Cook County Board Has Hearing on Cook County Health Budget for 2021

Cook County Finance Committee Departmental Budget Hearings
November 4, 2020

Cook County Health (CCH)

Proposed 2021 Budget - $3,387B                             Proposed FTES for 2021 - 6743
2020 Budget Amount -  $2,824 Billion                   2020 Budget FTEs - 6601
Difference - Increase of $653M (20%)                     Difference - Increase of 142
​
Highlights of Presentation and Questions:

• The increase in the 2021 budget is primarily due to the increase in County Care membership which affects both revenue and expenses and the staff increase for the County Jail due to Covid-19 requirements. Layoff’s occurred in the summer of 2020 to reduce the year’s deficit. Any additional union job cuts will likely result in filling openings in other areas.
• The increase in the 2021 FTE's is due to Covid-19 requirements at the jail, managed care, and hiring 91 permanent employees to replace Agency temporary hires.  . Commissioner Degnan asked that the projected savings by bringing agency positions in house be tracked to include not only compensation but benefits.  
• County Care Revenues for 2021 projected at $2.2 billion due to increased enrollment due to Covid-19 and employer layoffs.
• Overtime costs are expected to come down from a 9% of payroll high in 2020 to 6% in 2021.  And Commissioner Suffredin highlighted the System’s focus on improving the “prior authorization process” to reduce denials and thereby increase revenues.
• During this four-hour meeting, there were surprisingly few questions about budget numbers.  Most of the Commissioners were very concerned about service impact to their constituents.  There is only one service elimination.  The in-patient pediatrics which averages a little over 2 patients per day is suspended for fiscal year 2021.  Originally, CCH said it would be eliminated, but has now changed to suspended, likely due to internal and external pressures.  Interim CEO Carey and Interim Budget Chief Gibson held their ground on the necessity for and the reasoning behind service cuts.  
• Most of the questions were about clinical care especially mental health services and the consolidation of south side’s two ambulatory clinics into the Provident Clinic affecting approximately 9,000 patients.  
• Interim CEO Carey gave a clarion call that something has to be done about charity care stating that CCH cannot continue to absorb the more than $312 million in charity care costs [$320 in 2020 due to COVID and people staying home].
• The reversal of the Affordable Care Act was also a topic  In its budget presentation, the System estimated a loss of approximately $600 million annually in County Care capitation revenue, another at least $100 million annually from other Managed Care providers, and an increase of $700 million annually in uncompensated care costs.  
• Regarding the public’s concern about the Morton School Clinic, Carey said the System is very close to closing on an agreement to transfer services.  And the Lurie Partnership is taking over the services at the Child Advocate Center.  
• All Physical Therapy services will be centered in space developed in Harrison Square, which is the name now given to the old Stroger Hospital Building.
• Of the approximately 5,000 inmates at Cermak, it is estimated that 2,000 are listed as having mental health issues.  Very little discussion on the COVID-19 contact tracing but a hearing has been requested I believe by Commissioner Suffredin on this issue.
• An unknown for 2021 is the potential impact on the CCH System if Mercy Hospital closes for both regular and charity care patients.

Observer – Diane Edmundson                                                     Length of Meeting - 4 hours