Cook County Board Finance Committee - Departmental Budget Hearings - October 29 
 
Public Hearing
Capital Budget
​
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:

• Aleisha Hill, a patient from Woodlawn Health and Hospitals talked about her wonderful, supportive care.
• Dr. Maurice Lemon, from Access to Care board, testified that Cook County Health does a heroic job giving care to uninsured folks.  There are 500,000 uninsured folks still in Cook County, and increasingly high deductible but insured patients make up a substantial portion of clients. Suffredin asked what ACESS is doing to raise other funds. $750M comes from private donors, and about $3M from Loyola.
• Lawrence Msall from Civic Federation spoke in favor of the 2019 budget.  He complimented the county on no increase in taxes, and their responsibly paying supplemental pension contributions even though it was not mandated by law.  The Civic Federation recommends pension payments be mandated by law so that future administrations could not cut it, they support County Care, suggested that the Oak Forest Health property be shut down, and suggested that more data was needed from the criminal justice system to be able to understand how the jail population had decreased by 40% but that expenses were not commensurate.  Suffredin asked if it might make sense to break up the county budget into thirds:  Cook County Health, criminal justice, and the rest of Cook County?  Msall thought it might shed more light on things.  Boykin asked if there was an ability to correlate criminal violence with public health.  Msall did not know of a measurement that currently exists.  Gainer asked the Budget Director why there are no ratios for inmates at the jail versus employees.  She responded that closing three divisions within the jail will reduce employment and redeploy manpower.  Cook County is doing a study on the entire jail campus, including assets and operations, which should be finished in the next couple of months.  2018 overtime has been reduced by $70M, due to reduction in managing home checks by staff, according to the sheriff.  Msall offered that Washington DC and Winnebago county have greatly reduced criminal justice costs and recidivism, and would make sense to study these examples.
• Esther Corpus, the CEO of Alivio Medical Center, which handles 85,000 visits per year at six offices spoke.  7,000 of their patients have insurance or County Care but the rest have no insurance.  Suffredin asked how County Care worked with Alivio compared to BlueCross/BlueShield (BCBS).  Corpus said that County Care was involved with every step of the illness and treatment while BCBS was distant, uninvolved, except at the end for billing.
• Craig Rosenbaum, attorney who represents Court Interpreters, asked for an increase in the budget to hire more full time interpreters.  He said Polish interpreters are particularly unavailable.  There are only 27 FT interpreters and his bargaining unit is asking for 39 FT within this 2019 budget.
• Ruby Pinto, from the Chicago Community Bond Fund, spoke about how reforms in bond court are having a positive effect.  But she complained that the Sheriff’s budget has increased per capita per inmate from $24 K to $59 K.  Chicago Community Bond Fund is funded by donations while the organization is sustainable because the bonds that are fronted are repaid.  Suffredin asked what reforms the group would recommend.  Ms. Pinto suggested a more proactive Pre-Trial services group could greatly reduce recitivism.  She also suggested the County look at Washington DC court system reforms.  Gainer asked if the group could provide specific proposals for reform, and Ms. Pinto agreed to do that.
• Donny Anderson representing the blind vendors complained that they were being cut out of contracts.  Jessica Caffrey of Capital Budget Department agreed to work with them on inclusion.

