Travis County Commissioners Court
May 5, 2009,
Item 31
31, receive a presentation and discuss the transition of the Austin Travis County community health center's operations and employees from the city of Austin to the Travis County health care district.
>> morning, I知 trish young, the president and ceo of the Travis County health care district.
I have with me the chief operating officer of community air, which you're going to learn more about in just a minute.
we'd like to spend a little bit of time with you this morning reviewing with you the transition that recently occurred from the operation of what is now known as community care, but was formerly known as the Austin and Travis County community health centers.
their transfer of that operation from the city of Austin to the district's support.
we're going to spend a little bit of time -- actually, if I could get some guidance from you.
how much time would you like to spend on this topic this morning?
>> is 10 minutes too much?
>> the shorter the better for me.
>> we've been talking about this for two years and christie, if you want to go ahead and get our presentation up, we'll move through some slides very quickly.
I think y'all know we were established in 2004, the district was, but we made an agreement with the city of Austin at that time to continue to operate the community health centers until such time that we are able to build the infrastructure necessary to assume that responsibility.
we did that over a period of years and that transition actually was scheduled for March 1st and took place on March 1st.
a large component of that was the creation of a nonprofit 501(c)3 corporation.
its legal name is central Texas community health centers, but its business name or d/b/a is community care.
and it is -- the board of that corporation that is the federally qualified health center board.
the members of that board used to serve for the city as the federally qualified health center board.
they have merely moved their responsibilities into this new corporation.
along with this transition or a large part of this transition was actually getting the federal government to approve the transfer of the fqhc status associated with the community health centers from the city to the district sponsorship.
and we went through a process that result understand both the district and community care becoming co-applicants for the federally qualified health center designation.
and by virtue of being co-applicants, I think about us as joint holders of that status.
the way it works in actuality is the district is the owner of assets, the holder and actual recipient of grants, and we have a co-applicant agreement with the community care organization and its board that sets forth the various responsibilities and authorities of each entity.
the district of course goes through a process to -- with community care to develop budget, to do strategic planning, to ensure that the service delivery of the system meets the community's needs, but we do this in a cooperative manner because we are in fact two separate legal entities.
there's -- the next slide with the structure depicts that.
my voice is a little scratchy.
if you will see on the right-hand side the Travis County health care district board, which you're very familiar with, and also on the left-hand side it reflects the organizational structure of community care.
what it doesn't slow on this slide that we'll add next time is the legal corporate organization.
you will see that the fqhc does have its own ceo and that is mr. David slade who is not here today and leslie is here in his sted.
and of course I continue to operate as the president and ceo of the Travis County health care district.
one thing that did change during the course of our development of this transition plan, we had originally planned that employees that were transferring and becoming part of the clinic operations in the new structure, we originally planned that they would be directly employed by community care and any employee that would be a direct employee of the district mostly related to the medical assistance program, that is in fact a district program and district funded program.
we expected those employees to transfer in and become employees of the district.
fairly late in the process, actually late last calendar year, we had some discussions with the city of Austin employee retirement system around how proportionality would be implemented going forward on March 1st between the employees that were transferring from the city of Austin and becoming employees of the two new respective entities.
I think you will recall back in the last legislative session we did get some legislation that permitted proportionality between the district's reteermt plan and the city of Austin's retirement plan.
we had to get that special legislation because the district offers a different type of plan than the city did and we had to create a special circumstances where it was recognized that the service plans between the organizations would be mutually organized.
that process required a determination from the department of labor that both the district and its related 501(c)3 corporation community care were sufficiently controlled such that any employee of community care as well as employee of the district would be considered to be in a qualified -- in our qualified plan.
that could then have proportionality with the city's plan.
the dol issued a moratorium about halfway through our process on such determinations and because we were not able to get that determination prior to the transition of March 1st, we came up with a compromise solution which was to go ahead and transfer the employment of all of the employees directly to the district pending resolution of that determination and once that determination is made and everything is okay in terms of moving forward, those employees can actually transfer to become employees directly of community care.
so it's a stopgap measure and what it does essentially is protect's the transitioning employees in their proportionality and their able to participate in the city's retirement system.
we thought that was very important to accomplish.
what has happened logistically as they have all become employees of the district, but those that work for community care are assigned over and they operate under that structure that we just looked at.
in other words, they operate under that fqhc board, that ceo.
that's their management structure.
and so me, for example, in the district, we're not directly supervising those individuals.
they're being supervised under that structure.
in order to obtain efficiencies in our prp respective operations, we do share infrastructure and you will recall through several of our budget presentations we shared with you how we were developing that infrastructure around human resources, information technology, financial systems and we've put all those in place and we have achieved very good economies by sharing these systems between these two separate legal organizations.
