Wednesday, April 25, 2018
News Roundup

Hernando County health administrator puts teamwork in fiscal corrective plan

BROOKSVILLE — One day last month, Phil Spence brainstormed over pizza with staffers at the Hernando County Health Department's dental clinic.

Spence, the department's new administrator, provided the pies; employees served up the ideas.

"How could they help me and help the organization by offering up suggestions on how to improve and be more efficient?" Spence recalled.

The lunch is an example of what Spence calls walkabout leadership. Employees at every level needed to meet the new guy, but they must also be part of an ongoing effort to get the department's finances in order, the retired Army colonel and veteran health administrator told the Tampa Bay Times last week after about 2 1/2 months on the job.

Tapped by Michael Sentman, the state's assistant deputy secretary for health, to replace retiring longtime leader Elizabeth Callaghan, Spence recently submitted to his bosses in Tallahassee a three-pronged fiscal corrective action plan.

The first strategy has nothing to do with numbers. The goal, he wrote, is to build a "culture of team work, collaboration, trust and program ownership." That's especially important in the wake of last fall's round of layoffs at the department, Spence said.

"If your employees feel you're hiding things from them, if they don't understand the big picture, then you can't really expect them to jump onto the bus," he said.

• • •

Shortly after arriving, Spence formed a "productivity committee" comprised of employees from all levels of the department. The committee meets once a week, and the minutes are distributed to the entire staff.

Success means striking a tricky balance between two seemingly conflicting missions: provide as many services as possible to an increasingly needy population, and keep a business-minded eye on the bottom line to remain viable and build up the department's reserves.

The administrator and his charges have work ahead of them. The state wants departments the size of Hernando's to keep reserves of about 7.5 percent of the total budget. By the time Spence arrived, the $7 million budget had dipped into the red by a little more than 3 percent.

Spence has set a goal to have the reserve figure up to 4 percent by June 30, and to 7.5 percent by the end of the calendar year. He said he is still optimistic that the department can avoid layoffs and cuts to services if the state doesn't slash funding and the current legislative session doesn't produce major changes to the Medicaid program.

There are already initial signs of improvement. By the end of January, the rainy day fund had crept into the black by about one-half of 1 percent. That was due in part to an easy fix. The department had been running nearly a month behind in processing billing slips, so a team of staffers attacked the problem.

The long-term health of any department, however, has much to do with the volume of clients that come through the doors and how they pay, so that's another component of Spence's recovery plan.

Some patients have insurance, some are covered by Medicare or Medicaid, and some are under-insured or uninsured. Fees for that last category are levied according to a seven-tier sliding scale based on income. Indigent patients pay nothing. No one needing care is turned away.

The problem in the dental clinic, where roughly 65 percent of current patients are eligible for free services, shows how important a balanced payer mix is to the overall operation.

"You just cannot maintain an operation where you don't have enough revenue being generated to pay for the cost of doing business, and that is what has happened with our dental program," Spence said. "The revenues we receive from the other 35 percent do not sustain the program."

The solution is not to cut the program or deny service to the needy, especially since the department's new 57,000-square-foot building on Forest Oaks Boulevard in Spring Hill features a dental suite with room to grow. The goal is to bring in more patients who can pay or have insurance, and that revenue subsidizes services for poorer patients. Ideally, the money could even cover the cost to expand services.

With that in mind, Spence has tasked the staff with promoting the department's dental services for children who are covered by Medicaid.

The department will seek potential clients in places such as pediatricians' and obstetricians' offices, and in Head Start programs. There is also a contest among the staff to come up with a new name that captures a family-friendly mission. Spence has ponied up a $20 gift card for the winning name.

Bringing in more children for dental services is a good business call, but it's also a sound health policy, said Dr. Pedro Lense, the department's senior dentist.

"We can prevent future problems," Lense said. "It saves a lot of heartache later."

Spence is convinced there are ways to get clients in and out more efficiently. He acknowledges, though, that encouraging physicians to see more patients can be a touchy prospect.

"That's a delicate balance between practicing good medicine and getting enough people through the door to be cost effective," he said. "There's definitely room for improvement, but I can't just walk in and make an edict that we're going to see five more patients a day than what we're seeing. It has to be us working as a team."

• • •

One employee-driven success story involves the HIV/AIDS program.

Through an inter-local contract, Hillsborough County uses grant money to reimburse the Hernando department for providing HIV/AIDS services to clients in this area. There is a waiting list for those services, but even with the grant money, the program wasn't cost effective, Spence said.

Staffers were able to negotiate with Hillsborough to increase the reimbursement rate by some 50 percent. The local department will also be able to see more patients by working with the lab to accommodate their blood work.

The open lines of communication and Spence's accessible style have helped to somewhat settle the nerves of workers doing more with less, employees told the Times.

