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.
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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

Cook County Health and Hospitals System Board - April 29, 2016

Significant Decisions Made:
Approval of $112,700,000 Contract for New Health Center which will adjoin John Stroger Hospital, replacing 3 aging structures: Fantus Clinic , the current administration building on Polk St.  and the Hektoen Building.

• Via RFP (request for proposal) Clayco, Inc was selected to lead the development, design and construction of this new nine-story Health Center housing expanded outpatient services and administrative space and adjacent future parking structure. 
• Completion is expected in 2018 at a cost less than estimated for deferred maintenance on the old buildings.
• CCHHS are gambling that a more attractive, efficient facility will serve to retain patients, who are now insured under Medicaid (under the Affordable Care Act) and are increasingly choosing to go to other hospitals.  
• Board members commented that great care was taken in the contract to mitigate cost over-runs and insure local hires.

Significant Topics Discussed:
Concern was expressed by Director Erica Marsh, MD, that the nearly 800 employed HHS physicians  are not being assessed for productivity.  The number of physicians per patient is high compared to other hospitals.

• Doctor generated RVU (Relative Value Units: standardized measure of value for physician reimbursement) are used by other health care organizations to hire or retain and in some cases a doctor must meet a 50% or higher threshold compared to peers to be retained.  This, or comparable data (number of patient visits/encounters per day) is critical to predicting the fiscal sustainability of the organization and should be included in the HHS Strategic Plan under discussion. 
• Dr.Claudia Fagan agreed that there have been complaints that some physicians may only be seeing a couple of patients a day and they are not required to time -in or out.  There is a history at CCHHS of paying lower salaries and not particularly being concerned about the amount of work, because this was a charity hospital.  Most of the physicians are employed and belong to the union. 
• Director Lerner stated that there needed to be a new medical staff structure for the Strategic Plan including labor partners. 
• Productivity monitoring and performance achievement are needed added CEO Shannon.  Dr. Fagen responded “you cannot change culture overnight; it has always been like this at County”. 
• Director Junge (labor attorney) countered that the doctors have employment contracts.

Unexpected Events:
CCHHS Board Member, Lewis Collens, has unexpectedly resigned. The resignation was announced by Chair Hammock who noted the dedicated service as Chair of the Finance Committee that Director Collens had given to CCHHS.  He mentioned that the resignation was for family reasons. 

In an unscheduled visit to the Board meeting, Senator Dick Durbin,  our Illinois US Senator, cautioned the Board on the heroin epidemic. He noted that opiate abuse was on the rise and HHS will be at the forefront. 

• He also noted that the Zika Virus was unlikely to be of much concern to our region this year
• Both of these are central to the mission of CC Dept of Public Health which is administratively a component of HHS.                               

Observer: Susan Kern                                Meeting Length: 3 hours 45 minutes 

CCHHS Board of Directors meeting, 12/18/15

Observer: Linda Christianson

Contracts approved:

• $21 million “lease” (line of credit) approved (with 3 voting “present” and 1 disapproving) to provide funds for renovation costs providing leeway for needed expenditures, defined as operational rather than capital and thus falling to CCHHS rather than County board for approval, identified by Chair Hill Hammock as “an unusual transaction.”
• Contract extensions for ventilator services to nursing home patients not on Medicaid.
• $12.5 million contract to provide laboratory automation equipment;
• CountyCare contracts: United Healthcare contract for $10 million to manage pharmacy benefits; First Transit contract for $5.3 million for transportation management, and DentaQuest contract for $4.1 million to manage dental and vision benefits.

Discussed: 
Penalties for readmission of patients within 30 days of discharge.  Even if the patient has a different diagnosis the second time, the penalty still applies.

Rates of readmission higher in inner cities, and higher for Medicaid patients than for Medicare patients.

Human Resources Director Gladys Lopez reported filling 1,267 vacancies in 2015, with 808 remaining vacancies.  Average hiring time has been reduced from 181 days to 121 days.

Items to Watch for:
A public speaker representing the nurses’ union said 98 nurses are scheduled to be displaced or laid off.

Deputy CEO Doug Elwell reported that the Government Accounting Standards Board will probably require CCHHS to recognize its pension funding, currently $60 million, now reflected in the County budget but not in the CCHHS budget.  If/when this change occurs CCHHS pension liability will total $280 million including unfunded pension interest for prior years. Most pension costs are associated with staff in “Tier One”, with defined benefit, rather than “Tier Two”, with defined contribution. Chairman Hammock responded, “These are expenses any hospital would have to deal with. Historically the County has borne the burden of this.”