Concern Rising Over Likely Cuts in Federal Medicaid Funding

Cook County Health & Hospital Systems (CCHHS) Board Meeting - May 26, 2017

Significant Decisions Made:

• As concern rises over likely federal cuts and the 2018 changes in the State Medicaid reimbursement caps, the Board asked for a “dive” into CCHHS finances at both the June Board and Finance Committee meetings. President Hammock wants this done before the start of 2018 Budget preparation.
• A contract with Superior Air-Ground Ambulance Services, Inc. to provide sole use services to CCHHS to transport County Care, Medicaid, and other patients needing transport to the hospital and clinics was approved.  Pick up guaranteed!  The Board requested quarterly reports on the metrics to be used to evaluate these services. 

Significant Topics Discussed:
Finance:

• Unexpectedly high pension expense numbers were received from the County. HHS budgeted $220,000 against the new number of $321,000. 
• Overall, HHS is currently 20% off target for income.
• Overtime continues to be a big driver of actual v budgeted expenses.

County Care: 

• Not meeting client targets for primary and surgical care as well as deliveries.                            
• Enrollment stabilized at 141,776 vs budget number of 142,500 clients
• Market Share is 3rd place for managed care in Cook County.
• Call center meeting all targets

Application for the State Medicaid RFP 

• Cook County submitted their application early and there are 2 other applicants.
• Director Glass believes CCHHS much more responsive to the RFP.
• Concern expressed that care metrics must be increased.

Quality & Patient Safety:

• Metrics developed for cleanliness.
• Operating Room Improvement noted.
• Two new managers hired and will go floor by floor for intensive cleaning. 
• Patient satisfaction re communication with nurses and cleanliness continues to be an issue.  New protocols developed.  Nurses are being asked to make hourly rounds and the managers are to increase their rounds. 
  
• More training is scheduled for:  coaching, monitoring of/by supervisors, cleaning, and use of Family Medical Leave Act (FMLA).

Items to Watch in the Future:  

• Immigration and Customs Enforcement (ICE) activity [none reported to date].  
• CCHHS ability to accurately determine cost to treat patient vs state reimbursement.  Will become more important with expected cuts in federal and state Medicaid reimbursements and state managed care reimbursements. 

Observers:  Diane Edmundson, Bill Edmundson                    Meeting Length - 2 1/2 hours