About Allen
Experience Matters
- Served on the IRMC Board of Directors for 3 years
- Served as Chairman IRMC Foundation for 4 years
- Served as Co-Chair (With Helen Post) of the 21st Century Capital
- Campaign raising over $50 million to build the Heart Center, the
- Emergency Department and the Patient Pavilion
- Served as an IRC Hospital District Trustee for 8 years 2014-2022
- Was Treasurer all 8 years
- Millage reduced by 48% from FY 2016 to FY 2022
- Other Major accomplishments as a Trustee include:
- Supporting the Partners in Women’s Health Program
- including metrics for patient outcomes
- Embedding IRC Healthy Start representatives in the prenatal process resulting in improved neonatal mortality outcomes
- Restructuring the Gifford Health Center from a pediatric center run by the Health Department to a full-service primary care facility run by Treasure Coast Community Health
- Played a central role on the Collaboration Committee that determined IRMC could not financially survive in the long term and a well-financed partner was needed
- Played a central role in the selection of Cleveland Clinic to take over the operation of the community’s hospital based on:
- Patient care results consistently achieved elsewhere
- (Almost all hospitals in the Cleveland Clinic system were CMS 4 stars or better)
- Financial strength (AA-rated balance sheet by Moody’s and Standard and Poors)
- Financial terms of the Cleveland Clinic offer were adequate (With the assumption of all hospital indigent care expenses plus commitment of $250 million in capital expenditures over the first 10 years)
After graduating from the University of Arkansas in 1964, Allen served
in the U.S. Air Force through 1968. He entered the investment
business in 1969, eventually joining Merrill Lynch and rising to senior
executive, serving on the Executive Committee of ML Private Client
and was Chairman, President and CEO of a Merrill Lynch subsidiary
company. He led and helped establish Merrill Lynch Private Client
initiatives to measure client investment performance by individual
client and individual Financial Advisor, to measure client satisfaction
by Financial Advisor and to convert the Merrill Lynch business model
from commission based to fee based.
Allen retired in 2001 moving to Vero Beach and spent most of his time
giving back to the community principally through the local hospital
then known as Indian River Memorial Hospital. He served as
Chairman of the Indian River Medical Center Foundation and served
on the Board of Directors of the hospital. In 2014, he was elected to
become a Trustee of the Indian River Hospital District. As Treasurer of
the District, he oversaw the reduction in the District’s millage tax rate
by 48% between 2016 and 2022. He also began a program to establish
performance metrics for healthcare organizations being supported by
the District, and led the effort in broadening the services available in
the Gifford Health Center. He played a central role in analyzing the
long term viability of the community’s hospital, IRMC, and in bringing
Cleveland Clinic to take over the operation of the hospital. In addition,
he oversaw the operation of the District’s program to improve
neonatal mortality to well better than the Florida average through its
Partners in Women’s Health program now operated by CCIRH. A key
factor in differentiating care mothers received was embedding IRC
Healthy Start in the program in 2015 which Allen led the effort to do.
Allen eventually joined the Board of IRC Health Start in 2020.
In addition to a BSBA from the University of Arkansas, Allen
completed advanced management programs at Northwestern
University, University of Pennsylvania and Stanford University.
Allen and his wife, Ann, have been happily married for 60 years, have
two children, a daughter in Hawaii and a son in Florida. Allen and Ann
have homes in both places with Vero Beach being their main
residence. Allen joined the Board of Healthy Start at the end of 2020.
For context, I believe the IRC Hospital District has 4 principal issues regarding the electorate
- It’s mission and purpose are not well understood
- It spends more now than prior to Cleveland Clinic taking over
- In a word, Cleveland Clinic’s administration of the hospital has been a disappointment in the minds of much of the voting population
- Reimbursement rates for care provided in Medicare and
- Medicaid is inadequate to cover costs
MISSION AND PURPOSE
The stated mission of the IRC Hospital District is to improve the
health of the residents of the county.
It provides an important mechanism to address local problems,
locally at a relatively inexpensive cost i.e. about 4% of county
government expenditures.
