10/12/2005
e,
NEW HANOVER COUNTY BOARD OF HEALTH
New Hanover County Health Department
Dr. Thomas Fanning Wood Memorial Conference Room
2029 S. 17a' Street
Wilmington, North Carolina 28401
Wednesday, October 12, 2005
AGENDA
Date: October 12, 2005
Time: 8:00 A.M.
Place: Dr. Thomas Fanning Wood Memorial Conference Room
New Hanover County Health Department
Presiding: Mr. Donald P. Blake, Chairman
Invocation: Dr. Sandra L. Miles
• Minutes: September 7, 2005
Recognitions: Mr. Donald P. Blake
Personnel
New Emplovee(s)
Leigh Ann D'Adamo, Public Health Nurse, Clinic Team
Jay Edwards, Environmental Health Specialist, Environmental Health Services
Yvonne Hughes, Fiscal Support Supervisor, Fiscal Operations
Courtney Parker, Shelter Attendant, Animal Control Services
Five (5) Year Service Award
Gail Bordeaux, Public Health Nurse, School Health
Laura West, Public Health Nurse, School Health
Retiring
Betty Rauth, Program Support Supervisor, Program Support, Support Services
Other Recognitions
Betty Jo McCorkle, PHN Clinic Supervisor, Personal Health Services
NCPHA Margaret B. Dol A and fo u mg Excellence ,
G{~xoSµ~l~l ~11»~ - ~t I~ ff~. ~ev~,
Departmental Focal: N C by~
• Personal Health Services - Child Health Services (CSC) Update Ms. Janet McCumbee
Personal Health Services Manager
~t BOH Agenda
October 12, 2005
Page 2
}-8 Monthly Financial Report: July/August 2005 Ms. Cindy W. Hewett
9 (Includes Grant Update) Business Manager
Committee Reports:
Executive Committee Mr. Donald P. Blake
New Business: Mr. Donald P. Blake
Change to NHC Health Department Fee Policy - Use of State Codes,
Implementation of Lab Codes, Implementation of an Administrative
Penalty Fee for delinquent patient accounts, Adjusting "Proof of Income"
grace period to 10 business days and Billing (Third Party Payors) for
Administration of State provided Menactra Vaccine
Appointment of Nominating Committee - Health Director's Appraisal
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Comments: Rr)
Board of Health Members Mr. Donald P. Blake
Health Director 1
Mr. David E. Rice
A. Health Director
1. Hurricane Ophelia - After Action
2. Performance Management - Work Plans
3. N rth Caroli a ublic Health Association (NCPHA) Annual Meeting - October 4-6, 2005
-L00 L/
Other Business: - Mr. Donald P. Blake
Adiourn: - Mr. Donald P. Blake
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zt Mr. Donald P. Blake, Chairman called the regular business meeting of the New Hanover County
Board of Health (NHCBH) to order at 8:00 a.m. on Wednesday, September 7, 2005 in the
• Thomas Fanning Wood Conference Room of the New Hanover County Health Department
located at 2029 S. 17th Street, Wilmington, North Carolina.
Members Present:
Donald P. Blake, Chairman
Edward Weaver, Jr., OD, Vice-Chairman
Marvin E. Freeman, Sr.
James R. Hickmon, RPh
Cheryl Lofgren, RN
Sandra L. Miles, DDS
Robert M. Shakar, MD
G. Robert Weedon, DVM, MPH
Members Absent:
Nancy Pritchett, County Commissioner
John S. Tunstall, PE
Stanley G. Wardrip, Jr.
Others Present:
Trena Ballard, Administrative Support Supervisor, Customer Care, Support Services
Leigh Jackson, Environmental Health Specialist, Environmental Health Services
• Regina Abate, Administrative Support Technician, Program Support, Support Services
Kay Lunceford, Administrative Support Technician, Program Support, Support Services
Dina Sarro, Nutritionist, WIC, Personal Health Services
Cindy Hewett, Business Manager
Elisabeth Constantly, Health Promotions Supervisor, Health Programs Administration
Erin Cummings, Health Educator, Health Programs Administration
Dr. Jean McNeil, Animal Control Services Manager
Janet McCumbee, Personal Health Services Manager
Scott Harrelson, Assistant Health Director
David E. Rice, Health Director
Marilyn Roberts, Recording Secretary
Invocation:
Dr. Sandra Miles gave the invocation.
Minutes:
The minutes of the August 3, 2005 Board of Health Meeting were corrected and approved as
submitted.
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Recognitions:
Personnel
Five (5) Year Service Award
Regina Abate, Administrative Support Technician, Program Support, Support Services
Lee Ann Cook, LPN, Community Health, Personal Health Services
Dina Sarro, Nutritionist, WIC, Personal Health Services
Ten (10) Year Service Award
Leigh Jackson, Environmental Health Specialist, Environmental Health Services
Mr. David E. Rice, Health Director and Mr. Blake congratulated staff.
Other Recognitions
None
Department Focal: North Carolina Immunization Registry (NCIR)
Ms. Janet McCumbee, Personal Health Services Manager presented a quick introduction to the
North Carolina Immunization Registry (NCIR). New Hanover County Health Department is one
of five pilot counties to go online with NCIR. Highlights included:
The North Carolina Immunization Registry (NCIR) is a secure web-based clinical tool, which
will become the official source for North Carolina immunization information. The NOR will
take the place of handwritten charting of immunizations administered in the state. Immunization
providers may access all recorded childhood immunizations administered in North Carolina,
regardless of where the immunizations were given.
Ms. McCumbee stated that all local county Health Departments are scheduled for connection to
the NOR in 2005. All nurses will have access to entering shot information. Since this is a
paperless process it will make gathering and entering data faster and more efficient and will also
provide better inventory. The state would like to see this done nationally but right now it is only
statewide and the plan is to try to get online by the end of the calendar year and then the private
physicians online and lastly the hospital will be going online with NCIR.
Ms. Trena Ballard, Administrative Support Supervisor and Ms. Kay Lunceford, Administrative
Support Technician demonstrated entering data/gathering data with NCIR.
The primary purposes of the NOR are:
• To give patients, parents, health care providers, schools and child care facilities timely
access to complete, accurate and relevant immunization data;
• To assist in the evaluation of a child's immunizations status and identify children who
need (or are past due for) immunizations;
• To assist communities in assessing their immunization coverage and identifying areas of
under-immunizations; and
• To fulfill federal and state immunization reporting needs.
Additional NCIR information: •
• Current Status
• Parent's FAQ's about the Registry
• Useful Registry Links
2
Information for Providers:
• NCIR User Manual - Required for all NCIR users
• Interactive How-To Lessons for NCIR
• Providers FAQs about Registries - coming soon!
Helpful Contacts:
• NCIR Help Desk -1877-873-6247
• NC's Local Health Departments Phone Numbers: www.ncalhd.org/county.htm
There was much discussion/questions among the Board of Health members regarding
tracking/reporting data and HIPAA compliance issues.
Mr. Blake thanked Ms. McCumbee and staff for their presentation.
Monthly Financial Report - July 2005 (Including Grant Status Resort)
Ms. Cindy W. Hewett, Business Manager reported due to New Hanover County's conversion of
Finance and Human Resources system to Municipal Information Systems (MUNIS) we are
experiencing difficulty in retrieving reports.
Ms. Hewett presented the July Revenue Summary Report that reflects an earned revenue total of
$428,141 with a remaining revenue budget of $6,342,260. Ms. Hewett stated that revenue is on
track as compared to last year. Expenditure report will be provided as soon as the County
Financial System is working properly.
• Ms. Hewett reported the Health Department Grant Status. Totals for grants requested $981,700
received $426,700 and denied $205,000. Two pending grants: NC Dept. of Insurance - Office of
State Fire Marshall - Risk Watch Continuation Grant for $25,000 and HUD (partnership with
City of Wilmington) - Lead Outreach and Education Program (3 year funding) for $275,000.
