Cook County Health
Cook County Health Special Board Meeting – September 11, 2020
COOK COUNTY HEALTH BOARD APPROVES $3.3 BILLION DOLLAR BUDGET FOR 2021 BUT……
After one hour of testimony and four hours of discussion, the Cook County Health Board approved a budget of $3.3 billion for 2021. The budget for 2020 was $2.8 billion. However, along with the approved budget, it also voted 6-4 to add an amendment asking for an additional $23 million which equates to the "indirect" costs of CC Correctional and Public Health Departments. Interim CEO Carey and Interim Chief Business Officer Gibson were asked to ASAP identify what services, staff, etc. would be restored if the $23 million was granted.
Hours were spent in discussion with a majority of board members stating that they wanted to have more early involvement in setting budget priorities. The Board’s Vice-Chair made the following points:
Interim CEO Carey noted that there were over 100 public speakers during the two budget hearings and the Sept. 11, 2020 special board meeting to approve the budget. Two programs eliminated in the 2021 budget generated a significant amount of testimony:
More revenue is needed to fulfill the System’s mission and mandates.
The System needs to develop a robust Regional Planning process which must include a strategic discussion on charity care.
For those wishing to have more information about the budget categories and amounts, the 2021 proposed budget can be found at this website: http://www.cookcountyhealth.org
Diane Edmundson, Observer
COOK COUNTY HEALTH BOARD APPROVES $3.3 BILLION DOLLAR BUDGET FOR 2021 BUT……
After one hour of testimony and four hours of discussion, the Cook County Health Board approved a budget of $3.3 billion for 2021. The budget for 2020 was $2.8 billion. However, along with the approved budget, it also voted 6-4 to add an amendment asking for an additional $23 million which equates to the "indirect" costs of CC Correctional and Public Health Departments. Interim CEO Carey and Interim Chief Business Officer Gibson were asked to ASAP identify what services, staff, etc. would be restored if the $23 million was granted.
Hours were spent in discussion with a majority of board members stating that they wanted to have more early involvement in setting budget priorities. The Board’s Vice-Chair made the following points:
- The budget process is too reactive and needs to be more proactive.
- The System needs to explain what services cannot be performed because of revenue shortfalls.
- The System needs to articulate who is its targeted population.
Interim CEO Carey noted that there were over 100 public speakers during the two budget hearings and the Sept. 11, 2020 special board meeting to approve the budget. Two programs eliminated in the 2021 budget generated a significant amount of testimony:
- Health Care service at the Morton East High School. Carey indicated the System believes it can find a replacement provider, but Directors want more feedback on who or what would be the replacement.
- Children's Advocacy Center. In 2020, the budget was $500,000 for mental and physical health services. The Center offers many other services that will continue, and Carey said the System is looking into alternatives. Director Deer who is both a Director on the CCH Board and an elected Cook County Commissioner expressed concern, and used this as an example of why the Directors should be involved earlier in the discussions of what will continue, be cut, or added when developing the annual budget.
More revenue is needed to fulfill the System’s mission and mandates.
The System needs to develop a robust Regional Planning process which must include a strategic discussion on charity care.
For those wishing to have more information about the budget categories and amounts, the 2021 proposed budget can be found at this website: http://www.cookcountyhealth.org
Diane Edmundson, Observer
Challenges Remain For CCH
Cook County Health (CCH) Board of Directors Meeting July 31, 2020
This meeting was held remotely with audio only available for observer
Public Comments
Dr M. Fujara talked about CCH being the recipient of a three-year Department of Justice Grant for the Child Safety Forward Initiative, aimed at reducing child fatalities and recurring injuries due to abuse and neglect. CCH is one of five national sites chosen for this grant. She said the legacy of child abuse persists into adulthood with the risk of serious medical issues, substance abuse, mental illness, involvement in the juvenile justice system and abusive romantic relationships, all creating community challenges. The grant aims to develop strategies to address child fatalities and injuries to help families.
Other comments from staff RNs were about the need for nurses to receive extra non-nursing duty pay for the extra work nurses now perform for their Covid-19 patients. Nurses now deliver food tray and clean patient room, perform dietary duties, clerk duties and patient transport.
Committee Reports
Human Resources reported that it took 90 days on average to hire, from the time of initial job posting to hiring. CCH's Employment Plan brought CCH into compliance with the Shakman decrees, Federal court orders, which prohibit political influence into the employment process, but adds steps to the hiring process. It was suggested that hiring steps be broken down to see if there could be improvement in hiring time and to compare the hiring time of CCH to other Chicago hospital systems. A request for the diversity breakdown of nurses was requested. Almost half of nurses are African American, Asian and white each make up about
one-fifth of nurses. HR actively recruits bilingual staff and reaches out to local groups and universities.
Managed Care reported that as of July 2, 2020 CountyCare membership was 364,973 with 10.5% of these members using CCH clinics. July 2, 2020 numbers are an increase over June 3, 2020 numbers. August membership numbers are projected to be around 369,000 due to increased Medicaid members and IL Healthcare and Family Services (HFS) temporarily stopping the redetermination process during the Covid-19 crisis. HFS's May data showed CountyCare had a 31.9% share of the Cook County Medicaid market. At some future point HFS will start up the redetermination process again and Medicaid numbers will decline. During Covid-19 pandemic, CountyCare patients are getting care along with food, transportation, specialty care. James Kiamos, CEO Health Plan Services, is leaving CCH and this is his last report.
Quality and Patient Safety presented a new Quality Dashboard, specific graphs with reference targets for data collection and monitoring. This dashboard now contains categories at CCH that need to be improved in the CMS Star Rating reports. These CMS reports let consumers compare hospitals based on quality ratings. An important area for CCH is clinical documentation to accurately record a patient's problems such as homelessness and other insecurities/illness/case complexity so as to get properly reimbursed for that patient's care.
In the LOWN Institute Hospital Index, Stroger Hospital rated very high in Civic Leadership, Value of Care, and Patient Safety.
Finance Committee presented the revision of the IDPH Covid-19 Contact Tracing Grant.
