Board of Commissioners

Town of Swansboro Board of Commissioners July 09, 2024, Regular Meeting Minutes In attendance: Mayor John Davis, Mayor Pro Tem William Justice, Commissioner Jeffrey Conaway, Commissioner Pat Turner, Commissioner Joseph Brown, and Commissioner Douglas Eckendorf. ********************************** Call to Order/Opening Prayer/Pledge The meeting was called to order at 6:00 pm. Mayor Davis led the Pledge of Allegiance. Public Comment Citizens were offered an opportunity to address the Board regarding items listed on the agenda. No comments were given. Adoption of Agenda and Consent Items On a motion by Commissioner Conaway, seconded by Commissioner Turner, the agenda was adopted unanimously. Appointments/Recognitions/Presentations Parks & Recreation Month Mayor John Davis presented Parks and Recreation Director Stanley and her department with a proclamation designating July as the Parks and Recreation Month. Director Stanley shared that the success of parks & recreation was successful due to the collaboration and partnership with many local businesses, volunteers and support from employees and the other Town departments. Onslow Memorial Hospital Penny Burlingame-Deal, President and CEO of Onslow Memorial Hospital, presented on the hospital's achievements, challenges, and strategic plans. She highlighted the hospital's recognition for maternity care, cost-efficiency, and equity, as well as its recent financial turnaround with $16 million in excess revenue. Despite improved finances, quality scores (Leapfrog C, CMS 2-star rating) lagged due to outdated data and hospice- related mortality reporting. The hospital faced emergency department capacity issues, exacerbated by behavioral health and social hold cases. Mrs. Burlingame-Deal also discussed workforce shortages and residency programs initiated to address them. In response to inquiries from the board Mrs. Burlingame-Deal clarified the following: - Plans for expanding services to outlying areas for satellite facilities had been considered but are still in the early stages of development. Page 1 of 3  - She encouraged feedback on loyalty and community perception, acknowledging the importance of these factors in improving hospital reputation and patient care experience. Business Non-Consent Advanced Life Support Enhancement – Update Fire Chief Jacob Randall reviewed his slides, attached herein with the power point presentation of the meeting, for the proposal to transition the Swansboro Fire Department to an advanced life support (ALS) system to improve emergency medical services (EMS) and patient outcomes. The plan aimed to enhance response capabilities and address long response times, particularly in rural areas, where the average time reached 13 minutes. Swansboro’s remote location and growing call volume were also contributing to delays in accessing critical care. The phased proposal would implement paramedic-level services over three years, introduce a transport service, and acquire necessary equipment. Key challenges included recruiting and retaining personnel, and managing financial impacts, which were still under review. The next steps involved seeking approval for an interlocal agreement with Onslow County EMS, with a July 15th deadline to submit the proposal. The following plan options were reviewed. Plan A – Paramedic (Recommended)  Provides Dedicated Provider per Shift on a Quick Response Vehicle - Consistency  Alleviates Fire Apparatus from Scene Dedication  Provides Personnel to Respond with Secondary Apparatus Type for Fire Incidents (ISO)  Maximizes Operational Efficiency – Creating