THURSDAY, JUNE 20, 2013: SUBMITTED BY BOARD MEMBER W MICHAEL TROUT for discussion, to be added to AGENDA under Item 2: Additions

, Deletions, or Substitutions AGENGA: It appears that the appropriate time and place for general Board discussions prior to receiving Staff Reports is immediately after the Call to Order. I have prepared these requests for Discussions to be taken up by the Board at this time. Shall the Board institute a general policy of requesting that Board members present items to be discussed, to be submitted to staff and included in the printed agendas for our meetings? Shall the Board change the language of the Agenda's Item 2 to read: Board Member Submissions, Additions, Deletions, or Substitutions? As it is our mission to develop and oversee present and future policy of the Primary Care Clinics, I think it's important for us to expand our focus in this area, and encourage each other to bring challenging topics into view that will help shape the (future) direction of this Board. There is a fine article on a National Institutes of Health website that touches on best practices of governance for non-profit boards, and especially hospital and healthcare organization boards that I would like to share with my fellow Members: Effective governance: the roles and responsibilities of board members http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276331/ The author, Don Arnwine, is chair of the Board of Baylor Medical Center at Irving, Texas. Mr. Arnwine also highly recommends the resources and tools available to boards from the Governance Institute (http://GovernanceInstitute.org). The Governance Institute also provides newsletters, seminars, and even an E-Portal online tool for use by boards. FUNDRAISING: At my first attendence of the of the Board as a Member, I spoke of my interest in beginning a discussion of the organization of a Fundraising arm of Board activities. Legal Counsel Romanello stated that there is already a foundation that may be used by the Primary Clinic board to channel fundraising efforts and funds. My suggestion, for discussion, is that we institute a dualpronged fundraising effort – one (division) for cash/monetary contributions, and another (division) for solicitation of in-kind gifts (office, medical, technical gifts, for example). In conversation just after last months meeting, Mr Romanello seemed to indicate to me that the current Board of Directors of the Glades Foundation was composed of staff members of the Primary Care Clinics. DISCUSSION: Is it appropriate for Primary Care Clinic staff members to hold seats on the board of the Glades Foundation, if it is founded in any way to benefit the Clinics. If it is not founded to benefit the clinics, is it appropriate for staff to be involved with that foundation? What steps might the Board take to establish an Health Auxiliary type non-profit foundation to conduct it's own fundraising and the solicitation of in-kind donations to benefit the Primary Care Clinics from the community?

GENERAL TRANSPARENCY :: DISCUSSION :: At our last meeting, Chairman Dr. Doran indicated her interest that the community know that this Board will operate with the highest degree of transparency. It is possible for the Board to institute even higher degrees of transparency than what is required by Florida's Sunshine laws. Shall the Board develop language that provides a higher standard of transparency than the Sunshine Laws of Florida require, and incorporate that into our by-laws, as was suggested by Dr. Doran?

EYEBUYDIRECT.COM: Discuss Luxotica monopoly, vision care, etc. :: EyeBuyDirect offers prescription eyeglasses, including frames and lenses, for as low as $4 a pair. Shall the Board consider posting information about these and other services onsite in the clinics? What is the extent of vision care currently offered by the Primary Care Clinics? Do the Primary Care Clinics own any optometric apparatus used by optometrists in private practice? PBC Legislative Delegation Hearing on health care expansion on July 15: Mark Pafford: Discuss :: Shall the board consider participation in this meeting/hearing? Broward County will have a similar event at Ft Lauderdale Commission Chambers on June 25. FOR DISCUSSION :: “At hospitals, full price for uninsured” By