Capital Budget  

• Ammar Rizki, CFO, discussed the accomplishments in 2018:  CC has reduced its debt by $400M,  CC has stopped funding what always should have been operating expenses (assets with less than a five  year life, like computers) with long term debt.  As a result the County has a much better bond rating and lower interest rates for AAA ratings have significantly reduced Cook County’s costs for debt.  Debt has been reduced 11% from 2011 to 2018.
• The Asset Manager described 210 unique properties of which 50 are leased.  2018 saw the demolition of Jail divisions 1 and 1A. The department assessed all 210 properties to determine priorities for maintenance and replacement.  45% of capital improvements will be for public safety (including jails), 38% will be for health systems, and 17% for corporate investments. In the past 2 years, the county has constructed a new 9 story healthcare facility, renovated bond courts using in-house trades to save money, relocated clerk and elections to a high efficiency space to Cicero, among its cost-saving projects.  The budget for 2019 is $2,041M.
• The Transportation and Highways Department has a budget of $183M.  Cook County decided several years ago to stop diverting the Motor Fuel Tax to other programs to direct it back to highways and transportation.  This means that the county has been able to secure federal and state matching grants of $53M, and has also worked with townships and local authorities to plan better for projects that enhance Cook County’s role as North America’s freight capital.  The Cook County Transportation and Highway dept has become the coordinating lead agency to work with state, federal and local groups on projects, apparently a greatly-improved position from previous years, according to all the accolades from commissioners for John Yonan, the superintendent.  Boykin asked about correlation of transportation dollars to jobs created.  Yonan said the rule of thumb is 13 jobs created for every $1M spent. 
• The Chief Information Officer Tom Lynch, echoed the better accounting practice of financing computers and cell phones with operating funds rather than long term debt.  Major IT systems like the Clerk of the Circuit Court system, were financed by debt.  Suffredin said that according to Clerk Brown, the new system was a disaster, and Suffredin agreed that it was awful for attorneys to e-file.  Lynch said it was the learning curve, and that it was particularly cumbersome for pro se filers (individuals) because the language is many times obscure Latin, and not presented in layman’s terms.  Suffredin worried that attorneys could choose to file in other counties like DuPage and Lake, rather than having to deal with Cook County’s back-up.  Apparently self-filers are slowing the system down and attorneys can’t file quickly.  Suffredin worried if suits were filed in other counties it would adversely affect county finances.

Observer - Amy Little                                             Meeting Length - 3 hours

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
Remarks:   

• The proposed 2019 budget is $2.7 billion of which $102 million or >3% is a tax allocation from Cook County.  The $102 million is earmarked for correctional health at the Cook County Jail and the Cook County Dept. of Public Health.  These are services that the County is required to provide but is unable to bill.  [Note:  HHS is generating 97% of its operating revenue]
• For the last 3 years, HHS has assumed responsibility for its new capital expenses and for depreciation of current and new capital expenditures which amounts to approximately $25 million annually.  Additionally, it assumed $30 million in pension costs in its 2018 and 2019 budgets.
• The FY 19 budget is driven by the HHS 2017-19 strategic plan which includes investing in behavioral health, care management, social determinants of health, and addressing issues in the justice-involved population.
• HHS partners with the Greater Chicago Food Depository to distribute more than 400,000 pounds of fresh produce that impacts 58,000 household members.  These households are identified in the HHS clinics as “food insecure”.
• Deaths related to opioids today in Cook County [avg. 3 per day], are more common than those attributed to guns or motor vehicle accidents.  HHS is initiating programs to address some of the serious Public Health threats impacting Cook County communities.
• “HHS is the linchpin of the county’s health ecosystem that could collapse without it”. 

Questions/Answers

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 Finance Committee - Departmental Budget Hearings
October 24, 2018

Cook County Assessor
​Cook County Treasurer
Chicago Board of Elections
Clerk of the Circuit Court
Office of the Secretary to the Board

There were 10 Cook County Commissioners present.

Cook County Assessor: Joseph Berrios                            
Budget Highlights:

• The department’s proposed budget of 25.4 million is within the county target
• Planned technological enhancements will allow this office to operate more efficiently. 
• Develop and implement Property Tax system with other county agencies for full launch expected in 2020.
• Fraud unit is working well to make sure people are not defrauding the system. Approximately $35 Million have been collected.
• Working to create new tools and policies that will aid in the development of more affordable housing countywide.

Comments:
The Commissioners thanked Assessor Berrios for his serve.

Cook County Treasurer: Maria Pappas
Budget Highlights:

• FY2019 will be the 18th consecutive year that the Treasurer’s Office has reduced its budget above and beyond the budgetary targets requested.
• Very proud of the fact that all of the IT services are done in house. 
• Technological improvements have reduced costs, and improved services
• Treasurers collect $14 billion each year in taxes from owners of more than 1.8 million parcels of property.

Comments:
Maria Pappas, commented that tax bills are being sent out in a timely matter and more and more people are accessing their bills and paying their bills online. March Bills will be online in December. This has saved the county money. Commissioners pointed out that all of the IT work is done in house and this has saved the County money. They also noted that the Cook County Treasurer’s Website is very user friendly.

Chicago Board of Election: Lance Gough, Executive Director
Budget Highlights:

• In 2019, key operations of the Board of elections will involve managing the municipal elections and runoffs in February and April.
• The City of Chicago will bear the full costs of the 2019 Municipal Elections

Comments:
Board of Elections is continuing to grow online registrations. There has been an increase of early voting in the city and a growing participation in Vote by Mail. Commissioners asked whether new voting machines would be ready for the February and April elections. Mr. Gough responded that they will not be ready and the City of Chicago will be using the same equipment that is being used for the November 2018 Election. New equipment will be ready for the 2020 Presidential Election. He is confident that the new equipment will be secure. There was also discussion concerning the lack of polling places and judges in the City. Chicago is moving towards Voting Centers. Condominiums and schools do not want to open their spaces for voting. He said that the Super Site on West Washington is working well.

