Category: CCHHS Budget

Cook County Hospitals System Bottom-line May be Threatened by Decrease in Medicaid Enrollees and Federal Rule Changes for Immigrants

10/13/2018

Cook County Health & Hospitals System (CCHHS) Board Meeting
September 28, 2018

Threats to 2019 CCHHS budget predictions presented by CCHHS Administration and Staff:

Illinois Healthcare & Family Services actuaries predict a decrease in Medicaid Affordable Care Act (ACA) enrollees in Illinois by 5% and a drop in the Medicaid FHP category in Cook County by 10% in the next year reported Hospital System CountyCare/Managed Care staff.
CEO Shannon added that the US Dept. of Health and Human Services is chipping away at the ACA provisions such as proposed imposition of work rules which may result in loss of Medicaid eligibility.
Further threats to the increased volume of patients on which the 2019 Hospital System proposed budget is predicated may be the proposed change in Federal Immigration rules. Federally funded programs including Food stamps, WIC, & other Public Aid, when accessed for the legal children of illegal immigrant parents, are considered to be benefiting the entire family. This may be considered a violation of the “public charge law” which will be held against the adults when applying for Green Card/Visa/ Citizenship.
CEO Shannon warned that immigrants might be fearful of accessing the Hospital System.
Nearly 80% of CCHHS patients are Medicaid (36%) or Uninsured/immigrants (42%)

What did the Board Decide?

Approved 73-million-dollar Sole Source contract (MHN ACO, LLC) for care coordination at Federally Qualified Health Clinics (FQHCs) covering approximately 117,000 of the 335,039 CountyCare members. This improves health and reduces cost of care.

What else did the Board discuss:

Heather Prendergast, MD introduced as a new CCHHS Board Director. She is an Emergency Room physician, in leadership positions, at U. of Illinois Hospital which has a similar patient demographics as CCHHS.
A Public Testimony speaker reported that limited patient/visitor parking due to the Central Campus Redevelopment construction may hinder patient use of the Hospital System. CEO Shannon responded that this would be addressed.
Shakman Decree (law to prevent political hiring) imposed by the Courts on Cook County decades ago is set to be lifted next month as compliance in hiring has been achieved at CCHHS.

Items to Watch For in the Future:

CC Board President, Preckwinkle to appoint County Commissioner representation on Hospital Board after Mid-term Elections when new CC Board is seated
Hospital System 2.97-billion-dollar Budget hearings at CC Board scheduled in October 2018
New Professional/Administration Tower to open for business in October, 2018

Meeting Length: 2 hours 30 minutes
Observers - Susan Kern, MD, Michele Niccolai, Sarah Edwards, & Ellen Hunt

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Cook County Hospital Board Approves Preliminary $2.9B FY2019 Budget

9/6/2018

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Cook County Health and Hospitals System (CCHHS) Board Meeting - August 31, 2018

What did the Board Discuss:

In discussion of the proposed CCHHS budget, CEO Dr. Jay Shannon identified these key focus areas:

Improvement in behavioral health;
Long overdue equipment and facility improvements;
Improvement in the system’s financial position;
System’s continuance as the state’s largest managed care organization;
Continuing to reduce reliance on local taxpayers while taking on pension costs.

The budget anticipates:

$182.2m in CountyCare revenue;
$132m BIPA and $157m DSH (federal flow-through payments);
$494m in patient fees due in part to a 5-6% increase in surgeries, ER visits, primary care visits, specialty care,and an 11% increase in deliveries.

Other assumptions:

Uncompensated care will total $292m in charity care and $213m in bad debt, unchanged from 2018.
Full Time Employees (FTEs) will total 7,138.
Insured patients will account for 61%, while 39% of patients will be uninsured..
A move of out patient services from the Oak Forest campus by the end of the first quarter of 2019 to better-located facilities in the south suburbs.
The Cook County local tax allocation is projected at $102m, 3% of the system’s operating revenue.

