The Richmond Register

February 9, 2013

Board gives health director glowing evaluation

School health services discussed at meetings

By Sarah Hogsed
Register News Writer

RICHMOND — Many of the phrases used to describe Nancy Crewe’s leadership of the Madison County Health Department during her annual evaluation Wednesday seemed to be analogies about captaining a ship through troubled waters.

“I really appreciate the way she’s navigated MEPCO,” said board member Dale Barlow, nurse representative. “She has provided the leadership for the staff to salvage it.”

Barlow was referring to the board’s home health agency that faced serious financial difficulties because of changes in third-party reimbursements and rising healthcare costs. MEPCO has been part of the health department since 1974, and at one point in 2011, the board was considering selling it.

The majority of MEPCO patients are recipients of Medicaid and/or Medicaid, and many private home-health agencies will not accept these patients.

Board members noted that Crewe had a “different job when she walked in the door” in 2010, but board chair Dr. Stuart Tobin said he has been “pleased to bring her on board.”

Vice chair Dr. John Johnstone said Crewe had provided “sterling leadership” during an increasingly difficult climate for public health organizations in Kentucky and throughout the nation.

The board chose to give Crewe the top “outstanding” rating in all 40 areas of her evaluation, and it approved the positive review unanimously by voice vote.

The board conducted the evaluation as part of the regular meeting’s public session. In years past, the evaluation was done behind closed session, but the Register lodged a complaint last year stating this practice was in violation of Kentucky’s open meetings law. The newspaper also initially was denied copies of Crewe’s 2011 and 2012 evaluations.

However, before the Register could ask the state attorney general to rule on the legality of the closed-door evaluations, Tobin notified the newspaper and stated that the board would conduct all future health director evaluations in open session.

However, Tobin did ask audience members Wednesday to leave the room as a courtesy to Crewe if they did not have any input to give for the evaluation process.

In other business:

• Crewe discussed the health department’s ongoing talks with Madison County Schools and Berea Independent Schools about changes to next year’s contracts to provide school health services. The health department is not required to provide these services, but it is paid as a contractor to the two school systems.

Kentucky schools are required by law to provide certain health services to students.

This school year, Madison County Schools paid a contract fee of $453,000, and Berea Independent paid $23,000. Baptist Health in Richmond donated $50,000 to the school health services program.

Because one of the private Medicaid managed care organizations refused to pay any reimbursements for school health services, Chief Finance Officer David Reed is projecting the health department will incur a loss of $300,000 by the end of the school year.

Taking this into account, the health department increased its contract fees for the upcoming 2013-2014 school year.

“What we basically asked for was money amounts to break even,” Crewe said.

Crewe did not state what those amounts were, but said she would discuss the specifics more at the April board meeting.

Crewe also is asking the schools to cover any monetary shortfalls incurred by the health department in the future if more MCOs choose not to reimburse for student health services.

So far, the health department has received a response from one school district, but the other has asked for more information, Crewe said.

Tobin added that both the schools and the health department are “becoming a victim of the MCOs.” He said the current school contracts are causing serious “financial hemorrhaging” to the health department, and while the board is willing to absorb the losses for the current contracts, the board could not allow that to happen with next year.

Tobin said the school districts must come to a decision soon about the renewal.

“We just cannot be put off indefinitely,” he said.

• Reed gave a cautiously optimistic financial report to the board. He stated that the upcoming Medicaid cost settlement payments are projected to erase MEPCO’s current $457,000 deficit, putting the agency back in the black. 

“Current MEPCO trends point toward a sustainable future,” Reed said. “... That’s a lot better news than we were looking at last year.”

• Dr. Steve Davis was introduced as the new health department medical director. Davis recently retired as the deputy commissioner with the state Department of Public Health. He will be replacing Dr. John Johnstone.

• Jean Powell reported the number of people seen at the health department through same-day scheduling was down in the fourth quarter. She attributed the drop to several holidays that occurred during that period.

The health department is planning more marketing to promote the same-day scheduling service. Also, the city’s public transit system recently added a bus stop at the health department, which board members believe will aid people who have difficulty obtaining dependable transportation.

• Employees Leslie Farris and Lori Cartmill were recognized with the Shining Star award.

The next health board meeting is 7 p.m. April 3 at the Martha C. Pride Community Center, 1001 Ace Drive, Berea.

Sarah Hogsed can be reached at or 624-6694.