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Cook County Board Authorizes Video Gaming in Unincorporated Cook County

6/17/2018

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Cook County Board of Commissioners Board and Committee Meetings - June 6, 2018

Significant Decisions:

With little discussion, the Board approved video gaming in unincorporated Cook County (Item 18-3799), as recommended by the Finance Committee at a meeting and hearing held the prior day. Commissioner Gainer voted no, while Commissioners Fritchey, Silvestri, Sims, and Suffredin voted present. Commissioner Daley was absent. At the prior day’s meeting/hearing, several business people had testified that allowing such gaming would put them on par with similar businesses in adjoining Cook County municipalities, the majority of which have adopted laws authorizing such gaming. It will also bring in some additional revenues for the County. Commissioner Schneider led the effort to craft this ordinance.
With no discussion at either the Finance Committee meeting that day or the Board meeting, the Board accepted the 2017 Performance Based Budgeting Annual Report (Item 18-3151). The League testified at the Finance Committee meeting and submitted written comments which expressed disappointment with the measures and targets in the report, arguing that few actually measure performance. As a result, the program is doing little to encourage improvement in performance in Cook County departments. None of the Commissioners chose to inquire about the value of the measures in the Report.

Significant Topics Discussed:

In connection with approving several contracts presented by the Sheriff’s Office, Commissioner Tobolski raised the issue with the County doing business with companies located outside of not only Cook County, but outside of Illinois. The Commissioner complained that sales taxes paid for goods supplied from such vendors is going to other states and localities. He stated that one of his goals is to streamline the County’s process for becoming an approved vendor. Commissioners Deere, Gainer, and Moore also raised concerns. Commissioner Moore said he would like a report which shows the dollars that the County pays vendors from outside of the state vs. the dollars paid to Illinois vendors.
Comptroller’s Report through April 30: Looking at revenues less expenditures, both the General and Health Funds have favorable balances of $41 million and $2 million, respectively.
Commissioner Fritchey noted that this was the last meeting of the outgoing Chief Information Officer, Simona Rollinson, who was praised by Commissioners for making major improvements to the workings of the County through several major software programs that have been brought online during her tenure.

Items to Watch for:

Again deferred in the Finance Committee was the proposed ordinance (18-2073) to establish a Consensus Revenue Forecasting Commission, which is sponsored by Commissioners Boykin, Garcia, and Suffredin. (See the Eyewitness Report for the May 16 Board and Finance Committee meetings for more information.)

Observer - Priscilla Mims

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Cook County Board Holds Hearing on Billing and Collection Practices of Hospital System

6/11/2018

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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:

More negotiations with unions on standards, work rules, and performance accountability after repeated re-training.
Each step of the intake, coding, denial review, and accountability has to improve.
More staff
More training
Better IT systems to detail/code individual patient’s conditions and treatment.

There was a consensus on the board that resolving the collectibles issues is a high priority, and the mandate was made clear to the CCHHS senior staff.

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:

Since the ACA and the changes in State Medicaid payment practices, the number of billing codes increased from 17,000 to 140,000.
Every encounter leads to generating a bill whether for insured, uninsured, or charity care. CCHHS sent out 4.5 million bills in 2017.
Coders work first on insured services and higher reimbursable procedures.
Charges captured have gone up by 60%, but the internal staff has not reached the internal goals of both accurate and prompt coding.
The goal is to have charges coded within 1-2 days of service.
Yet needed and being negotiated with unions are daily expectation standards and process of review for work rules.
CCHHS has more than 20 contracts with various managed care providers including medical, dental, and prescription services, some with unique codes to be learned.

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:

CCHHS reported that about 50% of non-collectible accounts receivable is due to errors that can be improved. Its denial rate decreased by 40% between 2016 and 2017.
All hospitals are experiencing a higher bad debt due to the changes in billing and coding; and the competition for experienced coders is fierce.
Of the 76-78 hospitals in Cook County, 50% of the charity care county wide is handled by the two CCHHS Hospitals and 17 clinics.
Private hospitals have a much better “payer mix”. I.e., more patients with private and Medicare insurance. CCHHS has primarily Medicaid insurance and its payer mix is between 25-40%. Therefore private hospitals have a higher accounts receivable collection rate.
The Inspector General's report focused on “charges” when determining the amount lost in potentially collectable receivables. Insurers pay adjusted and negotiated rates which are much lower than actual charges.
Dr. Shannon gave an historical recapture metric for collectibles [40%] that may be helpful to understanding what may be realistically possible for its debt collection. Example for 2017: Of the $66M in charges that were deemed to be collectible if coded on time and accurately, $25M should have been collected. In 2016, the numbers are $108M deemed collectible of which $45M could have been recovered.

Observer - Diane Edmundson Meeting Length: 2 Hours

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Cook County Board Authorizes Video Gaming in Unincorporated Cook County

Cook County Board Holds Hearing on Billing and Collection Practices of Hospital System

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