Category: Cook County Health (CCH)

Cook County Board Seeks to Amend Health System Ordinance

3/3/2020

Cook County Board - Health & Hospital Committee Meeting
February 26, 2020

Meeting Report
The CC Health & Hospital Committee had two items on its agenda:

Agenda Item 20-1118 went through two substitute iterations with the final dated February 24, 2020 and contains major amendment changes to the 2008 Health and Hospitalts System Enabling Ordinance that established the independence of the Hospital System from the County President and Board and set up the mechanism for appointing an independent board. The chair of the committee, Dennis Deer, was not in attendance nor were Commissioners Moore and Tobolski. Commissioner Arroyo, Vice-Chair, ran the meeting.

All commissioners in attendance strongly supported the need for a viable and vibrant county public health care system and it was reflected in each of their remarks.
Agenda Item 20-1118 was passed out of Committee with the only exception to a unanimous vote being Alma Anaya who voted "present". Her comments are below as are selected other commissioners:
Larry Suffredin: Led off the discussion by stating that he strongly supports the amendments and considers them to allow for "re-balancing" of the relationship between the Cook County and System Boards as well as ensuring collaboration on executive hiring, financial, strategic planning, and labor relations issues. He offered that the Cook County Board is the Health Board for the County; and he pointed to the large increase in uncompensated care; the two highly critical Inspector General reports; and the increased number of grievances and arbitration cases as reason for the need to re-balance.
Sean Morrison: Stated he often communicated belief that the problem lies with the executive team.
Bridget Gainer: Stated that outward collaboration as well as between the Hospital and the CC Board is needed.
John Daley: Strongly supportive and stated that nearby U of I Hospital and Rush Hospital are both expanding their ambulatory centers and that the HHS System needs more help from them.
Alma Anaya: Stated she does not believe the amendments solves the root cause issues. She advocates creating a process such as a task force to identify, dissect, and address the problems - particularly financial. Wants to review and then change rather than "jumping the gun" with the proposed amendments.

Agenda Item 20-1229 was deferred without discussion. It would require top executive compensation and severance package approval by the President and County Board and because the matter is also covered in 20-1118, it may be withdrawn

Public testimony

Dr. Lindsay Ray Murray, Health & Medicine Policy Research Group. Stated that the System cannot cut its way out of its financial deficits. Called for a blue ribbon commission from a cross-section of health care professionals and experts to thoroughly explore the issues and make recommendations before approving changes to the 2008 enabling ordinance. H&M Policy Research Group is a member of the nominating committee that provides HHS board nominations to President Preckwinkle for her and the CC Board approval.
Laurence Msall, Civic Federation. His main objection is that 20-1118 gives the county board say over the selection and compensation of the CEO. He said that he has heard of no explanation on how the proposed changes will correct the System’s financial problems. The Civic Federation is also a member on the nominating committee for HHS board nominations.
Susan Avila, Collaborative Health Equity. She is also on the H & M Policy Board and worked at Stroger for a number of years. She stated that there was not enough information before the changes were proposed and is for a comprehensive analysis of the problems and at what works best (Best Practices approach).
Mr. George Blakemore also spoke and is in favor of more County Board involvement.

Significant Amendment changes included in Agenda Item 20-1118

The System Board will no longer have sole authority to hire the CEO, or interim CEO, or fix the compensation. Henceforth, it will recommend, subject to the advice and consent of the Cook County Board and the President’s departments on development of its three-year strategic plan as well as its operational and policy strategy.
Requires the Hospital System Board to direct its CEO to collaborate with President Preckwinkle and her departments on development of the strategic plan as well as its operational and policy strategy.
Increased HHS board membership from 11 to 12 – The twelfth member will be hired by and reports directly to President Preckwinkle and will serve the same 4-year term as the other directors. This appointee and the CC Board appointee, currently Dennis Deer, cannot serve as chair of the HHS Board.
Allows the System Board to recommend instead of fix compensation of employees and provides that the compensation must be in line with the county board’s budget appropriation.
Gives more responsibility to the Cook County Human Relations Bureau in handling grievance issues.
Provides that the HHS board shall meet 12 times a year.
Specifically states that the Cook County Board does not delegate Home Rule Authority to the System board.
Sets a threshold for county approval for capital expenditures at above $150,000 with monthly reporting of such expenditures of $5,000 to $150,000.