With the approval of the CCHHS Board the budget is now slated for review and approval by the Cook County Board on September 12.

Committee Reports:

Human Resources: currently 870 vacancies; 94 days to hire, down from 203 in 2014; 424 vacancies filled so far in 2018. New employment policies allow CEO to make final determination of salary and of discipline policy.
Managed Care: total CountyCare members 335,000 of whom 53,555 are served by CCHHS clinics (16%). The 2019 budget anticipates an enrollment increase to 345,000. CountyCare is already the state’s largest managed care organization, with the fewest complaints.
Quality and Patient Safety: 70% of patients would recommend Stroger Hospital; 63% of surgeries start on time; 84% rated ACHN clinics as clean.
Finance: 34 days of cash on hand (goal is 60); overtime totals 7.6%; the physical plant is 24.4 years old (goal is 10.7). Bills spend 97 days in Accounts Receivable, down from 125 in 12/17. 22% of initial claims are denied.

To Watch For: Dr. Shannon announced that the ribbon-cutting for the new clinic/admin building will take place October 29.

Observer - Linda Christianson Meeting Length: 3 hours

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Cook County Hospital Board Outlines Revenue Recovery Strategies

5/28/2018

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Cook County Health and Hospitals System (CCHHS) Board Meeting - May 25, 2018

What did the Board decide:

The CCHHS Board committed to add coders & billing staff, increase training and clinical documentation, and enforce performance standards for all employees who affect the revenue cycle process in order to improve revenue recovery.

Board chairman Hill Hammock and CEO Dr. Jay Shannon will present these revenue recovery strategies to the Cook County Board at a hearing at 1 p.m. on June 5.
CFO Ekerete Akpan explained the role of 3rd party billing, claim “denial prevention,” careful documentation, high-return medical procedures, and high quality EMR software, which the hospitals system hopes to acquire, in recouping revenue. After documenting and coding a patient encounter, a claim is prepared, submitted to the payer, and sometimes resubmitted. Additional 3rd party billers will engage with insurance companies regarding denied claims. Ongoing training will improve the skills of staff managers who use scheduling, registration and verifications systems. Coding is complex! There are “cheat sheets” with codes that insurers will pay. Revenue comes from procedures with the highest return, e.g., surgery and joint replacements. All employees who affect the revenue cycle process are trained in the use of electronic medical records (EMR), where prompts tell you the level of coding. Akpan said he hopes the hospitals system will acquire 3M software to provide more detailed information on the patient’s condition.
Net Accounts Receivable (AR) outstanding as of 3/18: $91.1m - “what we think we can collect”; 120 average days in AR; Discharged, not finally billed: $31.5m; Initial denials $10.9m.

Dr. Shannon, CCHHS CEO, spoke at some length about the issue of revenue recovery, explaining, “We recognized this as a challenge years ago, and embedded strategies in the strategic plan to meet the challenge.” Until 2014 billing was simplistic, but now the system has 20 payer contracts. Despite the challenges, patients and local taxpayers have benefited: taxpayer liability has been reduced by 75% since 2009, and the system has been able to redirect $2.5b to other Cook County needs over the last ten years. The system dispensed $300m in charity care in 2017 without additional resources from local taxpayers.

Other Data Presented to the Board:

331,000 CountyCare members as of May 1, of whom 60,000 have a primary care provider with the County HHS. 48% of visits to neighborhood clinics (ACHNs) in 2017 were CountyCare members. CountyCare represents 11% of total Hospital System revenue.
Over 180,000 patients were lost from Medicaid rolls early in 2018 due to the state backlog of patients who must recommit each year; some lost benefits in the interim. A concern is that some patients may not go back into the system.
Overall system operating expenses were 21% above budget as of May 1, attributed in part to sole product providers (no possibility of a competitive bid). Surgeries increased 5%.
42% of Cook County Health and Hospital System patients are uninsured, vs. 38% last year.

