CCH Board Observer Reports

Cook County Department of Public Health Receives $40.8 Million Grant for Contact Tracing

6/30/2020

Cook County Health (CCH) Board of Directors Meeting - June 26,2020
This meeting was held remotely with audio only available to observer.

Public Comments

An employee stated they did feel they received adequate pay during their course of coronavirus infection.
Other employees said they needed to have more PPE, better staffing and more testing.

Annual Business

Annually a Chair and Vice Chair of the CCH Board of Directors is elected. At this meeting, Hill Hammock was elected as Chair and David Munar was elected as Vice Chair.

Committee Reports

Human Resources reported that hiring has slowed down in 2020 and the time to hire has been slowly decreasing over the past several years and is very close to meeting this goal in 2020.
Managed Care reported that current membership as of June 3, 2020 is 342,196, of which 10.5% are enrolled in CCH clinics. The IL Dept of Health and Family Services' April 2020 data showed that CountyCare had a 31.9% market share of the Managed Medicaid Organizations in Cook County (CC). It was predicted the number of members will increase in July due to the economic downturn, loss of jobs, and CountyCare outreach. People are enrolling in Medicaid in increasing numbers. Medical claims payments have continued to improve with priority payments to safety net hospitals, Federally Qualified Health Centers, and nursing homes. A recently passed Illinois law offers Medicaid to noncitizen seniors (over 65) with income at or under federal poverty level beginning July 1, 2020 when the Illinois FY2021 begins.
With Coronavirus overshadowing healthcare systems over the previous months, routine healthcare visits, elective surgeries are slowly starting to increase. Telehealth visits have played an important role in patient care. The Board approved an extended contract to Res Publica Group, LLC for continued marketing and advertising for CountyCare. Priorities for CountyCare are retaining current membership, recruiting new members and increasing brand awareness for those applying for Medicaid because of job loss.
Quality and Patient Safety is aware of the need to improve patients' willingness to recommend CCH OP clinics, Provident and Stroger hospitals to family members and friends. As a result a Patient Experience Steering Committee was created to improve Patient Satisfaction Scores. It is known that staff communication with patients, frequent rounding/checking in with patients and quiet surroundings rate high.
Finance A grant from the IL Dept of Human Services was approved by the Board to purchase NARCAN, medication for emergency treatment of narcotic overdose, for CCH OP health centers.
Also approved by Board was the $40.8 million Grant given to Cook County Dept Public Health (CCDPH) for Contact Tracing from the IL Dept Public Health. CCDPH provides public health services for suburban Cook County (CC). There was Board discussion on the Contract for the Hektoen Institute for Medical Research as related to the $40.8 Contact Tracing Grant. The contract as presented stated Hektoen would provide services for the Contact Tracing Grant: management, financial duties, hire staff, fill contact tracer positions, and give work to community based organizations outreach efforts. Board discussion of the Hektoen Contract as presented centered on defining Hektoen's role as to the hiring plan, management/staffing, payroll and financial details. It was felt the hiring process needed to hire from communities and minority groups most impacted by Covid-19 and there was a need to have input from CCH and CC human resources and unions regarding hiring. The Board suggested that the Finance Committee call a special meeting to meet with pertinent parties without delay to iron out and finalize the Hektoen Contract and report back to the July Board meeting.

Debra Carey, Interim CEO Report

CCH has adjusted to living with the Coronavirus, "The New Normal".
There is an emphasis on health care at CCH's Cermak Hospital.
Employee guidelines for returning to work are in place for those who worked remotely during the pandemic.
CCDPH has contact tracing plans.
CCH has preparedness plans for a potential resurgence of Covid-19.
Patient income generating visits have dropped off and surgery volumes are down for 2020. Telehealth visits have increased in 2020.
Community in-person events since March have been canceled.

