Category: Healthcare

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

0 Comments

Cook County Board Holds Hearing on Cook County Health Finances

9/30/2019

0 Comments

Cook County Board of Commissioners Health and Hospitals Committee
Public Hearing
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

CCH is using other assets to pay claims in County Care, so the “hospital system is subsidizing the County Care Insurance program.”
There is between $501-$700 million in outstanding bills -—not paid or paid late.
Vendors are not supplying some necessary hospital, medical items because they are not being paid.
Transparency of revenues and losses is an issue.

Deloitte Analysis--

Revenues from County Care (provided from governments state and county) have covered its expenses.
CCH needs to make more timely payments to providers (90% of claims are processed but not nearly that number are paid) and this is a concern
County Care is profitable and can run the program
Assets and Liabilities in County Care are sustainable
At any point in time, County Care will have a $500 million or so liability because as old bills are paid, new ones come in that need to be paid -a backlog.
Funds from the State and County are sometimes not timely, which puts payments behind.

Dr. Shannon (CEO of CCH) Statements:

The premiums that County Care receives are more than enough to pay its expenses in County Care and in fact subsidizes some of the charity care and other programs that CCH undertakes.
CCH has suffered reputitional damage due to the IG report. People will not be willing to use CCH if they don't feel confident in its sustainability and viability.
The State of Illinois needs to speed up its application process for Medicaid enrollees.
CCH is in deficit due to increased charity care and non-payment by individuals who have insurance—NOT because of County Care.

Cook County Budget Office:

CCH will be working with the Cook County Budget Office to use best practices and increased transparency in reporting between CCH and Cook County Board.
There is room for improvement on the cash/payments flow system and they are working on it.

Observer : Karin Hribar Length of Committee Hearing: 2 hours and 20 minutes

0 Comments

Cook County Health (CCH) Focus of Cook County Board Mid-year Budget Review

7/26/2019

0 Comments

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.

Other Discussion:
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.

Additional observations:
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

0 Comments

Cook County Board Approves Resolution in Support of The Medicare for All Act - HR1384

6/15/2019

0 Comments

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.
Rationale:

The United States spends nearly twice as much per capita on health care as all other comparable countries, yet ranks only 35th by global health standards.
The uninsured rate for U. S. adults has risen for four straight years up to nearly 30 million uninsured.
More than 40% of all U.S. adults under the age of 65 forego needed medical care, fail to fill a prescription or take less than the recommended dose of their medication.
The inability to pay medical bills continues to be a leading cause of personal bankruptcy.
55% of the uninsured are people of color.
Due to their profit incentive, private insurance companies deny up to one-fourth of all claims for care.

The Medicare for All Act supposedly will:

Establish guaranteed, universal health care to all U.S. residents, eliminating all costs for premiums, deductibles, copays and other out of pocket costs.
Ensure genuine patient choice of any doctor, hospital or clinic a patient chooses.
Reduce the cost of prescription drugs by authorizing Medicare to negotiate lower drug prices.

Other Items of Interest:

The meeting began with three public speakers, nurses at Stroger Hospital, in support of the above bill.
The Board referred to the Criminal Justice Committee a proposed ordinance to change the hours of the Law Library, to make it more accessible to the public for the purposes of legal research.
The Board approved the authorization to renew a Cook County States Attorney’s Office grant to provide funding for a total of 21 victim specialists to provide services to all crime victims throughout Cook County. - Grant amount: $2,250,000.00

Observer: – Beverly Graham Meeting Length: 55 minutes

0 Comments

Cook County Board Holds Hearing on Billing and Collection Practices of Hospital System

6/11/2018

0 Comments

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:

More negotiations with unions on standards, work rules, and performance accountability after repeated re-training.
Each step of the intake, coding, denial review, and accountability has to improve.
More staff
More training
Better IT systems to detail/code individual patient’s conditions and treatment.

There was a consensus on the board that resolving the collectibles issues is a high priority, and the mandate was made clear to the CCHHS senior staff.

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:

Since the ACA and the changes in State Medicaid payment practices, the number of billing codes increased from 17,000 to 140,000.
Every encounter leads to generating a bill whether for insured, uninsured, or charity care. CCHHS sent out 4.5 million bills in 2017.
Coders work first on insured services and higher reimbursable procedures.
Charges captured have gone up by 60%, but the internal staff has not reached the internal goals of both accurate and prompt coding.
The goal is to have charges coded within 1-2 days of service.
Yet needed and being negotiated with unions are daily expectation standards and process of review for work rules.
CCHHS has more than 20 contracts with various managed care providers including medical, dental, and prescription services, some with unique codes to be learned.

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:

CCHHS reported that about 50% of non-collectible accounts receivable is due to errors that can be improved. Its denial rate decreased by 40% between 2016 and 2017.
All hospitals are experiencing a higher bad debt due to the changes in billing and coding; and the competition for experienced coders is fierce.
Of the 76-78 hospitals in Cook County, 50% of the charity care county wide is handled by the two CCHHS Hospitals and 17 clinics.
Private hospitals have a much better “payer mix”. I.e., more patients with private and Medicare insurance. CCHHS has primarily Medicaid insurance and its payer mix is between 25-40%. Therefore private hospitals have a higher accounts receivable collection rate.
The Inspector General's report focused on “charges” when determining the amount lost in potentially collectable receivables. Insurers pay adjusted and negotiated rates which are much lower than actual charges.
Dr. Shannon gave an historical recapture metric for collectibles [40%] that may be helpful to understanding what may be realistically possible for its debt collection. Example for 2017: Of the $66M in charges that were deemed to be collectible if coded on time and accurately, $25M should have been collected. In 2016, the numbers are $108M deemed collectible of which $45M could have been recovered.