1. Hektoen Institute for Medical Research will receive a one-year funding of $6 million for the administration of contracts with those Community Based Organizations that provide services in communities most impacted by Covid-19. Hektoen will monitor progress, have oversight of funding and issue payments. 2. Hektoen will receive approximately $3.5 million to hire a startup contact tracing team of sixty positions so the initial launch phase of contact tracing will not be delayed. After this, CCH will work to bring on a larger contact tracing workforce taking over hiring. For the next year, monthly hiring reports will be provided to the Finance Committee. A grant was received that provides wellness kits for patients with chronic illnesses.
A grant for Chicago Cook County Breast Cancer Risk Identification screening and Prevention will provide services for underserved CC patient populations. CCH Financial Update for the six months ended May 31, 2020: financial results are ahead of budget by $52 million. Net patient service revenue is below budget due to Covid-19 pandemic. $77.6 million received from CARES Act received through May to help compensate for the decline in patient activity. The FY2020 projected year end deficit is $61 million. Current financial planning is for FY2021 budget, seek Federal and State revenue for Covid-19 pandemic, and looking at areas where expenses can be reduced. At the end of this report is the Guiding Principles and Timeline for the FY2021 budget.
Debra Carey, Interim CEO: Cermak hospital expanded testing to all inmates and with social distancing and mitigation strategies, the virus is contained in CC jail.
Items to Watch for in the Future:
FY2021 Budget Request for Approval at August 28 CCH Board of Directors Meeting
Observed by: Michele Niccolai Meeting Length: 3 hours
Link to the CCH Statement on Health Equity approved by the Board of Directors
https://cookcountyhealth.org/wp-content/uploads/Item-VIC-Approved-Resolution-06-26-20.pdf
Cook County Health (CCH) Board of Directors Meeting July 31, 2020
This meeting was held remotely with audio only available for observer
Public Comments
Dr M. Fujara talked about CCH being the recipient of a three-year Department of Justice Grant for the Child Safety Forward Initiative, aimed at reducing child fatalities and recurring injuries due to abuse and neglect. CCH is one of five national sites chosen for this grant. She said the legacy of child abuse persists into adulthood with the risk of serious medical issues, substance abuse, mental illness, involvement in the juvenile justice system and abusive romantic relationships, all creating community challenges. The grant aims to develop strategies to address child fatalities and injuries to help families.
Other comments from staff RNs were about the need for nurses to receive extra non-nursing duty pay for the extra work nurses now perform for their Covid-19 patients. Nurses now deliver food tray and clean patient room, perform dietary duties, clerk duties and patient transport.
Committee Reports
Human Resources reported that it took 90 days on average to hire, from the time of initial job posting to hiring. CCH's Employment Plan brought CCH into compliance with the Shakman decrees, Federal court orders, which prohibit political influence into the employment process, but adds steps to the hiring process. It was suggested that hiring steps be broken down to see if there could be improvement in hiring time and to compare the hiring time of CCH to other Chicago hospital systems. A request for the diversity breakdown of nurses was requested. Almost half of nurses are African American, Asian and white each make up about
one-fifth of nurses. HR actively recruits bilingual staff and reaches out to local groups and universities.
Managed Care reported that as of July 2, 2020 CountyCare membership was 364,973 with 10.5% of these members using CCH clinics. July 2, 2020 numbers are an increase over June 3, 2020 numbers. August membership numbers are projected to be around 369,000 due to increased Medicaid members and IL Healthcare and Family Services (HFS) temporarily stopping the redetermination process during the Covid-19 crisis. HFS's May data showed CountyCare had a 31.9% share of the Cook County Medicaid market. At some future point HFS will start up the redetermination process again and Medicaid numbers will decline. During Covid-19 pandemic, CountyCare patients are getting care along with food, transportation, specialty care. James Kiamos, CEO Health Plan Services, is leaving CCH and this is his last report.
Quality and Patient Safety presented a new Quality Dashboard, specific graphs with reference targets for data collection and monitoring. This dashboard now contains categories at CCH that need to be improved in the CMS Star Rating reports. These CMS reports let consumers compare hospitals based on quality ratings. An important area for CCH is clinical documentation to accurately record a patient's problems such as homelessness and other insecurities/illness/case complexity so as to get properly reimbursed for that patient's care.
In the LOWN Institute Hospital Index, Stroger Hospital rated very high in Civic Leadership, Value of Care, and Patient Safety.
Finance Committee presented the revision of the IDPH Covid-19 Contact Tracing Grant.
1. Hektoen Institute for Medical Research will receive a one-year funding of $6 million for the administration of contracts with those Community Based Organizations that provide services in communities most impacted by Covid-19. Hektoen will monitor progress, have oversight of funding and issue payments. 2. Hektoen will receive approximately $3.5 million to hire a startup contact tracing team of sixty positions so the initial launch phase of contact tracing will not be delayed. After this, CCH will work to bring on a larger contact tracing workforce taking over hiring. For the next year, monthly hiring reports will be provided to the Finance Committee. A grant was received that provides wellness kits for patients with chronic illnesses.
A grant for Chicago Cook County Breast Cancer Risk Identification screening and Prevention will provide services for underserved CC patient populations. CCH Financial Update for the six months ended May 31, 2020: financial results are ahead of budget by $52 million. Net patient service revenue is below budget due to Covid-19 pandemic. $77.6 million received from CARES Act received through May to help compensate for the decline in patient activity. The FY2020 projected year end deficit is $61 million. Current financial planning is for FY2021 budget, seek Federal and State revenue for Covid-19 pandemic, and looking at areas where expenses can be reduced. At the end of this report is the Guiding Principles and Timeline for the FY2021 budget.
Debra Carey, Interim CEO: Cermak hospital expanded testing to all inmates and with social distancing and mitigation strategies, the virus is contained in CC jail.
Items to Watch for in the Future:
FY2021 Budget Request for Approval at August 28 CCH Board of Directors Meeting
Observed by: Michele Niccolai Meeting Length: 3 hours
Link to the CCH Statement on Health Equity approved by the Board of Directors
https://cookcountyhealth.org/wp-content/uploads/Item-VIC-Approved-Resolution-06-26-20.pdf
Cook County League of Women Voters
Observer Report
Observed by: Susan Kern, MD
Date: May 29, 2020 Meeting Length: 3 hours and 15 minutes
(virtual audio meeting due to COVID-19 shut down)
Meeting Name: Cook County Health Board of Directors Meeting
Will COVID-19 Transform the Hospital System?
