This meeting was relatively uneventful with lots of time being taken by giving kudos and good-byes to the departing Superintendent Bylina and his Assistant Superintendent. There seems to be consensus that these two helped move the Forest Preserve district in the right direction of being responsive to the public interest and improving professionalism in the District.
President Preckwinkle ran a fairly efficient meeting, and started on time, which often did not happen under President Stroger.
The only noteworthy piece of business was when Commissioner Gorman moved emphatically to have an easement in Orland Park ok'd and then Commissioner Suffredin spoke during discussion to point out that a public hearing had never been held. In order to conform with the Land Management Policy adopted by the district, it is necessary to have a public hearing even if the Commissioners generally agree that the negotiation was a good one. It was a procedural question that has important precedent for how business will be conducted in this administration and President Preckwinkle supported the move to follow the Land Management Policy. When Commissioner Murphy offered to hold the hearing quickly but questions were raised about whether a quorum could be reached on the South Side in the near term (holiday season), the Board President stated that it is the job of Commissioners to attend these hearings and they need to show up. If all goes as planned, the Orland Park motion can come up again at the January meeting with no more questions.
After the meeting, President Preckwinkle hosted a press conference out in the hall and announced the appointment of the new CCFP Superintendent, Arnold Randall, and new Assistant Superintendent, Mary Laraia. They all took questions. Because Randall has a strong background in Park District administration, it was requested that President Preckwinkle speak to the fundamental differences between a Forest Preserve and a Park District. She cited her husband, a science teacher, in her response, saying that she and her administration understand that the Forest Preserve has part of its mission to be Conservation, as well as Recreation, and that she intends to honor both aspects of the mission. She and Randall intend to focus on improving public involvement and outreach in there future work.
Sunday, December 19, 2010
Saturday, December 18, 2010
Health and Hospital Systems Board Meeting
December 17, 2010
The meeting was called to order shortly after 7:30am by Chairman Batts. Only 1 public speaker before the Board got to the business of Committee Reports.
Finance Committee
A contract with Hektoen Institute of Medicine was included for approval. Hektoen oversees research grants within the system and the Board had determined that an agreement between Hektoen and HHS was needed to establish control over the grant monies involved. While it was reported that Hektoen was not satisfied with the contract Director Carvalho, Finance Committee Chair, asked for approval anyway stating that “change is hard.”
The Board had questions about the loss of medicaide revenue as reported in the Financial Statements for September and October – a total of $55m for the year to date. Mr. Ayres, the CFO, stated that he could do some analysis but he had no hypothesis as to why there was a decrease. Mr Foley, CEO for the system, stated that a major issue was the back log at the state in processing of medicaide applications for eligibility. He said they were trying to get an agreement wherein the County would provide funds for processing of eligibility that would presumably result in a net gain of funds if more applicants were found eligible. Further discussion revealed that this fall off in medicaide revenue is not being seen at other hospitals and that there may be other reasons for why the System is experiencing this decrease in medicaide revenue. There was also a reported decrease in patient hospital days which resulted in a discussion of whether the financial reports reflect actual patient days in the hospital or billed hospital days. There seemed to be confusion over the way that patient days are recorded in the financial reports and the confusion did not appear to be resolved.
Audit and Compliance Committee
It was reported that the committee is anxious to get started on the audit of Hektoen.
Chairman’s Report
Mr. Batts received a letter from the leadership of SEIU. They had done a budget analysis of the HHS proposed budget and sent their budget recommendations to the Board and also included suggestions for geographic representation of membership on the HHS Board, a labor/management partnership, and a Safety Net Summit. A response letter from the Chairman was presented seeking Board support. A discussion among the Board members ensued in which they discussed the new administration’s request that they spend only 21% of their 2011 budget request in the first quarter of the fiscal year. The CFO reported that the spending as of the end of 2010 was consistent with this request if they continued in the same pattern. Mr. Foley stated that reductions in spending may be less challenging as the year progresses when parts of Provident and Oak Forest are closed later in the year. It was also pointed out that more revenue is needed in the next few years to get the Strategic Plan moving forward and if that doesn’t happen this Independent Board will be perceived as doing the same old thing. Other directors pointed out that it was necessary to hear what different constituencies were saying and to get the community to work with them, although it was also pointed out that sometimes the community that claims they haven’t been heard is saying “you didn’t do what we wanted you to do”. Another opinion expressed was that you can do all the communicating you want but if you don’t deliver service it won’t make any difference.
Systems Operational Plan Update
A presentation was given by Dr. Schrader from the Emergency Dept. and a representative from Price Waterhouse on Simulation Modeling that has been done in the Emergency Room. Monitoring of all processes in the ER from when a patient walks in to when they are discharged from the ER was done during a 2 week period in October. Analysis was done to determine where processes could be expedited and some changes have already been instituted to decrease wait times and to expedite the time for tests so the patients can be moved through the ER in a more efficient manner. The big obstacle continues to be bed availability for patients that need to be admitted. Mr. Foley said that issue was being addressed in a different way.
Employee Engagement Survey
A system wide Employee Engagement Survey will be done in January. Such a survey has not been done recently and it will provide a baseline for further evaluation of employee satisfaction. It is being conducted by the survey arm of Price Waterhouse Coopers. The computerized survey has 50 questions and will take 20-30 minutes to complete, and participation is not required but strongly encouraged. The survey process will begin on January 12 and run for 10 days, with the hope of presenting the aggregate data results to the Board by March. Training will also be provided to managers so that they can utilize data gleaned to develop departmental goals which are in line with the Strategic Plan 2015 Vision.
HHS System Compensation Review
Mr. Foley stated that there has been a heightened level of concern regarding compensation levels within the HHS. The CC Board approved an ordinance requesting the County Auditor do an audit of the appropriateness of compensation packages in HHS. The President’s office will outline the scope of the audit. They have requested that it include comparisons to other large public hospitals. The CC Board wants this completed by Jan. 19 so they will have the information prior to their consideration of the budget. It was pointed out that comparisons have been done based on similar positions in the Chicago area and not on similar hospitals in other locations. This is consistent with comparisons for other personnel salaries that are also based on location (Chicago) and not type of institution (public hospitals in other cities). The scope remains to be determined, and it is not clear what the President and the CC Board will do with the information once they have it.
Observer left at 9:15am and board was still meeting with 1 remaining item on agenda before going into closed session.
Cynthia Schilsky
LWVCC Observer
The meeting was called to order shortly after 7:30am by Chairman Batts. Only 1 public speaker before the Board got to the business of Committee Reports.
Finance Committee
A contract with Hektoen Institute of Medicine was included for approval. Hektoen oversees research grants within the system and the Board had determined that an agreement between Hektoen and HHS was needed to establish control over the grant monies involved. While it was reported that Hektoen was not satisfied with the contract Director Carvalho, Finance Committee Chair, asked for approval anyway stating that “change is hard.”
The Board had questions about the loss of medicaide revenue as reported in the Financial Statements for September and October – a total of $55m for the year to date. Mr. Ayres, the CFO, stated that he could do some analysis but he had no hypothesis as to why there was a decrease. Mr Foley, CEO for the system, stated that a major issue was the back log at the state in processing of medicaide applications for eligibility. He said they were trying to get an agreement wherein the County would provide funds for processing of eligibility that would presumably result in a net gain of funds if more applicants were found eligible. Further discussion revealed that this fall off in medicaide revenue is not being seen at other hospitals and that there may be other reasons for why the System is experiencing this decrease in medicaide revenue. There was also a reported decrease in patient hospital days which resulted in a discussion of whether the financial reports reflect actual patient days in the hospital or billed hospital days. There seemed to be confusion over the way that patient days are recorded in the financial reports and the confusion did not appear to be resolved.
Audit and Compliance Committee
It was reported that the committee is anxious to get started on the audit of Hektoen.
Chairman’s Report
Mr. Batts received a letter from the leadership of SEIU. They had done a budget analysis of the HHS proposed budget and sent their budget recommendations to the Board and also included suggestions for geographic representation of membership on the HHS Board, a labor/management partnership, and a Safety Net Summit. A response letter from the Chairman was presented seeking Board support. A discussion among the Board members ensued in which they discussed the new administration’s request that they spend only 21% of their 2011 budget request in the first quarter of the fiscal year. The CFO reported that the spending as of the end of 2010 was consistent with this request if they continued in the same pattern. Mr. Foley stated that reductions in spending may be less challenging as the year progresses when parts of Provident and Oak Forest are closed later in the year. It was also pointed out that more revenue is needed in the next few years to get the Strategic Plan moving forward and if that doesn’t happen this Independent Board will be perceived as doing the same old thing. Other directors pointed out that it was necessary to hear what different constituencies were saying and to get the community to work with them, although it was also pointed out that sometimes the community that claims they haven’t been heard is saying “you didn’t do what we wanted you to do”. Another opinion expressed was that you can do all the communicating you want but if you don’t deliver service it won’t make any difference.
Systems Operational Plan Update
A presentation was given by Dr. Schrader from the Emergency Dept. and a representative from Price Waterhouse on Simulation Modeling that has been done in the Emergency Room. Monitoring of all processes in the ER from when a patient walks in to when they are discharged from the ER was done during a 2 week period in October. Analysis was done to determine where processes could be expedited and some changes have already been instituted to decrease wait times and to expedite the time for tests so the patients can be moved through the ER in a more efficient manner. The big obstacle continues to be bed availability for patients that need to be admitted. Mr. Foley said that issue was being addressed in a different way.
Employee Engagement Survey
A system wide Employee Engagement Survey will be done in January. Such a survey has not been done recently and it will provide a baseline for further evaluation of employee satisfaction. It is being conducted by the survey arm of Price Waterhouse Coopers. The computerized survey has 50 questions and will take 20-30 minutes to complete, and participation is not required but strongly encouraged. The survey process will begin on January 12 and run for 10 days, with the hope of presenting the aggregate data results to the Board by March. Training will also be provided to managers so that they can utilize data gleaned to develop departmental goals which are in line with the Strategic Plan 2015 Vision.
HHS System Compensation Review
Mr. Foley stated that there has been a heightened level of concern regarding compensation levels within the HHS. The CC Board approved an ordinance requesting the County Auditor do an audit of the appropriateness of compensation packages in HHS. The President’s office will outline the scope of the audit. They have requested that it include comparisons to other large public hospitals. The CC Board wants this completed by Jan. 19 so they will have the information prior to their consideration of the budget. It was pointed out that comparisons have been done based on similar positions in the Chicago area and not on similar hospitals in other locations. This is consistent with comparisons for other personnel salaries that are also based on location (Chicago) and not type of institution (public hospitals in other cities). The scope remains to be determined, and it is not clear what the President and the CC Board will do with the information once they have it.
Observer left at 9:15am and board was still meeting with 1 remaining item on agenda before going into closed session.
Cynthia Schilsky
LWVCC Observer
Tuesday, December 14, 2010
Preckwinkle Runs First Board Meeting December 14, 2010
Today being the first board meeting of the new Preckwinkle administration, there were lots of changes: new calendar, new seating arrangements, new rules and procedures, new committee assignments, and a very speedy meeting. Done before noon! New commissioners Tobolski, Garcia, and Fritchey tried to keep up with the fast pace of approving resolutions, ordinances, contracts, expenses; audience members were madly flipping agenda pages to follow along.
Some major expenditures included more pass-through grant money from the federal government to Project Shield, which is part of Homeland Security. The Johnson Controls contract was extended for another year, which brings the total expenditures to $25, 884,644.00 since 2008. This controversial project is in the last of three stages--now concerning inter-operable mobile, video, and data network system for first responders throughout the county.
Concerns by Comm. Gainer, Beavers and others about pay raises and salary adjustments for administrators at the Health and Hospital System (HHS) delayed their approval. Human Resources Dept. head Sova was asked to provide a written rationale and Auditor Berman will do a review of salaries at HHS once she is given the scope and number of employees to be reviewed. This will be determined by Pres. Preckwinkle's office.
