Category: CCHHS Budget

Cook County Health Board Transfers Millions from Special Purpose and Wage Funds to Cover External Provider Claims

10/4/2019

Cook County Health (CCH) Board of Directors Meeting
September 27, 2019

What did the Board Decide:

Cook County Health (CCH), CEO Shannon explained that underestimation of external claims from non-CCH Network providers of the Managed Medicaid/CountyCare program exceeded the total appropriated dollars. Payment of these bills necessitates transfer of funds from other CCH budgeted items still showing a positive balance. Over $80M was transferred form special Purpose and Wage Funds to cover the claims.

The Board voted to purchase a renovated Blue Island building replacing the closing Oak Forest Clinic for $15.3 million, a savings over a 10 year $17.3 million lease.

Located at 12757 S. Western Ave. servicing the same population as Oak Forest Clinic/hospital, it will be a multi-disciplinary clinic including radiology, lab, specialty and primary care services.
Several Board Directors expressed concerns over the lack of parking and access as the nearby L station is slated to be shuttered. Administration pointed out that “L” station closing would open up their parking lot, and an adjacent building might be purchased for parking.

What else did the Board discuss or refer to committee?

New vendor using “Big Data” and algorithms identified $1.9 million in overpayments which CCH hopes to recoup.
Cultural Competency course & training program for CCH staff in development. Leadership are contributing components. Director Gugenheim urged that all levels of the organization be involved in its creation.
Dr. Mason, CEO of Cook County Dept. of Public Health reported adoption of the Good Food Purchasing Program (GFPP) by Chicago Public Schools; soon to extend to the County Sheriff’s Office and Juvenile Detention Center. It is a national organization and movement to bring ecologically positive changes to food sourcing including: 1) locally grown food 2) animal welfare and nutrition 3) environmental sustainability such as compostable cutlery and plates
Public Speaker, Laurie Cohen, of the Chicago Civic Federation called for greater transparency in presentation of CCH's finances. She alluded to the Board’s Sept. Finance Com. discussion & PowerPoint which states : CountyCare-CCH reimbursement rate has been adjusted to 100% of the Medicaid rate for current fiscal year. There was no explanation of how this impacted the system or budget.

CEO Shannon responded at the end of the meeting: Medicaid rate education would be considered. This response does not seem to address Ms. Cohen’s concerns that the consequences of various financial metric variations are not elaborated on to the public.

Observed by: Susan Kern, MD and Megan Kennedy Meeting Length: 2 hours and 45 minutes

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Cook County Health Board Approves Preliminary 2020 Budget

9/20/2019

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Cook County Health Board Meetings
August 30 and September 13, 2019

Special Meeting - September 13

With two abstentions, at a special meeting on September 13, 2019, the Board approved its 2020 preliminary budget for presentation to the County Board on September 26. The abstentions were in support of more revenue from the County for the Health System. CEO Shannon described it as “no doubt the most challenging budget” to prepare and meet since he became CEO in 2014. The $2,966 billion budget includes cuts to headcount in the form of eliminating 400+ vacancies in ambulatory care clinics and up to another 200 vacant positions in other areas.
Investments made over the last four years, primarily funded by the revenue brought in from its County Care Insurance Program, include substantially increased behavioral health and drug addiction services; a broader care management approach focusing on preventive care and housing/food insecurity; transportation services; a County authorized Direct Access Insurance Program* for the uninsured; and investment in new facilities, equipment and technology. This while absorbing a decrease in county funding from 25% in 2013 to 5% in 2020.
Expense drivers include Uncompensated Care which has risen almost 88% from $314 million after the ACA was enacted in 2014 to a projected $590 million in 2020, employee compensation, overtime, and rising prescription and medical supplies. Uncompensated Care includes charity care and bad debt. Dr. Shannon stated there is “no question other providers are redirecting charity care to CCH” and that the system cannot cut its way [expenses] out of the increase cost of charity care.
For more information on the preliminary 2020 budget CLICK HERE:

* Direct Access is a subset of Charity Care and county residents qualify based on income. About 50% of charity care costs is attributed to the Direct Access Program.

