Cook County Board Finance Committee - Departmental Budget Hearings
October 25, 2018
Cook County Health and Hospitals System
Commissioners present: Boykin, Fritchie, Goslin, Morrison, Schneider, Silvestri, Suffredin, Daley
Cook County Health and Hospitals System (HHS) – Jay Shannon, CEO
Suffredin: Is there a way to get the other 68 hospitals in Cook County to pick up a fairer share of charity care? The latest statistics from state government shows that Stroger and Provident handle almost 50% of the care while the other 68 cover the remaining 50%. In 2016, the system expended $265.7 million in uncompensated charity care. The next closest hospital, Northwestern, was listed at 7% in 2016. He also expressed the possibility “while draconian” to consider the county charging property taxes for those hospitals that don’t increase their share. Ans: Shannon said that the hospital can lead by example and "moral suasion". Legal incentives would be up to the county, city, and state.
Suffredin: How can the system grow its Medicare numbers? Ans: Each year 4% of the system’s Medicaid patients turn 65. HHS is reaching out to these members and encouraging retention within the system by promoting the benefits of continuity of care, the expansion of care management, and the specialty services available at the ambulatory clinics and Provident.
Suffredin: Do you have a target for increasing the percentage of County Care members that will choose to use the system’s services rather than go elsewhere: Ans: 18-20% based on aggressive meetings with other provider services, marketing, and improved care and specialty services being available at the ambulatory care centers.
Morrison: What is the definition of “charity care”? Ans: At HHS, charity care is lumped under Uncompensated Care with two subsets: 1) Individuals that cannot afford to pay and have completed the paper work for Care Link which qualifies them for 100%, 75%, or 50% forgiveness depending on their income situation. 2) Bad Debt includes charity individuals who cannot pay but did not fill out the Care Link paperwork.
Morrison: Asked for a breakout of the 243 FTE’s included in the 2019 budget. Ans: 101 due to the expansion of clinical care management required to serve FHN and Aetna member acquisitions as well as the expansion of care management such as health risk assessments, expanded operating room services at Provident and Stroger, and new hemodialysis services at Provident. HHS will also bring in house advanced imaging services and advanced cardiac rhythmic services; 50 nurses and techs to support the clinical staff; 30 for the Juvenile Detention Center [new for 2019]; 12 community health workers; and 55 for environmental service workers for the hospital and new professional building.
Morrison: What is the cost of the adding 243 FTE’s in 2019. Ans: $20 million.
Morrison: We have met with you over these past months to discuss the revenue cycle and uncollected receivables. Where do we stand? Ans: in 2018 HHS reduced by 25% the number of days a bill is in accounts receivable [AR]; it has reduced by 40% the time it takes between patient discharge and the bill going out the door; and it has reduced claim denials by 40%. These improvements have and will continue to occur because of the in-house hiring and training emphasis not only for clerical staff but also for doctors and technicians; the hiring of “at elbow” contractor employees to help train on 3rd party billing and denials management and other institutional and clinical coding, training, and process needs as identified.
Boykin: What efforts are under way to increase the representation of black minority contractors, particularly prime contractors? Ans: Vendor fairs; work with President Preckwinkle’s outside provider to increase the roster of qualified minority owned businesses; and break bigger projects into sub-contracts. Shannon noted a 40% increase above 2017 in minority contracts awarded. Shannon also stated that HHS is one of the anchor institutions on the West side of Chicago whose goal is to improve economic health, physical health, and local hiring.
Boykin: Is there an opportunity for HHS to work with the sheriff on the west side where he has an interest in putting more officers? Ans: West side triage has a mobile health team that can go to a home or join the police at an incident site where there might be a mental or behavioral health issue. Shannon noted that the system is averaging 2-3 gun-shot patients a day at Stroger. “Gun violence and opioids are a symptom not the cause”.
Goslin: Asked if the Access to Care services in the northern suburbs is still a relevant model. Ans: More than 2/3 of the budget of Access to Care is funded by HHS. Shannon noted that it was set up prior to the Affordable Care Act and noted that it is not a registered provider required to provide information to the state and federal governments. He said he could not comment on the quality of care. He did mention the new Arlington Heights Ambulatory Care facility with state of the art services to be opened yet this year. Shannon went on to say that ophthalmology and mammography services are being expanded at Provident along with GYN, hand surgery, ENT surgery, and other elective outpatient services. Provident is also offering free Lasik surgery.
