CCHHS Board Meeting September 18, 2009

It was noted that the Finance Committee of the Cook County Board had approved the CCHHS budget. At the County Board meeting, Shakman Compliance Officer Mary Robinson's report was complimentary of CCHHS while encouraging CCHHS to take over HR functions from central office where there are posting delays and lack of control. New senior managers were introduced and a 3 month severance policy for senior managers was adopted.

The revenue functions were split between two vendors: Med Assets will continue to be the revenue cycle manager and Chamberlain, Edwards will under separate contract provide patient eligibility services. Both are expected to increase revenues significantly.

Two people spoke during the public comments opportunity. One was critical of the Board for labeling one Town Hall meeting Hispanic, finding it divisive. The other was a caseworker who was critical of the Board for transferring a Medicaid eligibility function to a new vendor when she felt the system has qualified employees who have carried out this function for many years.

--Submitted by Observer Nancy Staunton

CCHHS STRATEGIC PLANNING PUSHES FORWARD

CCHHS Board Special Meeting September 18, 2009

At a Special Meeting following a regular Board meeting, the Board members of CCHHS spent 3+ hours reviewing the data assembled by their consultant and feedback from the seven Town Hall meetings held in the summer. Their goal is to flesh out a Strategic Plan: what to be, what to do and how to do it. Among the findings were that Chicago has the lowest percentage of uninsured in the country; men, Latinos and 19-24 year olds lack services; infant mortality is highest in the southern part of the County; a large number of Federally Qualified Heath Centers (FQHC) provide services in areas of need; about 4% of Stroger ER services are provided to non-County residents; one-fourth of the budget goes to Provident and Oak Forest hospitals which doesn't coincide with usage. Medicaid usage is low and patients include very few Hispanics.

The reported major concerns raised at the public meetings attended by 400+ individuals were access and services. Regarding access, they noted geographic changes of the past decade have made the locations of facilities inappropriate, wait times are unacceptable and there are both language and physical barriers like parking and ingress. They felt the system is fragmented, has no continuity of care and lacks follow-up.

Observations by the Board regarding the physical plants: Fantus Clinic is deficient and needs to be replaced and its (re)location should be considered. Provident and Oak Forest hospitals are not configured for their current use; long term care and rehab may be more appropriate uses for Oak Forest hospital. Obstetric services are very low at Stroger and Provident hospitals. What should be the long term direction?

With much discussion from all members, some themes surfaced: planning should be patient-need focused, not facilities focused, keeping in mind geographic distribution and vulnerable populations. There is a potential for partnerships with FQHCs, VA services and medical schools. Volume thresholds and more programs of screening and early detection should be explored. Should the County be the provider of care or assure its delivery? Can County Primary Care services be coordinated and/or regionalized? Where should specialty care be located? Other issues: coordination of public health services, more emphasis on prevention/nutrition, role of school clinics, coordination with collar Counties. Is the best use a focus on areas of excellence, i.e., Trauma, Burn, AIDs, and development of others e.g., Diabetes, Asthma, Obesity? Nurse training? Education and research should be continued only as they serve the patient. Any planning must include financial forecasts that compare the current cost structure with a) planned productivity and supply changes and b) any additional changes.

--Submitted by Observer Nancy Staunton

Board of Commissioners Meeting September 16, 2009

I arrived late to the meeting at 11:30am and Mary Robinson, the Shakman Compliance Administrator for Cook County, was presenting her report which had been submitted to the commissioners in writing. In response to questions from Comm. Peraica she indicated that to date the County has spent $3.4M on the Compliance office and $3M settling claims investigated by the office. In responding to a question from President Stroger she stated that things don't change over night. She stated that systems are able to be manipulated and it is her job to work towards a system that does not allow that to happen. When she stated that her office still does not know who is "clouted" President Stroger assured her that no one was. He then asked her if Joe Sowa, the Director of Human Resources, was running his office and she responded that in some aspects he is and in others he is not. President Stroger told Ms. Robinson that she has access directly to him to report anything that needs reporting and she does not need to go through other people to get to him.

Comm. Gainer then asked if she has the ability to change things. Ms. Robinson stated that she has the ability to report her findings to those she thinks appropriate. Ms. Robinson also stated in response to further questioning that there seem to still be insurmountable obstacles in Human Resources. Mr. Sowa did not appear to be present for questions about HR since Laura Lechowitz-Fellicione answered a question directed to him. Ms. Robinson had to leave at noon for another appointment but indicated she was willing to meet with any commissioners that still had questions. (I presume her report will be posted on the Shakman Compliance Administrator website although it is not posted as of yet.)

