Category: Metrics

Will COVID-19 Transform the Cook County Hospital System?

6/5/2020

Cook County Health (CCH) Board of Directors Meeting - May 29, 2020
Virtual Audio Meeting due to COVID-19 shut down

Public Comment:

Public comment by a series of Hospital employees struck a similar chord: complaints of inadequate supplies of PPE (personal protective equipment), canceling of paid vacation time , refusal to grant “hazard pay” and criticism of temporary health staff hiring to cover COVID care tasks during the ongoing pandemic.
Dr. Fegan responded that there were adequate supplies of PPE from federal stockpiles which were inventoried twice daily. CCH follows CDC and IDPH utilization guidelines for PPE, adding that shoe and hair-covers are not COVID protective and N 95 masks & disposable gowns were designated for use by staff in close patient contact and with aerosolizing procedures. Additional employee education on proper PPE use would be planned.
Director Reiter was assured that canceled vacation time was rescheduled or financially compensated as defined in the union-negotiated employment contracts, and there was daily communication with the union and invited front-line employees.

Board Discussion/Decisions:

Hospital’s CountyCare, Medicaid managed care plan: 326,631 members, largest in Cook County
COVID-19 testing: 7,704; 2,355 positive patients across all CCH locations; CountyCare received 115 claims for in- patient admissions (low number attributed to lag in submission of charges)
COVID financial impact projected through June is a $75-$100 million revenue loss due to 40% decline in charges since March 15, 2020; decreases across all service lines ; plus $10-$15 million of increased costs: supply/equipment/agency temp. staff; and overtime $8-$12 million
Offsetting COVID financial assistance income: $59 million federal distribution for number of COVID positive patients; $11.1 million received to help offset revenue loss (CARES Act); federal reimbursement for testing/treating uninsured COVID patients, $1 million grant pending for telehealth from FCC;
$40 million grant from IDPH for CC Dept. Public Health with plans for 400 contact tracing hires
Discussed: $429 million Cook County awarded from the CARES Act. Hospital system will pursue payment from this grant!
Board voted to transfer a total of $5,339,739 from various accounts to accounts exclusively for COVID expenses under guidance from the County government in anticipation of applying for this CARES Act grant.
COVID net negative impact: income is $36.6 million below budgeted.
Expected rebound in volume of patient charges for CountyCare once the COVID shut down has loosened restrictions, will require provider payments from capitated payments already received, further undermining the financial outlook
Charity care and self-pay volumes and costs are up $18 million over 2019, likely reflecting high unemployment rates due to COVID shut down
Telehealth success: 44,335 telephone visits via the clinic system since COVID March shut down
CCH preparing for post-COVID opening, ramped up drive thru virus testing, Stroger & Provident
COVID containment at Cook County Jail due to ongoing testing of symptomatic, asymptomatic, new admissions to the jail and surveillance testing.
Outreach to COVID high risk members, providing thermometers and pulse oximeters for home self-testing (telehealth); telemonitoring of diabetes, hypertension, via home use glucometers, blood pressure cuffs etc.

Items to Watch for in the Future:

Post-COVID-19 adaptation of the Hospital system to the “New Normal”

Observed by: Susan Kern, MD Meeting Length: 3 hours and 15 minutes

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CountyCare Enrollment Declines by 33,000 in 2019

4/28/2019

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Cook County Health (CCH) Board Meeting - April 26, 2019

CountyCare - Managed Care Organization Update

Medicaid enrollment in CountyCare, Cook County's managed care organization, has declined by 33,000 from January-March of 2019. And statewide, since its April 2018 peak at 2,298,000, membership in Illinois' managed care organizations (MCOs) has declined by 205,890, most of them “Affordable Care Act” patients, older adults without children. The consequence of this decline for CCH is that the number of uncompensated emergency and primary care visits will increase.
CountyCare currently has 31.5% of market share, a total of 316,973 members, but Meridian (Wellcare) and Illinicare (Centene) will soon merge to become Cook County’s largest MCO with 33% of market share.
CEO Shannon praised new healthcare leadership in Springfield, including former CCH Deputy CEO Doug Elwell who now oversees the state of IL Medicaid program.
Dr. Shannon will visit Washington DC this summer to negotiate Medicaid and DSH (Disproportionate Share Hospitals) payments, hopefully to offset threatened funding cutbacks.

