Travis County Commissioners Court
December 16, 2008
Item 6
Number 6, consider and take appropriate action on several items funded in the 2009 budget for the employee wellness and health clinic including, a, job description for medical director of the employee wellness and health clinic at a pay grade 98. B, funding resuitment for medical director in an amount not to exceed 15,000. And c, architectural plan, site location and schematic design for new employee wellness and health club clinic near the del valle south rural community center. Good afternoon.
>> good afternoon, judge, Commissioners. We're here today to share some information with you about two matters dealing with the health clinic.
>> we may as well bring the others up since we delayed action this morning. Give them a chance to be here. Mr. Manseur. All of them.
>> they have all the answer so they should be --
>> welcome from your conference, dr. Stewart.
>> nice to see you, judge.
>> was that hawaii?
>> yes, it was.
>> that was hard work. That was not the kind of recreation you see on t.v. That was hard work at the conference.
>> it was. The conference was very good and the iron man had some very interesting cases.
>> that has little or nothing to do with today's item.
>> correct.
>> the budget included physician for medical -- position for medical director for the clinic operations and it also included funding for construction of new clinic in del valle. And what we're here today to do is discuss with you the job description for the medical director and seek approval of that job description. It should be included in your backup. Are there any questions about the job description?
>> I guess if we asked you about the highlights of the job description, what would you tell us?
>> I think the important information on this position is that it would provide direction for and administration for the clinics, the operation, the funding, budgetary aspects, and would also include research that would be geared toward our high claim cost of our health plan to determine if treatment was appropriate, what new treatments are coming on board and working with the clinic physicians on protocols and giving procedures that would be necessary for the operation of the clinic. The clinic has grown tremendously and it is an opportunity to bring someone in who is an administrator or researchers who can guide the clinic forward from this point. The job description lists the skills that we're looking for and that would include graduation from a medical school with five years directing experience, increasing responsibility in the area of administration as well as research. We want someone who has got experience and can come into the clinic and add their skill and knowledge to improve the services that are offered notice. I don't know if there is anything else on job description.
>> let me just -- I'm sorry, judge.
>> put this together that we look at best practices somewhere else? Or do we just put that we take a standard job description and give it our spin or what?
>> no, the job description was developed by compensation and h.r. And carlotta --
>> we did both, judge. We look at what our own doctors are required to do. And so we take both what's in the market and what is required by Travis County to create the job description. And that was reviewed by the doctors and staff.
>> okay. Commissioner Davis?
>> when it hits the street as far as looking for the type of person that we feel needs to fill this position, how long is it going to possibly take or how long do you anticipate it taking overall to make sure this happens? If the court decides to approve what we're doing here today from that standpoint, what time line are we looking at to actually fill the vacancy?
>> to be realistic, I would say about 60 to 90 days, and I say that because you've got publications that you need to post, and then you've got a search -- we've also as part of item b are requesting $15,000 for funding of recruitment. So we hope to do a statewide and national recruitment. This is still an innovative situation, site program, employee clinic, especially in the public sector you have a lot more private sector clinics with toyota and I think there were several other companies that I have read about. And they are paying off. But it -- what we would like to do is do a state search and then, you know, national search. So realistically, 60 to 90 days.
>> okay.
>> get the information out, get the applications in, review them, set a panel up because we do plan to have a panel. We do licensing checks on all professionals, those sorts of things.
>> and I was wondering, you led to my next question, and that was actually the panel situation. Of course, I don't think I could begin, not being a medical person, but for wellness clinic director job, however, that panel I guess would be made up of, what, medical staff or who would actually be doing the interview to I guess make sure that personnel are what the court -- or would the court have any involvement in that at all?
>> the actual panel has not been determined. We have discussed there would be a panel because as you so keenly pointed out, Commissioner, the need for medical expertise, we usually will use doctors, either out of the medical examiner's office or out of the sheriff's office, nurses, juvie court or, again, the sheriff's office. And then we will have other professionals also the panel.
>> physicians that have worked with us on previous programs.
>> uh-huh.
>> physicians who have worked with us on previous programs. Certainly the court is welcome to have a member on the panel. Obviously.
>> dan?
>> yes, sir.
>> not that my opinion means that much anymore, but --
>> dan didn't say that.
>> and doesn't believe that.