Public comment by a series of Hospital employees struck a similar chord: complaints of inadequate supplies of PPE (personal protective equipment), canceling of paid vacation time, refusal to grant “hazard pay” and criticism of temporary health staff hiring to cover COVID care tasks during the ongoing pandemic.
Dr. Fegan responded that there were adequate supplies of PPE from federal stockpiles which were inventoried twice daily. CCHHS follows CDC and IDPH utilization guidelines for PPE, adding that shoe and hair-covers are not COVID protective and N 95 masks & disposable gowns were designated for use by staff in close patient contact and with aerosolizing procedures. Additional employee education on proper PPE use would be planned.
Director Reiter was assured that canceled vacation time was rescheduled or financially compensated as defined in the union-negotiated employment contracts, and there was daily communication with the union and invited front-line employees.
Items to Watch for in the Future
Observer Report
Observed by: Susan Kern, MD
Date: May 29, 2020 Meeting Length: 3 hours and 15 minutes
(virtual audio meeting due to COVID-19 shut down)
Meeting Name: Cook County Health Board of Directors Meeting
Will COVID-19 Transform the Hospital System?
Public comment by a series of Hospital employees struck a similar chord: complaints of inadequate supplies of PPE (personal protective equipment), canceling of paid vacation time, refusal to grant “hazard pay” and criticism of temporary health staff hiring to cover COVID care tasks during the ongoing pandemic.
Dr. Fegan responded that there were adequate supplies of PPE from federal stockpiles which were inventoried twice daily. CCHHS follows CDC and IDPH utilization guidelines for PPE, adding that shoe and hair-covers are not COVID protective and N 95 masks & disposable gowns were designated for use by staff in close patient contact and with aerosolizing procedures. Additional employee education on proper PPE use would be planned.
Director Reiter was assured that canceled vacation time was rescheduled or financially compensated as defined in the union-negotiated employment contracts, and there was daily communication with the union and invited front-line employees.
- Hospital’s CountyCare, Medicaid managed care plan: 326,631 members, largest in Cook County
- COVID-19 testing: 7,704; 2,355 positive patients across all CCH locations; CountyCare received 115 claims for in- patient admits (low number attributed to lag in submission of charges)
- COVID financial impact projected through June $75-$100 million revenue loss due to 40% decline in charges since March 15, 2020; decreases across all service lines; plus $10-$15 million of increased costs: supply/equipment/agency temp. staff; and overtime $8-$12 million
- Offsetting COVID financial assistance income: $59 million federal distribution for number of COVID positive patients; $11.1 million received to help offset revenue loss (CARES Act); federal reimbursement for testing/treating uninsured COVID patients, $1 million grant pending for telehealth from FCC;
- $40 million grant from IDPH for CC Dept. Public Health with plans for 400 contact tracing hires
- Discussed: $429 million Cook County awarded from the CARES Act. Hospital system will pursue payment from this grant!
- COVID net negative impact: income is $36.6 million below budgeted.
- Expected rebound in volume of patient charges for CountyCare once the COVID shut down has loosened restrictions, will require provider payments from capitated payments already received, further undermining the financial outlook
- Charity care and self-pay volumes and costs are up $18 million over 2019, likely reflecting high unemployment rates due to COVID shut down
- Telehealth success: 44,335 telephone visits via the clinic system since COVID March shut down
- CCH preparing for post-COVID opening, ramped up drive thru virus testing, Stroger & Provident
- COVID containment at Cook C. Jail due to ongoing testing of symptomatic, asymptomatic, new admissions to the jail and surveillance testing.
- Outreach to COVID high risk members, providing thermometers and pulse oximeters for home self-testing (telehealth); telemonitoring of diabetes, hypertension, via home use glucometers, blood pressure cuffs etc.
Items to Watch for in the Future
- Post-COVID-19 adaptation of the Hospital system to the “New Normal”
Cook County League of Women Voters
Observer Report
Observed by: Diane Edmundson Date: 12-20-19 Meeting Length: 2 ½ Hrs.
Meeting Name: Cook County Health Board Meeting
OUTGOING CEO BEGINS STRATEGIC DISCUSSION ON SELF-PAY FOR MEDICAL SERVICES
Following up on the 2020 budget deliberations and the very real issue of the increased cost for charity care, Dr. Shannon, presiding at his final board meeting before leaving the system, lead a discussion on “self-pay” and how other major public hospitals across the country handle it.
For purposes of discussion, self-pay is used in place of charity care. There was a 17% increase in year-over-year charges from FY 2018 to 2019 from $158 million to $185 million. The percentage of self-pay was 1.2% in 2018 but dropped to .4% in 2019. The largest service increases are: Radiation Therapy [75%], Family Practice [50%], Gynecology [33%] and Surgery [29%].
Comparisons of NY Health & Hospitals; Jackson Memorial [N. Texas & Oklahoma]; Parkland [Dallas]; and Grady [Atlanta]; self-pay plans were passed to the Board and include:
Dr. Shannon listed several strategic considerations:
This would be a major change in policy for CCH as well as culture. Several board members questioned whether the County Commissioners and President would accept this concept. President Hammock responded that the System should provide an analysis and recommendations so that both it and the County elected officials have a base to work from including possibly deciding to provide more revenue to CCH to handle charity care.
Laurence Msall, President of the Civic Federation stated in public comments “The Civic Federation remains adamant in our support of this [volunteer] board…..” He also recommended that the System steer clear of initiatives that do not fit with its core strategy, but did not state what the
Observer Report
Observed by: Diane Edmundson Date: 12-20-19 Meeting Length: 2 ½ Hrs.
Meeting Name: Cook County Health Board Meeting
OUTGOING CEO BEGINS STRATEGIC DISCUSSION ON SELF-PAY FOR MEDICAL SERVICES
Following up on the 2020 budget deliberations and the very real issue of the increased cost for charity care, Dr. Shannon, presiding at his final board meeting before leaving the system, lead a discussion on “self-pay” and how other major public hospitals across the country handle it.