Ms. Hewett reported the Health Department Grant Status. Totals for grants requested $986,700
received $461,700 and denied $205,000. Two new grants to report: Wolfe-NC Public Health
Association Prenatal Grant for FY 05-06 and FY 06-07 for $5,000 and NC Alliance (NCAH) for
Secondhand Smoke - Local Control Initiative (if approved and awarded PA funds to be used for
educational purposes and media campaigns only) - $5,000. Two pending grants: NC Dept. of
Insurance - Office of State Fire Marshall - Risk Watch Continuation Grant for $25,000 in which
we have been notified that we will receive in it's entirety and HUD (partnership with City of
Wilmington) - Lead Outreach and Education Program (3 year funding) for $275,000.
Dr. Robert M. Shakar, Board of Health member expressed concern as to the average in applying
for grants and do we actually get what we apply for?
Committee Reports:
Executive Committee under new business.
Old Business:
None
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New Business:
Changes in the New Hanover County Health Department Fee Policy - Collections Process
The New Hanover County Health Department is requesting to change its Fee Policy thus allowing
submission of all eligible outstanding debt to the New Hanover County Legal Office for possible
collection through their internal collection process, Small Claims Court or through the NC Local
Government Debt-Setoff Program. Revenue generated through this process will be posted as
recognized revenue to the New Hanover County Health Department Budget in the Fiscal Year in
which it was received. Respective patient accounts will be updated to reflect any payment
activity resulting from this collection process.
Motion: Mr. Blake moved from the Executive Committee for the Board of Health to accept and
approve the Changes in the New Hanover County Health Department Fee Policy - Collections
Process as presented and submit to the New Hanover County Commissioners for their
consideration. Upon vote, the MOTION CARRIED UNANIMOUSLY.
New Hanover County Board of Health No Smoking Policy
The New Hanover County Board of Health No Smoking Policy has been revised to include new
legislation per N.C. General Statute 143-599, which permits local health departments to enact a
50' (linear) smoke-free perimeter around health department facilities. This policy will prohibit
smoking by NHCHD staff and customers within 50 linear-feet of the NHCHD facility.
Motion: Mr. Blake moved from the Executive Committee for the Board of Health to accept and
approve the New Hanover County Board of Health No Smoking Policy enacting a 50 linear-foot
smoke-free perimeter as presented and submit to the New Hanover County Commissioners for
their consideration. Upon vote, the MOTION CARRIED UNANIMOUSLY.
Other Business
Comments:
Mr. Blake shared a "humorous story" of a former restaurant owner that required staff to "swat
flies" while on "smoke breaks".
Mr. Blake inquired as to how Health Promotion is doing with the new SAFE KIDS van? Car
Seat check scheduled (along with other agencies) will be held on September 17th at the Mayfair
Center on Military Cutoff Road.
Mr. Blake commended Dr. Jean McNeil, Animal Control Services Manager, and staff on the
outstanding job that Animal Control Services did in handling the most recent "Adoption of the
Dachshunds". Mr. Blake also commended Dr. Robert Weedon in the spay/neutering aspect. Dr.
Weedon added that the UNC-W student volunteers that have been assisting him are gaining great
experience and that New Hanover County Animal Control Services is a "world class facility".
Dr. McNeil stated that out of 137 Dachshunds , there were approximately 117 final adoptions.
Mr. Blake again thanked Dr. McNeil and Dr. Weedon.
Dr. Miles expressed concern as to the New Hanover County Health Department email address •
and what other Board of Health members are doing with it?
Dr. Weedon expressed concern as to the recent Dachshund's adoption "dog related letters" and
did any of the Board of Health members respond to the emails? Dr. Weedon reminded Board of
Health members to remember the pets (zoo animals included) in the Hurricane Katrina aftermath.
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Mr. Marvin Freeman requested that we "liven up" staff recognition at Board of Health meetings.
• Ms. Cheryl Lofgren requested that we also recognize long-term retirees at Board of Health
meetings.
Dr. Shakar thanked Mr. Rice for speaking at his affiliated Rotary Club. Dr. Shakar also stated
that he would be the upcoming 2006 President of the New Hanover-Pender County Medical
Society and plans are to have a "general directory" hotline in conjunction with Brunswick County
for the general public to call with "standard" medical related questions for ex: referring them to
the "specific type" of physician (not to a particular physician). There was much discussion
among the Board of Health members in regards to the hotline.
Dr. Shakar inquired as to the number of Environmental Health Inspections during a year as
restaurant owners have approached him. These restaurant owners had inquired regarding the
possibility of reducing the number of inspections if they were "good players" and always
maintained a high score. There was discussion among the Board of Health and there is really
nothing that can be done at this level because it is State mandated that Environmental Health
Services inspect restaurants four (4) times a year.
Mr. Blake expressed concern as to the New Hanover County Emergency Services and do we have
a better plan in place than New Orleans, Louisiana since the recent destruction of Hurricane
Katrina. There was discussion as to New Hanover County's geographical location and our
experiences over the years.
Health Director
• Comments
Katrina Recovery
Mr. Rice reported that at least six (6) people in Personal Health Services and two (2) in
Environmental Health Services are on call for instructions and that we will be working with Mr.
Warren Lee, Emergency Management Services Manager to pursue further in regards to assistance
in Louisiana and Mississippi. There has already been State/Regional rapid response such as the
SMAT-2 Team.
Legislative Update
Mr. Rice reported that North Carolina now has a Lottery. Cigarette Tax has been increased. Food
and Lodging Fees did not surface from Bill Drafting.
School Sports Physicals
Mr. Rice reported that NC General Statute 90-21-16 states requirements for free clinics (School
Sports Physicals). New Hanover Health Network was previously involved and now the Health
Department has been approached to host the free clinics. There will be a stake holder's meeting
to include the hospital, schools, New Hanover-Pender County Medical Society and others
regarding these issues and he along with Ms. Janet McCumbee, Personal Health Services
Manager will be attending.
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Performance Management Training
Mr. Rice announced that Managers and Supervisors have attended Performance Management
Training on August 3 and 10 and now staff will be attending on September 9 and 19.
Project Management Training
Mr: Rice reported that he (along with other staff) attended a week of Project Management
Training August 16-19.
Interim County Manager
Mr. Rice reported that Mr. Allen O'Neal, County Manager retired August 31 and that Mr. David
Weaver will be the Interim County Manager.
Adjournment
Mr. Blake adjourned the regular business meeting of the Board of Health at 9:10 a.m.