Laura Green - Palm Beach Post Washington Bureau

Informative article about recent government publication regarding the all but transparent hospital pricing strategies and practices, including hospitals in our own PBC service area. Covered patients get muscle from Medicare, insurers to drive down charges. http://www.mypalmbeachpost.com/news/news/local/at-hospitals-full-price-for-uninsured/nYMFP/ NO TRANSPARENCY IN HOSPITAL CHARGES :: EXCERPT :: "In an effort to shine light into the murky world of hospital billing, the Centers for Medicare & Medicaid Services have released data showing how much is charged and how much Medicare paid for the 100 most commonly billed procedures in 2011 at 3,000 hospitals across the United States. The data reveal that patients who have no one to negotiate on their behalf are more likely to be saddled with what advocates say are bloated charges, designed to be a starting point for negotiation between hospitals and private insurers, or set by Medicare. In Palm Beach County, hospitals routinely charged six to eight times the Medicare rate, and as high as 12 times the rate. Take a simple-sounding diagnosis, like chest pain. Columbia Hospital (now West Palm) billed $34,109 for the treatment. Medicare reimburses only $3,763. A private insurer would likely pay closer to $5,000.” DISCUSS: Transparency in Primary Clinic pricing :: What is the average charge for a visit to a private primary care physician in PBC? For a recent inquiry, an urgent care walkin clinic visit was quoted at about $150. Walgreen's quoted $59 for a consultation at it's Take-Care clinic (with an RN). CVS has a similar consultation for it's 'Minute Clinic.' Shall the board establish a transparent consultation fee, to be possibly revised quarterly?

QUOTE :: “As a person interested in our local community, if a tenth of that money came into this community, not just for the education of providers but for the education of the public in terms of how they can protect themselves against disease processes through diet and exercise, it would make a dramatic difference in our overall health picture.” – Dr. Michael Dennis, Board Chairman of the Charles E Schmidt College of Medicine at Florida Atlantic University (FAU) DISCUSS: Reportedly, some 6% of Americans suffer from Diabetes. According to my calculations,

based on approximate population numbers, some 72,000 PBC residents may have Diabetes. If the economically disadvantaged and potentially uninsured population were 30% of that total, there may be a target population of over 20,000 PBC residents that may need attention in Primary Care Clinic services. How many Diabetes patients (Type 1, 2, and Juvenile) are currently registered in our clinics? What kind of medical assessments have we, or can we make concerning their prognoses, and compliance with medical advice and care, from a Public Health perspective? With regard to Diabetes, shall the board consider the advice of Dr Michael Dennis, and allocate resources to the education of patients and public to protect themselves through diet and exercise? How would we accomplish this? Should the clinics sponsor/offer programs to teach proper nutrition for Diabetics and those who wish to avoid becoming Diabetics? Should the clinics sponsor/offer programs of regular group exercise for our patients and the public? More Discussion: Hypertension, Cardiovascular Disease, Cancer, and other chronic conditions? BREAKING NEWS :: (VIA CNN) :: “The American Medical Association has adopted a new policy

that officially labels obesity as a disease "requiring a range of medical interventions to advance obesity treatment and prevention," according to an AMA statement.”

IF OUR WALLS COULD TALK: We can use the walls in the public areas of the clinics to share a lot of information with patients and the public. One way is to post papers and posters within view in the large waiting rooms. Another would be to have larger screen TV's controlled by our public affairs team to air loops of health related programming, and websites. Shall the board make any resolutions about this?

PHARMACY: For patients who are prescribed medications that are not covered or offered free through our clinics, we should be conscious of the burden that the cost of medications may present to our patients. DISCUSSION: How can the Clinics best serve our patients in this regard? Should we post the prices of all medications that may be prescribed and purchased on the walls by our pharmacy locations? Further, how can we assist patients with comparing the prices of outside private pharmacies? Who is in charge of pharmaceutical purchasing for our Primary Clinic pharmacies, and how are prices negotiated? Websites like GoodRx.com and Lowestmed.com claim to be reliable price comparison tools for consumers – Are there some of these that staff can review and feel comfortable endorsing to our patients and the public?

SOCIAL NETWORKING, WEBSITES, AND LEVERAGING ONLINE NEWSLETTERS AND OTHER RESOURCES: I'm sure that staff and maybe the board has discussed having a website for the Primary Care Clinics, possibly intertwined with the HCD's other websites, like Healthy Palm Beaches, Vita Health, etc. Can we get a staff update on any progress with this? Over 70% of the population uses Facebook, it seems logical to have a presence on that site with a dedicated page for the Primary Clinics. I receive various healthcare related newsletters, and would like to be able to share these resources with the public through our own media (post links to newsletter signups, etc).

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