Mid-Year Budget Hearings of the Finance Committee of the Cook County Board
July 17 and 24, 2019
Over these 2 days, the Finance Committee (composed of all 17 members of the Board and chaired by John Daley) met with each elected official, bureau chief and major department head to go over the expected revenues and expenses at the end of the 2019 budget year (Nov. 30, 2019), and what was expected for 2020.
Highlights from these meetings:
Overall: It is expected that the County will end this fiscal year in the black, and no new taxes or fees will be needed to balance the budget for the upcoming 2020 fiscal year.
Cook County Health (CCH):
Chief Judge: Asked to respond to Chicago Supt. of Police’s claim that too many people are being arrested for violent crimes and being released on electronic monitoring, Chief Judge Timothy Evans provided these statistics:
Sheriff: Questions raised as to why, with significant reduction in daily jail population (from 11,000/d a few years ago to 5,600 to 5,900/d now) there hasn’t been more cost reductions in Sheriff’s budget for the jail.
Public Defender: While will not exceed budget for 2019, PD Amy Campanelli said that will be pushing for more money than President’s Office wants for 2020, in part to start an immigration unit with 4 new staff members. These would represent those charged with crimes (whom they are representing anyway in State courts in Cook County) at Federal immigration detention hearings. Cites statistic that have a 90% chance of no detention if have a lawyer and 90% chance of detention if do not. Would not work past detention hearing, but leave to pro bono immigration attorneys to handle the rest of Federal cases.
County Clerk (elections):
County Clerk and Recorder merger in December 2020:
Observer: Priscilla Mims
Cook County Board of Commissioners - Finance Committee Meeting
Mid-year Budget Review - July 17, 2019
What did the Board decide?
Several commissioners requested follow up numbers from Cook County Health (CCH) on a number of issues.
Debra Carey (in the absence of Dr. Shannon, CCH CEO) presented the review of the budget and stated there is a projected shortage of $103M this year. She said they expect to be able to eliminate the deficit. They just received a payment of $77M from Medicaid for County Care and the rest they hope to cover by budget tightening and not filling open positions. Charity care is up for the first time since the implementation of the Affordable Care Act (ACA). This was blamed on a problem in Springfield because there is a backlog of eligibility determination and Medicaid is down 7%. The state is addressing this but it will take time.
It seems that coding and documentation is a big issue both for collecting revenue and the outside coding agencies are the delayed accounts payable cited by OIG. There was a lot of discussion on how this is being addressed.
Commissioner Tobolski asked if there is a structural deficit for the hospital and wants CCH to pay more attention to the business aspect.
Observer - Lisa Slankard Observed for 1 hour
Cook County Board and Finance Committee Meetings - November 15, 2018
By unanimous vote (15 to 0, with Commissioners Butler and Garcia absent), the Cook County Board approved the budget for fiscal year 2019 that begins on December 1, 2018. Prior to that vote, the Finance Committee (a committee composed of all the Commissioners) approved 16 amendments which are incorporated into the final budget.
These amendments include one which increased the Revenue for the General Fund amount by $11.4 million based on (1) higher surplus in TIF accounts released by Chicago, (2) higher projected revenues by the Treasurer, and (3) projected increases in reimbursements from other governments. This additional $11.4 million was disbursed by several amendments which
Two other amendments:
The Finance Committee meeting lasted less than 1 hour, the shortest budget amendment meeting since the League began observing in the mid-2000’s.
Observer - Priscilla Mims
Cook County Board Finance Committee - Departmental Budget Hearings - October 29
Commissioners Present - Suffredin, Daley, Boykin, Gainer, Schneider, Morrison, Moddy, Arroyo, Silvestri, Moore for the majority of the meeting. Sims arrived at 10:15, Deere arrived at 11:10. Most of the relevant probing questions came from Boykin, Suffredin, Gainer, and Daley.
Public Hearing: Comments from the Public:
Cook County Board Finance Committee - Departmental Budget Hearings
October 25, 2018
Commissioners present: Boykin, Goslin, Deer, Morrison, Schneider, Tobolski, Silvestri, Daley
Chief Judge - Tim Evans
Silvestri: Q: Where will the defendants of closed courts go. Ans: Grand & Central will pick up the Belmont cases and 111th Street will pick up the 51st and Wentworth cases.
Boykin: Urged more Restorative Justice Community Courts beyond the one in Lawndale.
Ans: A second court will be coming to Austin followed by Englewood. Evans noted that a courtroom isn’t needed. A room with a circular chair set up and good security are the two main facility requirements.
Boykin asked how many teens are in the Juvenile Temporary Detention Facility. Ans: 189 of which 21 to 25 are female.
Boykin then asked if the Judge had everything needed for the electronic monitoring system (EM). Ans: Evans noted Sheriff Dart’s objections to some releases to EM but reminded the Commissioners that the law calls for pre-trial release unless there is a “clear and present danger”. Dart had said that 9 people charged with murder were put on EM. Judge Evans said that 1-2 were police officers and the other 7 were higher risks but presumed innocent and put on EM because they were not assessed as a clear and present danger. He went on to say that he has received a pledge from stakeholders to stand behind judges when [not if] a released defendant commits a major crime while released and awaiting trial. He stated that 9 out of 10 on EM to date commit no crime during release or fail to appear in court.
Deer: Thanked Evans for his work and his compassion and said he is impressed by the Juvenile Detention Center and the Lawndale Restorative Justice Courts.
Daley: Commended the Restorative Justice Court and said that more are needed.
Observer - Diane Edmundson Meeting Length: 45 min.
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.
Individual authors are credited at the end of each post.