Mr. Donald P. Blake, Chairman
New Hanover County Board of Health O
David E. Rice, M.P.H., M.A., Health Director
New Hanover County Health Department
Approved:
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• NEW HANOVER COUNTY HEALTH DEPARTMENT
Revenue & Expenditure Summary for August 2005
Cumulative: 16.67% Month 2 of 12
REVENUES:
Current Year Prior Year
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned Remaining
Federal & State $ 1,816,791 $ 436,784 $ 1,380,007 24.04% $ 1,780,890 $ 181,646 $ 1,599,244 10.20%
AC Fees $ 659,496 $ 67,837 $ 591,659 10.29% $ 659,496 $ 67,837 $ 591,659 10.29%
Medicaid $ 1,484,368 $ - $ 1,484,368 0.00% $ 1,138,039 $ - $ 1,138,039 0.00%
Medicaid Max $ - $ - $ 151,600 $ -
EH Fees $ 300,212 $ 21,106 $ 279,106 7.03% $ 300,212 $ 41,009 $ 259,203 13.66%
Health Fees $ 128,000 $ 14,565 $ 113,435 11.38% $ 113,545 $ 28,381 $ 85,164 25.00%
Other $ 3,072,186 $ 181,419 $ 2,890,767 5.91% $ 2,413,854 $ 195,486 $ 2,218,368 8.10%
Totals $ 7,461,053 $ 721,711 $ 6,739,342 9.67%01 $ 6,557,636 $ 514,359 $ 5,891,677 7.84%
EXPENDITURES:
Current Year Prior Year
Type of Budgeted Expended Balance % Budgeted Expended Balance %
Expenditure Amount Amount Remaining Amount Amount Remaining
• Salary & Fringe $ 11,315,151 $ 680,502 $ 10,634,649 6.01% $10,395,481 $ 1,194,772 $ 9,200,709 11.49%
Operating $ 1,852,498 $ 138,952 $ 1,713,546 7.50% $ 1,553,763 $ 175,585 $ 1,378,178 11.30%
Capital Outlay $ 679,225 $ - $ 679,225 0.00% $ 179,750 $ - $ 179,750 0.00%
Totals $ 13,846,874 $ 819,454 $ 13,027,420 5.92% $ 12,128,99 $ 1,370,357 $10,758,637 11.30%
SUMMARY:
Expenditures: Budgeted Actual %
FY 05-06 FY 05-06
Salary & Fringe $11,315,151 $ 680,502
Operating $1,852,498 $ 138,952L t Il,
Capital Outlay $ 679,225 $ - _J
Totals $13,846,874 $ 819,454 5.92%
Revenues: $7,461,053 $ 721,711 9.67%
Net Coun : $6,385,821 $ 97,743 1.53%
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Revenue Summary . 7
For Month of August 2005
NEW HANOVER COUNTY HEALTH DEPARTMENT
Revenue & Expenditure Summary for July 2005
Cumulative: 8.33% Month 1of 12
REVENUES:
Current Year Prior Year
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned Remaining
Federal & State $ 1,814,456 $ 137,407 $ 1,677,049 7.57% $ 1,780,890 $ 181,646 $ 1,599,244 10.20%
AC Fees $ 659,496 $ 52,599 $ 606,897 7.98% $ 659,496 $ 52,599 $ 606,897 7.98%
Medicaid $ 1,484,368 $ 163,040 $ 1,321,328 10.98% $ 1,138,039 $ - $ 1,138,039 0.00%
Medicaid Max $ - $ - - $ 151,600 $ -
EH Fees $ 300,212 $ 20,371 $ 279,841 6.79% $ 300,212 $ 31,506 $ 268,706 10.49%
Health Fees $ 128,000 $ 20,013 $ 107,987 15.64% $ 113,545 $ 14,297 $ 99,248 12.59%
Other $ 2,420,969 $ 46,278 $ 2,374,691 1.91% $ 2,390,519 $ 3,022 $ 2,387,497 04330/0
Totals $ 6,807,501 $ 439,708 $ 6,367,793 6.46% $ 6,534,301 $ 283,070 $ 6,099,631 EXPENDITURES:
Type of Budgeted Expended Balance J4.91% Budgeted Expended Balance % e
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary&Fringe $11,205,722 $ 702,855 $10,502,867 $10,383,157 $ 436,664 $9,946,493 4.21%
Operating $ 1,577,178 $ 77,497 $ 1,499,681 $ 1,517,904 $ 22,104 $ 1,495,800 1.46%
Capital Outlay $ 181,200 $ 9,815 $ 171,385 $ 86,633 $ - $ 86,633 0.00%
Totals $ 12,964,100 $ 790,167 $12,173,933 $ 11,987,694 $ 458,768 $11,528,926 3.83%
SUMMARY:
Expenditures: Budgeted Actual %
FY 05-06 FY 05-06
Salary & Fringe $11,205,722 $702,855
Operating $1,577,178 $ 77,497
Capital Outlay $ 181,200 $ 9,815
Totals $12,964,100 $790,167 6.10%
Revenues: $6,807,501 $439,708 6.46%
Net Coun : $ 6,156,599 $ 350,459 5.69%
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Revenue and Expenditure Summary
For Month of July 2005 8
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 05-06
Date BOH Grant Requested Pending Received Denied
917/2005 No activity - for September 2005.
Wolfe-NC Public Health Association
Prenatal Grant for FY 05-06 and FY 06-07-
81312005 assistance for diabetic prenatal patients. $5,000 $5,000
• allocating
North Carolina A for $5,000 from
Secondhand Smoke- - Local Local Control existing PA
Initiative-if approved and awarded PA funds • allocating budget-
to be used for educational and a5,000 from approved by
purposes existing PA NHC-CC
media campaigns only. budget 9119105
7/6/2005 No activity for Jul 2005. I /
NC Dept of Insurance- Office State Fire
6/1/2005 Marshall- Risk Watch Continuation Grant $ 25,000 $ 25,000
HUD (partnership with City of Wilmington)
Lead Outreach and Education Program (3
year funding) $ 275,000 $ 275,000
Ministering Circle- Good Shepherd
Ministries Clinic supply & Equipment $ 15,000 $ 15,000 $ -
No activity for May 2005.
Cape Fear Memorial Foundation- Living
4/6/2005 Well Program $ 20,000 $ 20,000 $ -
National Safe Kids Coalition- Mobile Van for
3/2/2005 Car Seat Checks $ 49,500 $ 49,500 $ -
Smart Start- Child Care Nursing Program $ 239,000 $ 170,000 $ 69,000
Smart Start- Health Check Coordination
Program $ 43,800 $ 43,800
• Smart Start- Navigator Program $ 155,000 $ 44,000 $111,000
2/2/2005 No activity for February 2005.
Champion McDowell Davis Charitable
1/5/2005 Foundation - Good Shepherd Clinic $ 56,400 $ 56,400
12/1/2004 No activity for December 2004.
March of Dimes- Maternity Care Coordination
Program educational supplies and incentives
11!7/2004 for pregnant women. $ 3,000 $ 3,000 $ -
10/6/2004 No activity to report for October 2004.
9/1/2004 No activity to report for September 2004.
Office of the State Fire Marshal- NC
Department of Insurance- Risk Watch
814/2004 continuation funding (3 ears) $ 25,000 $ 25,000
NC Physical Activity and Nutrition Branch-
Eat Smart Move More North Carolina $ 20,000 $ 20,000
N arch o Dimes Community Grant
Program- Smoking Cessation- Program did
7/7/2004 not apply for rant. $ 50,000 $ - $ - $ -
Wolfe-NCPHA Prenatal Grant- Diabetic
Sup lies for Prenatal Patients $ 5,000 $ 5,000
• Totals $986,700 $280,000 $451,700 $205,000
28.38% 45.78% 20.78%
Pending Grants 2 13%
Funded Total Request 8 53%
Partial! Funded 3 20%
Denied Total Request 2 13% 9
Numbers of Grants Applied For 15 100%
As or 9/2212005
• NOTE: Notification received since last report.
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
• Request for Board Action
Agenda: 1 Consent Meeting Date: 10/17/05
Agenda:
Department: Health Presenter: Cindy Hewett, Business Mgr
Contact: Cindy Hewett, Business Manager, ext 6680
Subject: Changes in the New Hanover County Health Department Fee Policy- Use of
State Codes, Implementation of Lab Codes, Implementation of an Administrative Penalty
Fee for delinquent patient accounts, Adjusting "Proof of Income" grace period to 10
business days and Billing (Third Party Payors) for administration of State provided
Menactra Vaccine.
Brief Summary: The New Hanover County Health Department is proposing to change
its current Fee Policy, in order to:
(1) Submit statistical data to the State through the use of State approved codes (referred
to as Local Use (LU) Codes). Retro-active effective date 07/01/05.
(2) Implement use of Current Procedural Terminology (CPT) Codes 87081 (Culture-to be
used for Family Planning visits) and 82948 (Glucose, blood reagent strip--this will
replace CPT 82962) for respective laboratory services. Fees for each of these codes are
set at $20.00.
• (3) Bill third party payors (private insurance companies and Medicaid) for the
administration fee of State provided Menactra vaccine for children. Fee for this service is
- -$20.00. -
(4) Implement ability to apply a $15.00 administrative penalty fee to delinquent patient
accounts. Administrative penalty be "applied" to those delinquent accounts that are sent
to NHC Legal for processing. Patient statements will be updated to reflect this change.