"He has stated and restated to the staff that he really values input concerning how we might be able to streamline services, and I think he's stayed true to his word," said Kathleen Sauskojus, organizational development manager and a member of the new committee, who started at the department in 1982.

As a clerk specialist who sets appointments from the Brooksville office, Charlene Luke is on the front lines of the patient flow. She has already emailed to Spence some suggestions and observations.

"You can't just step into a position and snap your fingers and make everything work," Luke said. "It will eventually come together."

Tony Marrero can be reached at (352) 848-1431 or [email protected]

Comments
Pasco SRO under investigation after video shows takedown of student

Pasco SRO under investigation after video shows takedown of student

LAND O’LAKES — An investigation continues after a video surfaced on Tuesday that shows a Sunlake High School school resource officer wrestling a female student to the ground while taking her into custody, according to the Pasco County Sheriff’s Offic...
Updated: 10 minutes ago
The Daystarter: Competency hearing for Seminole Heights slaying suspect; Is TIA a dining destination?; Clearwater looks to relocate City Hall; ‘Most Interesting Man’ in Tampa

The Daystarter: Competency hearing for Seminole Heights slaying suspect; Is TIA a dining destination?; Clearwater looks to relocate City Hall; ‘Most Interesting Man’ in Tampa

Catching you up on overnight happenings, and what to know today.• Today’s high temperature tops out about 80 degrees, according to 10Weather WTSP. Our next rain chance is Friday when a weak front moves through. And next week brings the heat. Expect ...
Updated: 23 minutes ago
Forecast: Clear skies, pleasant conditions take hold over Tampa Bay

Forecast: Clear skies, pleasant conditions take hold over Tampa Bay

ST. PETERSBURG — Now that a cold front — which spawned a weak tornado in Ruskin — has departed, it leaves behind pleasant conditions across Tampa Bay.Relatively cool temperatures, clearing skies and low humidity will take hold until Friday, according...
Updated: 1 hour ago
Competency hearing today for Seminole Heights slaying suspect

Competency hearing today for Seminole Heights slaying suspect

TAMPA — A judge could determine today whether the man accused in four Seminole Heights slayings is competent to stand trial.Attorneys for Howell Emanuel Donaldson III filed a formal request on Monday to ask that Circuit Judge Mark Wolfe appoint a psy...
Updated: 1 hour ago
ESPN’s Rece Davis on hosting College GameDay from the NFL draft

ESPN’s Rece Davis on hosting College GameDay from the NFL draft

When ESPN's Rece Davis heard about the idea for boosting the college football insight into the NFL draft, he didn't need any convincing."My immediate reaction was, this is a no-brainer," Davis said.Davis will spearhead the network's overdue look at t...
Updated: 1 hour ago
We tried the new restaurants at Tampa International Airport, and we're full

We tried the new restaurants at Tampa International Airport, and we're full

When Tampa International Airport debuted in 1971, each terminal had a newsstand and a snack bar, called something kicky like Snack Bar.
Updated: 1 hour ago
Carlton: The zoo is changing, but don’t worry. The meerkats are on it.

Carlton: The zoo is changing, but don’t worry. The meerkats are on it.

The other day I stopped to check on some progress. And got to see a meerkat, too. Progress in Tampa these days usually refers to the development of Vinikville — excuse me, Water Street Tampa — along the south edge of downtown. Or what w...
Updated: 2 hours ago
Clearwater looks to move out of City Hall to speed up Imagine Clearwater waterfront redevelopment

Clearwater looks to move out of City Hall to speed up Imagine Clearwater waterfront redevelopment

CLEARWATER — Elected officials have talked about relocating City Hall from the downtown bluff for a good 30 years. Now there’s a jolt of urgency to actually do it.Voters backed a referendum in November that essentially greenlighted the $55 million re...
Updated: 2 hours ago
He spent 17 years in prison. Now he’s a free man.

He spent 17 years in prison. Now he’s a free man.

TAMPA — Dwight DuBose walked out of the Orient Road Jail on Tuesday night after trading an orange jumpsuit for a brand new polo shirt and slacks.It was about 9 p.m. He flashed a broad smile and hug staff members of the Innocence Project of Florida wh...
Updated: 2 hours ago
Pennsylvania women guilty of golfing while black; 13 trucks line up in Detroit to stop suicide; Puerto Rican anger grows over lack of basic services; more in U.S. news

Pennsylvania women guilty of golfing while black; 13 trucks line up in Detroit to stop suicide; Puerto Rican anger grows over lack of basic services; more in U.S. news

PennsyvlaniaGuilty of golfing while blackBlack people have long complained about getting pulled over by police for "driving while black," or being eyed suspiciously by security guards for "shopping while black." Now, five women say they got into trou...
Updated: 10 hours ago