Diane Edmundson - Observer

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Cook County Board Proposes Elimination of the Medical Examiner Advisory Committee

1/28/2020

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Cook County Board of Commissioners Meeting
January 16, 2020

Items of Interest Considered by the Board:

An amendment to the Medical Examiner Ordinance that includes the elimination of the Medical Examiner Advisory Committee was referred to the Legislative and Intergovernmental Relations Committee. The Medical Examiner office is performing well relative to 2012 when there were a series of burial scandals and overcrowded coolers. The office rarely has unclaimed cases over 90 days, and disposition of deceased persons is orderly and dignified. Coms. Kevin Morrison and Daley were very complimentary of the high standard of performance. (Agenda Item 20-0626)
The Performance Management Ordinance Amendment was referred back to the Finance Committee to make sure that Cook County Health was included. (Agenda Item 20-1076)
All the transportation expenditures were passed with many of the projects exceeding the Women and Minority Owned Business requirements.
Com. Bridget Degnen asked what kind of cars the Sheriff was leasing, and wanted to make sure that whenever possible, the selection is hybrid cars, not full emission. She is very interested in encouraging the County to become more sustainable. (Agenda Item 20-0018)
The Cannabis ordinances were all passed with Coms. Silvestri, Degnen, Moore, and Sean Morrison voting present, in all cases regarding cannabis.
Com. Suffredin will revise the amendments to the Ordinance on the General Powers of the System Board to ensure that severance payments for Cook County Health (CCH) employees are in line with Illinois state law. Comm. Suffredin discovered that there are several CCH employees with severances promised in excess of what is allowed by law. All commissioners were added as co-sponsors and the item was referred to the Health and Hospitals Committee. (Agenda Item 20-1229)

Amy Little, observer

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Cook County Board Recognizes 100th Anniversary of LWV and Proposes 3% Retail Tax on Cannabis Sales

1/20/2020

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Cook County Board of Commissioners
Committee and Consent Agenda Meetings
January 15, 2020

During the Consent Agenda Meeting the Board honored the League of Women Voters in recognition of its 100th anniversary on February 14, 2020. President Preckwinkle and Commissioners noted the many suggestions from the League over the years to improve the operations and transparency of the government, as well as the presence of League observers at most Cook County Board and Committee meetings.

The following actions by the Committees are subject to Board approval at the January 16 Board meeting:

With the advent of legal sales and possession of cannabis in Illinois as of January 1,
- The Finance Committee passed a 3% retailer’s sales tax on gross receipts of sales of recreational cannabis. Sales of cannabis for medicinal purposes are excluded. Tax (which is on top of the normal sales tax) to be effective July 1, 2020. Commissioner Suffredin noted that, based on the experience in other states that have legalized cannabis, the County can expect an increase in emergency room visits and in having to deal with more driving while under the influence cases, adding costs to the County’s health and public safety functions. Thus, the 3% tax is more than justified. Because the State collects the tax and then remits to the County, the County does not expect to receive any revenues until September or October. Item 20-0658.
- The Legislation and Intergovernmental Relations Committee passed a proposal to create a Cook County Cannabis Commission to analyze the impact of recreational and medicinal cannabis industries within unincorporated Cook County. Commissioner Lowry will be the chair. Item 20-0763.
The Health & Hospitals Committee passed a resolution for:
- (1) the Chair of the Independent Cook County Health (CCH) Board to meet with the Cook County President and Board to solicit input regarding the responsibilities, background, and attributes to consider with respect to recruiting and appointing a new CCH Chief Executive Officer, which will be done at a public meeting in the Board room within 30 days;
- (2) the Cook County Board to have “listening sessions” at several locations around the County so that the public can provide input;
- (3) the Cook County Auditor, with the assistance from professional auditing firms experienced in health care, to conduct a management audit of CCH; and
- (4) such audit to be completed by July 1, 2020, so that its recommendations can be considered for the 2021 budget. Item 20-0789.
The Business and Economic Development Committee passed a Substitute Amendment to the Real Estate Tax Incentive Program to waive the relatively new requirement that business receiving the incentive file annual affidavits of compliance. Previously, the requirement was that such affidavits be filed every 3 years. With the change, there had been a marked decrease in new businesses seeking the incentive. The waiver is in place until 2022. Several people spoke in support during public comments. Item 20-0768.
This Committee also passed a resolution supporting a review of the small business and entrepreneur ecosystem in Cook County by an independent expert. Item 20-0678