(5) Change Fee Policy Narrative, Section 1, General Guidelines, Item F. to the following:
The New Hanover County Health Department (NHCHD) will require "proof of income"
to reduce charges when applying the sliding fee scale. If a patient is unable to produce
this required information, they will be placed on a 100% sliding fee scale status, for a
period of ten (10) business days (inserting the word "business"). Fee Policy currently
states "for a period of ten (10) days". If proof of income is provided within the ten
business-day period (inserting the word "business"), the patient will be billed
accordingly.
Recommended Motion and Requested Actions: To accept and approve changes to the
New Hanover Count Health Department Fee Policy as resented.
Funding Source: Medicaid, Private Insurance Companies
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
ZNo Change in Position(s)
Ex lanation: Please see attachment for detailed information regarding LU Codes
Attachments: State approved "LU" Codes , Fee Policy Section I, General Guidelines, Item F.
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State-Approved Local Codes Effective 7/1/05
NEW Local Previous Description
Code Local Code
LU001 00001 Labs specimen obtained for Fu of newborn screening
LU002 C1001 Lice Treatment e.., Nix *
LU013 C1910 GlucometerCallibration
LU014 C9001 Printing Immunization Record for client
LU017 C9900 Completion of Disability Verification/Disability Leave Form
LU018 C9904 Co of Medical Record
LU019 C9941 Education and Outreach to Latino Population
LU020 C9985 Menu Planning (development/review for compliance with standards
for schools, day cares, nursing homes, etc.
LU021 C9999 Completion of form verifying exam (not at time of exam or other
billable service
LU022 C9002 Immunization Status Review for WIC; no vaccines needed
LU023 New Code Diabetic Teaching
LU024 New Code Determination of Presumptive Eligibility
LU100 C8601 HIV Pre-Test Counseling and Testing REPORT ONLY)
LU101 C8602 HIV Post-Test Results and Counseling REPORT ONLY
LU102 C8603 Completion of "Record of Tuberculosis Screening"- DHHS 3405
LU103 C8604 PPD, Positive Result REPORT ONLY
LU 104 C8605 PPD, Negative Result REPORT ONLY
LU114 C8620 PPD with State-Supplied vaccine (REPORT ONLY
• LU201 C8801 Repeat Pa Smear REPORT ONLY
LU202 C9041 Limited Interview: International Travel
LU203 C9905 Limited Physical: Employment
LU204 C9906 Limited Physical: DOT
LU205 C9907 Limited Physical: Dare Challenge
LU206 C9908 Limited Physical: Da Care
LU207 C9909 Limited Physical: Head Start
LU208 C9910 Limited Physical: Sports
LU209 C9911 Limited Physical: Foster Care
LU210 C9912 Limited Physical: Cam
LU211 C9913 Limited Physical: Scouts
LU212 C9914 Limited Physical: College
LU213 C9915 Limited Physical: Respirator
LU214 C9916 Limited Physical: Kindergarten
LU215 C9917 Limited Physical: DSS
LU216 C9918 Limited Physical: County Employee
LU217 C9921 Limited Physical: Senior Companion
LU218 C9923 Limited Physical: DOC
LU219 C9926 Limited Physical: US Forest Service
LU230 C9919 Blood Pressure Check*/
LU231 C99920 Pap Smear and Breast Assessment only (for non-B000P-
eli ibles per age or income
LU232 C9922 Test/Lab Results only visit REPORT ONLY
LU233 C9981 Condom Provision and counseling REPORT ONLY
LU234 C9982 Sterilization Counseling REPORT ONLY
LU235 C9983 Pill Replacement (REPORT ONLY
• LU236 C9984 Pill Pick-up REPORT ONLY
LU237 C9901 Non-Billable Social Worker contact (REPORT ONLY)
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LU238 C9902 Non-Billable Health Education contact (REPORT ONLY)
LU239 C9903 Non-Billable Nutritionist contact REPORT ONLY)
LU240 C9924 Non-Billable TB LPN Contact REPORT ONLY
LU241 C9925 Non-Billable Child Health Nurse Contact REPORT ONLY)
LU242 C9927 Non-Billable STD Contact REPORT ONLY
LU243 C9928 Non-billable Communicable Disease Contact REPORT ONLY
LU244 C9986 Non-Billable Interpreter Service REPORT ONLY
LU246 New Code Tubal Ligation Counseling/ Obtain Consent
LU247 New Code Non-Billable MH Nurse Contact REPORT ONLY
•
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NEW HANOVER COUNTY HEALTH DEPARTMENT
. FEE POLICIES
1. General Guidelines
A. The fee system implemented by this organization has been approved by the
New Hanover County Board of Health (NHCBOH). Implementation date was
July 1, 1984. For the Women's Preventive Health Section fee system was
approved by the NHCBOH in October 1983.
Revision Date: September 2005.
B. Services provided for the protection of the public's health and prevention of
disease will not be denied based on inability to pay. Every effort will be made
to provide services to patients at or below 150% of poverty.
C. Unless confidentiality is a barrier, if a patient has any form of third-party
reimbursement, to include Medicaid, Medicare and other private insurance,
that payer must be billed for services, with the exception of flat rate charges.
Medicaid will be billed as the payer of last resort. Patients must sign the
Authorization and Assignment of Benefits Form (Page 32) for all third party
reimbursement except for Medicaid. A patient's consent is not needed for
. Medicaid billing.
D. Patients -who_are receiving Medicaid (Title XIX) will submit their Medicaid
number for third party payment. Reimbursable visits will be claimed to Title
XIX for payment and no further charges will be made to the patient.
E. Sliding fee scales will be applied in specified programs (Pages 24 and 25).
F. The New Hanover County Health Department (NHCHD) will require "proof
of income" to reduce charges when applying the sliding fee scale. If a patient
PROPOSED is unable to produce this required information, they will be placed on a 100%
CHARGES sliding fee scale status, for a period of ten (10) business days. If proof of
income is provided within the ten business-day period, the patient will be
billed accordingly. If proof of income is not provided within the established
timeframe, the patient will be billed at 100%. The NHCHD representative has
the right to verify income information in all cases, however the patient must
read, understand, and sign the income statement (Page 30) in order for their
income to be checked. The sliding fee scale does not apply to all services.
Services with flat rate fees do not require proof of income. In extreme or
unusual circumstances, the Health Director or designee may make exceptions.
G. If a patient prefers not to produce required proof of income information, they
will be placed on a 100% sliding fee scale status. However, the patient must
read, sign, and date the waiver on the NHCHD Income Statement (Page 30).
13
I received a referral through Child Care Nursing from Total Child Care at the end of August. Total Child
Care was very concerned about this nearly two year old child's behavior. I left several messages for Mom
at work and on her cell phone and never received a response. I kept calling her at work and finally caught
up with her there. She explained that she and her husband had just separated and she had moved with
her three children to a new home. She reluctantly agreed for me to come and see her son last Thursday
. evening after work. I wasn't too sure that she would actually be there or if she'd cancel prior to the visit.
She was there and we ended up having a very good visit. Her son is doing fine developmentally but
behaviorally is as she says "wild." I saw him hit his mother on at least 4 occasions, hit his 6 month old
baby brother, throw toys, throw 4 tempet tantrums within a time span of about 1 hour. In addition he threw
blocks and crayons at me. He's getting referred to CDSA with Mom's consent. Since I was there, Mom
asked if I would screen her 6 month old son. When I left, Mom stated how much she appreciated my visit
and my willingness to visit on an evening so she did not have to take off from work. Actually, I don't think I
would have seen him because I don't think she would have taken off from work to see me.