Numerous departments requested vehicle purchases. These were referred to committee where some type of centralization of fleet management can be considered. Pres. Preckwinkle and Comm. Gorman were both concerned that vehicles be purchased in or near Cook County and that purchases be consolidated. This is intended to reduce costs and unnecessary duplication.
There was some concern by Comm. Gainer and Collins regarding foreclosure legal aid and mediation help. They asked for a report on how many Cook County people were actually helped, and in which way, by the $241, 000.00 fund delegated for this purpose.
Pres. Preckwinkle declared a moratorium on Capital Improvements projects and expenditures (except for health and safety) until they can be evaluated.
Retiring Chief Administrative Officer Mark Kilgallen was praised for his 29 years with the county. He will be replaced by CAO Robin Kelly in the Preckwinkle administration.
Tuesday, November 16, 2010
Cook County Health & Hospitals System Board Meeting October 28, 2010
Stroger Hospital, 5th floor Conference Room, 7:30 am
Board and Committee Reports
Finance Committee reported on the operating budget submitted to the County for public hearings. It requests appropriations of $817 million (a reduction from 2010 of about $48 million). Based on the revenue and expense projections, the required subsidy from Cook County would be approximately $217 million (almost 30% less than in 2010). The Board position has been to seek a cut in subsidy rather than across the total appropriation. The reduction will result in a loss of services of approximately 1000 Full Time Equivalent (FTE) positions. The budget process is anticipated to last until February.
Meanwhile, the CCHHS intends to proceed with implementation of its Strategic Plan.
Audit and Compliance Committee noted several policy revisions in process, notably the gift policy. Many departments are involved. Resolution is expected by December.
Quality and Patient Safety Committee reported on several services. With no in-patient psychiatric services at Stroger, the ER is inundated with cases. Obstetrics (OB) services at Provident have been suspended. Other improvements were noted with recognition that quality depends on staffing.
Resolutions were passed celebrating the 100th anniversary of Oak Forest Hospital and the 50th anniversary of Provident Hospital's Women's Auxiliary Board.
CEO Foley reported on progress on Leadership Goals. Under performance improvements, the Knowledge Web on the Internet has established a webpage for each department for internal use. Among operational improvements, lab consolidation has occurred, bringing testing from the clinics to Stroger, with anticipated savings of $5 million over 3 years, as well as more efficiency. Nursing professional development has streamlined 20 affiliation agreements to 10 at all levels, with better schedule monitoring and ability to assess competency.
The Strategic Plan proceeds with 14 teams addressing 350 tasks. The Cook County Ambulatory and Community Health Network (ACHN) team will address computer needs, regional outpatient services at Oak Forest and Provident, and potential expansion of Cicero and Palatine clinics. The consultant, Fantus, is involved in program planning for a new facility which involves County Capital Planning and Requests For Proposals with a target of Certificate Of Need (CON) approval in 2012 and construction in 2014.
The Oak Forest team has a March deadline for CON approval of a closure of inpatient beds in May, with inherent marketing and communications needs. They will also address an expansion of Building E to regional outpatient and specialty services, the development of ER to Urgent Care, and meetings with local hospitals.
The Provident team will address the downsizing of inpatient beds and suspended OB services, along with inherent communications needs, ER transition, the relationship with University of Chicago and collaboration with Federally Qualified Health Centers (FQHC) for primary care.
Overall goals continue: Access (which addresses barriers regarding phone, referral, and staff development), Quality, Service Excellence, and Cultural Competency. Specialized areas will continue to be examined, including ER/Trauma, Urgent Care, Maternal/child, Perioperative, Stroger capacity/length of stay, Staff development and training, and Staff satisfaction.
The meeting adjourned at 9:45 am. The next meeting will be on November 19 at 7:30 am.
--Submitted by Nancy Staunton, Observer
Board and Committee Reports
Finance Committee reported on the operating budget submitted to the County for public hearings. It requests appropriations of $817 million (a reduction from 2010 of about $48 million). Based on the revenue and expense projections, the required subsidy from Cook County would be approximately $217 million (almost 30% less than in 2010). The Board position has been to seek a cut in subsidy rather than across the total appropriation. The reduction will result in a loss of services of approximately 1000 Full Time Equivalent (FTE) positions. The budget process is anticipated to last until February.
Meanwhile, the CCHHS intends to proceed with implementation of its Strategic Plan.
Audit and Compliance Committee noted several policy revisions in process, notably the gift policy. Many departments are involved. Resolution is expected by December.
Quality and Patient Safety Committee reported on several services. With no in-patient psychiatric services at Stroger, the ER is inundated with cases. Obstetrics (OB) services at Provident have been suspended. Other improvements were noted with recognition that quality depends on staffing.
Resolutions were passed celebrating the 100th anniversary of Oak Forest Hospital and the 50th anniversary of Provident Hospital's Women's Auxiliary Board.
CEO Foley reported on progress on Leadership Goals. Under performance improvements, the Knowledge Web on the Internet has established a webpage for each department for internal use. Among operational improvements, lab consolidation has occurred, bringing testing from the clinics to Stroger, with anticipated savings of $5 million over 3 years, as well as more efficiency. Nursing professional development has streamlined 20 affiliation agreements to 10 at all levels, with better schedule monitoring and ability to assess competency.
The Strategic Plan proceeds with 14 teams addressing 350 tasks. The Cook County Ambulatory and Community Health Network (ACHN) team will address computer needs, regional outpatient services at Oak Forest and Provident, and potential expansion of Cicero and Palatine clinics. The consultant, Fantus, is involved in program planning for a new facility which involves County Capital Planning and Requests For Proposals with a target of Certificate Of Need (CON) approval in 2012 and construction in 2014.
The Oak Forest team has a March deadline for CON approval of a closure of inpatient beds in May, with inherent marketing and communications needs. They will also address an expansion of Building E to regional outpatient and specialty services, the development of ER to Urgent Care, and meetings with local hospitals.
The Provident team will address the downsizing of inpatient beds and suspended OB services, along with inherent communications needs, ER transition, the relationship with University of Chicago and collaboration with Federally Qualified Health Centers (FQHC) for primary care.
Overall goals continue: Access (which addresses barriers regarding phone, referral, and staff development), Quality, Service Excellence, and Cultural Competency. Specialized areas will continue to be examined, including ER/Trauma, Urgent Care, Maternal/child, Perioperative, Stroger capacity/length of stay, Staff development and training, and Staff satisfaction.
The meeting adjourned at 9:45 am. The next meeting will be on November 19 at 7:30 am.
--Submitted by Nancy Staunton, Observer
Thursday, November 4, 2010
Cook County Board Meeting --November 3, 2010
BUDGET REPORTS BEGIN
Starting the meeting were budget reports from the three transit agencies that receive some funding from Cook County or have board members appointed by Cook County Board. The audience did not have access to the actual budget numbers.
Terry Peterson, chair of the CTA Board stated there would be no fare increases and no service reductions for 2011 and that the budget was lower than in 2008. His concern was that the state of Illinois is late on payments to the CTA. The inspector general office of the CTA costs about $2 million per year, but is considered a good example for transportation oversight. In the future, the CTA and other transportation agencies would like to get away from fare cards and instead have customers use credit or debit cards.
Jim Dodge of the Metra Board presented a $1 billion balanced budget. They will need to move money from capital funds to operating funds this year. There was a concern that lower sales taxes and late funding from the state would impact the operations. There will be no fare increases in 2011 and there will be electric line improvements this year. Dodge stated the Metra Board is "resetting" after the scandals of administration payment irregularities. There is some concern over the type of inspector general office needed for Metra. Commissioner
Suffredin questioned Metra's plans regarding the replacement of 22 bridges and the ensuing disruption for North Shore riders. Dodge indicated the project will be re-planned to possibly cost less and cause less disruption.
PACE also indicated no fare increases or service reductions , but services cannot be expanded at this time. Ridership is down, probably due to higher unemployment. New buses will be hybrids and be smaller, since many buses are now half-empty. ADA (Americans with Disabilities Act) compliance is a large portion of the budget.
The RTA, which is the overriding agency of CTA, METRA, and PACE had concerns about the $300 million that the state of Illinois is behind in paying these agencies. All boards are having to dip into capital funds for operations. Commissioner Peraica expressed concern that the agencies have an alternate budget ready in case the state doesn't come through with the money. He also stated that employee pensions, salary, etc. will doom these transportation agencies.
During the Finance meeting, the revenue report for the last 10 months was presented by the Comptroller, Connie Kravitz. Revenues are currently ahead of budget projections by $4.7 million. However, by the end of the fiscal year it will come out even. Concern was shown about the reduction in sales tax rate, which began July 1st, and that the Health System is still behind in its collections. The county is also receiving more money due to increased foreclosures (fees) and late property tax payment penalties. The next (late) property tax bill will be mailed the week of Nov. 13th and will be due Dec. 15th.
The Board then went into executive session to discuss a lawsuit and this League member left. I missed the discussion on unemployment benefits for recently arrested staff member, Carla Oglesby.
Wednesday, October 20, 2010
Cook County Board Meeting October 19, 2010
The meeting of the Cook County Board was called to order about 10:20 a.m.
After passing a Resolution commemorating the achievements of the "Queen of Gospel" Albertina Walker and another Resolution recognizing and expressing Cook County's gratitude to their Sister County Partner of Cork for providing 8 boys of Mercy Home the opportunity to visit Ireland, the FINANCE COMMITTEE meeting convened.
After approving several routine items, a proposed ordinance amending the Ethics Code was introduced by Commissioner Anthony J. Peraica. The heatedly discussed ordinance amendment was a proposal to amend Chapter 2 Administration, Sections 2-570, 2-580. 2-581 and 2-585 of the Cook County Code of Ethics. The proposal would "prohibit elected officials from lobbying other elected officials". The proposal was defeated by a vote of 13 nays to two (2) yeas which were cast by Commissioners Beavers and Peraica. Among the reasons for the opposition was the concern that the proposed language would have voided ethics legislation recently passed dealing with pay to play, other inconsistencies in the language and complaints that the proposal actually targeted specific individuals.
Following this decision by the Finance Committee, the Commissioners went into executive session to discuss an Interest Arbitration Award Decision concerning AFSCME Council 31 (representing the County Police Officers, County Police Sergeants, Correctional Sergeants and Correctional Lieutenants) which involved pay raises covering these employees which would be effective from December 1, 2008 through June 1, 2012.
What was anticipated to be no more than a 30 minutes closed session lasted an hour and a half. Upon reconvening and having open discussion about approving this compulsory Interest arbitration award or taking the decision to court, the Commissioners voted twelve (12) to one (1), with Commissioner Peraica voting no, to accept the award.
INTEREST ARBITRATION AWARD PROVISIONS:
Effective December 1, 2008 (2.00%) $1,247,374
Effective December 1, 2009 (1.50%) $2,201,615
Effective December 1, 2010 (2.00%) $3,493.021
Effective December 1, 2011 (2.00%) $2,405.127
Effective June 1, 2012 (1.00%) $2,741.022
TOTAL ESTIMATED 4 YEAR COST: $12,088,159
This decision concluded the Finance Committee meeting which was followed expeditiously by the Roads and Bridges and Zoning and Building Committee Reports.
The Cook County Commissioners meeting was adjourned at approximately 1:45 p.m.
--Submitted (with sincere appreciation for the guidance of President Cynthia Schilsky) by Observer Syvia Tillman
After passing a Resolution commemorating the achievements of the "Queen of Gospel" Albertina Walker and another Resolution recognizing and expressing Cook County's gratitude to their Sister County Partner of Cork for providing 8 boys of Mercy Home the opportunity to visit Ireland, the FINANCE COMMITTEE meeting convened.