the Ability for Answering Overlapping Incidents  Builds Foundation for Future EMS Division Growth (Transport – If needed) Plan B – Firefighter/Paramedic  Provides ALS Provider per Shift and Trained Fire Personnel  Commits Fire Apparatus to the Scene of an EMS Incident – Awaiting Transport  Increases Certified Fire Personnel - Eliminates Paramedic Abilities when Performing Fire Suppression Activities Plan C – Part-Time Providers  Staff Apparatus with Part-Time Personnel  Requires a Significant Increase in Part-Time Personnel  Inconsistent Personnel Daily Impacting Daily Operational Efficiency Page 2 of 3   Impacts Program Quality & Management (Training, Report) Overall Consistency After discussion on the various options presented, the board requested a cost comparison between the plans, with an emphasis on utilizing current staff and identifying potential funding sources, such as grants. Due to the deadline of July 15, 2024, the board agreed to hold a special meeting on Saturday, July 13, 2024, at 8:00 am for Chief Randall to provide cost comparison details and to provide a decision on proceeding with the process to establish an Advanced Life Support Enhancement System in the Town of Swansboro. Future Agenda Topics Future agenda items were shared for visibility and comments. In addition, an opportunity was provided for the board to introduce items of interest and subsequent direction for placement on future agendas. The following items were addressed: - Discussion on tax reduction at a future meeting Public Comment Citizens were offered an opportunity to address the Board regarding items not listed on the agenda. No comments were given. Manager's Comments Manager Barlow shared in addition to his project brief, the 25 new Christmas decorations had been purchased along with 9 wreathes with bows. The poles which would be utilized to accommodate these decorations still needed power. Additionally, he shared that the resurfacing of Shore Drive had been completed. Board Comments Board members shared their appreciation to staff and the success of the July 3rd/4th event, and the Flag displayed over the bridge was complimented by many citizens. Adjournment On a motion by Commissioner Conaway, seconded by Commissioner Eckendorf, the meeting adjourned at 8:10 pm. Page 3 of 3  7/9/2024 Regular Meeting July 9, 2024 1 1. Please turn cell phones to “off” or “vibrate”. 2. The Board offers the public three opportunities to speak during the meeting: A comment period is offered at the beginning and end of the meeting. Please note that a separate opportunity is provided for those items requiring a public hearing. Public Hearing(s) – There are no public hearings scheduled for this meeting. 2 1  7/9/2024 PUBLIC COMMENT Citizen opportunity to address the Board for items listed on the agenda. 3 AGENDA AND CONSENT ITEMS Action Needed: Motion to Adopt the Agenda as prepared (or amended) and approval of the Consent Items 4 2  7/9/2024 Onslow Memorial Hospital Presenter: Penney Burlingame Deal – President & Chief Executive Officer for Onslow Memorial Hospital 5 UNC HEALTH CARE Onslow Memorial Hospital CEO Report FY2023 June 2024 6 6 3  7/9/2024 UNC HEALTH CARE MISSION To provide excellent patient health services in a healing and family-centered environment. VALUES Carolina Care One Great Team Leading the Way It Starts with Me 7 7 Overview of OMH • Originally founded in 1944 • 162-bed acute care, community hospital • Located in coastal North Carolina • Serving the city of Jacksonville and greater Onslow County • Nationally accredited by The Joint Commission 1,179 228 15 13 30 Employees Active