On 9/20/05, 1 accompanied one of my clients to WIC, DSS-Medicaid, DSS-Foodstamps, and Social
Security Administration. This mom has tried several times to get rides from her family and neighbors, but
because she lives off Middle Sound Loop Rd, this is a hard task. There is not any public transportation in
her area, and people who she has asked do not want to drive all the way to 17th St for the whole day and
wait. This mom was extremely frustrateclM I acknowledged her many efforts and praised her for that. I
then offered to help her with all of the various applications of available services. She was moved to tears,
literallyl She now calls me her "angel." I explained to her that this was part of my job to help her. She's
very gratefulll One day, and we accomplished all we set forth to dolll
his a 15 year old first-time mom referred to the Navigator Program from the
Wilmington Housing Authority. dft~came from a broken home. Her mother is
addicted to crack cocaine. The parental roles were drastically reversed. 4101M provided
• support to her mother, instead of her inotlier supporting her. was spoke of several
situations with her intensive home .visitor, when her mom would not come home for several
days, or come home high on crack cocaine or other street drugs. stated, she would
often try to convince her mother to quit the drugs, and come home @ night. #AIM was
later removed from the home and her cousin became her legal guardian. During this time
with her mother and since moving in iyitif lier cousin.&INOWas continued highschool
full-time, and consistently makes the AB honor roll. Since the delivery of her baby
4NRMhas returned back to school,, shortly_before Christmas, less than thirty days after
the delivery. Because she did not want ti miss her exams. keeps all her
appointments and the baby's appointments. Always calling her intensive home visitor in
advance if she needs to get to the doctor. 4MIlbbasks questions, and always requests
additional information. This young lady is truly amazing, with a very bright future ahead.
With the help of her intensive home visitor, 11 continue to-be supported-and encouraged to continue to strive for excellence. Way to goe~
his a 32 year old who recently delivered a baby girl. She enrolled in the Navigator
Program during her first month of pregnancy. She has an extensive history of drug abuse
and emotional issues. During one of the first home visits with her Navigator Social
Worker, 4Mexpressed that she was having a very hard time dealing with the
temptation of using drugs again and she needed help. The home visitor did some research
and found several support groups that mould attend and also a Psychiatrist that
would be willing to work with her.
• Even though does not have a car, nine months later she is still attending her support
group meetings weekly and seeing her counselor twice a month. 4Whas not given into
her temptations and has been drug free for 10 months.
• NEW HANOVER COUNTY HEALTH DEPARTMENT
HURRICANE OPHELIA - After Action Comments
What Worked
Personal Health Services
• EOC was responsive
• Interpreters good -
• Great support from supervisors, EOC, and school system
• Relationship between Health Department and Social Services
• Relationship with Law enforcement
• Supervisors' high priority on staff safety
Animal Control Services
• ACS pulled together quickly to respond to the immediate priorities,
including officers at area human shelters to recover animals, intake of
animals at the shelter, and answering inquiries about animal evacuation
needs.
• Storm time was utilized to do "extra" cleaning in areas that may not
• routinely get attention.
What Didn't Work Well/Needs Improvement
Personal Health Services
• Communication regarding supplies and equipment at Shelters. Updates
to EOC. Socks, Hygiene kits, oxygen, etc.
• Media coverage at Shelters
• Red Cross participation at Shelters
• Screening at Shelters - Could Law enforcement search all bags entering
building? Medical Triage of residents?
• Coordination Among EOC, Shelters, IC3, ER, and Law Enforcement -
Shelter residents, prescriptions, and Supplies
• Policy - Family members at Shelters?
• Coordination of Interpreters at Shelters
• Ambulance Services at Shelters?
• No smoking on school grounds - Can the rule be suspended for the
disaster?
Animal Control Services
• 0 There was no food for ACS Shelter on day one.
• ACS has a generator transfer switch, but no generator to attach to it. The
generator left from a year ago was not checked to see if it was useable.
• Increased media attention to the fact that animals need to be secured as
well as people. We are available for NHC residents to leave their pets
free of charge during the disaster.
Special Medical Issues Encountered
• Chronic medical problems of the shelter residents (Hypertension, heart
problems; however, some situations that required more intense
management are listed here.
• Two inmates from New Hanover County jail were released and
transported to the shelter, they were on day two of a five day detox
regimen without prescriptions.
• At least 3 at Johnson were at high risk for DTs (alcohol).
• Many people with Insulin Dependent Diabetes and no means to check
blood sugar, and some did not bring syringes.
• Open fracture, transported to ER, may not have been able to do that in a
stronger storm.
• Paranoid schizophrenic without medication.
• Child with trach/suction, oxygen, nebulizer (no filled prescription)
• Leg infection
• Victim of sexual assault (perpetrator in same shelter)
• Oxygen patients
• Pregnant women
_ Annual Report
•a'. Fiscal. Year 2004 -2005 ,
Health Programs Administration presents a more
streamlined version of the Annual Report, including:
Program highlights from Animal Control '
Services, Environmental Health Services,
Health Programs Administration. Personal.
Health Services, and Financial Management
Riv^p' _
` Annual Report
aY Fiscal Year 2004 -2005 -
Animal Control Services:
Fully erational Spay/
Neuter Facility
First surgery performed
- (by Dr.Bob Weedon)
on Sept 22, 2004
847 surgeries performed
in first calendar year
1.
Annual Report
Fiscal Year 2004-2005.-_
Environmental Health Services
• Hiring of 3 new EH Specialists July 8 August 2004
• Training and credentialing of new staff
• Vector Control-maintenance building almost complete ,
• Blossom Ferry water testing
1
I~
Fiscal Year 200 4 -2005
7Heafth Annual Report
ams Administration:
tal Unit update
• Strategic National Stockpile event, October 2004.
• SAFE KIDS Van
• Quality Assurance priorities
l 1
Annual Report
-
Fiscal Year 2004 -2005
1
r
F - - ..1..
. e Annual Report
a Fiscal Year 2004 -2005
Personal Health Services -
• Open Access Clinic Scheduling. July 2004
• Flu Vaccine Shortage, Fall 2004 '
• Hepatitis A Investigation, Fall 2004
• Reportable Communicable Diseases, FY 04105 _
i
2
•
t,
Annual Report
a ^ » Fiscal Year 2004 - 2005
l
` Annual Report
Fiscal Year 2004 -2005
t
i Annual Report
Fiscal Year 2004 - 2005
r Financial Management
3
Your
Health
.H
O W .
Priority
. Q
• NEW HANOV.ER COUNTY HE.-I.
Over 125 Years of
Public Health Service
2029 South 17th Street
Wilmington, NC 28401
910.343.6500
Veterinarian
www.nhchd.org
Medical Consultant j
Director's Message Management Team
On behalf of New Hanover Assistant Health Director
County Health Department, Scott Harrelson, MPA
I am pleased to present our
annual report for the fiscal
year 2004/05. You will find Administrative Support Coordinator
information about how we Marilyn O. Roberts
continue to demonstrate our
commitment to our mission: Animal Control Services Manager
Jean P. McNeil, DVM
To Assure a Safe and Healthy Community Business Manager
This report touches on all aspects of the department Cindy Hewett, MS1S
and some of the major events that have occurred over Dental Health Services Manager
the past year. Some of our existing services have David W. McDaniel, DDS
changed and we are adding new services for our
citizens. We are proud of our 126 years of service Environmental Health Services Manager
to this community and plan to continue assessing Dianne M. Harvell, REHS
the needs of the community and to continuously
strive to meet those needs. During the past year, the Personal Health Services Manager
department has seen the following accomplishments Janet B. MCCumbee, RN, BSN
and challenges:
Physician Epidemiologist
• Open Access Clinic (OAS) scheduling Thomas Morris, MD, MPH
• Hepatitis A investigation
• Operation of Spay / Neuter facility
Our Mission and Vision
• Bioterrorism preparedness exercise
The mission of the New Hanover County
• Influenza vaccine shortage Health Department is to assure a safe and
• Funding for mobile dental unit healthy community.
• Board of Health Strategic Planning Retreat The vision of the New Hanover County Health
Department is: Healthy People, Healthy
• Arrival of SAFE KIDS van Environment, Healthy Community.
Motto
"Your Health - Our Priority"
"From the Northeast River to Federal Point, and from
the Cape Fear to the Sea-City; Suburb, Village and
David E. Rice, MPH, MA Farm-we are one people striving for healthful and
Health Director useful living."
