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Covid Continues To Dominate Business of Cook County Health

9/30/2020

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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
0 Comments

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

8/1/2017

1 Comment

 
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
1 Comment

Deficit in Current CCHHS Budget Primarily Attributed to Pension Expenses 

10/31/2016

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Cook County Health and Hospitals System Board Meeting -  October 28, 2016

Significant Topics Discussed:
  • A $240 million deficit in the current Cook County Health and Hospitals System (CCHHS) budget was attributed to pension expenses ($183m), self insurance costs ($12m), and revenue shortfall ($44m).
  • Only 66% of CountyCare members see a doctor at least once a year.  Chairman Hammock asked that an action plan be prepared for improving utilization.  Board member Mary Richardson-Lowry commented, “We have to get to the issue of why people aren’t speaking highly of us.” CountyCare currently has 147,000 members; September’s CountyCare revenue was $16m, only 63% of the budgeted amount of $26m.
  • Metrics: Only half of scheduled surgeries at Stroger start on time; 75% of patients are willing to recommend the hospital; 75% are satisfied with their visits to CCHHS ambulatory clinics.
  • Due to the current “labor hold” only 77 nurses were hired in September, vs. 362 in September of 2015. Chairman Hammock explained that unions must “release” the positions in order to fill them, and three unions, SEIU, AFSCME, and the nursing union, together represent 50% of all CCHHS employees. 112 days are required, on average, to hire a new employee. Overtime is currently at 8%, v. a goal of 5%.
  • A new WEPlan, a multi-agency initiative involving planning, transportation, food distribution, and assessing the need for services in order to combat poverty, chronic disease, behavioral health, and health inequities was presented by Dr. Terry Mason, CEO of Cook County Department of Public Health.

Contract Concerns:  Questions centered on amounts, number of bidders, and whether services contracted could be brought in-house.  Examples: 
  1. Almost $1.5m was approved to outsource some nursing services, which Deputy CEO Doug Elwell attributed to the “labor hold.”  
  2. A $40m contract was approved for Information Technology management services.  “Our hospital is being hacked at an alarming rate,” said Elwell.  “This /IT/ has historically been a very difficult area to recruit.”  
  3. A $3,135 two year contract with Deloitte Consulting was approved to develop a system wide job classification system to cover all employees, looking at the value of  CCHHS compensation packages compared with that of other employers.
Announcements from Dr. Jay Shannon, CEO:   
  1. A $243,000 grant to provide mental health services
  2. The opening of the Roseland Triage Center
  3. A Medicaid Redetermination Event at Stroger Hospital with 8,000 invitees
  4. Deborah Carey will replace Karen Duncan as manager  of hospital-based services. 
Board member Mary Gugenheim congratulated Dr. Shannon on his presentation at the Oct. 18 budget hearing before the Cook County Board, successful due to vetting of County board members beforehand and attention to detail.

Observer -  Linda Christianson                                            Meeting Length - 3 hours
0 Comments

CCHHS Board Proposes $11M Decrease in Taxpayers Subsidy in 2017 Budget

9/9/2016

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Cook County Health and Hospitals System Board Meeting -  August 26, 2016

Significant Decision Made:

The Cook County Health and Hospitals System (CCHHS) Board adopted a proposed budget of $1.849 billion
that now
 goes to the Cook County Board for consideration/adoption slated for Sept. Importantly the direct Cook County (CC) proposed subsidy is shrinking from $121 million in 2016 to $110 million in 2017.  At $1.849 billion vs the $1.714 billion 2016 budget, the proposed 2017 budget assumes a $214 million deficit and this does not include pension costs of $175 million, depreciation of $28 million or debt servicing costs.

Budget concerns discussed at the meeting: 
  • How will CCHHS balance what is predicted to be decreased CC subsidy and pension contribution from CC with increased labor costs (a proposed increase of 129 FTE's and salary increases of up to 4.2% for unionized staff)?  Dr. Shannon, CEO explained that the focus will be on increasing patient volumes in primary & specialty care and surgeries (dental benefits & mental health care attract patients) and decreasing costs such as overtime, 8.1% in July, which has chronically exceeded the goal of 5%.  
  • Director Lerner questioned the rosy revenue and expense projections in the budget.  “What happens if they fail to materialize?”  D. Elwell, Deputy CEO of Finance & Strategy, agreed that that this was a very tight budget.  “Per member monthly payment rate for Medicaid patients (2/3 of patients) from the State is not out yet and due to the high CCHHS cost per plan member, 3rd party managed care plans refuse to contract with CCHHS”. 
  • What keeps him up at night?  D. Elwell worries about overtime labor costs, concern that there is not enough investment for capital expenditures and equipment is aging, law suits against CCHHS to fund budget-breaking Hepatitis C treatment, such as Harboni (Hep C treatment may be over $100,000/patient).
  • Dir. Lowry cautioned that the patient experience at CCHHS needed to improve to increase patient volumes.  D. Elwell responded that they are bringing in an outside organization to assist in making changes to counter patient complaints about lack of cleanliness, staff rudeness and long wait-times.   Dir. Driscoll noted that this organization needed to have experience with a unionized work force!

Items of Note:
  • Per new Government Accounting Standards, the financial balance sheet is now required to report net pension liability which is $4.347 billion for CCHHS.

Four new CCHHS Board members were introduced:
  • Layla Suleiman Gonzalez, PhD, JD leadership positions in Latino community engagement, IL Dept. Human Services and academic positions
  • Virginia Bishop, MD, MPH, pediatrician/Assistant Prof. Northwestern U School of Medicine
  • Sidney Thomas, MSW, Director Provider Relations, CCHHS, 25 years, healthcare consultant
  • Mary Driscoll, RN, MPH, Division Chief Patient Safety and Quality at IL Dept. Pub. Health, Chief of Nursing Officer CC Bureau of Health Services

Observer: Susan Kern, MD                                                                 Meeting Length: 3 hours, 15 minutes
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CCHHS Board Approves $112.7M Contract for New Health Center

5/4/2016

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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 
0 Comments

CCHHS Board funds renovations, lab equipment and CountyCare pharmacy benefits at December meeting.

1/1/2016

0 Comments

 
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.”


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