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

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.