After approving several routine items, a proposed ordinance amending the Ethics Code was introduced by Commissioner Anthony J. Peraica. The heatedly discussed ordinance amendment was a proposal to amend Chapter 2 Administration, Sections 2-570, 2-580. 2-581 and 2-585 of the Cook County Code of Ethics. The proposal would "prohibit elected officials from lobbying other elected officials". The proposal was defeated by a vote of 13 nays to two (2) yeas which were cast by Commissioners Beavers and Peraica. Among the reasons for the opposition was the concern that the proposed language would have voided ethics legislation recently passed dealing with pay to play, other inconsistencies in the language and complaints that the proposal actually targeted specific individuals.
Following this decision by the Finance Committee, the Commissioners went into executive session to discuss an Interest Arbitration Award Decision concerning AFSCME Council 31 (representing the County Police Officers, County Police Sergeants, Correctional Sergeants and Correctional Lieutenants) which involved pay raises covering these employees which would be effective from December 1, 2008 through June 1, 2012.
What was anticipated to be no more than a 30 minutes closed session lasted an hour and a half. Upon reconvening and having open discussion about approving this compulsory Interest arbitration award or taking the decision to court, the Commissioners voted twelve (12) to one (1), with Commissioner Peraica voting no, to accept the award.
INTEREST ARBITRATION AWARD PROVISIONS:
Effective December 1, 2008 (2.00%) $1,247,374
Effective December 1, 2009 (1.50%) $2,201,615
Effective December 1, 2010 (2.00%) $3,493.021
Effective December 1, 2011 (2.00%) $2,405.127
Effective June 1, 2012 (1.00%) $2,741.022
TOTAL ESTIMATED 4 YEAR COST: $12,088,159
This decision concluded the Finance Committee meeting which was followed expeditiously by the Roads and Bridges and Zoning and Building Committee Reports.
The Cook County Commissioners meeting was adjourned at approximately 1:45 p.m.
--Submitted (with sincere appreciation for the guidance of President Cynthia Schilsky) by Observer Syvia Tillman
Thursday, October 14, 2010
October 6 Forest Preserve District Meeting
The short congenial meeting started at 10:30 with 3 absent.
There was considerable discussion about the payment of legal fees, regarding the Michael L. Shakman decree in the amount of $270.238.41. A roll call was requested and the question was asked of the County Atty. Dennis White, “what would happen if we refused to pay” The answer was the Judge would demand they pay. The payment was approved.
In the discussion regarding the money for the Forest Preserve to meet the obligation of this year, the CFO said that there is not a problem. Comm. Suffredin said that the plan for the property tax bills “at this time” are scheduled to be mailed Nov. 22nd and due by Dec. 22nd.
Alice Brandon, of Friends of the Forest Preserve, presented several paid interns that have worked and enjoyed the experience. She also said the Forest Preserve has had 10,000 volunteer hours.
Bikers and hikers will be pleased when the Cal-Sag Trail is completed and will connect to the
I & M Canal Trail in Lemont. The trail will be approximately 32 miles long.
The meeting was over by 11:30
A special meeting was called, and Pres. Todd Stroger made a very complimentary speech regarding the successes of the Forest Preserve before presenting the next budget, which was received and filed.
Mary Ann Tate
October 6, 2010
There was considerable discussion about the payment of legal fees, regarding the Michael L. Shakman decree in the amount of $270.238.41. A roll call was requested and the question was asked of the County Atty. Dennis White, “what would happen if we refused to pay” The answer was the Judge would demand they pay. The payment was approved.
In the discussion regarding the money for the Forest Preserve to meet the obligation of this year, the CFO said that there is not a problem. Comm. Suffredin said that the plan for the property tax bills “at this time” are scheduled to be mailed Nov. 22nd and due by Dec. 22nd.
Alice Brandon, of Friends of the Forest Preserve, presented several paid interns that have worked and enjoyed the experience. She also said the Forest Preserve has had 10,000 volunteer hours.
Bikers and hikers will be pleased when the Cal-Sag Trail is completed and will connect to the
I & M Canal Trail in Lemont. The trail will be approximately 32 miles long.
The meeting was over by 11:30
A special meeting was called, and Pres. Todd Stroger made a very complimentary speech regarding the successes of the Forest Preserve before presenting the next budget, which was received and filed.
Mary Ann Tate
October 6, 2010
Sunday, October 10, 2010
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In keeping with the spirit of the League of Women Voters, please be civil. The comments will be monitored, and should any violate general League guidelines (in our estimation), a statement may be edited or deleted.
In keeping with the spirit of the League of Women Voters, please be civil. The comments will be monitored, and should any violate general League guidelines (in our estimation), a statement may be edited or deleted.
Monday, October 4, 2010
CC Health & Hospitals System Board Meeting Sept. 30, 2010
7:30 am, Stroger Hospital 5th floor conference room
The Finance Committee Minutes noted a projected shortfall in revenue partly due to delays in State of Illinois payments for Medicaid patients. Illinois' proposed move to an HMO model for Medicaid reimbursement threatens to undermine a previously established "special" relationship that the County had enjoyed.
HHS also has an issue with the Cook County Board regarding an across-the-board reduction in appropriations that does not recognize the revenues generated by HHS. They seek a reduction in subsidy rather than in total appropriations. A communiqué from the Office of the County Board's President identifies an 11% reduction. HHS questions whether dialog should be with the President or the Board of Commissioners who established HHS.
CCHHS Financial Statements and Audit Management Letter were discussed. The latter identified errors but shows improvement.
The HHS Budget for 2011 will go to the Finance Committee for discussion.
The Board Education presentation was devoted to National Healthcare Reform. Many questions remain unanswered, e.g., about Exchanges, Waivers, Partnerships. Rules are in process.
Implementation of the HHS Strategic Plan will be discussed at the October meeting with timetables for various stages. Meanwhile, necessary steps are underway for Certificate of Need (ON) approval for the closure of in-patient beds at Oak Forest Hospital and the suspension of Obstetrics at Provident Hospital as of October.
Discussion with University of Chicago regarding Provident Hospital continues.
Work-force rebalancing and staff reductions of 400 FTEs are underway. Unions have been notified.
Several management initiatives are underway. One addresses long wait lines at Fantus Clinic. The Website is being redesigned to be more consumer friendly. The General Medical Clinic has implemented changes in its internal reporting structure that has improved outcomes regarding access and patient satisfaction.
The meeting adjourned at 9:30 am.
--Submitted by Nancy Staunton, Observer
Saturday, September 25, 2010
Cook County Board Meeting - September 15, 2010
The Board meeting was preceeded by a meeting of the Law Enforcement Committee chaired by Comm. Gainer. Judge Kinnaird from the Chancery Division of the Courts provided an update on the Mortgage Foreclosure Program that was initiated by the Chief Judge several months ago. This update had been requested by the Board. Judge Kinnaird stated that the program was instituted in response to the dramatic increase in foreclosures seen in the courts within the last few years. The program provides certified counselors for mediation when requested in foreclosure cases. Outreach is done for those cases coming into the court and they have received 12,000 calls to their hotline with 3,000 coming in for assistance. 412 cases have resulted in mediation with attorneys being appointed. Calls go to a hotline run by IHDA and persons are referred to a counselor who can see them at the court building or meet with them off site and then they may be referred to an attorney if legal services are in order. Lawyers from Chicago Volunteer Legal Services are used. Judge Kinnaird said that she anticipated they would spend $2.85m by the end of the year for running the program. The Commissioners wanted to know how many people had actually been saved from foreclosure. Judge Kinneard stated statistics would be provided later.
The Cook County Board Meeting follwed and was called to order at 10:18am by President Stroger. All commissioners were present. The first hour of the meeting was spent paying tribute to Congressman Dan Rostenkowski and to Ms. Terrie McDermott who will soon be retiring as Execuitve Director of the Department of Womens Justice Services, an appointed position within the Sheriff's Office.
The Finance Committee was called to order by Comm. Daley at 11:20am. They decided to first consider a Resolution Calling on the General Assembly to Remove the Unnecessary Provision that Require Seniors to Reapply for the Senior Citizens Homeowners Exemption Each Year. Representative John Bradley, the Chairman of the Revenue Committee for the Illinois House of Representatives was introduced to answer questions about the recently passed state legislation that requires all counties with more than 3,000,000 people to require yearly renewal of the Senior Citizens Homeowner's Exemption by mail. In the ensuing interchange between the Commissioners and Rep. Bradley there was discussion of why Cook County had been singled out since it is the only county of that size in Illinois, and why it was problematic that the Cook County Assessor had chosen to change the yearly renewal process, with references being made to home rule powers and unfunded mandates.
Assessor Houlihan was then asked to make a statement. He stated that a discussion prior to the decision would have been more appropriate and that the legislature has no understanding of Cook County's process. Yearly renewal will put an unnecessary burden on the seniors and the cross reference system he has in place no longer requires a yearly mailing for verification. Rep. Bradley felt that he was being unnecessarily attacked and he said the discussion was becoming "political" which resulted in Comm. Daley intervening to keep the conversation focused on the issue at hand in an effort to see what kind of compromise could be worked out. The Assessor then reviewed the 3 year program he began a few years ago where booklets were mailed to everyone explaining all the possible exemptions and requiring a response and then mailed again the following year. Now he matches sales data from the Recorder of Deeds and sends out cards to those addresses to establish if an exemption is still in effect. More discussion followed that established that the state law would have to be changed to change the policy. While it was thought that perhaps compromise was possible a vote was taken on the resolution. The resolution was approved.
Commissioners Sims, Steel, Collins, Murphy, Beavers and Peraica are now voting no on most all payments to the Shakman Compliance Administrators. Their stated reasons are that the county needs to be in compliance and paying the administrators is wasting money that should be spent in other ways.
The Workmen's Compensation bills again brought response from several of the commissioners questioning why compensation should be paid in some of the cases - for example, when people fall off broken chairs. Comm. Steele stated that dealing with these cases needs to be contracted out since the cases are out of control. Lisa Walik from the Dept. of Risk Management stated that state law is very liberal in settling workmens compensation claims and they do work with a contractor who does analysis on claims and works with claimants in getting them back to work.
The Revenue Report for 8 months was presented by the Comptroller. She stated that revenues are short $11m of expected revenue for the time period and that expenditures are about 65% of an expected 67%. October will see the first evidence of the Sales Tax reduction.
Comm. Gorman raised an issue about a bid that was denied to a lowest bidder because the company was from Arizona. She stated that saving the county $25,000 was more important than honoring the ordinance the board passed a few months ago to not do business with companies in Arizona. The Board expressed a desire to award the bid to the lowest bidder but the Purchasing Agent stated that since the contact was now over 90 days old the bid may no longer be valid. Bidders only guarantee their bid amounts for 90 days so they would have to go back to the bidders and see if their stated bids remained the same. A motion was then made to defer this contract. The roll call vote was 16 voting to defer with Comm. Claypool being absent for the vote.
The Finance Committee then adjourned for the Building and Zoning Comm. and the Roads and Bridges committee meetings which were very brief and the Board Meeting finally resumed at 1:10pm for the board agenda. The observer had to leave at this time.
The Cook County Board Meeting follwed and was called to order at 10:18am by President Stroger. All commissioners were present. The first hour of the meeting was spent paying tribute to Congressman Dan Rostenkowski and to Ms. Terrie McDermott who will soon be retiring as Execuitve Director of the Department of Womens Justice Services, an appointed position within the Sheriff's Office.