Med Staff Employed Providers Board Members Volunteers 8 4  7/9/2024 Our Community Community Partnerships Our Patients Stroke Care • Onslow County Health Department • Avg age 27.4 • Stroke Nurse Coordinator • Naval Hospital • Cancer • Free health checks • Aligned Partnerships – Home Health • Heart disease • Education on risk factors, and Skilled Nursing Centers • Payor Mix: prevention, and identification • Onslow County EMS – Community • 38% MCR • Primary Stroke Center Paramedic Program • 18% MCD certification through The Joint • Caring Community Clinic • 13% BC Commission • Patient and Family Advisory Council • 22% CO • 9% Self-pay 9 10 5  7/9/2024 AWARDS, RECOGNITION, ACCREDITATION FY 2023: • The Joint Commission Triennial Survey February 2024 • The Joint Commission Advanced Primary Stroke Recertification Survey February 17, 2023 • Blue Cross Blue Shield Blue Distinction Honor for Maternity Care 2023 • Commission On Cancer Accredited Center-American College of Surgeons: Community Cancer Program 2020 (Recertified Dec 2023) • Get with the Guidelines for Heart Failure Gold with Honor Roll and Target: Type II Diabetes Honor Roll Achievement Award June 2023 • Get with the Guidelines for Stroke Gold Plus with Target: Type II Diabetes Honor Roll Achievement Award July 2023 • Intersocietal Accreditation Commission (IAC) Vascular Testing Accredited Facility: Extracranial Cerebrovascular Testing, Extracranial Cerebrovascular Testing, Peripheral Venous Testing, Peripheral Arterial Testing • American College of Radiology Certifications • Restorix Patient Satisfaction Wound Center Recognition 2023 • Restorix Clinical Distinction Wound Center Recognition 2023 11 AWARDS, RECOGNITION, ACCREDITATION FY 2023: • 2023 “Onslow Memorial Hospital’s Multidisciplinary Collaboration to Deliver Evidence-Based Guideline Directed Medical Therapy for Heart Failure Patients” presented in Philadelphia and at the International Quality Showcase at Scientific Sessions on November 11, 2023 • UNC Quality Expo 2023 Poster Presentation October 19, 2023. “Initiatives Implemented For an Upward Trend in Early Management Severe Sepsis/Shock Bundle”. • 2023 Implement HF Onslow Recognition - October 19, 2023 at Onslow Memorial Hospital 12 6  7/9/2024 OMH Year in Review: • UNC Health Partnership MSA Renewal – Metrics UNC HEALTH CARE • QIOC • Pharmaceuticals • Clinical Integration • Prioritized alignment with UNC Health Culture, Values • Workforce Engagement Survey -- SHARE (95% participation) • Equity and Inclusion Survey • Physician Engagement Survey (74% participation) • UNC Health Alignment with Organizational and Care Redesign Goals • The Impact Project • Chief Medical Officer • Nurse Residency Program • CNA Residency Program • Leapfrog score of C • CMS Star Rating 2 13 13 OMH FY 2023 in Review (continued): UNC HEALTH CARE • 8.95% (9.63%) Percentage of Self Pay • Admissions: 5,533 (5,223) • $54,827,384 ($46,823,329) in • ED: 55,746 (46,579) visits Uncompensated Care • ED Admissions: 6.8% of ED volume and 68.3% of OMH • 1,446 (1,338) births admissions • 5,351 (5,884) OR / EU Cases • Wound Care – $1,420,715 • 260 (297) Robotic Assisted Cases ($1,419,693) • 412 (393) Joint Center Cases • $22,310 – Grants and $291,552 Contributions – OMH Foundation • 3,548 (3,107) Surgicare Cases • Autopsies – 448 (470) • 437 (482) Dental Service Cases • Onslow Diagnostics – 19,204 • 19,923 (8,642) Radiation Oncology (20,569) Treatments/Procedures • OAS Clinic Encounters – 37,621 • 152 (202) ERSA Cases (32,490) • Doses Dispensed – 1,074,867 (1,091,851) • Meals Served: 232,182 (213,751) Figures in () denote last FY’s values