The Health and Hospitals system will allocate about $1m this year, and $2m next year, to staff a continuum of behavioral health services to be provided to detainees at the Cook County Juvenile Temporary Detention Center (population 200-250), similar to the services provided at the Cermak Clinic.

To Watch For:
Will there be a state budget by May 31? If not, the hospitals system is at risk for cash flow problems!

Observers - Linda Christianson and Marcia Powers Meeting Length - 3 hours

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Budget Concerns Continue for Cook County Health System

5/9/2018

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Cook County Health and Hospitals System Board Meeting - April 27, 2018

What did the Board Decide?

Board president asked the Finance Committee to do a “deep dive” on significant revenue and expense deviations – and in particular – claims, payments, increase in charity care numbers, and overtime issues. Director Robert Reiter is the new Finance Chair replacing departed Ric Estrada.
Approved contract for new space to consolidate the County’s Public Health Operations. Will be located on Roosevelt Road in Hillside.
Accepted the resignation of Director Virginia Bishop for health reasons. The Cook County Health & Hospital Committee of the Cook County Board of Commissioners will be asked to convene and recommend replacement nominations.

What did the Board Discuss?

Behavioral Outpatient Services. A behavioral staff member asked the board to bring this department back to Stroger. It was moved to Austin Clinic and Provident Hospital when the old Fantus Clinic was torn down. Dr. Shannon responded that most of the need is on the south and west sides which is where services are offered in addition to Telephone Psychiatry services. It is not scheduled to return to the new clinic or Stroger. However, all 15 ambulatory clinics have services. Director Richardson asked for metrics and continued feedback at future board and committee meetings.
While no discussion ensued, the Board was told that the System anticipates a “final” Shakman review from the Department of Justice regarding the Cermac Jail Health Facility.
A report was given on the Districts Behavior Health progress since the Evidence-Based Strategies were initiated three years ago. The report is yet to be posted with the board agenda nor were the April 27 board minutes available as of May 7, 2018. In 2017, over 53,000 patients were screened for baseline mental health evaluation, treatment options, referral locations, and follow up.
The Public Health Department presented a quick overview of its quarterly report. Highlights include their focus on high risk infants, screening newborns for hearing, and a reporting system for adverse birth outcomes - the Adverse Pregnancy Outcomes Reporting System [APORS].

Observer - Diane Edmundson

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Hospital System Contract for Tele-Psychiatry Tops $3M

3/12/2018

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Cook County Health & Hospital Systems (CCHHS) Board Meeting - March 2, 2018

What did the Board Decide?

A Sole Source contract for $3.12M with Regroup Therapy, Inc., a start up with deep Chicago roots, for Tele-Psychiatry services was approved by the Board last month. Services will be provided to the Hospital System, including Correctional Health at Cermak / Cook County Jail as well as to the City of Chicago via intergovernmental agreement. Doug Elwell, Deputy CEO, responded to the public speakers who complained that this was a private contract not including CCHHS mental health providers, lacking in transparency, evidence based data of the quality of care, racial/ethnic background of contracted providers, by noting that all providers would be credentialed through the Hospital’s Medical Staff and a licensed person would be present in the room for the Tele-psychiatry sessions. This contract fills a void in critically needed mental health services .

What did the Board Discuss?