The Finance Committee was called to order by Comm. Daley at 11:20am. They decided to first consider a Resolution Calling on the General Assembly to Remove the Unnecessary Provision that Require Seniors to Reapply for the Senior Citizens Homeowners Exemption Each Year. Representative John Bradley, the Chairman of the Revenue Committee for the Illinois House of Representatives was introduced to answer questions about the recently passed state legislation that requires all counties with more than 3,000,000 people to require yearly renewal of the Senior Citizens Homeowner's Exemption by mail. In the ensuing interchange between the Commissioners and Rep. Bradley there was discussion of why Cook County had been singled out since it is the only county of that size in Illinois, and why it was problematic that the Cook County Assessor had chosen to change the yearly renewal process, with references being made to home rule powers and unfunded mandates.
Assessor Houlihan was then asked to make a statement. He stated that a discussion prior to the decision would have been more appropriate and that the legislature has no understanding of Cook County's process. Yearly renewal will put an unnecessary burden on the seniors and the cross reference system he has in place no longer requires a yearly mailing for verification. Rep. Bradley felt that he was being unnecessarily attacked and he said the discussion was becoming "political" which resulted in Comm. Daley intervening to keep the conversation focused on the issue at hand in an effort to see what kind of compromise could be worked out. The Assessor then reviewed the 3 year program he began a few years ago where booklets were mailed to everyone explaining all the possible exemptions and requiring a response and then mailed again the following year. Now he matches sales data from the Recorder of Deeds and sends out cards to those addresses to establish if an exemption is still in effect. More discussion followed that established that the state law would have to be changed to change the policy. While it was thought that perhaps compromise was possible a vote was taken on the resolution. The resolution was approved.
Commissioners Sims, Steel, Collins, Murphy, Beavers and Peraica are now voting no on most all payments to the Shakman Compliance Administrators. Their stated reasons are that the county needs to be in compliance and paying the administrators is wasting money that should be spent in other ways.
The Workmen's Compensation bills again brought response from several of the commissioners questioning why compensation should be paid in some of the cases - for example, when people fall off broken chairs. Comm. Steele stated that dealing with these cases needs to be contracted out since the cases are out of control. Lisa Walik from the Dept. of Risk Management stated that state law is very liberal in settling workmens compensation claims and they do work with a contractor who does analysis on claims and works with claimants in getting them back to work.
The Revenue Report for 8 months was presented by the Comptroller. She stated that revenues are short $11m of expected revenue for the time period and that expenditures are about 65% of an expected 67%. October will see the first evidence of the Sales Tax reduction.
Comm. Gorman raised an issue about a bid that was denied to a lowest bidder because the company was from Arizona. She stated that saving the county $25,000 was more important than honoring the ordinance the board passed a few months ago to not do business with companies in Arizona. The Board expressed a desire to award the bid to the lowest bidder but the Purchasing Agent stated that since the contact was now over 90 days old the bid may no longer be valid. Bidders only guarantee their bid amounts for 90 days so they would have to go back to the bidders and see if their stated bids remained the same. A motion was then made to defer this contract. The roll call vote was 16 voting to defer with Comm. Claypool being absent for the vote.
The Finance Committee then adjourned for the Building and Zoning Comm. and the Roads and Bridges committee meetings which were very brief and the Board Meeting finally resumed at 1:10pm for the board agenda. The observer had to leave at this time.
Friday, September 3, 2010
Cook County Board Meeting September 1--Concern about Costs
Numerous commissioners were concerned and vocal about containing costs during this meeting. They also seemed to question various department officials and representatives much more thoroughly than in the past.
Among the topics of concern was Workmen's Compensation. Comm. Schneider complained about the high costs for questionable injuries. Comms. Gainer, Steele and Schneider requested Lisa Walik, Dir. of Risk Management, to look into a revamping of the procedures of workmen's compensation settlements--perhaps as the city of Chicago has done.
The cost of incarcerating inmates at Cook County facilities was also mentioned. It costs $117.30 per detainee per day in Cook County and about half that cost to send detainees to other counties when Cook facilities are too full. Capacity at Cook County Jail is 9,838 and currently holds 9,548 inmates. More officers are being hired by the Sheriff's Dept. to address the high numbers and follow the Duran Court Decree. Comm. Gainer sponsored an ordinance (passed) to set a lower rate for health care reimbursement to health care facilities for inmates at the Cook County jail. This would now be at the Medicaid rate.
Comm. Peraica was concerned about the high costs of prosecuting and detaining drug abusers. He stated it was a systemic problem in the States Attorney and Sheriff's offices. There have been many civil rights lawsuits and judgments against the Sheriff's Dept. Comm. Gainer asked if there has been disciplining of the offending jail employees when this occurs. No clear answer was given by the Sheriff's representative.
Chief Financial Officer Jaye Williams gave a report on the budget process for 2011. She anticipates a $300 million shortfall due to the decreased rate in sales tax (which will be fully effective next year) and less money from patient fees at the Health and Hospital System (HHS). She will ask all agencies to reduce their budgets by 10% and evaluate overtime and professional development funds. In her revenue report, Comptroller Connie Kravitz stated there is a $16.8 million shortfall in collections of all revenue as of the first 7 months of the fiscal year. Collections of sales taxes were at a higher level than anticipated so far this year.
CFO Ayers of the HHS reported that Medicaid revenues were down, due to fewer Medicaid patients, the ending of federal DSH payments and possibly a change in the Medicaid formula. An exact explanation of why there are fewer Medicaid patients was not given. However, access to clinics and hospitals, lengthy admittance procedures and short (8am-4pm) hours were mentioned.
An ordinance was passed dealing with transition in the offices of the President and all other elected officials. One day after the November election, the newly elected officers shall have office space and all pertinent information, services and assistance to acquire a working knowledge of the budget, etc. before they take office December 1. It should be noted that an amendment to this ordinance was added late and the audience had no access to this. Only because one commissioner spoke about it, was this observer able to figure out the passed amendment.
A resolution calling on the General Assembly to remove the unnecessary provision that requires seniors in Cook County to reapply yearly for the senior citizen homeowner's tax exemption was passed.
This observer left the meeting, which was still ongoing, at 1:10pm.
Thursday, September 2, 2010
Cook County Forest Preserve Mtg Sep 2
The meeting started 1/2 hour late but there was good attendance.
After the Finance Committee met, the regular Board convened and covered many items, almost all congenial and positive issues.
One of the first orders of business was to hear from staff and selected students and teachers about the very successful outreach programs that the Forest Preserve initiated with elementary schools and high schools. Thirty one elementary and home school groups and 103 high schools have participated including thousands of students. The Forest Preserve has funds and interest in expanding this program which offers a chance for school participants to learn about the ecosystem and participate in activities which restore nature. In addition to these programs, schools can also contact the nature centers to request that naturalists come for presentations.
It was announced that Chicago magazine has recently named Busse Woods as the best fishing spot in the area, and that the North Branch Bike Trail was named as the Best Bike Trail in the area.
Commissioner Larry Suffredin presented a permit report for his district which showed more use this year and fewer complaints than ever with a 98% satisfaction rate. Other Commissioners requested permit information pertaining to their districts so they can do the same type of analysis.
Resolutions were passed allowing the Forest Preserve Commission to seek grants in tandem with other bodies in order to take advantage of possible federal dollars which are coming available. Most of these grants relate to extending bike trails.
Sep 5 is National Public Lands day and there will be many volunteers working in the Forest Preserves.
Former Alderman and Cook County Commissioner Frank D'Amato was celebrated and congratulated upon his retirement after 49 years of civil service. He has recently been a staff member at the CCFP.
A temporary easement resolution was passed so that the Army Corps of Engineers can access two older dams on the Des Plaines River for removal. Mayors of Westchester and Riverside spoke in support of this project. It is hoped that it will help a little bit with the flooding problems in that area if the river is allowed to run smoothly. It will also help restore the natural ecosystem and allow fish to move freely. Funding for this project had been previously blocked but now seems to be coming available -- from the state and federal level. No County funds are requested for this effort.
Next meeting will be on October 6.
After the Finance Committee met, the regular Board convened and covered many items, almost all congenial and positive issues.
One of the first orders of business was to hear from staff and selected students and teachers about the very successful outreach programs that the Forest Preserve initiated with elementary schools and high schools. Thirty one elementary and home school groups and 103 high schools have participated including thousands of students. The Forest Preserve has funds and interest in expanding this program which offers a chance for school participants to learn about the ecosystem and participate in activities which restore nature. In addition to these programs, schools can also contact the nature centers to request that naturalists come for presentations.
It was announced that Chicago magazine has recently named Busse Woods as the best fishing spot in the area, and that the North Branch Bike Trail was named as the Best Bike Trail in the area.
Commissioner Larry Suffredin presented a permit report for his district which showed more use this year and fewer complaints than ever with a 98% satisfaction rate. Other Commissioners requested permit information pertaining to their districts so they can do the same type of analysis.
Resolutions were passed allowing the Forest Preserve Commission to seek grants in tandem with other bodies in order to take advantage of possible federal dollars which are coming available. Most of these grants relate to extending bike trails.
Sep 5 is National Public Lands day and there will be many volunteers working in the Forest Preserves.
Former Alderman and Cook County Commissioner Frank D'Amato was celebrated and congratulated upon his retirement after 49 years of civil service. He has recently been a staff member at the CCFP.
A temporary easement resolution was passed so that the Army Corps of Engineers can access two older dams on the Des Plaines River for removal. Mayors of Westchester and Riverside spoke in support of this project. It is hoped that it will help a little bit with the flooding problems in that area if the river is allowed to run smoothly. It will also help restore the natural ecosystem and allow fish to move freely. Funding for this project had been previously blocked but now seems to be coming available -- from the state and federal level. No County funds are requested for this effort.
Next meeting will be on October 6.
Tuesday, August 3, 2010
Health & Hospital System--Annual Meeting
Cook County Health and Hospitals System Board Meeting July 29, 2010 7:30 a.m.
At this Annual Meeting the existing Officers and Committee Chairs were reelected with unanimous support. This begins the third year of their tenure.
Finance Committee report noted that patient numbers are down and Medicaid revenues are below budget, some of which is attributable to payments backed up at the State. The next Board meeting will address how to read financial statements vis a vis projections.
Illinois Hospital Assn. dues were discussed and it was decided that their services and the benefits of participation outweighed the cost ($165,000). A contract that supplies coders (critical to billing) was renewed for six months while the problem of filling positions on a long term basis is addressed. Coders are in demand, certification is required and salaries are low. Human Resources will be asked to address productivity.
Meeting dates for the coming year were approved and will be posted on the Website.
CEO Foley reported on a visit to Oak Forest to assess strategies for development into a Regional Outpatient Center. Needs include staffing (now at 3.5 vs national 4.6) and IT.
A long discussion reviewed the contract with ACS for implementation of a new billing system. $11.5 million of a $34 million contract have already been invested in the system.
The problem lies with interface with the County system. The County will not decide on which system it will use until September. The conclusion was to continue with ACS on a reduced level until September.
Representatives from the County conducted a training session on the County Ethics Ordinance. It is required of all employees. A second session and quiz will take place next month. Gifts and political activity were emphasized in this session.
The Chief Medical Officer of ACHN (clinics) reported on productivity, access problems, partnerships, computerization of lab results, and billing. Delays continue to occur for both primary care and specialty appointments. Attention will be directed at getting more mid-level providers (Nurse Practitioners and Physician Assistants).
Moved to Closed session at 10:30 a.m.
Nancy Staunton, Observer
Wednesday, July 21, 2010
Forest Preserve Commission of Cook County July 14 2010
The most important news discussed at the Forest Preserve Commmission was about upgrades on the ratings of the Forest Preserve District's $115 million in outstanding GO bonds. Both Standard and Poor's and Moody's have upgraded their ratings. One of the benefits of having separate budgets and administrations is that the Cook County Board's financial issues do not become the Forest Preserve District's issues. This has served the Forest Preserve District well up to now.
Another interesting development is the proposal of a "Sustainability Doctrine" which was referred to the Environmental Control Committee to be considered for adoption by the Board. This draft document is the culmination of a very important and successful conference sponsored by the Commission last year and held at the Brookfield Zoo. We will certainly hear more about this in the future.
