Cook County Health Special Board Meeting - September 11, 2020

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.

As the meeting closed, several members of the board restated the following points:

•  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 HERE.

Diane Edmundson - Observer

Cook County Health (CCH) Board of Directors Meeting
August 28, 2020                                                                                                                                                     

Proposed Budget Discussion:

• Public speakers representing CCH employees and the SEIU labor union  objected to the proposed closing of the Woodlawn and Near South Clinics, conversion of the Provident Emergency Room to standby status and shuttering of the Oak Forest facility to help close a $187 million  deficit in the budget. 
• Despite cuts of 123 employees at Stroger, Provident and the clinics, there is a net increase of 134 FTEs System wide (from 2020)  due to the need for increased COVID-19 associated staffing at Cermak Health (provider of health services for Cook County Jail) and the transfer of CountyCare Managed Care employees to Stroger.
• The projected expense reductions of $55 million leave the remaining $133 million hole in the budget to be filled by increased revenues including Cook County Tax allocation increase of $30 million to $112.7 million.
• State IL , increased Medicaid payments to CCH :are paying the Fee For Service rate rather than lower  CountyCare Managed care rate
• Undocumented patients over 65 are now eligible for Medicaid reimbursement
• Planned improvements in bill collecting/ decrease in bill denials

 FY 2021 Budget Calendar: 

• Public hearings on budget Sept. 1 & 9, 2020
• CCH Board vote on proposed budget, Sept. 11,2020
• Cook County Board Meeting discuss/approve CCH Budget, Sept.24,2020

What else did the Board discuss or decide?

• Interim Chief Business Officer, Gibson reported the System showed  $94,065 million net income June 30,2020 but this was a result of Federal CARES act funding in excess of $122 million.  Revenues from charges are still 20% below 2019 due to COVID-19 shut-down and slow recovery of patient visits.
• Director Reiter made a plea for the Cook County Board to relook at the CCH tax subsidy which does not cover the 41% of patients who require uncompensated care.
• Dr. Joshi,  presented the quarterly report from the Cook County Dept. of Public Health, with an excellent COVID-19 PowerPoint update. He noted that there is a current resurgence of COVID positive testing (6.8%) primarily a younger population attributed to socialization without distancing/masking.

Items to Watch for in the Future: 

• Cook County Health, 2021 Budget hearings!

Virtual Meeting Observed by: Susan Kern, MD                  Meeting Length:  3 hours, 30 minutes

Cook County Health (CCH) Board of Directors Meeting
July 31, 2020                  
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 Committee 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 Committee 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 startup 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 Committee 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 Illinois Dept. of Public Health (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.*

    
Report from 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 hour

*Link to the CCH Statement on Health Equity approved by the Board of Directors

Cook County Health (CCH) Board of Directors Meeting - May 29, 2020       
Virtual Audio Meeting due to COVID-19 shut down

Public Comment:            

• 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.  CCH 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.

Board Discussion/Decisions:

• 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 admissions (low number attributed to lag in submission of charges)
• COVID financial impact projected through June is a  $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!
• Board voted to transfer a total of $5,339,739 from various accounts to accounts exclusively for   COVID expenses under guidance from the County government in anticipation of applying for this CARES Act 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 County 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”

Observed by:  Susan Kern, MD                           Meeting Length:  3 hours and 15 minutes