for comparative purposes 14 14 7  7/9/2024 FY 2023 Financials UNC HEALTH CARE BALANCE SHEET (in $000s) September 30, 2023 Current Assets $ 68,435 Assets Limited As to Use $ 21,216 Property, Plant and Equipment $ 71,248 Deferred Outflows $ 128 Total Assets and Deferred Outflows $ 161,027 Current Liabilities $ 40,065 Long-Term Debt $ 25,449 Other Long-Term Liabilities $ 12,487 Deferred Inflows $ 1,994 Net Position $ 81,032 Total Liabilities, Deferred Inflows and Net $ 161,027 Position 15 15 FY 2023 Financial (continued) INCOME STATEMENT (IN $000s) UNC HEALTH CARE Net Patient Service Revenue $ 187,412 Other Revenue $ 2,725 Total Operating Revenue $ 190,137 Salaries and Benefits $ 84,101 Other Expenses $ 89,299 Total Operating Expenses $ 173,404 Operating Income $ 16,733 Interest Expense $ 1,083 Property Tax Revenue Other Non-operating Expense, net Total Non-Operating Revenue $ 794 Total Income $ 16,444 CASH EXPENDITURES (in $000s) Salaries and Benefits $ 84,101 Physician Fees $ 10,216 Purchased Services $ 25,871 Supplies $ 26,961 Other $ 11,828 16 16 8  7/9/2024 FY 2023 Key Statistics UNC HEALTH CARE FY2023 BUDGET DAILY CENSUS 89 87 BIRTHS 1,446 1,186 ADMISSIONS 5,533 4,784 SURGICAL CASES 8,899 9,360 ED VISITS 55,746 43,573 17 17 FY 2023 Comparative Key Financial Indicators UNC HEALTH CARE Indicator FY 2021 FY 2022 FY 2023 BAA Moody’s Operating Margin 5.17% 3.34% 8.23% -0.30% Excess (Total) Margin 5.35% 3.05% 8.61% 2.70% Cash Days 120 79 54 204 Net AR 42 52 60 47 18 18 9  7/9/2024 High Visibility Indicators UNC HEALTH CARE 140 OCHA Days Cash133 on Hand 120 120 100 87 79 80 63 60 54 40 31 20 20 0 9/30/2016 9/30/2017 9/30/2018 9/30/2019 9/30/2020 9/30/2021 9/30/2022 9/30/2023 19 19 IMPACT Tracker FY 2023 (10-1-2022 through 9-30-2023) Delivery Team Baseline Target Target Progress Status Launched Implemented Confirmed UNC HEALTH CARE Workforce/HR $198,000 $198,000 $198,000 $98,000 $78,000 Revenue Cycle $928,875 $928,875 $3,810,197 $3,810,805 Supply Chain $49,912 $0 $0 $0 Pharmacy $0 $0 $0 $0 $0 Physician Services $332,154 $332,154 $332,154 $70,154 $0 Clinical Operations $779,232 $779,232 $779,232 $807,932 $347,293 Clinical Documentation $0 $0 $0 $0 $0 Market & Payer Strategy $0 $0 $0 $0 $0 Overall $2,288,173 $2,238,261 $4,786,283 $4,236,098 98% 209% 185% P&L Initiatives - Progress $6,000,000 $4,786,283 $5,000,000 $4,236,098 $4,000,000 $3,000,000 $2,238,261 $2,000,000 $1,000,000 $0 Launched Implemented Confirmed 20 20 10  7/9/2024 FY 23 Organizational Goals Through June 30, 2023 UNC HEALTH CARE 21 21 UNC HEALTH CARE 22 22 11  7/9/2024 OMH Strategic Plan, FY22 to FY24 UNC HEALTH CARE Our Mission: Provide excellent patient health services in a healing and family-centered environment Our Vision: OMH will be the choice of Onslow County patients, physicians, and health professionals The below key areas of focus, identified through the Strategic Planning process, are integral to achieving OMH’s vision New October 2023 Medical Staff Core Services Specialty Services Recruitment Community Awareness Clinical Quality and and Perception Retention Key areas of focus, OMH Strategic Plan, FY22 to FY24 after the Strategic Plan Refresh, Completed in October 2023. 