Much of the meeting was taken up with the introduction and brief statements by interns from the many programs which the Chicago Botanic Garden manages over the summer for youth. Ranging from college-age scientists working at the CBG to Juvenile offenders with the Sheriff's Boot Camp program, the Forest Preserve District seems to be making many cost-effective contributions to the education and involvement in youth working to achieve the mission of protecting and promote nature and healthy lifestyles. The students were very positive and articulate in the appreciation for opportunities provided. It sounds like they work hard and interact well with the staff professionals who run these programs.
There was some discussion of a resolution to oppose the Entertainment
Tax that the Village of Brookfield proposed (but which is not in play at the moment). The Zoo and the District both feel that the Village benefits greatly by having the Zoo in its confines, and the the Zoo and District have been very good neighbors over the years. All the Commissioners supported the resolution to oppose the tax.
Another interesting development is the proposal of a "Sustainability Doctrine" which was referred to the Environmental Control Committee to be considered for adoption by the Board. This draft document is the culmination of a very important and successful conference sponsored by the Commission last year and held at the Brookfield Zoo. We will certainly hear more about this in the future.
Much of the meeting was taken up with the introduction and brief statements by interns from the many programs which the Chicago Botanic Garden manages over the summer for youth. Ranging from college-age scientists working at the CBG to Juvenile offenders with the Sheriff's Boot Camp program, the Forest Preserve District seems to be making many cost-effective contributions to the education and involvement in youth working to achieve the mission of protecting and promote nature and healthy lifestyles. The students were very positive and articulate in the appreciation for opportunities provided. It sounds like they work hard and interact well with the staff professionals who run these programs.
There was some discussion of a resolution to oppose the Entertainment
Tax that the Village of Brookfield proposed (but which is not in play at the moment). The Zoo and the District both feel that the Village benefits greatly by having the Zoo in its confines, and the the Zoo and District have been very good neighbors over the years. All the Commissioners supported the resolution to oppose the tax.
Tuesday, July 20, 2010
CC Board Health & Hospitals Committee, July 14, 2010 Meeting
The Health and Hospitals Committee of the Cook County Board of Commissioners met on July 14 to discuss and approve the Cook County Health and Hospital Systems Board Strategic Plan that had been approved by their board in June. Commissioner Butler presided at the meeting which followed the Forest Preserve District meeting and he called the meeting to order at 12noon.
Mr. William Foley, CEO of the HHS presented a summary of the Strategic Plan. He stated that there were 5 key components of the plan and they are:
1. Enhancing access to the system for all persons wanting to use the services.
2. Ensuring quality service and cultural competency throughout the system.
3. Realigning resources and using service line planning within the system.
4. Staff development
5. Leadership development
He emphasized that the plan is a plan for growth with a goal of expanding the ability to treat outpatients by 50% over the next 5 years. The plan does anticipate health care reform although the effects of that are still uncertain. The focus is on primary care with a need to expand access to specialty care. The plan does call for realignment of services at Oak Forest and Provident Hospitals focusing more on outpatient care and access to specialty care at these facilities and a decrease in the inpatient services at both hospitals. He did not discuss specifics on cost but did say that the amount of money provided by the county to subsidize the system is not anticipated to change much over the next 5 years. It will remain at about $300M if they go forward with the changes as outlined. The amount provided for benefits, pension and debt service is an additional $172M for a total of $500M. Capital costs would be in addition and while some of those have already been budgeted (ie Fantus Clinic rebuilding) others would be additional. It was stressed that this is a strategic plan and that modifications can be made along the way and cost would be a determining factor in how the plan is executed.
Public Comments included groups such as the Civic Federation, Access to Care, and Dr. Q. Young speaking on behalf of the Health and Medicine Policy Research Group, and also several individuals who were in favor of the plan. There also were several speakers some representing unions, but also employees and patients who were opposed to the plan. Opposition was primarily focused on the closing of inpatient beds at Oak Forest and Provident with concern being focused on lack of access to county health services in the south suburbs.
After the public comment Comm. Beavers asked to hear from Dr. Mason who accompanied Mr. Foley to present the plan. Dr. Mason apparently had once worked at Provident Hospital. Comm. Beavers wanted to know how the city of Chicago could do "twice as much with half the resources" for the health of the persons in Chicago and also stated that closing Provident would leave a significant number of persons without access to emergency care since "95% of the persons that go to Provident are trauma cases." Dr. Mason stated that hard decisions needed to be made about how best to use the resources of the county. Comm. Beavers [corrected 10/9/10] then made a motion to defer the decision on the strategic plan.
Discussion then proceeded on both the motion to approve and the motion to defer.
Comm. Peraica pointed out the reality that many hospitals have been going out of business.
Comm. Gainer stated that the whole nature of health care is going to change and therefore the county also needs to change.
Comm. Schneider expressed concern about getting reimbursement from other counties or states when patients from outside Cook County use the system.
Comm. Claypool was pleased to see the primary care focus of the plan since that is what he sites as the key to better care and lower cost of health care. He stated that there will be radical change in the way hospitals function and cited an article in the current issue of Crain's.
Comm. Sims had reservations about the plan and was concerned that hospitals in the south suburbs would "cherry pick" patients and limit access to patients needing care in the south suburbs. She was not ready to vote and needed more time to consider the plan. Comm. Gorman commended the HHS Board for producing a plan within the time frame that they had established.
Comm. Murphy was happy with much of the plan but Oak Forest needed to have an emergency room and inpatient facilities included before she could support the plan. Comm. Butler stated that to delay is always costly and there is no perfect plan.
The motion to delay the decision was then taken by roll call with the following results:
Yes (3) - Beaver, Murphy, Sims No (9) - Claypool, Daley, Gainer, Gorman, Goslin, Peraica, Reyes, Schneider, Butler Absent (5) - Collins, Moreno, Silvestri, Steele, Suffredin
The motion to approve the 5 year CCHS Plan was then taken with the following results:
Yes (9) - Claypool, Daley, Gainer, Gorman, Goslin, Peraica, Reyes, Schneider, Butler No (3) - Beaver, Murphy, Sims Absent (5): Collins, Moreno, Silvestri, Steele, Suffredin
A motion to reconsider was taken immediately following with the reverse roll call being accepted. The Committee report now goes to the Board for approval.
The meeting was adjourned at 3:15pm.
--Submitted by Cynthia Schilsky
Mr. William Foley, CEO of the HHS presented a summary of the Strategic Plan. He stated that there were 5 key components of the plan and they are:
1. Enhancing access to the system for all persons wanting to use the services.
2. Ensuring quality service and cultural competency throughout the system.
3. Realigning resources and using service line planning within the system.
4. Staff development
5. Leadership development
He emphasized that the plan is a plan for growth with a goal of expanding the ability to treat outpatients by 50% over the next 5 years. The plan does anticipate health care reform although the effects of that are still uncertain. The focus is on primary care with a need to expand access to specialty care. The plan does call for realignment of services at Oak Forest and Provident Hospitals focusing more on outpatient care and access to specialty care at these facilities and a decrease in the inpatient services at both hospitals. He did not discuss specifics on cost but did say that the amount of money provided by the county to subsidize the system is not anticipated to change much over the next 5 years. It will remain at about $300M if they go forward with the changes as outlined. The amount provided for benefits, pension and debt service is an additional $172M for a total of $500M. Capital costs would be in addition and while some of those have already been budgeted (ie Fantus Clinic rebuilding) others would be additional. It was stressed that this is a strategic plan and that modifications can be made along the way and cost would be a determining factor in how the plan is executed.
Public Comments included groups such as the Civic Federation, Access to Care, and Dr. Q. Young speaking on behalf of the Health and Medicine Policy Research Group, and also several individuals who were in favor of the plan. There also were several speakers some representing unions, but also employees and patients who were opposed to the plan. Opposition was primarily focused on the closing of inpatient beds at Oak Forest and Provident with concern being focused on lack of access to county health services in the south suburbs.
After the public comment Comm. Beavers asked to hear from Dr. Mason who accompanied Mr. Foley to present the plan. Dr. Mason apparently had once worked at Provident Hospital. Comm. Beavers wanted to know how the city of Chicago could do "twice as much with half the resources" for the health of the persons in Chicago and also stated that closing Provident would leave a significant number of persons without access to emergency care since "95% of the persons that go to Provident are trauma cases." Dr. Mason stated that hard decisions needed to be made about how best to use the resources of the county. Comm. Beavers [corrected 10/9/10] then made a motion to defer the decision on the strategic plan.
Discussion then proceeded on both the motion to approve and the motion to defer.
Comm. Peraica pointed out the reality that many hospitals have been going out of business.
Comm. Gainer stated that the whole nature of health care is going to change and therefore the county also needs to change.
Comm. Schneider expressed concern about getting reimbursement from other counties or states when patients from outside Cook County use the system.
Comm. Claypool was pleased to see the primary care focus of the plan since that is what he sites as the key to better care and lower cost of health care. He stated that there will be radical change in the way hospitals function and cited an article in the current issue of Crain's.
Comm. Sims had reservations about the plan and was concerned that hospitals in the south suburbs would "cherry pick" patients and limit access to patients needing care in the south suburbs. She was not ready to vote and needed more time to consider the plan. Comm. Gorman commended the HHS Board for producing a plan within the time frame that they had established.
Comm. Murphy was happy with much of the plan but Oak Forest needed to have an emergency room and inpatient facilities included before she could support the plan. Comm. Butler stated that to delay is always costly and there is no perfect plan.
The motion to delay the decision was then taken by roll call with the following results:
Yes (3) - Beaver, Murphy, Sims No (9) - Claypool, Daley, Gainer, Gorman, Goslin, Peraica, Reyes, Schneider, Butler Absent (5) - Collins, Moreno, Silvestri, Steele, Suffredin
The motion to approve the 5 year CCHS Plan was then taken with the following results:
Yes (9) - Claypool, Daley, Gainer, Gorman, Goslin, Peraica, Reyes, Schneider, Butler No (3) - Beaver, Murphy, Sims Absent (5): Collins, Moreno, Silvestri, Steele, Suffredin
A motion to reconsider was taken immediately following with the reverse roll call being accepted. The Committee report now goes to the Board for approval.
The meeting was adjourned at 3:15pm.
--Submitted by Cynthia Schilsky
Thursday, July 15, 2010
Cook County Board Meeting July 13, 2010
The meeting was presided over by President Pro-tem Moreno as President Stroger was not present.
Ms. Eden Hurd was appointed to the Cook County Housing Authority to take the place of James Jones for a term to expire on 6/1/15.
The Cook County Dept. of Revenue received the 2010 National Association of Counties (NACo) Achievement Award for modernization of the collection process for Home Rule Taxes. The same award was given to Cook County Facilities Management for doing a good job of maintaining County Facilities. Several Unsung Heroine Awards were given to women who were recognized for altruistic activities in the county. Commissioner Silvestri received Oak Leyden Services President's Award for his efforts in assisting disabled adults to move to appropriate housing, thereby avoiding having to be institutionalized.
Commissioners Gorman, Moreno and Murphy submitted a proposal for the audio and video recording of the Cook County Health and Hospitals Board meetings. The proposal passed.
An amendment regarding the posting of the Cook County Board Meeting Agenda and the time lines pertaining to items being placed on the agenda was moved to the Rules Committee.
A proposal passed requiring the Cook County Health and Hospitals System to reward 35% of contracts to minority or women owned companies.
The Assessor's Office had a large printing bill for materials advising senior citizens that their tax exemptions would not be renewed automatically. The request was approved as the exemptions needed to be verified.
An item was passed prohibiting towns and villages other than Ford Heights from using Cook County Sheriffs Police in lieu of their own police departments. The Sheriff will police Ford Heights as the town has no funding for police services, but the cost of same for other villages will not be paid by the County in order to discourage this practice.