>> here is something that really would get my attention. I'm seeing something built here that is growing and growing and growing. And one of the things that we -- this is a long way from buying 150 pedometers or whatever we started out wellness and you remember how much you had to drag me kicking and screaming. And we all know what benefit we've had with our wellness clinic. You've made a believer out of me, I mean with, you know, visits being cut down, you know, from people going to their doctors and seeing our doctors. But please be careful with something like this because it is real easy to build a deal before you know it, I mean Travis County -- I mean what other urban counties have what we have, and if they have it are they growing, I mean where would we be with the other urban counties wellness? I would think we would have to be somewhat of a model by here's what you can see. So --
>> I've always told dan is that Travis County is really being progressive in what they are doing. We have an opportunity to be set -- to set ourselves as examples for other counties and businesses and actually large companies or corporations like toyota, they do have something like this in place. And if you go to the well coa site, you see where the corporations are being recognized with, like, awards which I'm hoping we could do that at some opportunity in time. But definitely we have an opportunity right now to be an example for other public service entities.
>> I think we have to be careful because when you compare to toyota and alcoa and people, the distinction between private and public and at some point in time somebody starts asking you, I mean one thing to be the leader in something, and I'm very willing to admit the benefit, you know, of what we've seen so far, but I just say be careful, I mean because you'll grow -- before you know it, I'll look in five or six years down the road at the county budget and I'll go wow, I mean the wellness clinic now, you know, has, you know, their own building.
>> point well taken.
>> so that's the only thing to be careful of. What's really eye catching to you when you read y'all's backup is no general fund expenditure which is great, but if you are an employee, you start saying exactly -- how much money is in the employee health benefit fund and why does that money continue to grow and be in there because it is money -- might our premiums be less or might we find as a way as opposed to growing 30 million or wherever we were at with reserves --
>> I think this year you will see a decrease down to 27. About 27.
>> I knew we were going to dip --
>> we're going down.
>> so just be a little careful of that because if somebody comes up and starts asking you off the street, well I mean, how would you respond to that.
>> do we budget this at mid-point?
>> where -- no, mid-point is --
>> 181.
>> and I think this one is at 150. Is where the budget was. That's why in the memorandum we say if indeed we can't get someone or the person we really want is more, we would have to come back to the court. But the range is 139 to 223. The mid-point is 180 --
>> 181.
>> 181 and we have 150. Okay.
>> well, I guess what I wanted to find out is the medical director going to then do research to find best practices for the patients that both doctors see to come up with better ways of addressing their issues? Whatever that issue is, whether it's heart disease or diabetes or, you know, whatever else, allergies.
>> that could certainly be one of the things that they look at. Yeah, it would be a number of different things. It could be weight loss.
>> but how will we encourage employees to participate to the point of that best practice? I mean you can give somebody -- this is what you need to do and if they don't follow that plan, they don't get better. Or they are not well prepared. How will that affect your research in trying to get employees to participate, not only employees, but their dependents because they can come as well. So that there isn't the effect of that disease that they have.
>> I think that is part of the research, to determine how you gain compliance from patients and have the best results, the best out come.
>> I am certainly always open to new ideas on thousand motivate by patients to do what medically is best for them.
>> and so if we do that then we should see a decrease in -- in the cost of the medical care, right?
>> and what we are really aiming for is a decrease in the high claims cost.
>> right.
>> for example, pre-natal treatment, assure that everyone is getting pre-natal treatment because we're aware that can be very high cost. And if there is anything wrong with the baby afterwards, that's very high cost. We know that's an area to focus on. We know that diabetes is an area. We know back injuries is an area. So we have an idea of what the high cost drivers are. And the research that we were talking about, the particular doctor doing -- working with the doctor, the team, to have evidence that correlates the wellness programs to in fact the cost of -- of health care for Travis County. We know now that there is a correlation like we have seen a decrease in diabetes, but getting under those -- those numbers becomes more difficult. These are clinicians. They practice. We need -- we need people -- we need the administrator to work with them and look at not only have a clinical perspective that's an academic perspective to try to prove some of these correlations through evidence and then be able to say yes, this works or not. And that just takes time and effort and creativity and knowledge.
>> and then is that rate going to be shared with other medical associations?
>> we -- we are encouraging all our doctors to publish, yes.
>> I have one last question. And that is will this particular person, the medical director of our wellness clinic, will they be in direct contact as much as possible with our actuary? I'm trying to oversee our programs, oversee all the things that we deal with. I was trying to determine what kind of relationship would that be and to track as they do trends as far as where we are, where we were in 2004 I think when we first came up with some of these things, 2003, whatever it was, I can't recall. Dan, I guess you remember. But anyway, where we were then and where we are today and where we're going. I think that's very important and I think if that person is closely tied in with the actuary to see that the goals, the things that are reported as far as our programs and our preventive and all the other things that's necessary to deal with our wellness for our Travis County employees and retirees, I was hoping that somewhere there would be a relationship with the actuary that deals with our profile of where we are actually with our premiums and a lot of other things are based in dealing with this medical director person to make sure that we are all going in the same direction.
>> yes, sir, we anticipate that the medical director will be a member of the benefits committee that looks at all that data and will work very closely with dan and cindy as well as with the current clinical staff.