Board Chair Hammock Report

Chair Hammock proposed that the CCH Board of Directors work together to issue a Board Resolution affirming CCH's commitment and work for Health Equity. There was also a suggestion for a new position in the FY2021 budget for a Chief Equity Officer as the health equity gap needed to be closed.
Chair Hammock also felt now was the time for the Board to begin planning and forecasting for the FY2021 budget. Discussions regarding finances included decline in patient revenues and cost saving measures such as renegotiating/putting on hold vendor contracts, reducing overtime and expenses, and decreasing non-union positions.
The growth of CountyCare is a priority for CCH's FY2021 budget. As CountyCare members get rehired into jobs as the economy picks up, membership loss will follow.
Chair Hammock referred to the June 26, 2020 CC FY2021 Preliminary Budget Forecast. President Preckwinkle stated that the projected shortfall in health funds was projected to rise to approximately $187 million. The Board felt that this number did not include the cost saving efforts of CCH.

Items to Watch For in the Future

The Finance Committee's revised contract for Hektoen Institute for Medical Research.
The Board Resolution affirming CCH's work for Health Equity

Observed by: Michele Niccolai Meeting Length: 3 hours

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Will COVID-19 Transform the Cook County Hospital System?

6/5/2020

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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

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Cook County Health Hires AArete Consulting to Help with Financial Strategy

3/3/2020

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Cook County Health (CCH) Board Meeting - February 28, 2020

Board Reports and Discussion:

Public speaker- one person representing a vendor requested more timely payment.
Staffing - 750 of the positions left vacant have been deleted from the budget. The board discussed the impact on care from staff cuts. Positions are only being cut through attrition, no lay offs planned.
CountyCare membership is up. A partnership with the Chicago Public Schools has helped drive students to join CountyCare. The automatic assignment of patients to CountyCare will now be 50%.. There is a problem in payments to CountyCare and other vendors.
The Audit and Compliance Committee shared results from the outside audit on coding. They found that there is improvement since the last audit but there is still a significant problem with coding and it is a whole house issue involving multiple people and departments.

The Finance Committee stated that there are multiple problems with income streams.

CountyCare is waiting for payment of $350 million dollars. The claims are adjudicated but not paid. Uncompensated care is an increasing problem.
Robert Sumter will be the interim CFO.
There were changes made to the organizational chart for the area.
It is felt that there is a significant problem in cash flow, including a lack of clarity and communication with Cook County board. Need to set up more meetings with the Cook County Commissioners.
Better integration is needed between the accrual-based accounting of Cook County Health and the modified cash based accounting used by the Cook County Board.
Bob Clark, a CPA from AArete Consulting, will be hired to help with financial strategy and bring in a clear set of eyes. He is highly experienced in health care entities.
Contracts and procurement items were voted on.

West Side United presented an overview of their plans. Six hospitals on the west side have joined together to address social determinants of health. The life expectancy on the west side is 16 years shorter than in the Loop that is just a couple miles away. They hope to halve the difference by 2030. They just completed a 1000-day plan and will be starting the next 1000-day strategic plan. They are convening with the community on March 5, 2020.

Dr. Sharon Welbel, epidemiologist at Stroger and Dr. Kiran Joshi of CC department of public health presented a COVID-19 update. Cook County has testing capabilities and does not need to use CDC kits. CCH has been actively preparing for an influx of cases and have implemented a rapid identification plan and set aside 2 ER rooms for suspected COVID-19 cases that are not in proximity to other rooms. Over 1000 healthcare workers have already been trained.

Board President Hammock report:

The CCH Board has been working closely with Cook County Board.
Otis Story has been appointed to the CCH board by President Preckwinkle to help educate the Cook County Commissioners on health issues.
The search for a new CEO has started. A proposed position profile for the CEO was shared and discussed. It will be sent to the CC board for use in hiring the CEO.

Items to Watch for in the Future:

Many changes are anticipated to correct financial problems.