--Submitted by Beverly Graham
Monday, June 21, 2010
Cook County Board Meeting June 15, 2010
The Finance Committee meeting began at 11:50 and started with a discussion of Shackman oversight by the Duty of Compliance Administrator, overseen by Judge Wayne Anderson. The amount allotted ($1,923,000) was questioned by Commissioner Collins. C. Daley responded that the funds go to the administrators. He explained that there are 15 monitors who ensure compliance with the decree. The item was unanimously approved. All bills and claims were approved and passed. C. Peraica questioned the tax bills sent by certified mail. C. Daley explained that they were delinquent notices.
All Workman's Comp. claims were approved, as were all subrogation claims.
Revenue Report: The Comptroller reported a negative $10.6 million. County sales tax increased slightly. Alcohol tax was negative $1 million. Reports were given from Provident Hospital revealing a loss of Medicaid revenue. Their CFO said that payments were 86% below expected level. Oak Forest Hospital reported a loss of 56%. It is expected that the percentage of decline will continue for the rest of the year. New rates begin July 1, 2010. The cause of underpayments is a drop in the number of Medicaid patients. It was also reported that Med Assets would be replaced by Price Waterhouse, and that the scope of their oversight would be broadened. Forty percent of patients are undocumented; that is, they do not provide sufficient information; and as a result, $48 million is lost.
Red Light Violation Contracts: Less money was collected than anticipated. (A further discussion of this item took place as an item on the Board of Commissioners agenda.)
All Highway bills were approved, as were Zoning and Building, and Roads and Bridges.
Cook County Board of Commissioners Agenda - Proposed Ordinance Amendments, and other items:
The meeting was chaired by C. Moreno, President pro-temp. President Stroger returned towards the end of the meeting.
The meeting began with the reading of a long list of clerical mistakes on the items submitted for the agenda. There was an equally lengthy discussion about the number of mistakes. C. Beavers suggested that everyone responsible for the mistakes should be fired. C. Murphy suggested that if an item has a mistake, they should vote no. Item 2 was withdrawn, and Item 4, requiring all personnel activity (hires, resignations, reclassifications, transfers), be reported to the Board of Commissioners, passed.
Item 5, establishment of an automated red light traffic safety system, was discussed at length. The amendment allows municipalities to "opt out" of the installation and maintenance of the cameras. Apparently, the Commissioners had been contacted by numerous town and village presidents and mayors who were not if favor of the monitors. Rupert Graham (Highways), stated that the top 30 intersections for serious accidents were identified and thus selected to have the cameras installed. C. Murphy said that she does not believe that the municipalities are aware of this, and she requested that Mr. Graham provide statistics of traffic fatalities. C. Daley said that there had been "communication problems" between the county and the towns. The issue was further politicised by the fact that the contract was with a company from Arizona. At the end of the discussion, the amendment was passed, so that towns will be able to opt out.
Items 6 and 7 passed regarding additional filing fees and the installation of blue hospitality signs along the county highways.
Item 8, regarding a committee of two, (C. Sims, Chairman, and C. Goslin) be established to oversee the use of federal funds in suburban Cook County for Homeland Security. C. Sims stated that the committee would oversee the use of federal funds, and nothing more. There was some discussion about the small size of the committee, and C. Sims responded that they would report back to the board. The amendment was passed.
Item 9 , consent calendar, and Item 11, regarding the use of credit cards for bail, were passed. The cost to the county is nil. Items 13 - 15 passed, 16 and 17 were moved to Environmental Control, 26 - 31 were moved to Construction. Three items were withdrawn, and the rest were passed without discussion.
There was a discussion at the end of the meeting regarding the federal employee who is currently in charge of the Juvenile Detention Center, Mr. Delaney. C. Beavers was unreserved and outspoken regarding his disdain for this individual, and said he had asked Judge Evans to "get rid of him". Mr. D., defended himself by saying that all the people he had hired were minorities, although no one had accused him of racism. Mr. Stroger admonished Mr. D. for speaking, saying that this was his turf, and that Mr. D. could not speak. C. Murphy said that the conditions at the detention center had improved vastly under his supervision. The motion passed, and the meeting was adjourned.
All Workman's Comp. claims were approved, as were all subrogation claims.
Revenue Report: The Comptroller reported a negative $10.6 million. County sales tax increased slightly. Alcohol tax was negative $1 million. Reports were given from Provident Hospital revealing a loss of Medicaid revenue. Their CFO said that payments were 86% below expected level. Oak Forest Hospital reported a loss of 56%. It is expected that the percentage of decline will continue for the rest of the year. New rates begin July 1, 2010. The cause of underpayments is a drop in the number of Medicaid patients. It was also reported that Med Assets would be replaced by Price Waterhouse, and that the scope of their oversight would be broadened. Forty percent of patients are undocumented; that is, they do not provide sufficient information; and as a result, $48 million is lost.
Red Light Violation Contracts: Less money was collected than anticipated. (A further discussion of this item took place as an item on the Board of Commissioners agenda.)
All Highway bills were approved, as were Zoning and Building, and Roads and Bridges.
Cook County Board of Commissioners Agenda - Proposed Ordinance Amendments, and other items:
The meeting was chaired by C. Moreno, President pro-temp. President Stroger returned towards the end of the meeting.
The meeting began with the reading of a long list of clerical mistakes on the items submitted for the agenda. There was an equally lengthy discussion about the number of mistakes. C. Beavers suggested that everyone responsible for the mistakes should be fired. C. Murphy suggested that if an item has a mistake, they should vote no. Item 2 was withdrawn, and Item 4, requiring all personnel activity (hires, resignations, reclassifications, transfers), be reported to the Board of Commissioners, passed.
Item 5, establishment of an automated red light traffic safety system, was discussed at length. The amendment allows municipalities to "opt out" of the installation and maintenance of the cameras. Apparently, the Commissioners had been contacted by numerous town and village presidents and mayors who were not if favor of the monitors. Rupert Graham (Highways), stated that the top 30 intersections for serious accidents were identified and thus selected to have the cameras installed. C. Murphy said that she does not believe that the municipalities are aware of this, and she requested that Mr. Graham provide statistics of traffic fatalities. C. Daley said that there had been "communication problems" between the county and the towns. The issue was further politicised by the fact that the contract was with a company from Arizona. At the end of the discussion, the amendment was passed, so that towns will be able to opt out.
Items 6 and 7 passed regarding additional filing fees and the installation of blue hospitality signs along the county highways.
Item 8, regarding a committee of two, (C. Sims, Chairman, and C. Goslin) be established to oversee the use of federal funds in suburban Cook County for Homeland Security. C. Sims stated that the committee would oversee the use of federal funds, and nothing more. There was some discussion about the small size of the committee, and C. Sims responded that they would report back to the board. The amendment was passed.
Item 9 , consent calendar, and Item 11, regarding the use of credit cards for bail, were passed. The cost to the county is nil. Items 13 - 15 passed, 16 and 17 were moved to Environmental Control, 26 - 31 were moved to Construction. Three items were withdrawn, and the rest were passed without discussion.
There was a discussion at the end of the meeting regarding the federal employee who is currently in charge of the Juvenile Detention Center, Mr. Delaney. C. Beavers was unreserved and outspoken regarding his disdain for this individual, and said he had asked Judge Evans to "get rid of him". Mr. D., defended himself by saying that all the people he had hired were minorities, although no one had accused him of racism. Mr. Stroger admonished Mr. D. for speaking, saying that this was his turf, and that Mr. D. could not speak. C. Murphy said that the conditions at the detention center had improved vastly under his supervision. The motion passed, and the meeting was adjourned.
Wednesday, June 2, 2010
Cook County Board Meeting June 1--Two Big Issues
First on the agenda was deciding whether to make the Health and Hospital System (HHS) independent board a permanent one. Although the nurses and SEICU unions spoke against making the board permanently independent, and many commissioners had concerns about the large raises given to administrators of the HHS, this was passed. The vote was 13 in favor, 3 against (Commissioners Beavers, Murphy and Sims) and 1 absent (Comm. Steele).
The next hour of the meeting was taken up by memorials, recognitions, etc. After 12:00 pm, the business portion of the meeting was addressed again.
A resolution to boycott Arizona and its businesses was proposed by Comms. Reyes, Moreno, and Murphy. This was intended as a protest to the new immigration law in Arizona to go into effect later this summer. The discussion among the commissioners was quite heated, with some mentioning that Arizona businesses who employ minorities would be hurt; others mentioned racial profiling; and some that the federal government should be addressing this issue. The boycott resolution passed 10 to 6 with Commissioners Daley, Gorman, Goslin, Peraica, Schneider and Silvestri voting against. Comm. Steele was absent.It should be noted that the resolution as stated in the agenda was not the resolution voted on. A last-minute set of major changes was made and this observer and the others in the audience did not have access to the new wording.
Sometime after this vote, the Board voted to award a red-light camera contract to Arizona-based American Traffic Solutions.
Although the Board meeting continued for a very long time, this observer left at 1:15.
Friday, May 21, 2010
Cook County Board Meeting, May 18, 2010
Todd Stroger, President of the Cook County Board of Commissioners, said the May 4, 2010 ordinance limiting some of his powers regarding personnel violates the statutory and Constitutional authority of the President of the Cook County Board. He stated that the Ordinance is an unconstitutional attempt to alter the form of County government. A long discussion followed and a vote was taken over whether to override Stroger's veto of the May 4th statutory that limits his hiring. The tally was 9 to 6, failing to override his veto because eleven votes would be required.
Questions were raised, including, Does the override apply to the new President? Is there an expiration date at the end of the fiscal year? The questions were not answered or resolved.
The County has a significant revenue shortfall. It may be over $50 to $70 million. There has been a sales tax roll back of 1/2 of l per cent. The budget will be reduced so a deficit will not be expected. There will be an effort to increase revenue.
Oak Forest and Provident Hospital have had a severe drop in patients. Mr. Foley reported that the staff at Oak Forest has been reduced from 934 to 743. The staff will continue to be reduced and the outpatient clinics will be redesigned. Oak Forest has only sixty in-house patients. There have been 30,000 outpatient visits this past year. There has been a 33% revenue shortfall and a deficit of $l5 million dollars. A new contact has been made with Price-Waterhouse. All salaries for Grade 24 positions must remain fixed or adjusted by the Board of Commissioners.
Submitted by Arline Doblin
Sunday, May 9, 2010
May 5 Meeting of the Cook County Forest Preserve Commission
Chairman Stroger did not show up so Commissioner Reyes ran the meeting. It started with a break for the Finance Committee agenda where Commissioner Peraica questioned whether there is enough reporting. It was explained that much of the Forest Preserve spending is seasonal as are revenues and that Cash Flow reports do not reflect the overall financial picture for the Forest Preserve (which is quite healthy). There was general satisfaction that the Forest Preserve finances are in good financial shape.
After various other business there was some interesting discussion during the vote on payment to lawyers for the Shakman compliance work. Commissioner Silvestri and others concur that the Shakman compliance is taking too long and is expensive. Commissioner Collins expressed her desire not to try to meet the requirements inhouse but to change personnel to get into compliance, as the Sheriff's office did. Commissioner Sims thought it would be a good idea to go back to court -- perhaps to get a change in the decree?
There was a long report on the Bass Fishing Sectionals which were apparently very successful. Also an award was given to an exemplary CCFP Police Officer.
After various other business there was some interesting discussion during the vote on payment to lawyers for the Shakman compliance work. Commissioner Silvestri and others concur that the Shakman compliance is taking too long and is expensive. Commissioner Collins expressed her desire not to try to meet the requirements inhouse but to change personnel to get into compliance, as the Sheriff's office did. Commissioner Sims thought it would be a good idea to go back to court -- perhaps to get a change in the decree?