in addition, our arrangement, our contractual arrangement between the district and community care essentially has the district delegating to the community care organization its human resources and financial policies, so we get some consistency and appropriate controls in management of assets and resources.
so it's actually a very -- it's a very cooperative arrangement and I think it's facilitied both of our entities being able to focus on what we're here to do, which is the provision of health care services.
in the district's case it's for the arrangement of services, the operation of the medical assistance program, the direct contracting of services, and with regard to community care, it's the actual direct service of delivery of primary care services to the community.
so unless you have any questions, I would like to turn it over to leslie to describe to you a bit about how community care is different than it was before.
in many ways how it's the same.
but what their plans are for the future and this new organizational structure.
>> what responses have you gotten from the affected employees?
>> actually, I think leslie can speak to this, but it's gone very well.
I think the fact that we took a full two years to plan, we took -- we gave notice to the employees a year in advance of the transition about what their benefits and compensations, and really involved them in this process of change and developing the infrastructure for nut -- for the new organization, I think we've had very good success.
>> we went through a time where so many things were unknown, but as we started a year in advance of rolling into the new company, giving more specifics on what types of benefits were going to be available as employees started to see the quality of benefits that we were going to bring forward as they saw the salary structure and the new organization, those types of things, they've been very pleased and we've seen better retention thu now than we had for several years before moving into the new organization.
it's always a little unsettling because things are changing and we went through a whole data system change at that same cutover time when we went into the new organization.
we're working out a few kinks along the way.
that will happen in any type of situation where you're moving this many employees.
but for the average patient there hasn't been a lot of change.
every patient that was a patient of ours before is a patient now.
every employee is an employee now.
so it's been pretty seamless for most folks.
>> one thing we were able to do, which I think it's fair to say was received very favorably as the employees is part of this agreement and transition plan, the district basically -- I asked and the district board approved honoring all employees vacation and sick time in the city.
the way the city's policy works is if you leave the city, if your employment were terminated, you can be able to cash out your vacation leave up to 240 hours limit.
if you had sick time, unless you were an employee I think as of sometime in 1986, any sick time that you had accrued was essentially disappeared when you left.
what we did, the district did, was to honor everyone's pto or vacation and sick leave balance at the time of the transition and they were given the option to either have the city pay out what it was obligated to pay out to them or transfer part of that, any or all of it into their new pto balance because we adopted a pto man as opposed to a sick and vacation plan.
and in addition --
>> what is the -- explain that.
>> paid time off.
it's all in a single pot which they can use for whatever purpose that they need.
and so we gave them the option of -- with regard to what the city owed them, they could either have the city paid out or transfer it to their new account and with regard to their sick time the same thing.
they could have transfer it to their new pto account or up to certain limits, of course, each account has a limit, or we would pay out the remaining balance to them as a retention payment.
so at six months, I believe -- we'll pay one-third at six months and then the remaining two-thirds at a year.
so it was an incentive for folks to realize the value of that time they had accrued and also come with us through this transition and help kind of get to that other side.
so that was very well received and that was actually very valuable for folks that had been there for a very long time and were facing the loss of a benefit that they felt like was important to them.
>> how do you -- you made a statement earlier and I知 trying to wrap my arms around it.
the statement that 240 hours, that's normally the max.
in other words, use or lose stuff.
normally you carry it over to the next fiscal year; however, how do you determine if you're going to put that leave all in one pot, how is it determined what is vacation and then what's sick?
and especially if you get in a situation -- I guess there's no use or lose.
do you carry it over to the next year what's in that one pot?
>> well, two things.
and I知 assuming you're asking me about our pto plan going forward?
>> exactly.
>> the hours that the transferring employees, the hours that they choose to put into their new pto bank, they're all one and the same.
there's no differentiation between sick and vacation.
it's just leave time and they can use that leave time for whatever purposes their supervisor grants them.
the way our pto policy works is it does have a limit based on -- we have several categories of accrual rates, so just as in any organization depending on how long you've been there and what type of employee you are, you have a different accrual rate.
then you have a different cap in terms of the maximum that you can accrue to that account.
another benefit of our plan, however, is once you reach that cap you essentially are -- you are paid out your pto to keep you under that cap, so you never lose the value of an accrued hour of leave.
you either take it, it remains in your bank or it's cashed out to you once you've hit your limit.
likewise you have the ability once a year to make an election to cash out up to 80 hours of our pto.
just take it as a payment, as long as you keep an 80 hour balance in your bank.
we have to make sure that employees maintain enough leave in case they do become sick.
so there is no distinction between sick or vacation.
you use the time however you need.
and you never lose the value of a single hour of accrued time.