For purposes of discussion, self-pay is used in place of charity care. There was a 17% increase in year-over-year charges from FY 2018 to 2019 from $158 million to $185 million. The percentage of self-pay was 1.2% in 2018 but dropped to .4% in 2019. The largest service increases are: Radiation Therapy [75%], Family Practice [50%], Gynecology [33%] and Surgery [29%].
Comparisons of NY Health & Hospitals; Jackson Memorial [N. Texas & Oklahoma]; Parkland [Dallas]; and Grady [Atlanta]; self-pay plans were passed to the Board and include:
- Sliding scale fees based on Federal Poverty Levels
- All or a portion of the patient responsibility paid in advance
- Services covered limited to emergent [emergency]
- Six months residency required to qualify for charity care
Dr. Shannon listed several strategic considerations:
- Continuous improvement in revenue cycle process
- Refine and update self-pay policies and procedures to include collection of co-pays from insured or payment for others [self-pay].
- Refine and update policies on taking self-pay transfers from other healthcare facilities
- Build-out point of service collections/payment capacity including:
- Online payments as part of patient portal improvements
- Kiosks with payment options
- Training staff to collect/swipe cash or credit/debit cards
This would be a major change in policy for CCH as well as culture. Several board members questioned whether the County Commissioners and President would accept this concept. President Hammock responded that the System should provide an analysis and recommendations so that both it and the County elected officials have a base to work from including possibly deciding to provide more revenue to CCH to handle charity care.
Laurence Msall, President of the Civic Federation stated in public comments “The Civic Federation remains adamant in our support of this [volunteer] board…..” He also recommended that the System steer clear of initiatives that do not fit with its core strategy, but did not state what the
Cook County League of Women Voters
Observer Report
Observed by: Susan Kern, MD
Date: November 22, 2019 Meeting Length: 3 hours
Meeting Name: Cook County Health Board of Directors Meeting
Hospital CEO Jay Shannon Leaving at Year’s End
The vote by the Cook County Health Board to not renew CEO Shannon’s contract transpired after the Public portion of the Board meeting had adjourned and was reported by the media Friday afternoon November 22, 2019. Chicago Sun Times, Crain’s Chicago Business and WBEZ, NPR News Station reported that the Board named Debra Carey, deputy CEO, as Interim CEO beginning Jan. 1, 2020 while the Hospital System searches for a permanent replacement.
Observer Report
Observed by: Susan Kern, MD
Date: November 22, 2019 Meeting Length: 3 hours
Meeting Name: Cook County Health Board of Directors Meeting
Hospital CEO Jay Shannon Leaving at Year’s End
The vote by the Cook County Health Board to not renew CEO Shannon’s contract transpired after the Public portion of the Board meeting had adjourned and was reported by the media Friday afternoon November 22, 2019. Chicago Sun Times, Crain’s Chicago Business and WBEZ, NPR News Station reported that the Board named Debra Carey, deputy CEO, as Interim CEO beginning Jan. 1, 2020 while the Hospital System searches for a permanent replacement.
- CountyCare members 318,196 which is below budgeted numbers, resulted in decreased revenue and decreased expenses, net contribution of $144 vs budgeted $269 million to CCH. Backlog of Medicaid applications of nearly 100,000 at the State Level is contributing to the lower enrollment.
- Medicaid enrollment has decreased by 15% countywide, a trend seen Statewide as well as nationally, attributed to fewer “navigators” assisting in enrollment of Medicaid individuals under the PPACA explained Kiamos of CountyCare.
- Net year end 2019 loss for CCH as a whole is projected at $156 million vs the budgeted loss of $180 million, which is a positive.
- Charity Care is projected to total $377 million and an additional $167 million in bad debt, severely stressing CCH finances. CEO Shannon stated that this trend was unsustainable.
- Shannon noted that patients who come for elective services such as expensive MRI/CT take advantage of the free care and he suggested that the Board should consider implementing partial pre-payment prior to the service which is the policy at other hospitals.
- CEO Shannon reported that the CCH 2020 budget had been approved by the Cook County Board.
- New Provident Hospital update, $240 million budget ($205 million in bonds and $35 million in furniture and fixtures from CCH); groundbreaking Fall 2020, fully open for business end of 2023; 42 med-surgical and 6 ICU beds (vs currently staffed 25 beds and average daily census 13)
- CCH research indicates the Provident service area is in need of surgical and specialty services and has a better payer mix than Stroger Hospital
- Director Thomas cautioned that the New Provident Hospital would be a difficult sell to the community as they had been told for years to use Stroger. He also warned that the University of Chicago would likely “dump” patients on Provident whenever they were on “bypass”.
Cook County League of Women Voters
Observer Report
Observed by: Linda Christianson
Date: October 25, 2019 Meeting Length: 3 hours
Cook County Health (CCH) Board of Directors Meeting
“We ARE the Safety Net in Cook County.”
CEO Dr. Jay Shannon summarized recent CCH positive developments: the IL Health Facilities Board has approved the application for a new Provident Hospital; the National Committee for Quality Assurance (NCQA) has given CountyCare high approval ratings; the US Congress passed a continuing resolution through November 2021 to continue the current $157m in “Disadvantaged Share Hospital” (DSH) funding to CCH, though, he cautioned, this agreement must be monitored.
But CCH faces serious funding challenges: it is $30m over budget in charity care despite $25m in new revenue this year. In 2020 CCH anticipates providing $590m in uncompensated care, for which the only designated funding sources are the federal DSH ($157m) and BIPA ($132m) allocations. The demand for charity care has grown by $100m since 2017. CCH is now providing about 60% of all charity care in Cook County. Of Stroger Hospital’s total patients, 47% are on Medicaid, 15% Medicare, 5% insured, and 35% uninsured. The possible solutions to the funding gap do not inspire hope: more state and federal funding, possibly County funding from a sales tax.