There was a long report on the Bass Fishing Sectionals which were apparently very successful. Also an award was given to an exemplary CCFP Police Officer.
Wednesday, May 5, 2010
Cook County Board's Hot-button Topics
Despite all being present and on time, the May 4th meeting of the Cook County Board of Commissioners started 25 minutes late; at 11:00, after memorials, tributes, picture-taking, etc., the business portion of the meeting began. Last minute changes to the agenda were addressed first. It should be noted that many of these changes were distributed to the Board during the meeting and were not available to observers. This caused confusion, since it was not clear what exactly was being voting on.
Commissioners Reyes and Moreno presented a resolution to protest Arizona's recently passed immigration law by boycotting Arizona businesses and canceling Cook County contracts with Arizona companies. However this desire was cut short when some realized that minority businesses in Cook County could be hurt by this. No vote on the resolution was taken today and it was sent to the finance committee for further discussion.
Commissioner Goslin submitted a resolution (passed) regarding PC Power Management which should reduce electrical costs to the county.
The majority of time was spent on three ordinances (all passed by large majorities or unanimously) designed to keep closer watch on the expenditures of the county elected officials and departments, particularly President Stroger's office. Reports are to be submitted to the Board of Commissioners within 72 hours of any purchases and contracts over $750.00. Board approval is still necessary for all contracts of $25,000 or more. The Board also approved a requirement for departments to submit information regarding promotions and changes in salary and job titles. Third is a hiring freeze throughout the county. There was a lot of discussion on this last issue as some commissioners felt the county could not do its job with fewer people if some retired or left their positions.
Commissioner Daley requested that pay raises for grades 24 and up be put on board agendas for the necessary approval. This was an ordinance passed last December, but was not being followed by various county officials.
Commissioner Collins once again stated the county is not proceeding fast enough to comply with the Shakman Decrees regarding political-based hiring. Her resolution to create an ad hoc committee to analyze the cost of Shakman Compliance options was referred to the litigation committee. It was brought up that President Stroger has retained the law firm Sidley & Austin to represent him regarding Shakman. It was unclear why he required this.
Commissioner Sims presented an affirmative action hiring resolution which would have a personnel goal of 50% minority, 25% women, and 5% disabled.
This observer could not get a copy of this resolution/ordinance, so the specifics are not known to me.
CFO Jaye Williams spoke about the OPTIMA program which is designed to move from a paper to on-line methods for doing business. This will first be used for procurements and the tax process. Bid openings will also go on-line. This should make for more efficient and less costly procedures. Many commissioners were unaware of this program.
Tuesday, May 4, 2010
CCHHS Board Presented with Options in Delivery of Care
Cook County Health and Hospitals System Board Meeting
April 30, 2010 7:30 am to 4:00 pm
This was an all day meeting which covered regular Board agenda matters and a review of the Strategic Plan. The regular meeting spilled over its projected two hour time frame because of lengthy public comments, a protracted discussion of a contract for laundry linen services and a closed session regarding personnel matters. The current provider of laundry services was underbid by the GPO (Group Purchasing), a mechanism which had been approved several months ago to seek the lowest bidder for all services. Proponents of the current provider and losing bidder spoke of jobs lost by local residents to an out-of-state company. But Board members responded with arguments that the $2 million saving over 3 years of the contract could not be ignored. They recognized that use of GPOs represents change that may be hard on previous vendors and asked for a report on the efforts of the GPO to mentor small vendors to encourage their participation. The contract was approved with one negative vote.
The meeting resumed with a presentation of the current state of the Strategic Plan and the challenges inherent in it. Integrated Clinical Solutions, Inc., the consultant team, provided an in-depth assessment of community needs and related access factors, an overall evaluation of the System's current state, and key issues and a framework for the System to reach its goals. Four staff physicians then reported the progress of certain service lines whose development they are responsible for shepherding.
A few key issues drove the discussion: (1) There are significant unmet healthcare needs in Cook County. The community areas with the lowest health rankings – near south side, southland, east southland – have the least health resource coverage. Access to health care is a major issue in these communities. (2) System access points are not aligned geographically with patient populations having the greatest healthcare needs. There has been a significant geographic redistribution of the vulnerable population over the past 20+ years. (3) The current system configuration does not support a population/patient-centered approach to healthcare delivery. CCHHS is disproportionately skewed toward the provision of acute inpatient services, while evolving healthcare models are placing increased emphasis on primary care/prevention and comprehensive case management/care coordination. A greater proportion of CCHHS' traditional patients will have a choice in selecting their providers as national health care reforms. (4) CCHHS' current cost structure is not sustainable. Its cost per inpatient day is high, its losses are projected to increase; there is a significant opportunity to modify these by reallocating dollars.
Proposed scenarios would develop Regional Outpatient Centers that provide specialty services and are accessible to geographic areas with greatest needs – South, DT/West, and North, formalize partnerships with existing FQHCs (Federally Qualified health Centers) and other providers. The options include considerable detail regarding existing inpatient facilities, emergency services and long term care.
The final hour or so was devoted to four Service Lines which are considered critical to the Plan; Outpatient, Emergency, Maternal/Child Health and Surgical Services were scrutinized. The status and needs of each was detailed by the lead Physician especially as to how each fits into a long term plan.
The Board had many questions and will continue to peruse the mass of information that was provided. They hope to come to closure on a direction by their June meeting.
--Submitted by Observer Nancy Staunton
Thursday, April 1, 2010
Health & Hospitals System Board Meeting March 26, 2010
A speaker in the public comment period related his bad experience which involved duplicate dental x-rays and a prolonged wait for dental services which in the end were not available, which information should have been known prior to referral. The Board recognized it as indicative of poor quality service and referred the issue to the Quality Committee.
Chairman Warren Batts reported on his visits to four Ambulatory & Community Health Network of Cook County ("ACHN") clinics. He found one adequate and the others very limited. Among deficiencies were few computers to expedite record keeping.
His remarks coincided with this month's Board Education, which was on the status of Information Technology. There has been progress, but equipment is still not adequate to implement Electronic Medical Records. The capital investment would be ~ $1.2 million. CCHHS would now have a rating of 4, having moved from a 1 in 2007; the ideal would be 6 to 7. About 50% of U.S. hospitals are below the ideal rate. December is the target date to eliminate paper documentation. Nursing is lagging and needs an advisory committee to expedite. With all hospitals now on one system, scheduling and billing should improve.
CEO William Foley discussed progress on leadership goals. There has been a delay in moving accounts payable and payroll functions to the CCHHS from the County. Using two different systems delays action, but a resolution appears near. Assessment of manager restructuring should be complete by July 1, leading to workforces changes. The goal is a reduction in costs of $106 million. He referenced the recently passed Health Care Reform legislation and noted one downside in its reduction in DSH allocations by the State. He also anticipates that public hospitals will have to compete with private hospitals for the increased number of Medicaid eligible patients. He projects a need to address clinics and primary care and a new demand for specialty care, better regional access, and the need to improve quality and manager accountability. The Strategic Plan continues to be refined.
In the Strategic Planning process, the consultant sees uncovered populations, more demand and a competitive marketplace. Overall goals continue to be accessible care, ease of entry, accountability, quality, continuity and cost-effectiveness. The big issues are potential re-configurations, ACHN clinics, Fantus Clinic, partnerships and community engagement. The next meeting of the Board on April 30 will be primarily a Retreat session to focus on the Strategic Plan.
With regard to partnerships, a joint consulting project with University of Chicago regarding use of Provident Hospital was discussed. Thus far a 5 week process has included a market assessment to determine the community need. It revealed a very fragmented market in the service area with more than 50% of inpatients out-migrating. Questions remain regarding the need for inpatient services at Provident. Both parties want to postpone furthur consideration until issues, including governance and capital improvements are resolved. The future of Provident Hospital is an important piece of the Strategic Plan.
Committee minutes were approved.
--Submitted by Observer Nancy Staunton
Wednesday, March 17, 2010
Taxes and the Health & Hospital System (HHS)--March 16, 2010
The March 16th meeting of the Cook County Board of Commissioners dealt with the issue of taxes once again. As of January 1, there is a $15.3 million shortfall in taxes and fees collected by the county. Comm. Peraica pointed out that cigarette tax revenues have been continually dropping--due to smokers purchasing cigarettes outside of the county--since the cigarette tax was doubled. Comm. Schneider mentioned a $40-50 million decrease in cigarette revenue since the sales tax increase. Comms. Moreno, Sims, and Murphy requested data to track a relationship between the sales tax increase on cigarettes and lung health issues at county hospitals. It was pointed out to these commissioners that the time span is too short to affect a health change.
Once again a gradual repeal of the 1% county sales tax was proposed. Surprisingly, it was sponsored by Comm. Moreno, who had voted against repeal numerous times previously. He indicated it was the right thing to do, his constituents wanted the repeal, and his primary election loss was partly due to his previous support of the sales tax. This proposed ordinance, however, was once again defeated (7 to 10), although for different reasons than before.
CFO Ayers of the Health and Hospital System (HHS) reported on the hospital revenue shortfall. There has been a reduction of volume of services at Provident Hospital resulting in a 60% decline in patient fees. He indicated this hospital is not being used effectively for patient services. Initiatives have begun to get Medicaid to pay for more procedures and to have a better billing system for insured payers. A system to better collect Medicare co-pays is also in process.
Comm. Collins proposed an ordinance allowing the Health and Hospital System to become completely independent of the County Board and allow it to levy its own taxes. Numerous reasons were given for voting against this: too many taxing bodies already exist in Cook County (over 1,600); HHS Board is not elected and so would not be accountable to taxpayers; this is premature in that there is no system currently set up for future board selection. The proposal failed , with only 6 commissioners voting in favor of it.
The quarterly report by HHS CEO Foley was presented. Among the findings: increase in numbers of people using county clinics and hospitals (up 14%). He stated that better staffing, record-keeping, and configurations of clinics would mean less use of expensive emergency rooms and shorter wait times for appointments--currently a 4 month wait for mammograms. Hub clinics incorporating mental and dental health need to be developed and partnering with outside hospitals would provide better and less costly health care for residents.
As far as funding, he requested that money saved by HHS should remain with HHS instead of going into the general fund of Cook County as is currently done. More consistent funding from the County is needed for better planning and "enterprise funds," as in the California health system, are being investigated. Improvements to the HHS include internal auditing, greater efficiencies, enhanced revenue collection and more federal funding.
With regard to staffing, Foley stated that management needs streamlining, workforce needs rebalancing (having the right kind of staff for the services provided), and more positions need to be eliminated. This will provide a $70 million savings. The graduate medical training program (doctor training) will be evaluated for cost v. benefit.
Tuesday, March 9, 2010
Forest Preserve Commission February 10 2010
The February meeting of the CCFP was the most well attended and the shortest meeting ever! There was agreement on the Finance Agenda. There were no issues to discuss. The supplemental agenda honored Ralph Freese on his induction into the National Rivers Hall of Fame and Ralph undoubtedly deserves this honor as he has worked tirelessly to promote paddling on the Chicago River for many many years.
One of the most interesting items on the agenda, which was agreed upon and not discussed, is the ongoing agreement that the Forest Preserve has with the Audubon Society of the Chicago Region. Since 2006, the two organizations have had a collaborative arrangement where the Audubon uses volunteers, interns and staff to manage and restore rare habitat and the Forest Preserve reimburses some of the expenses using funds previously allocated for land management. This appears to be a good collaboration because the Audubon staff specialize in environmental science, they have a good network for recruiting qualified interns, and they make extensive use of citizen volunteers both to do the work and to measure impact through their frog, plant, and bird monitoring programs. Being a nonprofit organization, they also supplement the County funding with contribution monies raised. Overall it seems to be a program that is very well-managed and works in the interest of the taxpayers and citizens of Cook County.