Observer - Priscilla Mims

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Cook County Board Business Conducted At Lightening Speed After 2 Hour Retirement Ceremony

12/20/2019

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Cook County Board of Commissioners Meeting
December 19, 2019

The Board devoted the first 2 hours of their meeting to the honoring of retiring employee Martha Martinez, former Commissioner Jerry Butler, and the late Reverend Clay Evans. Testimonials lauded Martinez for thirty-four years of exemplary service. Former Commissioner Jerry Butler received a touching tribute from the Board. HIs career as a popular vocal artist and member of the Rock and Roll Hall of Fame was noted. Commissioner Butler sang one of his hits, “Let It Be Me” to the delight of all present. The late Reverend Clay Evans was honored as an icon of the black community and for his work on civil rights with Dr. Martin Luther King.

Action Items:

Agenda Item 20-0016- The proposed amendment to the Inspector General ordinance regarding reports and public statements was referred to the legislative committee. It requires that the IG share a statement with the head of the affected department and not issue a public statement for ten days. If the department has a response, this must be attached to the public statement. The Civic Federation supported this amendment during the public comment period.
Agenda Item 20-0735- The Board unanimously passed a resolution supporting federal universal background checks for firearms. It is hoped that this will add pressure for passage of gun control legislation in Washington.
Agenda Item 20-0721- The Board unanimously passed a resolution to support refugee resettlement efforts in Cook County. Several agencies testified to the challenge of working under current punitive federal policy.
Agenda Item 20-0437- Approved an intergovernmental agreement between the pension fund and Cook County. In 2016 the pension was 54% funded. $306.2 million will be contributed for 2020. This infusion of funds has now raised the percentage funded to 68%, one of the highest in the state.
Agenda Item 20-0732 - Changes in committee chairmanships were approved. These new assignments will give greater responsibility to the newer members of the Board.
Agenda Item 20-0658 - Proposed tax on cannabis was referred to the finance committee.
Agenda Item 20-1831- Board approved a commission chaired by Britton to create a new design for the county flag. The deadline is 2021 when the county celebrates its 190th anniversary. High school students will be asked to submit designs in a competition.
Agenda Item 20-0726 - Board approved a resolution to support Cook County Health’s construction of a new Provident Hospital. It also provides for the Cook County Board Health & Hospital Committee to hold a hearing to receive an update on the project.
Agenda Item 20-0712 - Board approved a resolution to discuss the Cook County Health Formulary Program. The resolution describes how insurance companies use “step therapy” in an effort to control drug costs. Step therapy is when patients first try the less costly drugs to see if they work. This can delay patients getting the treatment they need.
Agenda Item 20-0011 - Proposed ordinance regarding zoning for recreational cannabis was referred to committee.
Agenda Item 20-0579- Board approved authority for Public Defender to accept $500,000 grant to aid data analytics.

Commissioners Daley, Deer, Suffredin, Arroyo, Sylvestri, Gainer and Moore thanked Dr. Shannon (CCH) for his service to Cook County Health. Dr. Shannon was present and acknowledged their kind words.

Observer - Georgia Gebhardt Meeting Length: 3 hours, 20 minutes (includes 40 minute lunch break)

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Good Food Purchasing Program Pursued by Cook County Health

12/20/2019

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Cook County Board of Commissioners - Committee Meetings
December 18, 2019

Dr. Terry Mason, CEO Cook County Department of Public Health, reported on an initiative to address food purchases made throughout the offices and departments of Cook County government. This includes Stroger Hospital, County Jail, Juvenile Temporary Detention Center and others. After assessing costs, vendors, quality of food for healthy eating, etc., the program will promote sustainability, economic development, using local food growers, good quality food and other healthy eating goals. The power point presentation of this program is available on cook-county.legistar.com

Other topics discussed and/or passed by the various committees:

Rules and Administration—Several changes have been made to the previously approved list of standing committee and subcommittee chairs and vice-chairs mainly to give new Board members more experience and responsibility and also to replace Commissioner Tobolski’s committee positions. This Rules committee will have Commissioner Britton as the new Chair and Commissioner Degnan as Vice-chair. Commissioner Suffredin is stepping down from the committee completely.
Human Relations—Agenda Item 19-6895 an amendment to the Just Housing ordinance was passed which will give a one-month grace period before penalties and fines could be assessed for not following the ordinance. This ordinance was passed recently but has needed several hearings and changes to be acceptable to most stakeholders. It sets forth parameters to make it easier for former convicted felons to rent housing.
Finance--An amendment to the Master Bond Ordinance was passed which allowed the issuance of General Obligation Refunding Bonds. This will bring about $230 million in bonds to be refinanced at a lower interest rate. Cook County earns a lower interest rate than several other Illinois governments due to its higher rating. $138,000 will be paid to the outside organizers of this deal.

