Cook County Health, (CCH) Board of Directors Meeting
August 27, 2021

A Special Meeting of the Finance Committee of the CCH Board was held on 8-23-2021, Public Hearings were held August 23 and 24 and individual budget briefings with community partners including the League of Women Voters of Cook County, were convened to deliberate the proposed preliminary County Hospital System’s budget for fiscal year ending in 2022

County Health Board of Directors voted to adopt this proposed budget which will now be forwarded to the Cook County Board, representing the Unit of Government responsible for adopting any final Appropriations Bill.  Cook County Public Hearings on the County Health System’s proposed budget will be scheduled on a date not yet determined  in October/November 2021.

Proposed 2022 budget Highlights:

• Nearly 4 billion dollars ($3,889,000,000) an increase of $501 million dollars over last year
• 758  additional Full Time Employees for total of 7,560 FTEs
• Increased revenue assumptions include: 1) Enhanced utilization of CCH services by CountyCare members 2) Increased volume of surgical cases and procedures 3 )Increased Federal Medical Assistance payments (DSH/BIPA) 4)newly eligible for IL. State Medicaid ,undocumented population 55 years and older (IL Legislation 2021/2022, state funded; no federal funding)                    
• Board members requested regular updates on volumes and revenue for surgical cases, emergency, primary care and specialty care visits, deliveries and bed utilization census: projected increases  in most of these categories are cited in the 2022 budget 
• Cook County taxpayer Support of Cook County Health included in proposed 2022 budget is $137,700,000
• Additional Cook County taxpayer Support of Cook County Health not included in 2022 budget - Pension cost of $162,900,000; Debt Service $136,400,000; and Capital Equipment $9,000,000

Items to Watch for in the Future:  Cook County Board hearings on this Cook County Health System budget in October 2021.  Will there be amendments or significant changes to the proposed budget approved by the Cook County Health Board ?

Virtual Meeting Observer:  Susan Kern, MD             Meeting Length: 2 ½ hours

Cook County Health (CCH)  Special Board Meeting
August 9, 2021
Preliminary Presentation of 2022 CCH Budget

Highlights of the Presentation

• Cook County Health’s preliminary $3.9 billion budget for the 2022 fiscal year factors in an expected boost in surgical procedures and Medicaid managed care plan enrollment. Spending will increase by $501 million.
• The assumption is that next year will look more like the patient volumes experienced in 2019, but CEO Israel Rocha warns it will take years for Cook County to fully recover from the COVID-19 pandemic.
• Compared with fiscal 2021, the proposed 2022 budget would increase spending by $501M, or nearly 15 percent. The bulk of the growth is related to CountyCare, the health system’s Medicaid managed care plan, which is growing faster than expected with about 410,000 members.
• Cook County Health covers Stroger and Provident hospitals, a network of neighborhood clinics, Medicaid and its new Medicare Advantage health plans, the County’s Department of Public Health, and medical services for detainees at the Cook County Department of Corrections.
• The health system is set to get a tax allocation of $137.7 million from the county. While the majority of the funds would be used to cover public health and correctional health operations, about $8 million would go toward providing free care to low-income patients, according to Andrea Gibson, Interim Chief Business Officer. The health system previously has not received money from the county to cover charity care expenses.
• Ms. Gibson noted that charity care costs are expected to increase 6 percent to $384 million in fiscal 2022.  This does include bad debt, which is billed but not recovered. Costs associated with charity care declined during the pandemic as more people became eligible for Medicaid and others avoided medical care. 
• The preliminary budget also includes investments in neurology, cardiology and oncology to help grow the health system’s patient base. Currently, one of the reasons that CCH loses patients to other specialty care providers is its long wait times. 
• Full-time equivalent (FTE) employment is expected to rise by 780 FTEs or 11% to 7,583 FTEs. New positions in behavioral health and other areas aim to improve services and reduce patient wait times. Plus a “float pool” of employees will be put in place for FMLA coverage and to reduce the use of agency nurses.

