Cook County Health (CCH) Board Meeting
​March 25, 2022     

Enrolled in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), since 2014, Stroger is now winning big for patients by decreasing surgical site infection rate from 1.5 times the national (NSQIP) average in 2016 to 0.77 of the rate in 2022!  Annual Stroger savings of $237,210 with avoidance of prolonged hospital & ICU stay and even death of patients who suffer from post-op wound infections is the bonus.  Accomplished by implementation of rigorous procedures for disinfection of skin prior to surgery, additional pre and post-op antibiotics, changes of gowns, gloves and instruments twice: for surgery and again for wound closure and patient education were key elements of this successful plan.  Surgeon Wille notes that this is an ongoing process, with direct comparisons of outcomes to other hospitals nationally on the numerous targets of enhanced quality with decreased cost that are being studied.  Initially there was skepticism of the program Dr. Fegan, Chief Medical Officer, at CCH commented but the successes are now making believers of surgeons from all CCH specialties.  CCH’s low rate of surgical morbidity/complications for its patients places it in the top 20% of all NSQIP hospitals for 2021. 

Highlights from Board Reports:

• CCH Financial Report: $5.156 million positive operating margin year to date, vs budget which predicted loss ($19,257) - Gain due to higher inpatient volumes and decreased County Care claims expenses.  Pension costs ($160 million/year) not included.
• CCH hospital and CountyCare (Medicaid plan) financials combined - not separate accounting 
• Human Resources: 4 new outside contracts to improve hiring/retention/technology
• Charity care cost: projected $464.5 million to exceed 2022 budget of $452 million 
• CountyCare: 429,256 members slightly increased YTD 2022, largest managed Medicaid organization in Cook County followed by BCBS 334,273
• Redetermination for CountyCare membership delayed by State- is expected September.  CCH outreach efforts to retain members described for the Board.
• Hospital volumes: Admissions, patient days, average daily census, Emergency Room Visits, surgeries and ambulatory visits All still lagging 2020. 

Items to Watch for in the Future:

• Aaron Galeener still listed as Interim Chief Executive Officer, Health Plan Services (CountyCare, Medicare).  When will a permanent CEO of CountyCare be appointed?

Observer - Susan Kern, MD

Cook County Health Board Meeting - September 25, 2020

The only action items were related to procurement but the board went into a closed session. 

• The public speaker testimony was all from Stroger employees and dealt with the handling of COVID-19. SEIU employees were laid off in the spring and many of their duties were transferred to the nurses. Neither group feels this is fair. The service employees want their hours back, sufficient PPE and additional training to do their jobs. The nurses want to do only nursing work. They all want hazard pay and PPE needed to do their jobs. 
• The board thanked the departing board members and welcomed Directors Garza and Curry. The new directors introduced themselves and spoke about their professional backgrounds. Director Richardson-Lowry stayed on for this meeting.

Committee Reports:

• Most of the committee reports addressed the changes made by the pandemic, including rule changes that were made to accommodate telemedicine and the financial effects.
• The quality committee spoke about changing the HgA1C indicator to include only patients that were seen twice in the last year.  (The HgA1C is a measure of how well blood glucose is controlled. Instead of a snapshot like a glucose level it takes into account 3 months of levels.)
• The contract metrics on women and minority owned businesses were not good this summer, possibly COVID related. YTD shows a surplus of revenue of $119 million but that includes $153 million received from the CARES act. 

​Interim CEO, Debra Carey reported: 

• that the hospital is encouraging patients to complete their census forms;
• and In the ER, they are helping people register to vote using the TurboVote platform via the patient’s phones.
  
• The Cook County jail after having a rough time with COVID is now down to a 0.5% positivity rate. 
• All employees are being encouraged to receive flu shots in advance of an expected difficult winter.
• The ER will be using a combined flu/COVID swab test. 
• he big concern is the possibility of the ACA being struck down in the Supreme Court. This will have an approximately $600 million dollar negative impact on the bottom line.

 
Items to Watch for in the Future:

• The future of the ACA or a replacement.
• Shortage and cost of PPE.
• Women and minority owned business contracts. 

Observer:  Lisa Slankard                                       Length of Meeting:  2 and 3/4 hours

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

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

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