Cook County Board Finance Committee Hearing - June 5, 2018, 4:00 p.m.
Purpose : Discussion of the billing, collection, and accounts payable practices of the Cook County Health and Hospitals System (CCHHS)
Quick Points Summary of the meeting:
When the Cook County Health and Hospitals System (CCHHS) CFO, Ekerete Akpan, was asked what is yet needed to improve collectability, he responded:
Commissioner Morrison believes there has been and is a systematic failure of management and called for more discussion on best practices and standards. He cited a lack of urgency in resolving problems.
Commissioner Schneider called for a discussion on the issue of getting more County Care insurance subscribers to use the CCHHS services and facilities.
Background for the Hearing:
Following a critical report from the Cook County Inspector General’s Office in April of 2018, Commissioners Daley and Suffredin called for this hearing to discuss in more depth the billing, collections, and accounts payable practices of CCHHS. Chairman Daley was absent from the meeting due to a hospitalization. Commissioner Sims chaired the meeting which started three hours after its scheduled time.
Comm. Suffredin opened the meeting stating that he and Daley recognized that Senior Management and the board understand the need to address changes in its coding, billing, and collection systems brought about by the Affordable Care Act [ACA] and the State of Illinois changes from a Managed Care fee per visit [fee for service] to charging for each type of service. He specifically charged the Commissioners use this hearing to deal with direct services provided by Stroger and Provident Hospitals, and the CCHHS ambulatory clinics. County Care issues were not a subject for this hearing and as it turned out, time did not allow for a discussion on accounts payable practices except a brief mention on the delay of payment due to the delay in receivables.
Public Speaker: Helen Thornton, Union Representative from AFSCME Council #31 [administrative/clerical workers], stated the union is committed to making the hospital and its membership successful. It called for: 1) the same training for all; and 2) cross training.
Hill Hammock, Chair of the CCHHS Board of Directors reported all the System changes made since the ACA was enacted: 1) New Sr. Management; 2) New four-year Strategic Plan adopted in 2016 and implemented in 2017; 3) New Systems; 4) New Metrics and Standards; and 5) Training to work for a cultural change to a “Patient First” model. Why? Because 60% of HHS patients now have insurance and can choose a different service provider. Prior to ACA, 70% of CCHHS patients had no insurance.
Dr. Shannon, CCHHS CEO, commented that in 2017 the System absorbed $250M (At the May 25, 2018 CCHHS Board meeting he pegged the number at $300M) in charity care while budgeted to receive $102M from county taxpayers out of a $2 billion plus budget for 2018. According to CCHHS, this $102M covers the Jail’s Cermac Health Center, the Cook County Public Health Department, and the Juvenile Detention Facility’s health needs. He noted that the System has started to cover part of its pension obligation while reducing reliance on county taxes by 75% since 2009. That said he and his team recognize the need to improve collectables by reducing insurance denials, more accurate coding, better training, and more staff. Specifically he noted:
Commissioner Suffredin asked how many coders CCHHS has on staff. Answer: 37 internal staff with 15 more in the hiring process plus contracted coders. Commissioner Deer said that the number isn’t enough for the size of CCHHS. It needs an “army” of coders and verifiers at multiple levels.
Additional “Accounts Receivable [collectibles]” information:
Observer - Diane Edmundson Meeting Length: 2 Hours
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