What did the Board discuss?

Personnel status - 7,265 positions, 1,265 vacancies, 2.8% turnover, 103 days to fill a position
A $33.6 million budget shortfall for 3 months ending in February 2019, less than the $43 million projected, due in part to lower-than-expected pension costs. CCH has 21 days’ cash on hand.
45% of patients are uninsured, 5% have commercial insurance; almost all others are covered by Medicare (15%) or Medicaid (33%).
Primary care visits are up 4%, specialty care up 3%, surgical care down 2%, ER visits down 3%. 65% of Stroger patients would recommend the hospital.

Items to Watch for in the Future

Many accolades went to Marketing/Communications Director Caryn Stancik after her presentation showing the consistent growth in the department’s activities to raise awareness of the value of CCH and alerting staff to the upcoming MAKING AN IMPACT campaign highlighting CCH accomplishments.

Other Comments or Observations

Dr. Terry Mason, Director of the Cook County Department of Public Health, alerted the board to a Countywide increase in sexually transmitted infections (STIs), due, he said, to the large number of phone apps that can lead to anonymous sex.

Observer - Linda Christianson Meeting Length: 3 hours

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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 Approves $189M/ 4 Year Contract with Evolent Health

4/3/2018

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Cook County Health and Hospitals System (CCHHS) Board Meeting - March 29, 2018

What did the Board decide?

The Board approved a $189m 4-year contract with Evolent Health that commits Evolent to third party administrative services for the CountyCare program. CCHHS retains the right to cancel the contract with little notice if Evolent does not perform. There were 4 responses to the competitive bid.
The CCHHS board also approved a 3-year, $5,945,000 contract with Cerner Corporation for software support and maintenance upgrades, a sole source contract, “an expensive part of what we do,” Deputy CEO Doug Elwell said. The government allows Cerner to change requirements for hospital accreditation, and customers like CCHHS must pay for the changes.

What else did the Board discuss or refer to committee?

The finance committee reported a year-to-date $48,138,000 shortfall (vs. $39.7 anticipated shortfall), attributed to more external claims expenses and higher pharmaceutical costs than anticipated.
James Kiamos, ED of Managed Care, reported 328,870 CountyCare members as of 3/1/18; of these 220,500 are family health patients, with 48,000 of these served by CCHHS ambulatory care clinics. The hope is that the clinics can put more pediatricians in these clinics and attract more patients. CountyCare represents 75% of CCHHS revenue.

Unexpected Votes, Events, Testimony or Items to Watch for in the Future:

After at least 4 years of monitoring and effort to improve outcomes, only 67% of Stroger Hospital patients would recommend the hospital to others, and only 68% of Stroger surgeries begin on time.
Do CCHHS staff experience themselves as stakeholders in the system’s survival?

Any Other Comments or Observations:

CEO Dr. Shannon spoke movingly of participating in the March for Our Lives in Washington DC with members of the HHS trauma and social work teams; they met with Robin Kelly at the rally, where they spoke not only of specific violent gun incidents, but of the crisis in neighborhoods plagued by ongoing gun violence, the trauma of repeated incidents over time.

Observer - Linda Christianson Meeting Length 2.5 hours

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Cook County Tells the Hospital System to Slash their Budget by $27 Million

11/2/2017

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Cook County Health and Hospitals System (CCHHS) Board Meeting - October 27, 2017

Budget Cut Discussion Highlights:
Cook County has requested that CCHHS cut their budget to help fill the $200M hole left by the repeal of the sweetened beverage tax. While the 10% budget cut request indicated was $27m, CCHHS CEO Shannon cautioned that higher numbers were being floated by Cook County leadership: 10% ($190 million) of the Hospital’s $1.9 billion total revenues ; $80 million (10%) of the budget exclusive of the $1.2 billion Medicaid which Shannon said “can’t be touched as it was Federal money”. Why not just 10% ($11 million) of the $110 million Cook County subsidy to CCHHS queried Director Reiter? Shannon will argue against draconian cuts at the Cook County budget hearing Nov. 7 that he iterated would result in closing certain operations and cutting staff in the Hospital System. CCHHS cost savings ideas that have been suggested which Shannon opposes:

Sweep vacancies or freeze hirings
10% salary cut of all non-union employees over a certain income
Consolidation of Human Resources (HR) and Procurement services with other County departments

Significant Topics Discussed:

160,000 of disbanding Family Health Network managed Medicaid members to be added to CountyCare Nov. 1, 2017 swelling rolls to 297,000 . Open enrollment Jan -March 2018, when any CountyCare member may select different non-HHS Medicaid Plan. Efforts ongoing to retain members and physician providers. 4 large FHN physician groups (4000 members) have chosen not to join CountyCare, primarily due to geographic distance from Stroger.
Financial Metrics: Net operating loss $286 million at 9 months into year, due to pension, overtime, salaries & benefits and external claims expense which are paid to non-CountyCare network providers.
Below budget target are: Total CountyCare members (1% drop to 139,723), primary care physician visits, specialty care, total inpatient discharges, surgical cases and ER visits. Deliveries are above target last 2 months.
Quality Metrics through Aug. 2017: No improvement in Patient Experience/willingness to recommend Stroger or Provident Hospital with cleanliness still the most cited negative. Stroger ranks in the 35% in national comparisons of hospitals “willingness to recommend”.
New Central Campus development multi-story building replacing Fantus Clinic, construction is right on schedule with massive structure ready for window installation.
Provident Hospital inspection by Joint Commission: no deficiencies in the Medical Home component
CountyCare to add member incentives for engaging in their own healthcare and improving quality metrics: payments to members for making prenatal & postpartum visits, getting childhood immunizations, diabetes and blood pressure control etc.

Observer - Susan Kern, MD Meeting Length: 2 hours and 45 minutes

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Cook County Health System Acquisition of Family Health Network Set for November 1

10/23/2017

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Cook County Health and Hospitals System Board Meeting - September 29, 2017

Significant Topics Discussed

On November 1, 2017, the County will assume the care of over 160,00 members previously insured by the Family Health Network [FHN]. Patients should be able to keep their primary care physician, and County Care will incorporate several unnamed FHN Incentives into its coverage. There is no guarantee these members will use Stroger hospital or other services of the health system, but this acquisition is a much needed boost that may help the System meet its 2018 budget. The Health System has incorporated financial incentives in its contract with FHN to encourage patient retention
The newly implemented sole-use Transport service for County Care, Medicaid, and other patients needing transport to the hospital and clinics is being well received. The System’s management considers this another positive incentive for obtaining and retaining patients, and fifteen vehicles are now in use.
Metrics: Strong emphasis was put on the need for the Health System to get better in all areas if it is to compete and survive. Cleanliness has improved significantly. However, satisfaction on communication with doctors [84% vs 88% target] and nurses [71% vs 86%] are still below target as is willingness to recommend the hospital [71% vs 85% target].

Three important items were noted in Chief Executive Officer, Jay Shannon’s, report:

The October 11 County Board vote on rescinding the Sugary Drink Tax. If the tax is ultimately rescinded, the loss of revenue will have a significant impact on the Health System’s 2018 Budget.
The System’s CEO and Chief of Police have developed a protocol if approached by Immigration’s ICE agents.
Congress has not reauthorized the Children’s Medical CHIP Program. This will have an impact on the 2017 Budget and 2018 if not reauthorized by December 31.

Observer: Diane Edmundson Meeting Length: 2 ½ Hours

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Will COVID-19 Transform the Cook County Hospital System?

CountyCare Enrollment Declines by 33,000 in 2019

Cook County Hospital Board Approves Preliminary $2.9B FY2019 Budget

Cook County Hospital Board Approves $189M/ 4 Year Contract with Evolent Health

Cook County Tells the Hospital System to Slash their Budget by $27 Million

Cook County Health System Acquisition of Family Health Network Set for November 1

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