Committee Reports. Human Resources: Of 757 vacancies filled, 541 were external; average 101 days to hire. Managed Care: 320,177 CountyCare members as of 10/6/19, 31% of the total 1,012,425 managed care members in IL. 83% of CountyCare members choose to re-enroll in the program. Since January 2018 managed care enrollment has diminished by 180,000. An estimated 200,000 IL residents are eligible for Medicaid, but have not submitted applications. 96% of CountyCare claims are adjudicated within 30 days, but only 32% are paid within 30 days. Quality and Patient Safety: 72% of patients are now willing to recommend the Stroger Hospital. The hospital’s readmission rate is currently 9.7%, vs. a 15% national average. Finance: operating revenue is 23% below budget for 2019; the state is 2 months behind in payments. Primary care visits are up by 10%, specialty care up 6%, ER visits down 2%, deliveries up 5%. Significant contract awards: Cerner Corporation for software support - $191m for 5 years, $38.2m p.a.; Medline Industries for medical and surgical supplies - $70m for 36 months; Paschen Ashlaur Joint Venture to construct Belmont-Cragin Health Center - $12m.
What else did the Board discuss or refer to committee? (Which committee?)
Unexpected Votes, Events, Testimony or Items to Watch for in the Future
Any Other Comments or Observations
Submit this report to Cynthia Schilsky, cschilsky@comcast.net,
Diane Edmundson, dianedmundson@aol.com, for CC Health and MWRD
Carolyn Cosentino, cose1814@comcast.net, for Cook County Forest Preserve, Board, and Committees.
Observer Report
Observed by: Linda Christianson
Date: October 25, 2019 Meeting Length: 3 hours
Cook County Health (CCH) Board of Directors Meeting
“We ARE the Safety Net in Cook County.”
- CEO Dr. Jay Shannon
CEO Dr. Jay Shannon summarized recent CCH positive developments: the IL Health Facilities Board has approved the application for a new Provident Hospital; the National Committee for Quality Assurance (NCQA) has given CountyCare high approval ratings; the US Congress passed a continuing resolution through November 2021 to continue the current $157m in “Disadvantaged Share Hospital” (DSH) funding to CCH, though, he cautioned, this agreement must be monitored.
But CCH faces serious funding challenges: it is $30m over budget in charity care despite $25m in new revenue this year. In 2020 CCH anticipates providing $590m in uncompensated care, for which the only designated funding sources are the federal DSH ($157m) and BIPA ($132m) allocations. The demand for charity care has grown by $100m since 2017. CCH is now providing about 60% of all charity care in Cook County. Of Stroger Hospital’s total patients, 47% are on Medicaid, 15% Medicare, 5% insured, and 35% uninsured. The possible solutions to the funding gap do not inspire hope: more state and federal funding, possibly County funding from a sales tax.
Committee Reports. Human Resources: Of 757 vacancies filled, 541 were external; average 101 days to hire. Managed Care: 320,177 CountyCare members as of 10/6/19, 31% of the total 1,012,425 managed care members in IL. 83% of CountyCare members choose to re-enroll in the program. Since January 2018 managed care enrollment has diminished by 180,000. An estimated 200,000 IL residents are eligible for Medicaid, but have not submitted applications. 96% of CountyCare claims are adjudicated within 30 days, but only 32% are paid within 30 days. Quality and Patient Safety: 72% of patients are now willing to recommend the Stroger Hospital. The hospital’s readmission rate is currently 9.7%, vs. a 15% national average. Finance: operating revenue is 23% below budget for 2019; the state is 2 months behind in payments. Primary care visits are up by 10%, specialty care up 6%, ER visits down 2%, deliveries up 5%. Significant contract awards: Cerner Corporation for software support - $191m for 5 years, $38.2m p.a.; Medline Industries for medical and surgical supplies - $70m for 36 months; Paschen Ashlaur Joint Venture to construct Belmont-Cragin Health Center - $12m.
What else did the Board discuss or refer to committee? (Which committee?)
Unexpected Votes, Events, Testimony or Items to Watch for in the Future
Any Other Comments or Observations
Submit this report to Cynthia Schilsky, cschilsky@comcast.net,
Diane Edmundson, dianedmundson@aol.com, for CC Health and MWRD
Carolyn Cosentino, cose1814@comcast.net, for Cook County Forest Preserve, Board, and Committees.
Cook County League of Women Voters
Observer Report
Observed by: Linda Christianson
Date: October 25, 2019 Meeting Length: 3 hours
Cook County Health (CCH) Board of Directors Meeting
“We ARE the Safety Net in Cook County.”
CEO Dr. Jay Shannon summarized recent CCH positive developments: the IL Health Facilities Board has approved the application for a new Provident Hospital; the National Committee for Quality Assurance (NCQA) has given CountyCare high approval ratings; the US Congress passed a continuing resolution through November 2021 to continue the current $157m in “Disadvantaged Share Hospital” (DSH) funding to CCH, though, he cautioned, this agreement must be monitored.
But CCH faces serious funding challenges: it is $30m over budget in charity care despite $25m in new revenue this year. In 2020 CCH anticipates providing $590m in uncompensated care, for which the only designated funding sources are the federal DSH ($157m) and BIPA ($132m) allocations. The demand for charity care has grown by $100m since 2017. CCH is now providing about 60% of all charity care in Cook County. Of Stroger Hospital’s total patients, 47% are on Medicaid, 15% Medicare, 5% insured, and 35% uninsured. The possible solutions to the funding gap do not inspire hope: more state and federal funding, possibly County funding from a sales tax.
Committee Reports. Human Resources: Of 757 vacancies filled, 541 were external; average 101 days to hire. Managed Care: 320,177 CountyCare members as of 10/6/19, 31% of the total 1,012,425 managed care members in IL. 83% of CountyCare members choose to re-enroll in the program. Since January 2018 managed care enrollment has diminished by 180,000. An estimated 200,000 IL residents are eligible for Medicaid, but have not submitted applications. 96% of CountyCare claims are adjudicated within 30 days, but only 32% are paid within 30 days. Quality and Patient Safety: 72% of patients are now willing to recommend the Stroger Hospital. The hospital’s readmission rate is currently 9.7%, vs. a 15% national average. Finance: operating revenue is 23% below budget for 2019; the state is 2 months behind in payments. Primary care visits are up by 10%, specialty care up 6%, ER visits down 2%, deliveries up 5%. Significant contract awards: Cerner Corporation for software support - $191m for 5 years, $38.2m p.a.; Medline Industries for medical and surgical supplies - $70m for 36 months; Paschen Ashlaur Joint Venture to construct Belmont-Cragin Health Center - $12m.