Committee Reports from August 30, 2019 Board Meeting:

Human Resources: 7,200 total positions, 836 positions in process, 628 positions filled year to date. Average days to hire 102. Average vacancies per year 1100 to 1200.
Managed Care: CountyCare membership trending up to 318,676. Cook County continues to have a 31.6% market share, which is the largest among the seven Managed Care Operations in the county. However, when Meridian’s merger is completed at the end of 2019, it will pass CCH in market share. While state approval time for Medicaid applications is improving, there is still a 100,000 backlog to get initial application and redetermination applications approved. Illinois is looking at outside contracting for help in reducing the backlog.
Finance: The 2020 preliminary budget was pulled from the August 23 agenda to be further worked on and presented at the August 30 board meeting. See above September 13 board meeting text, as presentations and discussion at the August 30 meeting were similar except there was no vote.
Requests: Chairman Hammock asked for a longitudinal chart on monthly memberships in the Health System’s County Care Insurance Program. He did not specify how far to go back.

Other information of note:

The Deloitte forensic audit of the Health System’s County Care financials and the System’s overall method of accounting was completed, and on September 4, 2019, CEO Shannon submitted the Deloitte report and the Health Systems response to the highly critical Inspector General (IG) Report of June 26, 2019. CCH Executive Management stood behind its initial public response that the IG got it wrong and provided a 15 page rebuttal. It also claimed in public comments that the Deloitte report mainly agrees with CCH. The County board will review both the Deloitte report and the Health System’s response at its September 26, 2019 meeting. CCH Management will attend as likely will the Cook County Inspector General.

Observer - Diane Edmundson Meeting Length: 4 hours total

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Cook County Health Approves Preliminary 2020 Strategic Plan

7/30/2019

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Cook County Health (CCH) Board of Directors Meeting - July 26, 2019

Board Decisions:
The board unanimously approved the preliminary 2020 strategic plan, which will be available for public input later this summer and presented to the Cook County Board in September.
The plan calls for:

Increased surgeries, emergency visits, primary care, specialty care, and deliveries;
5% cost savings; and
Sustaining CountyCare membership,

Challenges to the system include:

Salary increases,
Increased cost of equipment and supplies;
Revenue loss in CountyCare;
Consolidation of hospitals
A $52m pension requirement.

CEO Dr. Jay Shannon pointed out that CCH needs to attract and retain paying patients When CCH loses CountyCare patients, there is a 53% chance they will present for charity care, which consumes 25% of CCH revenue.

Committee Reports.

Human Resources: 7,265 total positions, 1,151 vacancies, 830 positions in process, 364 external positions filled. Hiring for coders and billers difficult; not enough qualified candidates.
Managed Care: CountyCare membership 316,730 as of May 2019, 31.6% of market share. Home visits to high risk patients to encourage them to use CountyCare. Commissioner Sidney expressed concern that patients were being “auto-assigned” to health care plans without patient input.
Quality and Patient Safety: CCH has a 16% readmission rate (near national average), attributed to hypertension and kidney disease; 8 falls with injury per month average; no hospital acquired conditions in last 3 months, but some infections. 74% willing to recommend Provident, 69% to recommend Stroger.
Finance: Budget 23% below target due to increased (1) charity care, (2) clinical activity and (3) pharmacy costs. “We need to be better compensated for care to the uninsured,” CEO Shannon commented. Finance Chair Robert Reiter pointed out that CCH provides half of the charity care countywide; other hospitals are providing less. Commissioner Mike Koetting emphasized the “centrality of making sure we are the provider of choice; otherwise the percentage of charity care will continue to grow.” 45% of CCH patients are now uninsured. 51% of patients identify as African American; 32% identify as Latino.

CCH Board Chair Hill Hammock announced that the Deloitte accounting firm will examine CCH’s financial books and accounting principles, with a response from CCH by the end of August.

Observed by: Linda Christianson Meeting Length: 3 hours

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

10/13/2018

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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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Cook County Health Board Transfers Millions from Special Purpose and Wage Funds to Cover External Provider Claims

Cook County Health Board Approves Preliminary 2020 Budget

Cook County Health Approves Preliminary 2020 Strategic Plan

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

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