Will COVID-19 Transform the Cook County Hospital System?

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