Cook County Health Board Meeting - September 25, 2020

The only action items were related to procurement but the board went into a closed session. 

• The public speaker testimony was all from Stroger employees and dealt with the handling of COVID-19. SEIU employees were laid off in the spring and many of their duties were transferred to the nurses. Neither group feels this is fair. The service employees want their hours back, sufficient PPE and additional training to do their jobs. The nurses want to do only nursing work. They all want hazard pay and PPE needed to do their jobs. 
• The board thanked the departing board members and welcomed Directors Garza and Curry. The new directors introduced themselves and spoke about their professional backgrounds. Director Richardson-Lowry stayed on for this meeting.

Committee Reports:

• Most of the committee reports addressed the changes made by the pandemic, including rule changes that were made to accommodate telemedicine and the financial effects.
• The quality committee spoke about changing the HgA1C indicator to include only patients that were seen twice in the last year.  (The HgA1C is a measure of how well blood glucose is controlled. Instead of a snapshot like a glucose level it takes into account 3 months of levels.)
• The contract metrics on women and minority owned businesses were not good this summer, possibly COVID related. YTD shows a surplus of revenue of $119 million but that includes $153 million received from the CARES act. 

​Interim CEO, Debra Carey reported: 

• that the hospital is encouraging patients to complete their census forms;
• and In the ER, they are helping people register to vote using the TurboVote platform via the patient’s phones.
  
• The Cook County jail after having a rough time with COVID is now down to a 0.5% positivity rate. 
• All employees are being encouraged to receive flu shots in advance of an expected difficult winter.
• The ER will be using a combined flu/COVID swab test. 
• he big concern is the possibility of the ACA being struck down in the Supreme Court. This will have an approximately $600 million dollar negative impact on the bottom line.

 
Items to Watch for in the Future:

• The future of the ACA or a replacement.
• Shortage and cost of PPE.
• Women and minority owned business contracts. 

Observer:  Lisa Slankard                                       Length of Meeting:  2 and 3/4 hours

 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