Observer Report
Observed by: Linda Christianson
Date: October 25, 2019 Meeting Length: 3 hours
Cook County Health (CCH) Board of Directors Meeting
“We ARE the Safety Net in Cook County.”
- CEO Dr. Jay Shannon
CEO Dr. Jay Shannon summarized recent CCH positive developments: the IL Health Facilities Board has approved the application for a new Provident Hospital; the National Committee for Quality Assurance (NCQA) has given CountyCare high approval ratings; the US Congress passed a continuing resolution through November 2021 to continue the current $157m in “Disadvantaged Share Hospital” (DSH) funding to CCH, though, he cautioned, this agreement must be monitored.
But CCH faces serious funding challenges: it is $30m over budget in charity care despite $25m in new revenue this year. In 2020 CCH anticipates providing $590m in uncompensated care, for which the only designated funding sources are the federal DSH ($157m) and BIPA ($132m) allocations. The demand for charity care has grown by $100m since 2017. CCH is now providing about 60% of all charity care in Cook County. Of Stroger Hospital’s total patients, 47% are on Medicaid, 15% Medicare, 5% insured, and 35% uninsured. The possible solutions to the funding gap do not inspire hope: more state and federal funding, possibly County funding from a sales tax.
Committee Reports. Human Resources: Of 757 vacancies filled, 541 were external; average 101 days to hire. Managed Care: 320,177 CountyCare members as of 10/6/19, 31% of the total 1,012,425 managed care members in IL. 83% of CountyCare members choose to re-enroll in the program. Since January 2018 managed care enrollment has diminished by 180,000. An estimated 200,000 IL residents are eligible for Medicaid, but have not submitted applications. 96% of CountyCare claims are adjudicated within 30 days, but only 32% are paid within 30 days. Quality and Patient Safety: 72% of patients are now willing to recommend the Stroger Hospital. The hospital’s readmission rate is currently 9.7%, vs. a 15% national average. Finance: operating revenue is 23% below budget for 2019; the state is 2 months behind in payments. Primary care visits are up by 10%, specialty care up 6%, ER visits down 2%, deliveries up 5%. Significant contract awards: Cerner Corporation for software support - $191m for 5 years, $38.2m p.a.; Medline Industries for medical and surgical supplies - $70m for 36 months; Paschen Ashlaur Joint Venture to construct Belmont-Cragin Health Center - $12m.
Cook County League of Women Voters
Observer Report
Observed by: Linda Christianson
Date: July 26, 2019 Meeting Length: 3 hours
Cook County Health (CCH) Board of Directors Meeting
“CCH Must Attract and Retain Paying Patients.”
The board unanimously approved the preliminary 2020 strategic plan, which will be available for public input later this summer and presented to the Cook County Board in September. The plan calls for: increased surgeries, emergency visits, primary care, specialty care, and deliveries; 5% cost savings; and sustaining CountyCare membership, while facing challenges of: salary increases, cost of equipment and supplies; revenue loss in CountyCare; consolidation of hospitals; and $52m pension requirement. CEO Dr. Jay Shannon pointed out that when HHS loses CountyCare patients, there is a 53% chance they will present for charity care, which consumes 25% of CCH revenue.
Committee Reports. Human Resources: 7,265 total positions, 1,151 vacancies, 830 positions in process, 364 external positions filled. Hiring for coders and billers difficult; not enough qualified candidates. Managed Care: CountyCare membership 316,730 as of May 2019, 31.6% of market share. Home visits to high risk patients to encourage them to use CountyCare. Commissioner Sidney expressed concern that patients were being “auto-assigned” to health care plans without patient input. Quality and Patient Safety: CCH has a 16% readmission rate (near national average), attributed to hypertension and kidney disease; 8 falls with injury per month average; no hospital acquired conditions in last 3 months, but some infections. 74% willing to recommend Provident, 69% to recommend Stroger. Finance: Budget 23% below target due to increased (1) charity care, (2) clinical activity and (3) pharmacy costs. “We need to be better compensated for care to the uninsured,” CEO Shannon commented. Finance Chair Robert Reiter pointed out that CCH provides half of the charity care countywide; other hospitals are providing less. Commissioner Mike Koetting emphasized the “centrality of making sure we are the provider of choice; otherwise the percentage of charity care will continue to grow.” 45% of HHS patients are now uninsured. 51% of patients identify as African American; 32% identify as Latino.
CCH Board Chair Hill Hammock announced that the Deloitte accounting firm will examine CCH’s financial books and accounting principles, with a response from CCH by the end of August.
Observer Report
Observed by: Linda Christianson
Date: July 26, 2019 Meeting Length: 3 hours
Cook County Health (CCH) Board of Directors Meeting
“CCH Must Attract and Retain Paying Patients.”
- CEO Dr. Jay Shannon
The board unanimously approved the preliminary 2020 strategic plan, which will be available for public input later this summer and presented to the Cook County Board in September. The plan calls for: increased surgeries, emergency visits, primary care, specialty care, and deliveries; 5% cost savings; and sustaining CountyCare membership, while facing challenges of: salary increases, cost of equipment and supplies; revenue loss in CountyCare; consolidation of hospitals; and $52m pension requirement. CEO Dr. Jay Shannon pointed out that when HHS loses CountyCare patients, there is a 53% chance they will present for charity care, which consumes 25% of CCH revenue.