It is estimated that IRC has roughly 18,000 residents earning income
below the Federal Poverty Income Guidelines. In addition, another
52,000 are estimated to be in the category referred to as the ALICE
population (Asset Limited, Income Constrained but Employed).
Access to healthcare is limited for primary care, dental and behavioral
health services.
The IRCHD is an important supporter and coordinator of healthcare
facilities and services. The current FY budget is about $16 million or a
little less than $900 per person living in poverty situations and a little
over $200 per person including those living in an ALICE situation.
FINANCIALS
When IRCHD supported healthcare prior to Cleveland Clinic leasing
our hospital, the annual tax revenues collected were about
$15,000,000 with about half going to provide indigent care at IRMC,
and the other half supporting healthcare facilities throughout the
county.
The millage in FY 2018/9 was .9122. County total millage was about 15
mils, so the District represented roughly 6% of tax receipts.
In the current FY, the IRCHD millage was .5110 or about 4% of tax
receipts.
In the current FY, millage was unchanged vs the previous FY despite
significant property tax valuation increases resulting in the District
budgeting more in the current FY than before Cleveland Clinic
assumed responsibility for indigent care. That shouldn’t happen.
CLEVELAND CLINIC INDIAN RIVER HOSPITAL
The Hospital District Trustees and IRMC Board of Directors selected
Cleveland Clinic to operate the community’s hospital effective
January 1, 2019.
The Hospital District, on behalf of the community, established a 75
year lease requiring CCIRH to pick up indigent care at the hospital
and to spend $250 million improving hospital facilities in the first 10
years of the lease.
Though 100% of the IRMC Board, including several physicians
employed at the hospital, voted in favor of Cleveland Clinic, over the
following 5 years, many of the physicians left the hospital for a variety
of reasons. Access to care at the hospital became difficult to secure a
prompt appointment and there became widespread discontent.
While discontent emerged in the community with Cleveland Clinic’s
operation of the hospital, the patient outcome care has improved
significantly for those who have to be hospitalized. Based principally
on measurements of mortality, patient safety, readmission rates, and
patient experience, CCIRH is rated 4 stars i.e. top 1/3 of hospitals in
the country versus IRMC, which was 2 stars i.e. bottom 25% of
hospitals in the U.S. The principal problems now are physician
turnover and access to care, but patient care for those unfortunate
enough to be an inpatient is much improved.
For those that think the District should have chosen a different
hospital system, read the Barron’s Magazine article of June 14, 2024
on Mission Hospital in Asheville, NC acquired by HCA in 2019 about
the same time CCIRH assumed control of CCIRH.
CCIRH is rated as high or higher than any hospital on the Treasure
Coast.
REIMBURSEMENT
Healthcare in the U.S. is funded principally be a combination of
capitalism and socialism. This results in inconsistencies that are
difficult for healthcare providers to manage.
Medicare reimbursement and FL Medicaid payments are generally
inadequate to cover hospital costs. Private insurance pays varying
rates negotiated with each hospital or hospital group. This results in a
wide range of payments for the same or similar services that favors
organizations that have a larger number of hospitals.
Hospitals have difficulty choices to make between sustainable
profitability and healthcare service provided because of the
reimbursement system
This an issue for the IRCHD because it reflects the difficulty of
healthcare organizations caring for patients on a sustainable basis
and underscores the importance of having the District to support
these services locally.
The IRC Hospital District is unique and important helping to differentiate the quality of life in Indian River County
- The District’s support of the Partners in Women’s Health Program (including IRC Healthy Start participation) provides prenatal care and birthing services resulting in zero maternal deaths for over a decade and neonatal mortality results about 74% lower (i.e. better) than IRC mothers that selected other providers
- The District’s support is the reason Gifford has its Health Center
- The District was a central participant in establishing and now funding the Mental Health Association
- The District is an important supporter of Treasure Coast Community Health and Whole Family Health. Both provide primary physician care and other services principally for low-income often uninsured patients. Between them, they serve about 20,000 unique patients
- The District is an important supporter of substance abuse treatment and is an important factor in attempting to establish a detox center, which the county presently doesn’t have and needs. The Cleveland Clinic decision is made, and the objective is to help them succeed, with patient outcomes being the foremost objective.