>> okay. That's my final question. I support this all the way.
>> medical staff, you mean doctors and nurses?
>> yes.
>> yes.
>> medical staff, doctors, nurses and then medical assistants.
>> I second anybody's motion.
>> the director would be a practicing physician also.
>> yes, sir. Absolutely.
>> okay. No need for a legal background or any county judge experience. Medical is what we're looking at.
>> yes, sir.
>> Commissioner Davis approves a or I approve it. He seconded my motion. Any more discussion? Of a? All in favor? That passes by unanimous vote. Commissioner eckhardt --
>> you promise we're not going to have a whole bunch more.
>> we hear you.
>> in so many words dan gave that promise. It passes by unanimous vote. B is funding recruitment for medical director position in an amount not to exceed 15,000. Move approval.
>> second.
>> we will spend up to that amount. If we can spend substantially less, we will.
>> absolutely.
>> discuss? All in favor? That passes by unanimous vote. C, roger is headed this way. The schematic design. Site location. This is on county owned property, right?
>> yes, sir.
>> good afternoon. Roger corey, managementer facilities department. I have with me the architect and we have located the location of the new wellness clinic at the -- next to the community center on del valle off fm 973, and we locate it to be in the parking lot. That parking lot is not used much, but the reason we put it in the parking lot area because we're not going to increase any impervious cover. The location is outside the city of Austin, but it's in the extraterritorial jurisdiction and it's in a county property. And gabe will go ahead and give you some briefing about the layout of the building. It's about -- it's 1,490 square feet. Go ahead.
>> as roger mentioned -- as roger mentioned, we're locating it here next to the community center just off 973. This is the main parking lot for the south row community center. This is kind of an overlfow parking for that space, it's not striped or anything. So what we want to do instead of increasing impervious cover on the site, go ahead and use some and this parking lot would still be used for overflow here and a few spots will be used for the wellness clinic. It also gifts us good visual connection to 973 and easy to find. The main entry into this facility will be off of the west corner here. You'll enter from the parking lot and there's a lobby, private reception area. A meeting room that can also be used for classes and other events they want out there. We have two exam rooms, a testing room connected to the restroom or adjacent to the restroom. Staff break room and two offices. One for the nurse and one for the doctor. We intentionally kept this hallway open at the end for natural light and natural ventilation throughout. And the elevations, this would be the main entry elevation. This would be the view from the south rural community center as you enter into the building. This would be the view from 973. And we're over the hallway we have these clear story windows to let the natural light in. This would be the main -- the main view from the new parking lot of the building and this would be of the rear, the back of the building. So that's pretty much it for the schematic design.
>> this building is going to be designed completely with staff. Gabe is going to be the architect of record and I'm going to be the engineer of record. We're going to do all the civil, all the mechanical, electrical, plumbing and
>> [inaudible] is going to be done in-house. And we will also coordinate the construction and we requested a total budget including construction design, procurement of engineering service outside facilities management like geotechnical and also of the metal assessment plus some survey and it's been approved in the budget process for, again, everything, i.d.s. Included, security and the move and construction design for $369,000. And it's been approved in the budget.
>> roger, again, if the court ends up supporting c and the construction and all the other necessary components for completion of this particular project from today's date, when would you anticipate completion date of this particular project?
>> at the end of September 2009. We asked for nine months.
>> nine months?
>> yes. End of September.
>> end of September.
>> what we would like also to talk to dan about the funding. If the fund can be transferred from the risk management fund to facilities so we can move forward with managing the fund and managing the project.
>> the funding is in the clinic budget and we're asking that it be transferred to facilities so it can be in their budge total start the construction.
>> design and construction.
>> design and build.
>> transfer from your particular risk manager fund to a line item within the facilities management.
>> within facilities.
>> probably need a budget amendment and transfer to do that.
>> yes.
>> remind what size the clinic is across the street compared to this one?
>> the size of the clinic here downtown?
>> including the recreational area.
>> I need to -- it's smaller than this one right here, but have I to give you the exact number. It's about, like, two offices and very, very small office, you know, for the doctor. And then the lobby and one work room area. And I think it's very small.
>> okay.
>> this one is much, much better, it's better laid out and better functional.
>> more comparable to the one at the airport.
>> yes, you can say that.
>> the clinic out at the airport boulevard, judge, this would be --.
>> okay. Questions? We indicated during the budget process that we would approve funding for this design and construction this fiscal year.
>> yes.
>> move approval.
>> second.
>> discussion? All in favor? That passes by unanimous vote. Of the three present.
>> thank you.
>> we've come a long ways. Thank you for the hard work. We've come a long way.
>> appreciate your patience.
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Last Modified:
Tuesday, December 16, 2008 7:06 PM