Committee Reports. Human Resources: 7,265 total positions, 1,151 vacancies, 830 positions in process, 364 external positions filled. Hiring for coders and billers difficult; not enough qualified candidates. Managed Care: CountyCare membership 316,730 as of May 2019, 31.6% of market share. Home visits to high risk patients to encourage them to use CountyCare. Commissioner Sidney expressed concern that patients were being “auto-assigned” to health care plans without patient input. Quality and Patient Safety: CCH has a 16% readmission rate (near national average), attributed to hypertension and kidney disease; 8 falls with injury per month average; no hospital acquired conditions in last 3 months, but some infections. 74% willing to recommend Provident, 69% to recommend Stroger. Finance: Budget 23% below target due to increased (1) charity care, (2) clinical activity and (3) pharmacy costs. “We need to be better compensated for care to the uninsured,” CEO Shannon commented. Finance Chair Robert Reiter pointed out that CCH provides half of the charity care countywide; other hospitals are providing less. Commissioner Mike Koetting emphasized the “centrality of making sure we are the provider of choice; otherwise the percentage of charity care will continue to grow.” 45% of HHS patients are now uninsured. 51% of patients identify as African American; 32% identify as Latino.
CCH Board Chair Hill Hammock announced that the Deloitte accounting firm will examine CCH’s financial books and accounting principles, with a response from CCH by the end of August.
League of Women Voters Cook County Observer Report
Observed by: Michele Niccolai
Date: May 31, 2019 Meeting Length: 3 hours
Cook County Health (CCH) Board Meeting
CCH Strategic Plan 2020 -2022 Nearing Completion
-The 2020 - 2022 planning process started Fall 2018. After months of considering key issues, industry trends, looking at future needs, and seeking input through community town halls and surveys, the
CCH Strategic Plan 2020 - 2022 is nearing completion.
-CCH recognized its nurses May 6 - 12 during the annual National Nurses Week.
-CountyCare, CCH Medicaid managed care organization, numbers were slightly down again as of
May 5, 2019 to 316,831 members. The Illinois spring legislation addressed problems with Illinois Medicaid: reducing lapse of care when benefits are terminated, easier process for initial Medicaid applications and redetermination for individuals to stay on Medicaid. CountyCare will benefit from these improvements.
-CCH committed $1 million toward the Flexible Housing Pool- a partnership that has the goal of housing vulnerable homeless and connecting them with support services. Overall this support is a cost-effective way to help them improve their lives and health.
-The Board acknowledged the Cook County Health Foundation. This foundation partners with CCH giving financial support to further the health systems mission of health care to residents regardless of their ability to pay. The foundation increases awareness of CCH and raises money to help the health system build for the future and remain a leader in public health.
-A May presentation "Diabetes Update" explained that over time elevated blood sugar (glucose) levels damages both large and small blood vessels. This damage can lead to complications that affect the whole body. A CCH study showed that a gain in patients' knowledge of diabetes management targets is associated with better blood sugar control.
-CCH contracted with an architectural consulting service to review the physical spaces of its out-patient clinics. The goal is a positive patient experience in waiting areas and a good experience when being efficiently moved through clinic areas.
-The Board approved a furniture contract for new clinics in Hillside, North Riverside, and Blue Island.
Observed by: Michele Niccolai
Date: May 31, 2019 Meeting Length: 3 hours
Cook County Health (CCH) Board Meeting
CCH Strategic Plan 2020 -2022 Nearing Completion
-The 2020 - 2022 planning process started Fall 2018. After months of considering key issues, industry trends, looking at future needs, and seeking input through community town halls and surveys, the
CCH Strategic Plan 2020 - 2022 is nearing completion.
-CCH recognized its nurses May 6 - 12 during the annual National Nurses Week.
-CountyCare, CCH Medicaid managed care organization, numbers were slightly down again as of
May 5, 2019 to 316,831 members. The Illinois spring legislation addressed problems with Illinois Medicaid: reducing lapse of care when benefits are terminated, easier process for initial Medicaid applications and redetermination for individuals to stay on Medicaid. CountyCare will benefit from these improvements.
-CCH committed $1 million toward the Flexible Housing Pool- a partnership that has the goal of housing vulnerable homeless and connecting them with support services. Overall this support is a cost-effective way to help them improve their lives and health.
-The Board acknowledged the Cook County Health Foundation. This foundation partners with CCH giving financial support to further the health systems mission of health care to residents regardless of their ability to pay. The foundation increases awareness of CCH and raises money to help the health system build for the future and remain a leader in public health.
-A May presentation "Diabetes Update" explained that over time elevated blood sugar (glucose) levels damages both large and small blood vessels. This damage can lead to complications that affect the whole body. A CCH study showed that a gain in patients' knowledge of diabetes management targets is associated with better blood sugar control.
-CCH contracted with an architectural consulting service to review the physical spaces of its out-patient clinics. The goal is a positive patient experience in waiting areas and a good experience when being efficiently moved through clinic areas.
-The Board approved a furniture contract for new clinics in Hillside, North Riverside, and Blue Island.
Observed by Linda Christianson
4/26/19 Meeting Length 3 hours
Meeting Name Cook County Health (CCH) Board Meeting
Cook County managed care organization Medicaid enrollment declines by 33,000 from January-March 2019
And statewide, since its April 2018 peak at 2,298,000, membership in Illinois managed care organizations (MCOs) has declined by 205,890, most of them “Affordable Care Act” patients, older adults without children. The consequence for CCH is that the number of uncompensated emergency and primary care visits will increase. CountyCare currently has 31.5% of market share, a total of 316,973 members, but Meridian (Wellcare) and Illinicare (Centene) will soon merge to become Cook County’s largest MCO with 33% of market share. CEO Shannon praised new healthcare leadership in Springfield, including former HHS Deputy CEO Doug Elwell who now oversees the state of IL Medicaid program. Dr. Shannon will visit Washington DC this summer to negotiate Medicaid and DSH (Disproportionate Share Hospitals) payments, hopefully offsetting threatened funding cutbacks.
What did the Board discuss?
Items to Watch for in the Future
Many accolades went to Marketing/Communications Director Caryn Stancik after her presentation showing the consistent growth in the department’s activities to raise awareness of the value of CCH and alerting staff to the upcoming MAKING AN IMPACT campaign highlighting CCH accomplishments.
Other Comments or Observations
Dr. Terry Mason, Director of the Cook County Department of Public Health, alerted the board to a Countywide increase in sexually transmitted infections (STIs), due, he said, to the large number of phone apps that can lead to anonymous sex.