>> maybe I知 not understanding.
I知 just trying to determine what is allowed to carryover from one fiscal year to another?
>> the 240.
whatever your maximum is.
>> so if you have -- let's say you that 7, 800 -- folks have a lot of sick leave that's accrued.
and of course, you don't use that.
you shouldn't lose that sick leave.
>> well, I think -- we have to look pretransition and post transition.
if someone has 700 hours of sick time in the city, they would have made a decision to transfer a part of that 700 to their new pto bank in the district.
and they could have chosen to put zero in there or they could have chosen to put, you know, as an example, 100 hours or up to -- whatever their limit was.
let's say they were at the 240 limit.
they could have transferred 240 hours into their bank and they would have started off with a pto balance of 240 hours.
that meant that that leave is available for them to take.
whatever the reason difference is between the 700 and the 240, that is going to be paid out to them in a retention payment, one-third if they stay six months and the remaining two-thirds if they stay a year.
if they don't stay with us, they will not get those at payments.
if they stay with us, they will get those cash payments.
>> what's the cap?
what's the cap on it?
>> there was no cap on what they could rollover.
it it was hours earned under the city, we were going to find a way --
>> we honored every hour that they had.
>> to get recognition for that as long as they stayed with us for a period of time.
>> now, if they're an employee in the new organization -- let's use the most common example.
they have a 240 hour pto maximum.
so they will accrue hours through the year.
in addition to what they transferred over, if they transferred anything to that beginning balance, they will accrue.
if they reach -- if they ea crew above their -- accrue above their 240 hour bank, they will actually receive a bank for the hours above and beyond that.
they will always be given the value of those hours.
they will not be able to accumulate 700 hours of leave.
they will always hit a maximum.
now, the question has been asked what happens if you have short-term disability, what happens if you have long-term needs?
the district is different than the city in that we actually provide long-term disability to the employees.
we pay for that.
that's 100% covered cost.
then it becomes the employees cost as to whether they take short-term disability coverage and we do contribute I think 25% to that cost.
so we will pay 25% of short-term disability and we pay 100% of long-term stability.
so the idea is if you have a short-term issue, you can use your pto balance to cover that.
or you can again choose to take short-term disability coverage, plus you are covered for a long-term disability.
so we no longer have the need for someone to accumulate 700 hours of sick leave.
you essentially get the payment in cash and you're covered by your disability benefit.
>> what's the -- are the majority of employees ultimately going to be in the fqhc?
>> probably 400 or.
so.
>> what's that split?
is it 40/60, 30/70.
onnumber of employees in the district versus those in community care?
>> I would say we probably -- there would be 400 or so in the fqhc and there would be 50 to 60 in the district.
>> yeah, more like 90/10.
>> yeah, more like a 90/10 split, yeah.
>> any other highlights?
>> I did want to go through just a few things on the community care side as we rolled out with our brand new name.
we have stayed committed to our mission that we've always had in place for some time.
we will work with community.
it's about being responsive, providing the right care at the right place, at the right time.
we've really framed what we're trying to do as we move forward in the new organization about that right care at the right time, at the right place.
we did send out information to all of our patients and have all new brochures and letterhead and everything that you normally would see with the corporation.
we've gone through and drafted all of that.
we've got new signage available.
I know we had brought forward some request previously to the Commissioners in order to get new signs up at all of our sites.
and those are in the process of being put into place.
we're leaving behind information and it went out in both english and spanish with all of our new contact information and understanding of what our practice is and what's available.
and then we've also included in that a copy of our work-in brochure information that we're starting to get out to our patients as well.
we are now operating two walk-in clinics so that patients that either become sick on a weekend or can't get into their regular physician will have a place to go to get care so we can keep them in our system as opposed to asking people to go to the emergency room on the weekends.
the direct mail announcement went out.
there's a copy of that in here as well.
all the new --
>> so the transition seems to be going well.
>> it is.
>> will you let us know if you run across any unexpected problems?
>> absolutely.
>> I do want to --
>> questions?
>> I want to mention one thing since we have opened the -- to the new organization April 1st we open add new clinic at rundberg.
that is serving both adults and pediatrics at that site.
on may 1st we finally opened after some delays our first affiliation with the u.t.
school of nursing.
that's the family wellness clinic.
that opened on may 1st and we look forward to adding the children's wellness center at del valle later this summer after they relocate that site.
so we continue to move forward and look at opportunities to expand care into the community and meet the needs of those in our community.
>> thank you.
>> thank you.
>> we appreciate your support.
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Last Modified:
Tuesday, May 5, 2009 5:40 PM