Animal Control Services
• Fiscal year 04/05 will be remembered at Animal Control greater flexibility in responding to field complaints. In
Services (ACS) as the year that our spay/neuter facility addition to this positive action, new parents may take
became operational. The first surgery was performed their pet home at the point of adoption rather than having
September 22, 2004, by Dr. Robert Weedon, the to wait to get their animal from the veterinary hospital. It
community partner for the Management Academy of is a proactive step towards reducing pet overpopulation in
Public Health (MAPH) team from ACS. (Note: Dr. our county. In the first calendar year of operation, there
Weedon went on to complete his MPH as a result of were 847 surgeries performed at the new facility.
joining the team and is currently the veterinarian on the r
Board of Health.) Dedication of our addition was held on ,r
November 15, 2004. Speakers included Commissioner
Nancy Pritchett, County Manger Allen O'Neal, and
Board of Health Chairman Don Blake. They also i ;
participated in the ribbon cutting ceremony. Dr. Steve
Orton from Chapel Hill came as a surprise visitor to the
occasion. He is the mentor/overseer for the management
academy. C
The clinic is utilized solely for sterilization of animals -
owned by New Hanover County to prepare them for
adoption from the shelter. It is a tremendous asset to the
division, since it has freed Animal Control Officers from ,
• transporting pets for next day surgery, thereby allowing Ribbon-cutting ceremony in November 2004.
Environmental Health Services
Three new Environmental Health Specialist positions during field observations by the Regional Environmental
were filled with interns between July and August 2004. Health Specialist (a NCDENR discipline specific expert).
Continuous growth of the local food service industry The presence of interns compels experienced staffto brush
has for a number of years made it impossible to provide up on their coaching/teaching techniques in addition to
adequate surveillance of restaurants and other similar their knowledge of health and safety standards. A great
establishments. Interns or inexperienced personnel deal of time is thus spent getting new staff to the point
are required to attend North Carolina's Department of of helping make a dent in the overall workload.
Environment and Natural Resources (NCDENR) Food
Safety, On-site Wastewater and General Environmental A long sought maintenance building for the Vector
Health training modules for a period of approximately Control Program is about two-thirds completed, and
seven weeks. will also offer shelter to preserve the integrity and
operational life span of various types of equipment. The
After successfully completing these modules via pace of development in the county gives rise to changing
participation and written examination, interns learn the habitats for mosquitoes as well as other potential disease
• practice through field experiences with their peers, and vectors. Staff continue to commit time for monitoring
independent field exercises. Finally, to gain authorization land disturbing activity and identifying and mapping
credentials from NCDENR to enforce state statutes and sites where larvicide may be safely applied to control
administrative code, interns must demonstrate their skills mosquito populations.
The impact of a growing population has never been more explanation for a source of contamination. Further, the
apparent than with some of the issues faced in the Water evaluation of properties to determine if wells and/or
Quality Program this year. Drinking water became a septic systems can be permitted seems seldom to be a
concern in a small subdivision served by private wells straight-forward task. Most evolve into a lengthy case
when reports of laboratory analyses showed inconsistent study of surrounding property use well before a soil auger
quality. Environmental surveys and testing of more touches the ground or a tape measure escapes the reel.
than fifty wells outside the subdivision did not offer
Health Programs Administration
Mobile Dental Unit
Little Mouths Create Big Challenger!
North Carolina has one of the worst dentist-to-population appointments. For this reason Brunswick County
ratios in the nation. If we doubled the number of Health Department and New Hanover County Health
dentists in our state we would still be under the national Department have teamed up to develop a mobile dental
average. That spells trouble for Medicaid recipients and unit program that will set up at local elementary schools
the uninsured. The result is dental neglect and people in both counties.
eventually crowding local emergency rooms for dental
extractions. That is expensive dental care! The Kate B. Reynolds Charitable Trust has pledged
support of $311,000 and the Cape Fear Memorial
New Hanover County is fortunate to have some dental Foundation has pledged $175,000. This money will
providers that accept Medicaid patients. With the growing purchase a state-of-the-art mobile dental unit, measuring
number of Medicaid children, as well as undocumented 53 feet long by 8 feet wide, with three chairs and a full
and uninsured children, local Medicaid providers cannot staff to include a dentist, three dental assistants and a
meet the current demand. New Hanover and Brunswick support position. This program will take the dental
county officials are sensitive to this situation. There office to the schools. The beauty of the program is
are over 18,000 children ages birth to 18 on Medicaid that it takes away the barriers of transportation and
between the two counties. One in four kindergartners has very low downtime while school is in session. If
in Brunswick County have untreated decay. One in five one child is absent or taking a test the dental staff will
kindergartners in New Hanover County have untreated simply move to the next name on the list and not miss
decay. an appointment. This program should accomplish three
main goals, provide a dental home to Medicaid children
An identified problem is that even when the care is that do not currently have one, offer low cost treatment
available, these children are not making it to their to the uninsured and some free treatment to children in
appointments. Local dentists site a notoriously poor hardship situations. This program should have an instant
show rate for Medicaid children, and the undocumented impact on the lives of the children in Brunswick and New
and uninsured children are having difficulty even getting Hanover counties.
n
00
m A „11 ~ B ~xnrtRnlz t
zxra ~nmm~ ~
• F FRO1N
NEW XANOY COUNTY HEALTH ALTH DEPARTMENT
" u.a...`. MOBILE DENTAL HEALTH OUTREACH
EACH
Strategic National Stockpile
• It is the responsibility of New Hanover County Health school's television system. Credentialing was held on
Department (NHCHD) to protect the public health of site to allow staff participants to sign in and collect
the population of New Hanover County by assuring assignment information and site map. Staff orienta-
that the necessary preparedness and response capability tion and training was conducted the week before. The
exists for natural and manmade disasters. The mission State Medical Assistance Team set up on site with lo-
of the Strategic National Stockpile (SNS) Program un- cal Emergency Medical Services to accept patients re-
der the direction of the U. S. Department of Homeland ferred from triage for isolation or transport to an alter-
Security is to rapidly respond with deployment of phar- nate treatment facility. Southeastern Center for Mental
maceutical medications and other medical supplies to a Health staffed general information stations to assess
national emergency site. need for, and provision of mental health counseling.
Incident Command was
Planning and exercise established onsite.
is critical to the overall _
emergency response. In University of North
the event of an emer- Carolina at Wilmington
gency, it is imperative graduate students
that NHCHD is ready to conducted a time study
respond, receive, manage, and distributed and
and distribute the SNS collected an evaluation
when the decision is made tool.
to deploy it. The October f
18, 2004 Mass Vaccination Through the exercise,
• Exercise, held at Hoggard several opportunities
High School, was designed r=~ II ~l for improvement in
to be a countywide terror- the County's ability to
ism exercise to simulate respond to a bioterrorism
an actual mass vaccination Staff and volunteers screen participants at a Triage Tent incident were identified.
site, and to test our capability to serve up to 300 people
per hour. An additional goal was to establish a learning Major recommendations included:
environment to familiarize agencies with the protocols • Public Health Incident Command procedures
for opening a Point of Dispensing. • Improved communication within the dispensing site
• Move credentialing away from dispensing site
1,058 individuals, representing 14 different local agen- . Triage procedures
cies and organizations participated. The NHCHD, prior . Distribution of health education materials
to the imposition of flu vaccine restrictions, intended to • Efficiency improvements to the setup and layout of
provide flu shots to 1500 people. However, since the dispensing site
restrictions were in effect on the day of the exercise,
only those who were eligible received flu and/or tetanus Additionally, several successes of this exercise were
shots. recognized, among them:
• The first test of the new SNS program Dispensing Site
The scope of exercise required activation of a Dispens- Operations Plan.
ing Site within a local high school, while students were . The first joint New Hanover County Health Department
still present. Staff was deployed to the school to pre- and Department of Emergency Management exercise.