Update on integration of 284,932 new CountyCare/Medicaid members from Aetna and FHN acquisition by newly appointed Director of Managed Care, James Kiamos, noted that total CountyCare member enrollment dropped from the original 425,000 in Dec. 2017 to 329,000, by end of Feb. 2018 with expected further drops during the open enrollment period ending 3-31-18. (Member attrition has not been as great as predicted yet and well within the budgeted minimum of 235,000 retained members).
Director Gugenheim questioned whether the CountyCare network of 53 hospitals, 26 Federally Qualified Health Centers, 4,690 primary care and 14,639 specialty providers shouldn’t be strategically narrowed to better control quality & cost.
2017 end of year financials still pending. Doug Elwell gave a verbal update, noting that 2017 was not a good year financially compared to the previous 3 years with a $31M deficit below budget due to both decreased revenues and increased costs. CFO Akpan said planned/ anticipated corrective actions were in place. Chair Hammock told Elwell and Akpan that finances must be on an accrual, not cash basis, and they needed to stay on top of it—No surprises for the Board!
PowerPoint report on Hospital System minority & women-owned business enterprise (MWBE) participation confirms that fewer than 10% of CCHHS contracts are with women or minority owned businesses. 1% Hispanic participation is very low noted Director Gonzales. Chair Hammock said he was not satisfied with the numbers and more work need to be done. CEO Shannon requested the % of potential/suitable MWBE available in our region compared to the % the Hospital System contracts with, by category, to better assess whether CCHHS’s % of MWBE doesn’t just reflect the lack of such available businesses in our area.

Items to Watch For in the Future

Director Estrada resigned due to work demands. Cook County Board President, Preckwinkle will be appointing a replacement

Observers - Susan Kern, MD & Michele Niccolai Meeting Length: 3 hours

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New Gleaming Glass-Sheathed Fantus Clinic and Administration Building - On Budget and On Time

1/30/2018

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Cook County Health and Hospitals System Board Meeting
January 26, 2018
Meeting Length: 2 ½ hours

What did the Board Discuss?

Status of the new clinic/Administration building elucidated by contractor: June 25, 2018 projected substantial completion on budget ($112,640,000) with move in of equipment and furniture budgeted at $19,148,179. Sept/Oct. 2018, building open for business.
Naming rights for new building—philanthropists welcome!
CountyCare membership after Aetna and Family Health Network acquired was 425,000 in December but dropped by 40,000 to 385,000 by January 1, 2018. Drop expected, primarily lost to Blue Cross Blue Shield but silver lining is that CCHHS saved on purchase price which was based on Jan. 1, 2018 membership.
Anticipated early financial projections for the massive increase in CountyCare, managed Medicaid members were not available due to complexities in merging the numbers from acquisition of 159,692 (Family Health Network) and 125,240 (Aetna). Metrics delayed till Feb. Board
New director of Managed Care, a transplant from Family Health Network, named

What did the Board Decide?
Stroger Hospital downgraded from two to one-star rating computed by the Centers for Medicare/Medicaid Services from years 2016 to 2017. Downgrade related to:

Above average readmission rate
Below average: Experience of Care, Timeliness of Care in the ER and Effectiveness of Care
Interventions are planned by category of deficiency. Cleanliness, cited as major negative in Experience of Care measure is being met by staffing, capital equipment and increased intensity of oversight and inspections of care areas

University of Illinois Hospital, another Medical District hospital also received one star

Items to Watch For in the Future

CEO Shannon delivered a PowerPoint update of expected changes/progress in the County Hospital’s Strategic Plan 2017-2019
Establish use of Relative Value Unit coding of all physician work to measure productivity
Implement utilization management program, with goal of balanced budget with overtime reduced by 20%
County Hospital’s uninsured numbers increased in 2017. Changes in outdated payment formula of the Hospital Tax Assessment Program that most hospitals contribute millions of dollars to in order to generate higher federal matching Medicaid funds, is being revised effective July 2018. Many safety net Hospitals who have been receiving far more dollars back from the program than they contribute may collapse when these funds dry up, resulting in uninsured flooding CCHHS.
Collective bargaining contracts coming up in 2018 may stress the hospital’s budget

Observer - Susan Kern, MD

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Cook County Hospitals System Bottom-line May be Threatened by Decrease in Medicaid Enrollees and Federal Rule Changes for Immigrants

Cook County Hospital Board Approves Preliminary $2.9B FY2019 Budget

Cook County Hospital Board Outlines Revenue Recovery Strategies

Budget Concerns Continue for Cook County Health System

Hospital System Contract for Tele-Psychiatry Tops $3M

New Gleaming Glass-Sheathed Fantus Clinic and Administration Building - On Budget and On Time

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