Observer- Lisa Slankard Meeting Length: 2 hours 40 minutes then meeting went to closed session

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Cook County Health Board Hears Update from Department of Public Health

2/4/2020

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Cook County Health (CCH) Board Meeting
January 31, 2020

Reports to the Board:
The Cook County Department of Public Health (CCDPH) - is at the command center for Chicago's coronavirus case, along with the Illinois State Department of Public Health and the Centers for Disease Control. The CCDPH website has links for coronavirus and flu information. Cook County Health has been screening for coronavirus. CCDPH also presented their 2019 Quality Improvement Projects. These projects result from Planning, Testing, Study, Implementation. The goal of planning is to understand and analyze a problem, potential solutions are pilot tested, afterward studied/evaluated, then the new process is implemented.
The 2019 CCDPH Quality Projects are:

Investigation of Food-borne Disease and Outbreaks
Promotion of Smoke-Free Multi-Unit Housing
Improving Tuberculosis Direct Observation Therapy- cost effective way of a video picture of patient taking their medication
Annual School Health Conference Check-Out Process
Improving Access to Services in the Illinois Breast and Cervical Cancer Program
Environmental Health Services Digitization: Forms
Improving Perinatal Hepatitis B Post Exposure Prophylaxis
Adverse Pregnancy Outcomes Reporting System Program face-to Face Contacts

Human Resources - starting out 2020 with approximately 526 vacant positions with 308 positions in the hiring process. They have a Position Control Committee that receives requests to hire. These requests must meet patient safety and quality standards, regulatory requirements, need to generate revenue and reduce expenses. If a position is approved by this committee, it goes for budget approval and then is posted on Taleo (the county's on line application site).

CountyCare - as of 1/2/2020 has 318,000 members, 10.6% of members using CCH clinics. Next Level Health, a Managed Care Organization (MCO) only available in Cook County, was recently purchased by Molina Healthcare. Molina is increasing its presence in the county. Over the past year, CountyCare membership has held steady with its 31.5% of total CC Medicaid members. In 2019 there has been an overall drop in total Medicaid members, and CountyCare membership has followed this trend. Auto-assignment of Medicaid enrollees into MCO health plans happens when a member does not choose a health plan/primary physician within the specified time. CountyCare auto-assignment has been increased from 35% to 50% starting April 1, 2020 and is open-ended. This increase is a result of CountyCare's innovations, quality and housing program. The 2020 projected enrollment is 326,000 members.

Quality and Patient Safety Committee - reports good results at the end of 2019 for decreased hospital acquired pressure injuries due to a focused nursing campaign. The aim is to sustain this decreased number with continuing preventive measures.

Other Business:

The CCH North Riverside Health Center, replacing the Cicero clinic, opened for patients January 27, 2020. CCH is installing posters, distributing flyers at all facilities to raise awareness of the 2020 Census.
The CC Board of Commissioners proposed changes to the 2008 Ordinance Establishing the Cook County Health and Hospitals System. The original ordinance can be found HERE. The proposed changes are in the Ordinance Amendment. (Cook County Board Agenda Item 20-1118) Members of the CCH Board discussed the proposed changes and decided to meet with the CC Board of Commissioners and present the CCH board's point of view on the proposed changes.

Observed by Michele Niccolai Meeting Length: 2 hours and 30 minutes

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Outgoing Cook County Health CEO Begins Strategic Discussion On Self-Pay For Medical Services

1/2/2020

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Cook County Health Board Meeting - December 20, 2019

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, led 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:

1. Online payments as part of patient portal improvements
2. Kiosks with payment options
3. 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 they might be.

Observer - Diane Edmundson Meeting Length: 2 ½ Hrs.

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Cook County Health CEO Jay Shannon Leaving at Year’s End

12/3/2019

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Cook County Health (CCH) Board of Directors Meeting
November 22, 2019

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.

Board Discussion

CountyCare members 318,196 which is below budgeted numbers, resulted in decreased revenue and decreased expenses, net contribution of $144 million 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”.

Observed by: Susan Kern, MD Meeting Length: 3 hours

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Cook County Department of Public Health Receives $40.8 Million Grant for Contact Tracing

Will COVID-19 Transform the Cook County Hospital System?

Cook County Health Hires AArete Consulting to Help with Financial Strategy

Cook County Health Board Hears Update from Department of Public Health

Outgoing Cook County Health CEO Begins Strategic Discussion On Self-Pay For Medical Services

Cook County Health CEO Jay Shannon Leaving at Year’s End

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