pare for administration of smallpox vaccine to incom- . The county's first exercise to comprehensively test
• ing participants. Law enforcement established traffic SNS dispensing operations in a single near real-
and crowd control, and permitted authorized access to time exercise.
specified areas of the school. Smallpox informational
videos in Spanish and English were aired through the
Arrival of SAFE KIDS Van
The New Hanover County Health Department has SAFE KIDS New Hanover County is part of the
coordinated the local SAFE KIDS Coalition for the past National SAFE KIDS Campaign, the first and only
six years, and the fiscal year 04/05 welcomed the arrival national nonprofit organization dedicated solely to
of a new Mobile Car Seat Check Up Van from SAFE the prevention of unintentional childhood injury - the
KIDS Worldwide. The van, valued at approximately number one killer of children ages 14 and under. SAFE
$50,000, was awarded to SAFE KIDS New Hanover KIDS New Hanover County is one of only 25 state and
County through a nationally competitive process. The local SAFE KIDS coalitions to be awarded a new van
van will enable the local coalition to provide car seat this year. The van program is sponsored by Chevrolet
inspections throughout New Hanover County and the and General Motors to educate parents and caregivers
region. The local coalition is a collaborative effort of about the importance of properly restraining children
many agencies and dedicated volunteers. on every ride.
Motor vehicle crashes are the leading killer of children f-^
under 14. Under North Carolina law, all children under
8 years or 80 pounds must be restrained in an appropriate Mew x~ova to Mme' x v
seat - whether in the family car, traveling with friends
or relatives, or in a rental car or taxi. According to
the National Highway Traffic Safety Administration,
approximately 73 percent of all child passenger restraints t..i~-~
(more than 80 percent of car seats and about 40 percent
of booster seats) are used incorrectly, more than tripling
the risk of serious injury or death in the event of a crash.
The van, one of 28 joining a nationwide fleet of 91,
is equipped with custom-designed tents, signage and
supplies to organize a car seat inspection capable of The SAFE KIDS Van will travel around the region,
serving several hundred families in a single day. and will increase capacity to check child safety seats
Quality, irlbat Everybody Rants
How do you create a quality assurance program for one of the department, and did not want a thick manual to
organization that does: restaurant inspections, inspections place on the shelf. We were searching for a process
for construction of waste water systems, vector control, to look at any system and make it better. Fortunately,
clinical services, animal control services, school nursing, the team spoke with an experienced quality assurance
care coordination, billing, health promotion, all hazards person from Chatham County Health Department. Based
preparedness, purchasing, IT, personnel and dental care? on conversations with Chatham, we adopted much of
The Quality Assurance Team found out (the hard way) their format to create a program for our own health
that there are no road maps for such a task. We spoke department.
with health departments from all over the United States.
We researched the National Public Health Performance There were a few things to do to get the program up and
Standards and the Public Health Competency Handbook. running:
We found that there are very few full service health • Create a team of employees from various areas of the
departments with a comprehensive quality assurance department
plan in place. Most stopped at program audits and chart • Provide quality assurance training for the team
audits which are required for certain federally funded • Adopt the 10 Step Process
programs. 1. Assign Responsibility- Prioritize areas of need
2. Delineate the Scope of Service- What does the process •
We had been through accreditation and passed with do, what should it produce? (QA Assessment Form)
flying colors, but we were looking for more. The QA 3. Identify Important Aspects of Service- What we are
Team wanted a system that could be applied to any area going to monitor in the areas we have chosen?
4. Identify the Indicators-What are the measurements? • Prioritize the top 5 processes to be addressed
5. Establish Thresholds- Predetermined acceptable 1. Data Collection/Reporting
ranges 2. Marketing
6. Collect & Organize Data- (QA Data Collection 3. Personnel
Checklist) 4. Billing/Collections
7. Initiate the Evaluation- Draft the QI Plan using the 5. Customer Satisfaction
(QI template)
8. Take Actions to Improve the Service Now we are left to implement the 10 steps. Once the
9. Assess the Effectiveness of Actions to Assure top 5 are complete we will move on to other items. In
Improvement is Maintained (Benchmarks have been the event that something else emerges as a pressing
set and reporting is in place) item we will begin to work on the new pressing item as
10. Communicate Results- Feedback to the affected soon as possible. We do not pretend to have all of the
group, management, full staff, much like the report answers, but we have found a few of them to make our
to the QA Team department better.
Personal Health Services
Open Access Clinic Scheduling
In an effort to better serve clients and reduce "no-shows", a Physical renovations were made to the clinic area to
new method of scheduling appointments was implemented accommodate the new concept, with three suites created
in July 2004. Open access scheduling (OAS) began in for the physician extender teams, an additional registration
• the main clinic first, with the Women Infants and Children window, and a check-out kiosk. Support Services staff
(WIC) Program beginning January 2005. were identified to take appointment calls, with provisions
made for Spanish speaking clients as well.
Objectives of OAS include:
Over the first year of OAS, the no show rate has decreased
• Improve patient access to care to an average of 15% and patient visits have increased. The
• See every patient, everyday, for everything Quality Assurance Committee has worked with clinic staff
• Eliminate specialty clinic restrictions and on patient flow and data collection, and changes continue
limited availability to be made to adjust to problems and improve customer
• Provide all clinic services every, day, both service.
walk-in and appointments
• Schedule same day appointments, with phone
lines opening at 7:30 AM
Open Access Schedule Data FY 0405
• Decrease the 50-60% no show rate
for appointments aoo
• Cross train and maximize staff s +aoo
600
• Improve agency compliance for 1000 -
u 1000 fAppts
APPis
WSh..
treatment of sexually transmitted E 600
diseases : 600
200
o - - -
°e o> A> PS y Q9 9 9 P:a
Oats
Flu Vaccine Shortage
Flu season for the New Hanover County Health October 22: NHCHD runs out of flu vaccine except
Department (NHCHD) began in the spring of 2004, for state-supplied vaccine designated for children and
when the first Centers for Disease Control and pregnant women.
Prevention (CDC) Influenza Memo was received on
April 16, 2004. That's when in-house plans for flu November 2: The NC Division of Public Health receives
season were developed. However, over the course of 5,000 doses of flu vaccine from Blue Cross & Blue Shield
the following months, the plans were changed due to of North Carolina.
extenuating circumstances. In October 2004, a large
manufacturer of influenza vaccine received notification November 4-5: NHCHD provides flu vaccine clinics for
that their license was suspended, essentially cutting in the general public who meet the high-risk criteria. 2,564
half the amount of available vaccine for the United doses of flu vaccine were given.
States. The CDC immediately established guidelines
for vaccination of high-risk populations only, including November 6: NHCHD is again out of flu vaccine except
the elderly and adults with chronic medical conditions. for state-supplied vaccine designated for children and
pregnant women.
This turn of events prompted the creation ofa statewide
hotline to answer questions from the general public. r
NHCHD also utilized a local number and created
a pre-recorded message about the availability of
vaccine, and guidance for those qualified recipients.
During the early weeks of October, many conference
calls were held discussing distribution of vaccine,
assessment of high-risk individuals, price gouging, -
protection from theft, and methods for collaborating
with local healthcare providers. Plans to vaccinate
NHC employees at a bioterrorism mass-vaccination
exercise were adjusted to meet state and federal
guidelines. Vaccination efforts began October 18,
2004 at the exercise site (Hoggard High School), \ . '
and in-house vaccinations began October 19. The Hundreds of people began lining up shortly after
following timeline displays the monumental efforts of midnight to receive flu vaccine in October, 2004
NHCHD staff and volunteers to ensure vaccinations were
delivered to the appropriate populations. November 9: More vaccine is made available from the
October 18: NHCHD provides flu vaccine to county CDC, with an additional 337,425 doses provided for
emplyees who were considered medically high-risk, as North Carolina. CDC announces that all private vaccine
part ofa mass vaccination bioterrorism exercise at Hoggard supplies for the remainder of the flu season will be
High School. 205 doses of flu vaccine were given. allocated to state health departments, for use by county
health departments.