4/26/19 Meeting Length 3 hours
Meeting Name Cook County Health (CCH) Board Meeting
Cook County managed care organization Medicaid enrollment declines by 33,000 from January-March 2019
And statewide, since its April 2018 peak at 2,298,000, membership in Illinois managed care organizations (MCOs) has declined by 205,890, most of them “Affordable Care Act” patients, older adults without children. The consequence for CCH is that the number of uncompensated emergency and primary care visits will increase. CountyCare currently has 31.5% of market share, a total of 316,973 members, but Meridian (Wellcare) and Illinicare (Centene) will soon merge to become Cook County’s largest MCO with 33% of market share. CEO Shannon praised new healthcare leadership in Springfield, including former HHS Deputy CEO Doug Elwell who now oversees the state of IL Medicaid program. Dr. Shannon will visit Washington DC this summer to negotiate Medicaid and DSH (Disproportionate Share Hospitals) payments, hopefully offsetting threatened funding cutbacks.
What did the Board discuss?
- 7,265 positions, 1,265 vacancies, 2.8% turnover, 103 days to fill a position
- A $33.6 million budget shortfall for 3 months ending in February 2019, less than the $43 million projected, due in part to lower-than-expected pension costs. CCH has 21 days’ cash on hand.
- 45% of patients are uninsured, 5% have commercial insurance; almost all others are covered by Medicare (15%) or Medicaid (33%).
- Primary care visits are up 4%, specialty care up 3%, surgical care down 2%, ER visits down 3%. 65% of Stroger patients would recommend the hospital.
Items to Watch for in the Future
Many accolades went to Marketing/Communications Director Caryn Stancik after her presentation showing the consistent growth in the department’s activities to raise awareness of the value of CCH and alerting staff to the upcoming MAKING AN IMPACT campaign highlighting CCH accomplishments.
Other Comments or Observations
Dr. Terry Mason, Director of the Cook County Department of Public Health, alerted the board to a Countywide increase in sexually transmitted infections (STIs), due, he said, to the large number of phone apps that can lead to anonymous sex.
Observed by: Bill Edmundson and Jackie Buttafuoco
Date: June 29, 2018 Meeting Length: 3 hours
Cook County Health and Hospitals System Annual Board Meeting
Hospital Board Requested that Human Resources properly designate the positions with a unique job code that they feel should require bi-lingual skills. These positions would be more highly compensated due to the requirement for these skills. It is felt that filling these positions appropriately would increase the culture competency along with ensuring proper care for patients. It was indicated that a bi-lingual worker would be especially helpful in working with many Out Patients. The Board also requested that Human Resources review the process for exit interviews with Department heads’ as there is currently a lack of helpful information being received.
Other Committee Actions or Discussions:
• Managed Care Committee-Increase of membership from 331,000 to 338,326. Board wanted a breakdown of the membership and the number of people who would be aging out of Medicaid.
• Quality and Patient Safety Committee-Discussed the 2018 proposed plan. Board talked about their concern about maternal deaths and the reasons behind them along with how to increase the number of woman who chose to give birth within the system.
• Audit/Compliance Committee-Fraud/waste/abuse have maintained from last year. New contract requires there to be 1investigator per 100,000 members so with our 338,000 plus members, we will need 4 investigators. The issue of revenue recovery will continue to be a major issue for the system and the results from the systems in place and those being put into place will be closely monitored. Board Chairman Hill Hammock and CEO Jay Shannon presented these revenue recovery strategies to Cook County Board at a hearing on June 5.
Other Data Presented to the Board:
As part of the Cook County Department of Public Health 3rd quarter report, an update was given on current TB Prevention efforts. It has been found that those most affected with the disease live in the suburbs and 70% are foreign born and have been living in the United States for 5 or more years. The city of Des Plaines in the Northwest suburbs is the most infected area. There has been no direct correlation between TB and Poverty Rates.The current treatment is provided by Nurses as part of a program called Directly Observed Therapy (DOT}. This program provides for a new treatment that takes 12 weeks instead of the old method that averaged 6 months. Each patient is assigned to a nurse who assumes responsibility for ensuring each of their patients takes their medication. This means these nurses are driving around the county doing DOT on a daily basis.
Date: June 29, 2018 Meeting Length: 3 hours
Cook County Health and Hospitals System Annual Board Meeting
Hospital Board Requested that Human Resources properly designate the positions with a unique job code that they feel should require bi-lingual skills. These positions would be more highly compensated due to the requirement for these skills. It is felt that filling these positions appropriately would increase the culture competency along with ensuring proper care for patients. It was indicated that a bi-lingual worker would be especially helpful in working with many Out Patients. The Board also requested that Human Resources review the process for exit interviews with Department heads’ as there is currently a lack of helpful information being received.
Other Committee Actions or Discussions:
• Managed Care Committee-Increase of membership from 331,000 to 338,326. Board wanted a breakdown of the membership and the number of people who would be aging out of Medicaid.
• Quality and Patient Safety Committee-Discussed the 2018 proposed plan. Board talked about their concern about maternal deaths and the reasons behind them along with how to increase the number of woman who chose to give birth within the system.
• Audit/Compliance Committee-Fraud/waste/abuse have maintained from last year. New contract requires there to be 1investigator per 100,000 members so with our 338,000 plus members, we will need 4 investigators. The issue of revenue recovery will continue to be a major issue for the system and the results from the systems in place and those being put into place will be closely monitored. Board Chairman Hill Hammock and CEO Jay Shannon presented these revenue recovery strategies to Cook County Board at a hearing on June 5.
Other Data Presented to the Board:
As part of the Cook County Department of Public Health 3rd quarter report, an update was given on current TB Prevention efforts. It has been found that those most affected with the disease live in the suburbs and 70% are foreign born and have been living in the United States for 5 or more years. The city of Des Plaines in the Northwest suburbs is the most infected area. There has been no direct correlation between TB and Poverty Rates.The current treatment is provided by Nurses as part of a program called Directly Observed Therapy (DOT}. This program provides for a new treatment that takes 12 weeks instead of the old method that averaged 6 months. Each patient is assigned to a nurse who assumes responsibility for ensuring each of their patients takes their medication. This means these nurses are driving around the county doing DOT on a daily basis.