent County Hospital and said the proceeds go to the Chester River Health Foundation. She asked how much of that money will stay in Kent County. Mr. Kozell stated that the Chester River Health Foundation in Chestertown are the stewards of the funds for all dollars raised locally and said that the responsibility of the Foundation is to make sure that the funds stay local, which was documented in a Memorandum of Understanding that was signed when Chester River Hospital and Shore Regional Health merged.
Ms. Gross stated that there could not be any consideration to relocating the emergency room after all of the money that was just spent on the rehabilitation. Mr. Kozell stated that the Board of Directors would insure that not just today but long into the future, the models created under the new environment would be there to provide quality outcomes for their patients.
Mr. Shoge stated that he would like the Hospital to emphasize to the public in a public forum where they will have to go for services. He said that when planning for a family, people need to think of where they will go to deliver a baby and then where a doctor will see that baby for treatment. He said that people had to consider time away from work and how their lives were affected when having to travel far distances for medical care.
Mr. Shoge stated that the Shore Regional Health was expanding all over the shore and asked the original vision of the system and why it seems to have changed so suddenly. Mr. Kozell stated that the original vision was to grow volume and add business, but the mandated changes had caps that can’t be offset by additional revenue, so they now have to work within the financial restraints mandated to them.
Mayor Cerino thanked Mr. Kozell for attending the meeting and said he looked forward to a future meeting where the entire evening was spent discussing the findings of the Strategic Services Delivery Council.
Mayor Cerino called forward Chief Baker. Chief Baker presented the police report for June 2015. Chief Baker stated that he was asked at the last meeting to review the change in location for Legacy Day and said that he was able to accommodate the Historic Society’s request to move the festival up a block in order to include Fountain Park as part of the festivities.
Mr. Ingersoll stated that at the last meeting he introduced Ordinance 02-2015 Declaring 333 South Cross Street as Surplus Property and Authorizing the Sale Thereof. He said that the Ordinance could be adopted at this meeting and would then become effective August 10, 2015. Ms. Gross moved to adopt Ordinance 02-2015 Declaring 333 South Cross Street and Surplus Property and Authorizing the Sale Thereof, was seconded by Mr. Shoge and carried unanimously.
Mr. Ingersoll stated he had a permit request from Jodi Bortz of River Arts and Jamie Frees of Washington College Center for the Environment and Society for RiverFest on Saturday, September 26, 2015 and read the permit request into the record. Ms. Gross stated that the locations requested to waive the open container needed to be better defined. Mr. Ingersoll stated that he would ask a representative to better define the area or to come before the Council to discuss the request.
Mr. Ingersoll stated that the State Highway Administration and the Chestertown SHA Task Force had a meeting scheduled for July 27, 2015 at 7:00 p.m. in the Town Hall meeting room.
Mayor Cerino stated that there have been discussions over the past several months about finalizing a Memorandum of Understanding with the Kent County Commissioners regarding out-of-town hook-up fees. He said that the Commissioners would be present at the Mayor and Council meeting of August 3rd to discuss the issue. Mr. Ingersoll asked if the meeting should begin at 7:00 p.m. The Council agreed.
Mayor Cerino stated that grants have been applied for planning and architectural work for the Chestertown Marina Interpretive Center, which is the building envisioned to replace the Williams Marine shed. It would be a marina store, interpretive center and possible marine related retail on the first floor with an open second floor balcony for public meetings. He said an application was made to the Maryland Heritage Areas Authority for $50,000.00 and the Town received an award of $35,000.00. He said that the Town also applied to the USDA for a similar amount and were awarded $22,000.00. He said that the total of $57,000.00 would help pay for architectural renderings for the interpretive center and then they could begin raising money to build. Mr. Ingersoll stated that this building would also have showers and bathroom facilities for the marina slip holders and transient visitors.
Ms. Gross asked what type of information would be available at the building. Mayor Cerino stated that a history of the waterfront and community, as well as maps and signage directing people to what was available in Town were some things that have been discussed. Ms. Gross stated that she would like the Town to work with members of the Center for the American Experience (CV Starr Center) to focus on the history as an industrial port and the African American community that lived and worked in the area. Mayor Cerino agreed.
Ms. Kuiper stated that “The Alligators” were performing in the Fountain Park on Wednesday as part of the Peoples Bank Concert Series from 6:30 p.m. to 8:00 p.m. In the case of rain the concert would move to the fire house.
Ms. Kuiper stated that the director of the Kent County Historical Society, Ms. Karen Emerson, was leaving Kent County. The new executive director was Ms. Suzanne Kohl and Ms. Amanda Smith is the deputy director.
Ms. Kuiper stated that Chestertown said good bye to two wonderful residents last week with celebrations of life for Mr. William Isaacs and Ms. Sandy Frohock.
Ms. Kuiper thanked Mr. Ingersoll and the Chestertown Police Department for the donations for her 4H team, noting that the 4H teams combined rose over $15,000.00.
Ms. Gross stated that she attended the Sultana groundbreaking last Saturday morning on South Cross Street and said that this new building would be an anchor for that part of Town.
Mr. Jon Wright of 101 S. Mill Street stated that there was a refrigerated trailer parked behind J.R.’s pub for 11 days now and it cycled on and off non-stop, 24-hours a day. He said that it was disturbing sleep for the residents in the area and should be moved. Mr. Ingersoll stated that he would offer his assistance to try and solve this problem starting the following morning.
There being no further business, Ms. Kuiper moved to adjourn the meeting at 8:50 p.m., was seconded by Ms. Gross and carried unanimously.
Submitted by: Approved by:
Jennifer Mulligan Chris Cerino
Town Clerk Mayor