During the Finance Committee Report Comm. Peraica raised a question about payments on a court case, Fairly, et al v. Andrews, et al. He thought the case had been closed. Comm. Silvestri stated that these bills were approved by the Litigation Committee in May and he thought these were the last bills to be paid. Mr. Driscoll from the State's Attorney's office said that when the bills were approved it was thought that they were the last but since then a petition for a rehearing has been filed so the case is not yet closed. So far $2.2M has been spent.

Again there was discussion of the problem with billing errors in the hospitals. A recent review of billing apparently revealed a 60% error rate in coding for Medicaide reimbursement which was resulting in denial of payment. The role of outside billing vendors and county employees was rehashed with Comm. Beavers and Comm. Simms wanting to know who was supposed to be training the county employees to do coding and why were contracts being awarded to companies that were not located in Cook County. This discussion occurs quite regularly at meetings but there does not seem to be a possible resolution for the problems with billing. Comm. Daley indicated that there were issues with union contracts that resulted in difficulties in terminating employees for incompetence.

Comm. Gorman introduced an amendment to the CC Code of Ethical Conduct that outlines disclosure requirements for family members of elected officials, lobbyists, and entities contracting with the county. There was minimal discussion and Comm. Gorman stated this was an issue of transparency in government and that Cook County could be a leader in this area. It was approved.

The Zoning and Building Committee meeting lasted for 30 minutes - the longest meeting Comm. Moreno said he had seen in 30 years. The issue being discussed was 2 amendments to the Cook County Zoning Ordinance introduced by Comm. Murphy concerning parking of commercial vehicles, trailers, recreational vehicles, and boats in residential districts. Comm. Murphy stated that the amendments were intended to alleviate restrictions on these vehicles in residential areas in unincorporated Cook County and the amendment was written so that Townships could chose whether to utilize the amendment or not. Both amendments were passed but Comm. Goslin pointed out that the 4 commissioners voting against the amendment (Gorman, Goslin, Peraica, Schneider) represented 95% of unincorporated Cook County.

The meeting was adjourned at 1:30pm.

Cynthia Schilsky
LWVCC Observer

Cook County Forest Preserve Board Meeting September 2, 2009

Prayers and the pledge opened this meeting at 10:45am.

Forest Preserve Police Chief Richard Waszak updated the commissioners on the new certified bicycle police that are now monitoring the trails and picnic areas. The Chief also gave a special commendation to an officer who managed to release the seatbelt of an unfortunate man who landed in a lake in his auto.

Benjamin Cox, Executive Director of the Friends of the Forest Preserve, introduced several young people who participated in the Chicago Conservation Leadership Corp. The students worked at 5 Forest Preserve sites, learning and practicing land management.

A spokesperson for the Chicago Botanic Gardens gave an informative presentation of the Garden's work with young men being held at the Cook County Boot Camp. These men ages 17-35 are planting, harvesting and eating vegetables they are now learning to grow on the grounds of the Boot Camp. Many have an interest in continuing the practice on their release. This program is also partnered with the Illinois Department of Commerce and Employment Opportunity (DCEO).

A two line request for a "peer audit" for the years 2002 – 2004 ended in a no vote after 40 minutes of discussion.

--Submitted by Observer Mary Ann Tate

Sales Tax Remains!

The September 1 Cook County Board meeting commenced with an invocation by Cardinal George, Archbishop of Chicago, the Pledge of Allegiance, and a moving tribute to recently-deceased Senator Ted Kennedy. The Board recognized eleven-year-old Adonis Bell for saving his family from a fire in the middle of the night.

Mr. William Foley, the recently-named CEO of the Health and Hospitals Systems (HHS), presented a report on the progress of the hospital's attempts to reduce their budget. A $74-million reduction in the budget has already been attained. Mr. Foley provided the dates for public hearings, to take place in September at various hospitals throughout Chicago. He characterized the county's new direction in health care as seeking partnerships with other health facilities and medical organizations to ease the financial burden of Cook County's massive health system.

After Mr. Foley's address to the Board, President Stroger introduced Edwin Reyes, the newly appointed 8th District Commissioner, filling the seat from which Commisssioner Maldonado recently resigned.

Commissioner Beavers introduced a motion that the Head of Ethics address the Board about potential conflicts of interest regarding commissioners' use of the sales tax to advance their own political clout. He warned the commissioners of potential ethical charges that may be filed, due to such conflicts of interest. The motion failed.

Commissioner Daley, concerned about the whereabouts of the budgets of various county groups, introduced a motion for Takashi Reinbold, Budget Director, to report on the status of departmental budgets. President Stroger requested such information some time ago. Mr. Reinbold reported that many 2010 budgets still must be submitted.

The commissioners each stated their current position on the veto of the tax rollback, after which a vote was taken to either support or reject President Stroger's veto of the tax rollback. President Stroger's veto was sustained so that the entired 1.75 per cent of the Cook County sales tax remains in effect. William Beavers, Jerry Butler, Joseph Mario Moreno, and Deborah Sims voted to sustain the veto.