Observer:  Diane Edmundson 

 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

Cook County Health (CCH) Board of Directors Meeting
July 31, 2020                  
Meeting was held remotely with audio only available for observer

Public Comments

• Dr M. Fujara talked about CCH being the recipient of a three year Department of Justice Grant for the Child Safety Forward Initiative, aimed at reducing child fatalities and recurring injuries due to abuse and neglect.  CCH is one of five national sites chosen for this grant.  She said the legacy of child abuse persists into adulthood with the risk of serious medical issues, substance abuse, mental illness, involvement in the juvenile justice system and abusive romantic relationships, all creating community challenges.  The grant aims to develop strategies to address child fatalities and injuries to help families.
• Other comments from staff RNs were about the need for nurses to receive extra non-nursing duty pay for the extra work nurses now perform for their Covid-19 patients. Nurses now deliver food tray and clean patient room, perform dietary duties,  clerk duties and patient transport.

Committee Reports

Human Resources Committee reported that it took 90 days on average to hire, from the time of initial job posting to hiring.  CCH's Employment Plan brought CCH into compliance with the Shakman decrees, Federal court orders, which prohibit political influence into the employment process, but adds steps to the hiring process.  It was suggested that hiring steps be broken down to see if there could be improvement in hiring time and to compare the hiring time of CCH to other Chicago hospital systems.  A request for the diversity breakdown of nurses was requested. Almost half of  nurses are African American; Asian and White each make up about 
one-fifth of nurses.  HR actively recruits bilingual staff and reaches out to local groups and universities.

Managed Care Committee reported that as of July 2, 2020 CountyCare membership was 364,973 with 10.5% of these members using CCH clinics.  July 2, 2020 numbers are an increase over June 3, 2020 numbers.   August membership numbers are projected to be around 369,000 due to increased Medicaid members and IL Healthcare and Family Services (HFS) temporarily stopping the redetermination process during the Covid-19 crisis.  HFS's May data showed CountyCare had a 31.9%  share of the Cook County Medicaid market.  At some future point HFS will startup the redetermination process again and Medicaid numbers will decline.  During Covid-19 pandemic, CountyCare patients are getting care along with food, transportation, specialty care.  James Kiamos, CEO Health Plan Services, is leaving CCH and this is his last report.

Quality and Patient Safety Committee presented a new Quality Dashboard, specific graphs with reference targets for data collection and monitoring.  This dashboard now contains categories at CCH that need to be improved in the CMS Star Rating reports.  These CMS reports let consumers compare hospitals based on quality ratings.  An important area for CCH is clinical documentation to accurately record a patient's problems such as homelessness and other insecurities/illness/case complexity so as to get properly reimbursed for that patient's care.  In the LOWN Institute Hospital Index, Stroger Hospital rated very high in Civic Leadership, Value of Care, and Patient Safety.    

Finance Committee

• Presented the revision of the Illinois Dept. of Public Health (IDPH) Covid-19 Contact Tracing Grant               1. Hektoen Institute for Medical Research will receive a one year funding of $6 million for the administration of contracts with those Community Based Organizations that provide services in communities most impacted by Covid-19.  Hektoen will monitor progress, have oversight of funding and issue payments.  2. Hektoen will receive approximately $3.5 million to hire a startup contact tracing team of sixty positions so the initial launch phase of contact tracing will not be delayed.  After this, CCH will work to bring on a larger contact tracing workforce taking over hiring.  For the next year, monthly hiring reports will be provided to the Finance Committee. 
• A grant was received that provides wellness kits for patients with chronic illnesses. 
• A grant for Chicago Cook County Breast Cancer Risk Identification screening and Prevention will provide services for underserved CC patient populations.
• CCH Financial Update for the six months ended May 31, 2020: financial results are ahead of budget by $52 million.  Net patient service revenue is below budget due to Covid-19 pandemic.  $77.6 million received from CARES Act received through May to help compensate for the decline in patient activity.  The FY2020 projected year end deficit is $61 million. 
• ​Current financial planning is for FY2021 budget, seek Federal and State revenue for Covid-19 pandemic, and looking at areas where expenses can be reduced.  At the end of this report is the Guiding Principles and Timeline for the FY2021 budget.*

    
Report from Debra Carey, Interim CEO:

• Cermak hospital expanded testing to all inmates and with social distancing and mitigation strategies, the virus is contained in CC jail.

Items to Watch For in the Future:

• FY2021 Budget Request for Approval at August 28 CCH Board of Directors Meeting

Observed by:  Michele Niccolai                                        Meeting Length:  3 hour

*Link to the CCH Statement on Health Equity approved by the Board of Directors