23 23 FY 22 – FY 24 Strategic Plan Priorities (Updated) UNC HEALTH CARE ➢ Core Services ➢ Specialty Services ➢ Medical Staff Recruitment and Retention ➢ Clinical Quality ➢ Community Awareness and Perception o Front Door and Community Access Points o Consumer Engagement/Satisfaction o Financial Position o Capital Investment and Facility Updates o Community Outreach and Engagement o Novel Partnerships Organizational Priorities 24 24 12  7/9/2024 Strategy Map Update 2023 Key Focus Area Status Notes UNC HEALTH CARE Core Services On Track -Medical Office Building (MOB) Development --Hospital Transport Services* Specialty Services On Track -Ambulatory Surgery Center (ASC) Development* Quality On Track -Consistency -Emergency Department Emphasis* Medical Staff Recruitment and In Progress -Prioritization Retention – Clinical Workforce -Clinical Workforce Recruitment and Retention* Community Awareness & New for FY -Broader Community Partnerships* Perception 2023 -Rebranding* -Facility Improvements* 25 25 UNC HEALTH CARE Thank You! 26 26 13  7/9/2024 Parks & Recreation Month Presenter: Mayor John Davis 27 NEW BUSINESS/NON-CONSENT Advanced Life Support Enhancement – Update At the May 14, 2024, regular meeting, direction was given to commence planning and seek approval to become an Advanced Life Support (ALS) provider with the Onslow County—Camp Lejeune EMS System. The development of an ALS system can be provided in various fashions. The system design model must be selected before submitting the final request to the Onslow County—Camp Lejeune EMS System Peer Review Committee for approval. Recommended Action: Approval to seek designation as an Advanced Life Support (Paramedic) First Responder program within the Onslow County – Camp Lejeune EMS System plan with a three-year phased implementation design. Presenter: Jacob Randall – Fire Chief 28 14  7/9/2024 Advanced Life Support Enhancement {Program Update} Jacob Randall – Fire Chief 29 To enhance the Town of Swansboro Fire Department's Emergency Medical Services (EMS) to the Paramedic level, providing for a Purpose higher quality of service and strengthening the overall response capabilities of the Onslow County—Camp Lejeune EMS system. 30 15  7/9/2024 Improve Improve Patient Outcomes Enhance Enhance Provider Capabilities Program Strengthen Strengthen System Resource Availability & Objectives Response Support Support Equitable Access to Care Amplify Amplify Operational Efficiency 31 Incident Response Rehabilitation Times Needs Time Assessment Sensitive – Critical Low System Resources Interventions Distance to Definitive Care 32 16  7/9/2024 Paramedic – Critical Interventions Emergency Medical Technician Advanced Emergency Medical Skill Paramedic (EMT) Technician (AEMT) 12- Lead Interpretation NO NO YES Cardiac Pacing NO NO YES Cardioversion NO NO YES Chest Decompression NO Traumatic Cardiac Arrest Only YES Cricothyrotomy NO NO YES Manual Defibrillation NO Pulseless Arrest Only YES Drug Assisted Intubation NO NO YES Intubation/Advanced Airway NO YES YES Intraosseous (IO) NO YES YES Intravenous Access (IV) NO YES YES 33 Onslow County Response Times Average Response Time 2024 2020 2021 2022 2023 (January 1 - May 14) County 9:16 10:01 10:33 10:33 10:02 Zone 5 10:41 12:13 14:43 13:14 11:28 Zone 9 8:54 9:33 10:22 9:38 9:15 Total Call Volume 2024 2020 2021 2022 2023 (January 1 - May 14) County 20,388 23,650 29,552 33,658 12,458 Zone 5 2,279 2,753 3,453 4,095 1,408 Zone 9 1,996 2,456 3,047 3,396 1,247 34 17  7/9/2024 Distance to Definitive Care {Onslow Memorial} 35 Distance to Definitive Care {Camp Lejeune – Naval} 36 18  7/9/2024 Distance to Definitive Care {Carteret Healthcare} 37 Distance to Definitive Care {Carolina East} 38 19  7/9/2024 System Resource Availability Increasing Distance of Overlapping Incident Travel for Incidents Volume Resources 39 Plan of Action 40 20  7/9/2024 Phased Implementation FULL REDUCES IMMEDIATE GENERATES ALLOWS ABILITY TO CREATES AN IMPLEMENTATION FINANCIAL IMPACTS – PLANNING CAPACITY SEEK ALTERNATIVE OPPORTUNITY TO OVER