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 - Departmental Budget Hearings
November 7, 2017
Cook County Health and Hospitals System (CCHHS)
Commissioners absent for all or most of the meetings: Moody
Commissioners present: Arroyo, Boykin, Butler (half the day), Daley, Deer, Fritchey (less than an hour), Gainer, Garcia, Goslin, Moore, Morrison, Schneider, Silvestri, Sims, Suffredin, Tobolski
Hospital System CEO Shannon’s letter outlined $12,430,000 in cuts of the $27 million requested (the amount allocated to CCHHS from Sweetened Beverage tax)
Items of Interest at the Hearing:
Observer - Dr. Susan Kern Length of Meeting - 7 hours
Impending Real Estate Delinquent Tax Sale Brings Rev. Jesse Jackson Sr. to Cook County Board Meeting
Cook County Board of Commissioners Board Meeting - March 22, 2017
Significant Issue Discussed:
Real Estate Delinquent Tax Sale - Commissioners Gainer, Boykin, and Garcia along with Treasurer Maria Pappas brought the issue to Rev. Jesse Jackson Sr., who spoke at the CC Board meeting. He asked all commissioners to inform their constituents about Real Estate Tax Delinquency buyers:
Other items of interest discussed:
Cook County Health and Hospitals System (CCHHS)
Observer - Amy Little
Cook County Board of Commissioners Meeting - September 14, 2016
Significant Topics Discussed
It was a full day at the Cook County Board meeting with much of the agenda focussed on the Cook County Health and Hospitals System (CCHHS).
Of Note: Two full hours (from 12:50pm-2:50pm) was spent on the Consent Agenda recognizing various anniversaries, retirements, 9-11 testimonials, and the accomplishments of constituents. Several citizens waiting to testify on the Responsible Business Act had to leave and return to their jobs before they could be heard since several committee meetings and this extremely long consent agenda delayed the time for public comment on the topic.
Observer - Georgia Gebhardt
January 13, 2016 Cook County Commissioners’ Board Meeting
County Commissioners called for a special hearing during the February Finance Committee meeting to determine the impact on grant revenues because of the failure of Illinois’ government to pass a 2016 Budget. At least $75 million dollars are at risk for human services grants that have been awarded by the County with the expectation that they would receive state funding in 2016 [Resolution 16-1090].
Criminal Justice issues were also very prominent. Approved was the call to appoint a Special State’s Attorney to handle the prosecution of Officer Jason Van Dyke [#16-0577] and to expand the Justice Department’s examination of Chicago policy practices to include the detention facility known as Homan Square. Emotional public testimony was given by lawyers and advocates in support of this Resolution [16-0964].
A resolution to establish a CC Task Force to research the expansion of affordable and quality healthcare to uninsured residents of Cook County [16-0690] was presented by the Workforce, Housing & Community Development Committee and approved by the full Board. Both human need and the cost of providing emergency room services were cited.
Other Resolutions referred to Committee:
Observed by: Diane Edmundson
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