Clerk of the Circuit Court -  Dorothy Brown
Budget Highlights:

• Removal of furlough days
• There has been a reduction in staff
• Implementation of the required eFilelL system, has caused significant difficulties for the Clerks’ office. This is due to the complexity of the system along with the volume of cases filed in Cook County.
• Case Management System (CMS) will serve all areas of law to advance technology and improve efficiency while reducing costs, improve efficiency of court operations, improve customer service, and enhance information access offered to the public.  Criminal division will go live by March 2019, and all other areas of law will go live by November 2019.

Comments:
Dorothy Brown commented that as of July 2018, e-Filing has become mandatory for all civil areas of law. This system has caused difficulties for the Clerk’s office as the staff has had to provide extra-specialized customer service assistants to both self-represented litigants and attorneys, in order for them to e-File successfully. The challenge is not having enough employees to help. The Commissioners suggested that perhaps they might need to charge for providing help. They also suggested that a printed quick reference card or TV presentation with directions as to how to use the system could be implemented. It was noted that this system was created first for smaller counties, and then implemented for use in Cook County. Dorothy Brown would like to hire more people but cannot until they meet the budget requirement concerning the furlough days. 

Office of the Secretary to the Board - Matthew De Leon
Budget Highlights:

• Full time employees will remain the same for FY2019

Matthew De Leon reported on the Highlights of last year some of which are as follows:

• Redesigned Secretary to the Board website to improve access to information.
• Completed media inventory of 35-year collection of audio and video recordings transferred from Department of Facilities Management.
• Replaced the 50 year old sound system
• Created virtual record of paper documents for all 2016 and 2017 County and Forest Preserve Board meetings.
• Goal for the Archives Advisory Committee
• Began process for County 2031: Cook County’s: Bicentennial Celebration.

Matthew De Leon presented a power point presentation of some of the old archive materials for the Bicentennial Celebration in 2031. You can go to Legistar to see this presentation.

​Commissioners had suggestions for the Board meetings and the boardroom

• During the meetings, the President or person leading the meeting should announce not only the item number but the page it is on, for example when referring to an item, such as item 18-111, you include that this item is on page 10 of the agenda. This will be helpful for commissioners that leave the room or  for an audience member that arrives after the Board meeting has started.   
• ADA compliance needs to be done
• Railing on stairs down to where the Commissioners sit
• Clock with a timer

Matthew De Leon stated that some of these request would be handled at the Capital Budget Hearing on Friday October 26.

Observer: Nancy Marcus (11:00-2:00 with an hour break for lunch)

Cook County Board Finance Committee - Departmental Budget Review
October 24, 2018

Board of Review

Commissioners absent: Butler, Fritchey, Goslin, Gainer and Garcia.

Board of Review Commissioners Rogers, Patlak and Cabonargi, presented the following:.

• There were 228,000 assessment appeals filed this year which is a 10% increase over last year.
• They asked to hire 11 new employees. 
• They presented charts showing 3 years of the digital appeals process which clearly demonstrated geographic areas that have never filed appeals. The goal is to reach out to those communities. Homes with no WiFi are less likely to appeal. 
• A problem is when homeowners appeal and get relief, the neighboring homeowners pick up the extra tax to meet the overall tax levy. 

Com Suffredin stated that a fairer system is needed.  When asked if the department was all right with the CC Board President’s budget, the response was yes.

When asked what areas they would like to grow/improve, the review board stated that they would like to have a separate PTELL unit (I believe it is currently 6 people). The PTELL unit defends challenges. If the Board of Review could have a larger PTELL unit, it could more effectively defend challenges, and that would recover more money for the county which would fund local schools and municipalities.  The Board of review asked for $90,000 for its appraisal budget.  It also suggested that an additional $750,000 to fund the PTELL defense budget would generate about $1 million for the county. In other words, it would pay for itself.   One of the commissioners said that as the county is doing well with revenue (sounded like it was due to increased revenue from sales tax), that it made sense to fund extra money for the Board of Review which would ultimately pay for itself. 

Observer - Laura Davis