Observed by Karin Hribar

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Charity Care Is The Challenge in FY2020 Budget for Cook County Health

11/16/2019

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Cook County Board of Commissioners- Finance Committee
Departmental Budget Hearing
Oct 29, 2019

Cook County Health (CCH)

CCH proposes an austere FY2020 balanced budget of $2.8 billion, of which approx $1.8 billion is related to County Care (CCH's Medicaid Managed Care plan).
In Cook County FY2020 budget, the Cook County Tax Allocation given to CCH represents less than 5% of CCH's operating revenue.
The CCH FY 2020 budget anticipates $590 million in uncompensated care (charity care, unpaid patient bills, insurance companies not reimbursing claims) of which $409 million will be for charity care.
The budget includes 6601 FTEs and no layoffs (750 vacant positions were taken out of the budget), expenses for expected increases for drugs, medical equipment, and for employees' wages/benefits.
The Cook County Budget allocation of $83 million to cover CCH health services provided to Cook County Jail, the Juvenile Temporary Detention Center and Public Health functions falls short of CCH's anticipated expenses.
$513 million patient fee revenue is projected for health care services from insured individuals (not County Care members) through their Medicare or other commercial insurance.
The FY2020 budget for Stroger Hospital is decreased by 8% and Provident Hospital budget increased by 5.4% due to planned increase in services
County Care receives approx $1.8 billion payments for its members from Medicaid administrator. Of this amount CCH anticipates earning $173 million for providing health care services to County Care's members. Other healthcare providers outside of/not associated with Cook County Health system receive $1.5 billion from County Care for providing health care services to its members.
Charity Care is the largest and most important/challenging expense/issue in CCH's FY2020 Budget. Charity care at CCH is anticipated to grow at 4% for a total of $409 million. CCH in 2019 provides over 50% of charity care in Cook County. DSH (Disproportionate Share) and BIPA (Benefits Improvement and Protection Act) are federal funds paid to CCH to offset charity care. In the FY2020 these payments are approximately $289 million. In the current year, CCH will spend more than $377 million for charity care, a budget gap. CCH spends $1 million/day for charity care and this means that in FY2020, CCH will run out of money before the end of the year to pay charity expenses. The ever increasing burden for CCH stems from more individuals being uninsured and underinsured. Also another major reason for this charity burden on CCH is that other Cook County hospitals will treat uninsured patients for emergency conditions but discharge these patients with referral/instructions to seek follow-up care at CCH (these institutions decline to treat these patients for follow-up care).
Plans are in place to improve the growth of CCH health system and revenue with new/expanded services such as chronic ambulatory dialysis at Provident campus, expansion of surgical services at Provident and Stroger hospitals. CCH anticipates continued growth in extramural funding which brought in more than $25 million over the past three years. CCH FY2020 budget anticipates County Care membership of 326,000 (as of today membership slightly over 320,000). CCH will continue to seek additional Federal, State, and Cook County money and continue improvements to revenue cycle capture of money (clinical documentation, billing, coding, collections).
The budget gap between DSH and BIPA federal funding and CCH's growing charity expense outlay is CCH's greatest FY2020 Budget challenge. CCH will always provide health care regardless of the ability of the patient to pay, but this budget challenge will force CCH to make necessary difficult choices in restricting/cutting back services/delay getting equipment.

Observed by: Michele Niccolai

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Cook County Board Seeks to Amend Health System Ordinance

Cook County Board Proposes Elimination of the Medical Examiner Advisory Committee

Cook County Board Recognizes 100th Anniversary of LWV and Proposes 3% Retail Tax on Cannabis Sales

Cook County Board Business Conducted At Lightening Speed After 2 Hour Retirement Ceremony

Good Food Purchasing Program Pursued by Cook County Health

Charity Care Is The Challenge in FY2020 Budget for Cook County Health

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