Fritchie: Was there any thought given to use outside contractors for the 55 new environmental worker positions rather than going with the Union and who made the decision? Shannon: “yes and I made the decision”. It came down to cost and local control. Fritchie asked if a comparison was done on internal vs external and wants any internal documents regarding the decision. He also asked if any staff had been contacted by Preckwinkle’s office. Shannon said he was not aware of any staff contact.
Schneider: Reflected on the idea of charging property taxes for hospitals that don’t take their fair share of charity care. What should Suburban Commissioners do to get the suburban hospitals to step up? Ans: Encourage Access to Care and other advocacy organizations to band together to encourage the hospitals; hold direct conversations with hospital administrators, and review relevant laws.
Schneider: Why was the Arlington Heights site picked for the new clinic? Ans: Demographics, transportation, other comparable services, affordable space, and the last hurdle is bureaucratic and political. Shannon took this opportunity to mention that the new 2018 transportation fleet set up to get patients to their doctor appointments has been very successful and popular. Cost is about $500,000 for 2018.
Silvestri: Why does the hiring process take so long? Ans: HHS has a very complicated hiring process accentuated by market competition; there is a shortage of specific skills and skill sets. Shannon noted that compensation for nurses is competitive when salary and benefits are combined. In the case of physicians, HHS is woefully not competitive with private hospitals in certain areas and specialties.
Daley: Urged continued improvement with in-house retention of County Care members and stated that it is incumbent on each Commissioner to meet with and urge hospitals in their districts to take on more charity care.
Observer - Diane Edmundson Meeting Length: 2 Hrs.
Cook County Board of Commissioners Finance Committee - Departmental Budget Hearings
October 22, 2018
Bureau of Finance - Budget Overview
Office of the President
Office of the Independent Inspector General
Commissioners present at least most of the time: Moody, Daley, Schneider, Suffredin, Boykin, Deer, Arroyo, Moore, Fritchey, Gainer.
Overview of the Budget - Ammar Rizki, CFO, and Tanya Anthony, Budget Director:
Comm. Daley several times reminded the other Commissioners to submit questions in writing that are not answered at the meeting. The answers will then be posted on the website.
Office of the President - Lanetta Hayes Turner, Chief of Staff:
Office of the Independent Inspector General - Pat Blanchard, Independent Inspector General (IIG):
Observer - Karin Hribar
Cook County Board of Commissioners Meeting - September 12, 2018
What the Board Decided:
The following Items were approved:
Observer - Jill Althage Meeting Length - 1 hour and 20 minutes (11:10am to 12:30pm)
Cook County Board Finance Committee - July 24, 2018
Midyear Budget Hearing - Day 2 - Morning Session
I arrived right at 9AM for the hearings and there were 2 commissioners present (Suffredin and Morrison) other than Chariman Daley. Seven more arrived by 9:30AM and 3 more by 11AM. Absent for the entire morning session were Commissioners Goslin, Gainer, Butler, and Fritchey. Commissioner Sims asked everyone the core mission of his or her department and if there was any waste to cut. She did this even when both questions were answered in the original presentation. Commissioner Morrison asked everyone what new taxes they would propose, if any. Most took no stand on this issue.
Board of Review (BoR): I came in just as their presentation was wrapping up, but I heard all of the questions.
The Assessor: This presentation and Q and A session was extremely short. It lasted maybe 15 minutes.
Cook County Health and Hospitals System (CCHHS): A short report was given to each commissioner.
State’s Attorney: Presentation was given by Cook County States Attorney Kim Foxx.
Observer - Jan Goldberg
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
Cook County Board of Commissioners Finance Committee and Board Meeting
May 16, 2018
FINANCE COMMITTEE MEETING
Public Speaker at the meeting - Mike Belsky, Executive Director Center for Municipal Finance, Harris School of Public Policy, University of Chicago, spoke in favor of the ordinance to establish a Consensus Revenue Forecasting Commission for Cook County.
Significant Topics Discussed
1. Cook County Health and Hospitals (CCHHS) Quarterly Report was presented and filed.
COOK COUNTY BOARD MEETING
Highlights from the meeting:
1. Ordinance Amendment increasing fines for Public Morals Violations - referred to Criminal Justice Committee.
Committee Items Requiring Board Action
Items to Watch for in the Future
Observer: Nancy Marcus Length of meeting - 5 hours with a lunch break
Individual authors are credited at the end of each post.