October 19-21: NHCHD provides flu vaccine clinics November 15: NHCHD redistributes 1,490 doses of flu
for the general public who meet the high-risk criteria. vaccine to nursing homes and other health care providers
Those individuals who could not stand in line were of the high-risk population.
accommodated by offering vaccination in cars at the
back loading dock, or stand-ins for those who were November 22: NHCHD provides a flu vaccine clinic for
able to go through the line for their family members or the general public who meet the high risk criteria. 1,048
friends. 6,219 doses of flu vaccine were given in less doses of flu vaccine were given.
than 3 business days.
December 1: FluMist (intranasal live vaccine) redistributed that amount of vaccine. By late January
restrictions are relaxed and was made available for 2005, all restrictions of risk categories were lifted, and
• the healthy 5-49 year population. vaccine was available to the general public. The final
count for flu vaccine given for fiscal year 04/05 was
December 13: NHCHD provides a flu vaccine clinic 9,280 doses. This far exceeds past years, and was due
for the general public who meet the high risk criteria. to health departments becoming the primary recipient of
137 doses of flu vaccine were given. the majority of the available vaccine. Media coverage
of the NHCHD role in distributing vaccine was highly
December 16 :NHCHD is again out of flu vaccine complementary of the efforts of staff and volunteers.
except for state-supplied vaccine designated for The public echoed that sentiment repeatedly throughout
children and pregnant women. the season.
As of December 31, 2004, NHCHD had received over
10,000 doses of flu vaccine and either administered or
Hepatitis A Investigation
New Hanover County experienced a significant increase New Nam rCounty HoM Dept
in the number of Hepatitis A cases in the first quarter of o°eeto° stp;top.
FY 04/05. From July through September 2004, there ,p
were 18 laboratory confirmed cases. Active outbreak
surveillance and investigation revealed that all 18 cases
were epidemiologically linked to a common source. While
contacts included children attending child care facilities and j
• a restaurant worker, there was no secondary transmission g ..ate
outside of the family, close contacts and social network of
the index case. In order to prevent secondary transmission °
and contain the spread of this communicable disease,
the New Hanover County Health Department provided
intensive outreach prevention and awareness education
on Hepatitis A to all local physicians, hospitals, child care 4,,01 ,~j
a a a
Y ,r`1 '1001
facilities and the community in general. A total of 198 dwd
contacts were investigated with 129 persons receiving
Immune Globulin (IG) as prophylaxis.
Reportable Communicable Diseases
(diseases with more than 1 case reported)
July 1, 2004 June 30, 2005
AIDS 23 Hepatitis B, Acute 6
Campylobacter 11 Hepatitis B, Chronic 32
Cryptosporidiosis 3 HIV Infection 58
Chlamydia 627 Rocky Mountain Spotted Fever 10
• E. Coli 0157.H7 2 Salmonella 101
Gonorrhea 322 Shigella 3
HepatitisA 17 Syphilis, Latent and Late 41
Strategic Planning Retreat
Mr. Bill Herzog again facilitated the New Hanover County After agreeing on the identification and ranking of
Health Department Strategic Planning retreat on April 16, the priorities listed above, they were divided into the
2005. Participants included Board of Health members, and following for "task group" discussion. Participants were
health department management and staff representatives. invited to move to the group that they felt most interested
Mr. Herzog initiated the session with a presentation about in, or that was most appropriate for their staff role at
the Strategic Planning Process and anticipated goals for NHCHD. The groups were compiled as follows:
the outcome of the day. Prior to the workshop, copies of
worksheets were distributed to participants to facilitate Group 1• Emerging Risks, Environmental, and Violence
identification of issues of interest, and also to help frame a (focusing on the individual and/or group issues of
group oriented identification of tasks and goals. Mr. Herzog emerging risks for all hazards, response preparedness,
encouraged the flow of individual ideas into group ideas, elimination of smoking in public places, protecting public
and then into group prioritization and task assignment. health from environmental risks, the physical environment,
updating state laws related to environmental service, the
Information was presented on the health statistics generated rise in violence against women, and gang violence)
from the 2004 Community Assessment process. Data was
delivered on morbidity and mortality statistics, the Behavior Group 2: Access to Care, Sexuality, and Disparities
Risk Factor Surveillance System, and other data related to (focusing on the individual and/or group issues of marketing
North Carolina, the eastern and/or southeastern regions, and ofNHCHD services, communication and education related
New Hanover County specifically. Information was then to health risks, child health, dental care with children, oral
shared about the provision of services for NHCHD, which health, access to preventive care, prenatal care, health
reflected the many changes in Personal Health Services
as a result of the changing clientele of the department, education, and access for the uninsured)
and the changes implemented to the structure of staff as Group 3: NHCHD Internal Issues and Animal Control
recommended by the Organizational Analysis of 2002.
(focusing on the individual and/or group issues of: staff
Participants were asked to take some time to identify their continuing education and training, working with budget
personal interests that they wanted to see addressed during cuts, increasing revenue, reporting of data and services,
the day, taking into account the information presented on HIPAA compliance and security. IT development for staff,
health statistics and service provision. Upon identification IT privacy, rabies control, and animal issues)
of the individual goals, small group facilitators compiled
the individual issues into a list of group issues. Through Group 4: Obesity (focusing on the individual and/or
a process to narrow the focus of individual interests, the group issues of: obesity related diseases, healthy youth,
following groups ofpriorities were established. Once these increased physical activity, improving nutrition, and
were identified, participants were given the opportunity to reducing obesity)
prioritize them through a voting process. Following is the
ranked list of Strategic Planning Priorities: These groups were tasked with developing long-term
goals that were:
1. Access to Health Care a.) clearly defined and could be clearly defined
2. Obesity to others,
3. Emerging Health Risks b.) would have negative consequences if not
4. Environmental Health Risks addressed, and,
5. NHCHD Internal Issues (including HR resource c.) have a reasonable chance of success.
development, IT, revenue)
6. Human Sexuality (as related to STD and Progress on these goals and objectives will be revisited
pregnancy prevention) through regular Strategic Planning and Community
7. Animal Control and Rabies Assessment Processes.
8. Health Disparities
9. Violence
Financial Management
• The New Hanover County Health Department Amended The Health Department's Business Manager was
Budget (Adopted Budget plus any amendments that were responsible for preparing expenditure reports that
processed during the fiscal year) for FY 2004-2005 was ensured billing and receipt of the Health Department's
$13,153,290. Actual expenditures for FY 2004-2005 state grant funds. The Health Department complied with
were $11,456,773. The Health Department's budget New Hanover County Financial Policies and Procedures,
was composed of 34 individual programs. Division which included an annual audit.
Managers submitted a line item budget for each
program within their respective divisions. The Health
Director and Business Manager reviewed all budget
requests. Budget hearings were conducted and a Budget
Workbook including all programs with line item narrative
justifications was prepared and submitted to the Board
of Health for approval.
Total Actual Expenditures for FY 2004.2005
Capital Figure 1 illustrates how the Actual Expenditure Budget is
Operating: outlay: divided among Salaries/Fringes,Operating andCapital
$ 1,76565,581 $ 69,896
1, Outlay items.
Salanes 8
• Fringes:
$ 9,621,296
84%
Figure I
Figure 2 illustrates the breakdown of the Health Total Revenue Earned FY 2004-2005
Department's total earned revenue ($6,73 7,617) Animal Control
Medicaid: Fees: $690,271
through Health Fees, Medicaid, Environmental $1.168.877 6% Coun
Health Fees, Animal Control Fees, and Other 0A l Appropriations:
(including miscellaneous grants and school Other: $2,706,113 $4,719,156
24% 40%
contributions). It also shows Federal and State
Grants through the North Carolina Department of
Federal8 State:
Health and Human Services ($1,745,323, which Environmental $1,745,323
Health Fees: Health Fees: 15%
is included in the above total revenuefigure) and $305,582 $181,451
County Appropriations ($4,719,156). 3% 2%
Figure 2
•