THREE YEARS STAGED FINANCIAL TO ALTER OPERATIONS FUNDING FOR BUILD CAPITAL AND PLANNING UTILIZING SUBSEQUENT YEARS NON-CAPITAL PERFORMANCE DATA – EQUIPMENT ORGANIZATION REPLACEMENT DEVELOPMENT SCHEDULES 41 System Design Model Options Plan A – Paramedic (Recommended) Plan B – Firefighter/Paramedic Plan C – Part-Time Providers Provides Dedicated Provider per Shift on a Quick Provides ALS Provider per Shift and Trained Fire Staff Apparatus with Part-Time Personnel Response Vehicle - Consistency Personnel Alleviates Fire Apparatus from Scene Dedication Commits Fire Apparatus to the Scene of an EMS Requires a Significant Increase in Part-Time Incident – Awaiting Transport Personnel Provides Personnel to Respond with Secondary Increases Certified Fire Personnel - Eliminates Inconsistent Personnel Daily Impacting Apparatus Type for Fire Incidents (ISO) Paramedic Abilities when Performing Fire Daily Operational Efficiency Suppression Activities Maximizes Operational Efficiency – Creating the Impacts Program Quality & Management Ability for Answering Overlapping Incidents (Training, Report) Overall Consistency Builds Foundation for Future EMS Division Growth (Transport – If Needed) 42 21  7/9/2024 Scope of Services Advanced Life Support – Fire Incident Rehab Mobile Integrated Health – Paramedic Community Paramedic Initiatives 43 Quick Response Vehicle Design • Aid in “Service” Credit for ISO Rating • Brush Truck Unit for Wildland Response • Increase Equipment for Scene Operations - Response Program Efficiency Personnel • In-House Training Program – Increase “On-Duty” Personnel for ISO • Provides Dedicated Personnel to Medical Operations on Incidents (Firefighter Rehab, Patient Care) 44 22  7/9/2024 Agency Operations • Unit Turnout Times • Response Times • First Arriving to Transfer of Patient Care • Ability to Answer Overlapping Incidents – ALS vs BLS Operational Provider Performance Performance • Interventions Performed Metrics • 12-lead Interpretation Accuracy • Notification Times {Strokes, STEMIs, and Trauma} Patient Outcomes • Shorter Pre- & Post- Defibrillation Pauses • Stroke Assessment/Triage • Trauma Assessment/Triage • Cardiac Arrest/Survival & Neurological Assessment 45 Next Steps 46 23  7/9/2024 • July 9, 2024 - Approval to Proceed – Select System Model Design Desired • July 15, 2024 – System Proposal Due – Submit to Onslow County Emergency Services Director System • August 6, 2024 – Onslow County – Camp Lejeune EMS System Peer Review Design Committee (PRC) Presentation – Subcommittee Providing Recommendation to Onslow County Board of Commissioners for Approval or Denial Timeline • TBD – Draft, Establish, or Revise Memorandum of Understanding or Inter-Local Agreement between the Town of Swansboro and Onslow County – IF Approved at PRC • TBD – Onslow County Board of Commissioners Approval – If Approved, ALS Services Can Begin • January 4, 2025 – Benchmark for Advanced Life Support Capable Response 47 Questions 48 24  7/9/2024 NEW BUSINESS/NON-CONSENT Future Agenda Items Future agenda items are shared for visibility and comment. In addition, an opportunity is provided for the Board to introduce items of interest and subsequent direction for placement on future agendas. Action Needed: Discuss and provide any guidance. Presenter: Alissa Fender – Town Clerk 49 PUBLIC COMMENT Citizen opportunity to address the Board. 50 25  7/9/2024 MANAGER’S COMMENTS Jonathan Barlow 51 BOARD COMMENTS Mayor John Davis Mayor Pro William Justice Commissioner Jeffrey Conaway Commissioner Douglas Eckendorf Commissioner Joseph Brown Commissioner Patrica Turner 52 26  7/9/2024 ADJOURN 53 27