- The millage rate should be even lower than it is
- Experience in measuring the performance of patient outcomes at these facilities along with my financial background are important distinguishing elements of my candidacy
DID YOU KNOW…..?
PARTNERS IN WOMEN’S HEALTH
Was founded in 1994 by the IRC Hospital District to address an alarming surge in neonatal mortality (after a live birth, deceased within 28 days). The program provides prenatal, delivery and postpartum care, regardless of ability to pay, originally with IRMH and now CCIRH.
IRC Healthy Start was embedded in the program in 2015.
In the latest year with reported data, 2022, 753 mothers gave birth using the program with 2 children tragically not surviving, a neonatal mortality result of 2.65 pre 1000 live births. The State of Florida average is 4. More significantly, 495 IRC residents gave birth elsewhere with 5 not surviving, a neonatal mortality rate of 10.1 per 1000 live births. A prime example of the IRC Hospital District addressing local health issues - locally.
FIMR (Fetal Infant Mortality Report)
This report examines the causes and potential solutions to infant mortality (after a live birth, deceased within 1 year). The State used to fund this analysis every 10 years allegedly because IRC has only about 1200 births a year. Incidentally, about half those are Medicaid eligible, and an estimated 70% involve at least one major risk factor. After 10 years with no FIMR, IRC Healthy Start requested State funding for a FIMR. It was denied. The IRC Hospital District then provided the funding
- to perform the FIMR on all infant mortality in a year and
- to do it annually
resulting in every infant mortality being examined and analyzed.
In 2023, the State Health Department determined this approach should be adopted in all counties, and commissioned IRC Healthy Start to train other neighboring counties on how to do this. Another example of the IRC Hospital District addressing local issues - locally.
GIFFORD HEALTH CENTER
The IRC Hospital District built the Gifford Health Center with significant support from philanthropy. The facility opened in 2003. It is owned by the District but is contracted to outside agencies to operate. Contrary to the original intent, its services had evolved to be limited to pediatrics only. After extensive community review, the IRC Hospital District executed a plan to restore it to a full service clinic operated by TCCH beginning in 2019. It now offers primary care, behavioral health, vision services and has added an on-site pharmacy to better serve the community. Again, the IRC Hospital District addressing local health issues-locally.
MEDICARE - EVOLVING CRITICAL ISSUE
Since the end of 2019, the American Hospital Association reports that the gap between Medicare reimbursements and and actual cost of hospital operations has widened significantly. In 2022, hospitals across the country experienced a record low -12.7% (operating
loss )on Medicare services with projections it will be worse in 2024. The disparity between reimbursement rates and actual operating costs has put significant financial pressure on hospitals. In Indian River County, 70% of CCIRH’s patients are Medicare eligible and another estimated 5-6% Medicaid. It remains to be seen how this financial issue will be resolved locally, but it’s an important issue for voters to understand. There is no question this would have been a crisis situation for IRMC. This is an example of what happens when local problems are addressed by the Federal Government rather than locally.
MILLAGE RATE
From FY 2016 through FY 2022, the millage rate collected by the IRC Hospital District declined 48%. It represented about 4% of all county taxes collected in 2022. The Treasurer during that period was Allen Jones who, as you know, is campaigning to return to the District Board in 2025. One of the main reasons for running is to limit the millage rate while maximizing the positive impact on healthcare.
CLEVELAND CLINIC INDIAN RIVER HOSPITAL
The arrival of Cleveland Clinic, with its AA-rated financial strength, to operate our community hospital likely saved the community much chaos during the pandemic of 2020/21. The Center for Medicare/ Medicaid Services ranks hospitals based on multiple elements of patient outcomes including mortality, effectiveness of care, patient experience, hospital associated infection rates, safety of care and readmission rates. It ranks CCIRH in the TOP 1/3 of hospitals on these and other measurements. This is a substantial improvement compared to IRMC results.
However, while patient care has improved markedly even during the disruptive pandemic, patient access to care has diminished. It is difficult to get an appointment, and many respected physicians have left. The focus now must be on how to help Cleveland Clinic succeed in our community with a particular focus on patient access to care as well as patient outcomes.