Cook County Board of Commissioners Health and Hospitals Committee
September 26, 2019
This hearing was requested by the Cook County Board of Commissioners to note and understand discrepancies between the Inspector General (IG) Report and the rebuttal of Cook County Health (CCH) and the firm—Deloitte—hired by CCH to analyze the Inspector General's Report. The IG Report generally stated that CCH’s insurance program, County Care, was unsustainable and was being subsidized by Cook County taxpayers. The IG report looked at ALL of the CCH finances, not just County Care. CCH disputed this and hired Deloitte to analyze the IG report —mainly the viability of County Care—and report to the Cook County Board. Deloitte did NOT do an audit as this was done previously by another division at the firm. It also only looked at County Care and not all of CCH.
There was a lot of confusion by the Board on what was being stated by both the IG Office and Deloitte. Mainly this was because of the Accounting Systems used by CCH and the various ways accounts receivable, payable, assets, etc. can be interpreted. All parties are looking at the financials and cash flow differently. The main question of the Cook County Board was “Do we have any concerns about the stability and viability of CCH?”
Here are the basic findings as this Observer understood them:
Inspector General Report
Dr. Shannon (CEO of CCH) Statements:
Cook County Budget Office:
Observer : Karin Hribar Length of Committee Hearing: 2 hours and 20 minutes
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 of Commissioners Meeting - June 6, 2019
Commissioner Absent: Stanley Moore
What did the Board Decide:
The Board approved a Resolution in Support of HR1384 - The Medicare for All Act.
Other Items of Interest:
Observer: – Beverly Graham Meeting Length: 55 minutes
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
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