Category: Metrics

Cook County Hospital Board Approves Preliminary $2.9B FY2019 Budget

9/6/2018

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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CountyCare Enrollment Must Increase for Cook County Health System to Remain Viable

8/29/2017

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Cook County Health & Hospitals System (CCHHS) Finance Committee Meeting - August 25, 2017

Significant Topics Discussed:

The State of IL retroactively (to January 2016) lowered the reimbursement rate to CCHHS for health services covered by Medicaid. How could this happen? Because the rate was not “recertified” every year, CCHHS must cover the outstanding cost for these services.
Pharmacy costs are $24m over budget for the first 6 months of 2017. Dr. Shannon identified pharmacy costs as one of the “holes” in the Affordable Care Act. Pharmaceutical firms may charge very high rates for rare but needed specialty drugs.
Can CountyCare increase from its current 141,000 to 225,000 members? Finance committee Chair Ric Estrada pointed out that customer service is key. Deputy CEO Doug Elwell summarized, “If the patient experience doesn’t go up, we’re not viable.”

June 2017 statistics:

$132m shortfall in CountyCare revenue
Patient visits and discharges slightly below 2016 levels
Deliveries and surgical cases up slightly

Draft 2018 Budget Projections - subject to public review and final approval by the Cook County Board:

The 2018 budget assumes: an improved patient experience, with 10% increases in surgical cases, primary care, specialty care, and deliveries. The budget also assumes CountyCare growth, personnel cost increases, a decline in overtime, increased uncompensated care, and increased pharmacy costs.
Based on these assumptions, overall revenue is projected to total $2,178b, with expenses to total $2,417b, yielding a deficit of $239m.
Sources of revenue: DSH (federal Disproportionate Share Hospital allocation) $134.7m; CountyCare $1,205.1b; Medicaid, Medicare, and private insurance payments $460m; BIPA (federal Benefits Improvement Protection Act allocation to safety net hospitals providing medical education) $132.7m; and the remaining $245m from grants and other revenue..
HHS predicts the number of FTEs (full time equivalents) at 6856, a very small decrease.
Cook County support for HHS will total $294.3m including $184.3m for pension, $6.9m for hospital/ambulatory services, and $103.1m correctional health (for jail detainees).
Chairman Hammock commended the staff for the quality of the information delivered to the board.

Observer - Linda Christianson Meeting Length - 2 hours

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Decision on Illinois' Managed Care Reorganization Due in August - How Will CountyCare Fit In?

8/1/2017

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Cook County Health & Hospitals System (CCHHS) Board Meeting - July 28, 2017

Beginning January 1, 2018, all Illinois managed care organization members, including those enrolled in CountyCare, will have 90 days during which they may opt for a different plan.

Significant Topics Discussed:
CountyCare (Managed Care):

Managed Care Director Steven Glass departs his post for a job in the private sector.
CountyCare seems likely to be chosen by the state of IL as one of 4-6 managed care organizations in the state’s reorganization of the delivery of managed care, with a decision on this due in August. Once the reorganization takes effect on January 1, 2018, Medicaid reimbursement rates to managed care organizations are likely to decline.
CountyCare enrollment continues at 141,000, 1.5% under budget.

Finance:

CCHHS will lease 13,700 square feet from Westside Health Authority to accommodate the behavioral health services currently housed in Fantus Clinic, with the anticipation that an additional site for behavioral health services will be identified on the south side.
For the first 6 months of 2017 revenue was $103,000 below budget projections, attributed to overtime (8% of payroll) and external claims expenses, including CountyCare payments to non-CCHHS providers.
2018 budget planning assumes an anticipated need of $84 million before considering any new expenditures and must include $30 million for staff pay increases; $28 million in capital needs; $26 million in furnishings and equipment for the new facilities.
73% of CCHHS budget is personnel-related; 90% of staff are unionized.

Quality and Patient Safety:

65% of Stroger patients would recommend the hospital, cleanliness the most pressing concern. A Director of Environmental Services has yet to be approved.
69% of ambulatory care patients expressed satisfaction with their patient visits.

Human Resources:

715 identified vacancies, 117 days required to hire a new Full Time Employee (FTE), a 4% turnover of total FTE’s, a 5.4% nursing turnover. The board raised questions concerning the length of hiring time.

Other Comments:

“To survive we must grow.” Deputy CEO Doug Elwell spoke of the “bolus” of uninsured patients CCHHS is committed to care for. CCHHS looks to improve the patient experience, increase volumes, sustain its financial position, sustain and grow CountyCare membership.
Public speakers representing nurses spoke of ICE agents entering CCHHS buildings without authorization.

Observers - Linda Christianson and Jackie Buttafuoco Meeting Length - 3 hours

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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

CountyCare Enrollment Must Increase for Cook County Health System to Remain Viable

Decision on Illinois' Managed Care Reorganization Due in August - How Will CountyCare Fit In?

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