Observer - Diane Edmundson Meeting Length: 2 Hours

0 Comments

County Hospital System Resists Cutting $27M at Cook County Budget Hearing

11/12/2017

0 Comments

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)

Closure of Oak Forest facility, patients transferred to other CCHHS sites
Overtime reductions by filling vacancies faster, & better coordination of staffing
Eliminate Tuberculosis Fund and lead monitoring & positions, with care transferred to Stroger
Eliminate Access to Care (suburban primary care)
Reduce pharmacy outpatient hours & positions
Transfer Child Advocacy Center to Stroger Hospital
Merge Morton East Clinic with Cicero Clinic
IT help desk consolidation, merge other departments, eliminate Grants
Merge substance abuse staffing with other departments
Eliminate vacancies that are unfilled for more than 2 years

Items of Interest at the Hearing:

Commissioners Morrison, Tobolski and Boykin asked the most probing questions, calling for the full $27 million in cuts out of the Hospital’s $2.4 billion budget, citing other County departments who were being forced to eliminate attorneys and other public safety and justice programs which were the responsibility of government. Shannon replied that any further cuts would have a detrimental impact on both revenue and care delivery due to decreased services. Commissioner Morrison responded that Shannon, not the Cook County Commissioners, is responsible for identifying cost savings and making the hard decisions on where to cut. “CCHHS needs the $403 million ($110 million direct subsidy plus $293 million pension and debt service) of tax payers’ funds for 2018 so they need to work collaboratively with the other Cook County departments to fill the $200 million deficit resulting from the loss of the beverage tax repeal” stated Morrison, echoed by Comm. Tobolski, Boykin and others.
Comm. Suffredin noted that $22 million of the DSH (**Disproportionate Share Hospital, CCHHS 2018 Budget on their website listed DSH total of $134.3 million) federal subsidy to indigent care hospitals was not included as revenue in the budget. Shannon replied that renewal of DSH had not been passed in Congress yet, but if paid, would be deducted from the $110 million CC hospital subsidy.
Comm. Boykin asked what the total expenditure on outside contracts/procurements was. Deputy CEO Elwell said he did not have that information immediately available and would get back, but agreed that it was a big dollar amount.
Comm. Boykin asked why the outpatient pharmacy wasn’t closed rather than just reducing hours, which would be greater cost savings. Shannon responded that the un-insured population don’t have access to medications at commercial pharmacies, so they need to obtain them at CCHHS.
Several Commissioners asked about employee salaries, including nurses, IT etc. noting that they were significantly higher than at comparable hospitals and that there seemed to be an excess of highly paid administrative staff. They were told they were all “justified based on CCHHS union pay scale, step increases, longevity & certifications”.
Comm. Boykin asked what the total “bad debt” was. When several different dollar amounts ranging from $90 to over $300 million were given to him, he asked why the CC Board was not being given an accurate number and what was being done to collect these accounts receivable. He was told that collections on bad medical debt was limited because most of the patients had no money and that very few companies would be interested in pursuing it. Comm. Sims asked for comparison of yield with prior debt collection vendors. The $90 million number is what is probably collectable.
Questions on why the 680 vacancy positions at CCHHS were not just eliminated, with cost savings. Shannon said that only 10% of the cost of these vacancies was included in the budget and that most of them were in the process of being filled. There is a normal turn-over of staff due to retirement, relocation etc. and no cost savings would result.
Commissioners asked what the number of staffed beds, RNs, RN/patient ratio and inpatient census were. Shannon said he thought there were 415 beds (**CCHHS website states 464) and didn’t know the exact number of RNs or census for Stroger or Provident. What is the ratio of clinical to non-clinical FTEs? Shannon said 35% non-clinical.
Comm. Garcia asked about the budget experience of the CCHHS independent Board and was told several were highly qualified in this area.
Many of the Commissioners asked whether CCHHS had ever shown a profit. The CEO provided a rather ambiguous response. (***CountyCare as a component of CCHHS per the published financials may have had an operating profit if pension & debt service were not factored in.)
What was the cost of the FHN (Family Health Network) acquisition which is expected to result in an additional 160,000 CountyCare members? A specific dollar amount was not provided, but CCHHS CEO expects most of the cost to be paid by the additional Medicaid capitated premiums and an additional 22 FTEs will be required to handle the increased volume of members. Comm. Schneider wondered if there was enough capacity at CCHHS for this large increase in patients which Shannon assured him there was more than enough capacity.
Comm. Tobolski asked for the risk profile of the new FHN members, annual cost and capitated income per member which the CEO did not know. What is the capitated rate and expense for the current CountyCare members. Shannon responded monthly payments are $626 for ACA Medicaid, Traditional Medicaid: in the low $200s and for seniors & persons with disability $1,150. Cost per member not mentioned. Several of the Commissioners questioned CCHHS on their risky uni-lateral decision to purchase Family Health Network without consulting with the CC Board, leaving the CC taxpayers as the deep pockets if this endeavor failed.

Observer - Dr. Susan Kern Length of Meeting - 7 hours

0 Comments

<<Previous

Cook County Board Seeks to Amend Health System Ordinance

Cook County Board Holds Hearing on Cook County Health Finances

Cook County Health (CCH) Focus of Cook County Board Mid-year Budget Review

Cook County Board Approves Resolution in Support of The Medicare for All Act - HR1384

Cook County Board Holds Hearing on Billing and Collection Practices of Hospital System

County Hospital System Resists Cutting $27M at Cook County Budget Hearing

Author

Archives

Categories