One of the most interesting items on the agenda, which was agreed upon and not discussed, is the ongoing agreement that the Forest Preserve has with the Audubon Society of the Chicago Region. Since 2006, the two organizations have had a collaborative arrangement where the Audubon uses volunteers, interns and staff to manage and restore rare habitat and the Forest Preserve reimburses some of the expenses using funds previously allocated for land management. This appears to be a good collaboration because the Audubon staff specialize in environmental science, they have a good network for recruiting qualified interns, and they make extensive use of citizen volunteers both to do the work and to measure impact through their frog, plant, and bird monitoring programs. Being a nonprofit organization, they also supplement the County funding with contribution monies raised. Overall it seems to be a program that is very well-managed and works in the interest of the taxpayers and citizens of Cook County.
Saturday, March 6, 2010
Focus on Hospitals at the Cook County Board of Commissioners Meeting, March 2, 2010
Commissioners voted for renovation of the historic Cook County Hospital Main Building for administrative office use for the Cook County Health & Hospitals System (CCHHS). Once renovated, the building will replace the 1900 West Polk facility, which will be demolished. This is the most affordable and lowest risk option. The estimated cost is $107,700,000. TIF funds will be sought.
The memory of Commissioner Carl R. Hansen was honored by passage of a resolution. Hansen was on the Board from l974 to 2006. Commissioners stated that his sense of duty and responsibility to the taxpayers of Cook County was widely known. He did not shrink from debate.
The state of Illinois lacks resources and is passing responsibility to Cook County. This is becoming a major problem. The end of the Duran and Harrington Decrees will save some money and enable some cases to end. [From a Sheriff's Office press release:
Four County mental health consultants were appointed to report on compliance at a cost of $600,000. They will report back to the Board in four months, though they have an eighteen month time frame."...the Cook County Board voted to move forward with plans to settle the Duran Consent Decree, an agreement governing jail conditions which took effect in 1982 after a lawsuit was filed in 1974. It has since hovered over the jail and cost taxpayers millions in attorneys and monitoring costs.
The settlement discussions would find an end brought to the Duran Decree, as well as an older Harrington Decree governing mental health care. In its place, the U.S. Department of Justice would agree to a new set of monitoring standards making the Cook County Sheriff responsible only for corrections issues at the jail."]
The Board discussed Court Decrees at length. State's Attorneys have discussed bench marks and costs for new decrees. The budget will be in the Health Dept. or Jail Dept.
CCHHS experienced a $4 million deficit in December. Stroger Hospital has a very large deficit. Oak Forest and Provident Hospitals have had fewer patients than anticipated and therefore have had a 54% drop in revenue. Michael Ayers, the health system Chief Financial Officer, stated that he believes the deficit can be overcome in the future because CCHHS is getting Disproportionate Share Hospital, or DSH ("dish"), payments to replace reduced Medicare and Medicaid funds. DSH payments are federal financial assistance to hospitals that serve a large number of low-income patients and the uninsured. In addition, CCHHS finances should be improved by the closure of some neighborhood facilities.
--Submitted by Arline Doblin
Tuesday, March 2, 2010
CCHHS: Strategic Plan Still in Play
Cook County Health and Hospitals System February 26, 2010 Board Meeting
As part of its on-going education, the Board heard details of the Internet Referral Information System, or IRIS, that has been implemented in recent years. It tracks patient visits and referrals. Visits decreased in 2007 with budget constraints and are resuming growth at about 10% per year.
Delays in referrals within the CCHHS reflect a need for more specialty services. Even nationally, referrals are disorganized, but the use of electronic records expedites the process. In Cook, there is a no-show rate of 40%, which wastes resources. Some problems can be attributed to an unstable patient population, some of whom do not have phones to receive reminders of appointments. An automated phone system calls with reminders 10 and 2 days before appointments. The backlog for colonoscopy referrals is especially high.
CEO Foley reviewed the progress in meeting Leadership Team goals. The assessment of management restructuring will be completed by the end of March. Centralization of functions brings purchasing and contract compliance within the system with HR in process. Building and Trades will now be centralized within the Health and Hospital System, rather than being handled by other County administrative offices. Participation in Graduate Medical Education needs review. Attention was drawn to the many affiliations with other hospitals, some of historic origin, not all explainable. This is an area where guiding principles are needed. Currently, an affiliation with University of Chicago is being explored with a view to a mutually beneficial use of Provident Hospital, now underutilized. A proposal will be brought to the Board in March.
Work continues on the Strategic Plan with a deadline of May; different scenarios will be presented. Areas under scrutiny include the Community Needs Analysis which should clarify where to target services, looking at socio-economic and health profiles. Data is available now on where patients come from. CCHHS through the Ambulatory Care Network and the separate Federally Qualified Health Centers (FQHCs) provides primary care throughout the County, but there are pockets of need for out-patient primary and specialty care. Closure of inpatient services at Oak Forest and Provident Hospitals remain under discussion. The negotiations with U of C regarding Provident will affect any such decision. A Board Retreat to consider all the data is tentatively scheduled for the April 30th meeting.
Minutes of the various Committees were approved. The Finance Committee reported an increase in Medicaid patients. The Group Purchasing Organization, or GPO, for pharmaceuticals satisfactorily dealt with the required minority member inclusion. A lease of Hinsdale property (the former TB Hospital) was also approved.
--Submitted by Nancy Staunton
Friday, February 12, 2010
Cook County Board Meeting February 9, 2010
Following an invocation by Bishop Demetrius of the Greek Orthodox Church, Chicago, and the Pledge of Allegiance, Cook County Board members debated whether the county should enter into a contract with USI Midwest, a financial insurance company. Commissioners questioned whether the risk tolerance level for the county should be raised. Commissioner Schneider suggested the county sign a one-year contract with USI Midwest, after which officials would prepare an RFP. Commissioner Gainer requested that Jaye Williams, Cook County CFO, provide the Board with information necessary to prepare the RFP. Commissioner Schneider addressed the commissioners' inability to access RFPs before making such decisions as the current one under discussion with USI Midwest, and expressed his belief that commissioners should be able to examine RFP information before making such important decisions. Commissioner Butler stepped into the discussion to clarify that the commissioners wish access to the responses of RFPs, and are concerned with the confidentiality of this information. A vote was taken with 15 yays and 1 nay from Commissioner Peraica, who informed the Board that the county knew three years ago that the risk level needed re-evaluation but did nothing to solve the matter. Commissioner Silvestri expressed concern about the process through which the insurance was obtained. Commissioner Gainer pointed out that 50 companies provide the insurance the Board is looking to purchase. Ms. Williams, who said there were only 8 other companies which offer the insurance, offered to add additional companies to her list of potential carriers.
Commissioner Silvestri applauded veteran officer Michael McCotter's contributions to the Chicago Police Department, and voiced congratulatory wishes for McCotter's appointment by Governor Quinn to the Chief Public Safety Officer at the Illinois Department of Corrections.
The Board discussed the county audit report, and County Auditor Laura Burman addressed the Board's questions on 20 missing forms when the audit was conducted.
Commissioner Daley motioned to pass the tax levy for 2010. Methods of appropriation for each department were addressed. Commissioner Daley noted that the tax levy has remained at the same level since 1994. A vote was taken and the motion passed with 15 yays and 2 absences.
Considerable discussion followed concerning a federal grant from the Department of Energy (through the American Recovery and Reinvestment Act of 2009) to promote energy conservation in Cook County. Commissioner Claypool asked Maurice Jones, Director of Planning and Development, how the incentives contained in the grant will be determined. Mr. Jones will provide this information to Commissioner Claypool. Commissioner Murphy asked Mr. Jones to explain the role of the CTA in the grant.
The topic then turned to the request from the Recorder of Deeds to sell information from its office. Commissioner Schneider questioned whether the projected $350,000 in profit from the sale of the Recorder of Deed's information was the maximum profit the county might receive from such a sale. Commissioner Schneider suggested that other companies besides Fidlar Technologies, Inc. may be interested in purchasing such data.
Finally, the Board addressed the county's $104 million debt owed to the Pension Board. An attorney representing the county requested permission from the Board to negotiate the debt in the form of a short-term note with a 2.7% interest rate, and a lump sum settlement. Commissioner Peraica suggested the county use the $200 million savings from the Health and Hospital Board to pay the $104 million debt. Commissioner Butler asked whether the county is current in its pension payments for 2008, 2009, and 2010, to which Commissioner Moreno answered in the affirmative. A roll call vote was taken and the motion passed, with 13 yays, 1 nay, and three absent. The meeting was adjourned.
--Submitted by Stephanie Polito
Monday, February 8, 2010
Strategic Plan Status Update at CCHHS Board Meeting, January 29, 2010
Jeanene Johnson, Director of the Office of Performance Improvement, gave an overview of activities and progress. The staff of three, specializing in finance, operations, and IT, oversee consultants with a goal of improving all business functions and becoming unnecessary as the management team grows. They will store all records on a restricted access website for future use. Their target is $105 million in reduced expenses. Some focus areas are lab consolidation and pharmacy formularies.
Ten employees will be funded to participate in relief efforts in Haiti for 10 days each.
CEO Foley reported on system leadership goals. The Strategic Plan and 5 year financial plan should be completed by June for approval by the Board. It will include management restructuring to achieve the budget reduction of $105 million (400-500 positions). It will include attention to cultural diversity, patient satisfaction and staff morale. A Board member reminded him that productivity is basic to budget reduction; the director of the Ambulatory & Community Health Network (ACHN) provided data that showed some improvement, e.g., the increase in patients seen per primary care physician session. Concerns continue regarding referrals to specialists. Financial statements will be provided next month. Management is in preliminary discussions with University of Chicago to explore shared use of Provident Hospital.
The Finance Committee Report noted that the Graduate Medical Education study showed inadequate documentation to claim reimbursement due to poor record keeping. Payment systems are still challenging. Systemic issues still need attention.
The Board adjourned to closed session to discuss relevant issues.
--Submitted by Observer Nancy Staunton
Friday, January 29, 2010
January 26 Cook County Board Meeting
At the Cook County Board meeting on January 26, 2010, Commissioner Butler offered his condolences to Haitian families who had lost loved ones in the recent disastrous earthquake. Commissioner Suffredin reminded those in attendance that after New York City, Chicago has the largest Haitian population in the country. Other commissioners also expressed sympathy and support for the people of Haiti. Dr. Baptiste provided a brief history of Haiti, including its vulnerability to storms such as Hurricane John in 2004 and four hurricanes in 2008. Individual tributes were paid to Robert "Squirrel" Lester, reknown blues singer; Carlos Hernandez Gomez, passionate news reporter and recipient of the Edward R. Murrow award; as well as Michael E. Lavelle, Sr., election law scholar and chairman of the Chicago Election Board.
The Board debated a comprehensive immigration reform proposal, authored by President Stroger and Commissioners Gainer and Moreno. The resolution, which the commissioners discussed at length, urges passage of the Comprehensive Immigration Reform for America's Security and Prosperity Act of 2009 (H.R. 4321). A vote was taken on the motion, which carried with thirteen yays; Commissioners Goslin, Gorman, and Schneider opposed its passage. Board members then questioned how much money the county was paying to Shakman compliance officers. A county spokesperson promised to provide this information the Board requested regarding this issue. Commissioner Schneider called attention to the county's payment of $8000 to an employee who fell off of a chair. The commissioners turned to the Comptroller Revenue Report, which revealed that the Health and Hospitals budget has suffered because this arm of Cook County government had to return $53.1 million. Commissioner Collins asked whether the public is aware of Stroger Hospital's state-of-the-art medical facilities, implying more should be done to let others know.
Commissioner Peraica drew the Board's attention to the revenue report. He stated that the county is losing money on its sale of cigarettes because of the county sales tax. Commissioner Moreno expressed disagreement over this statement, suggesting that the reason cigarette sales have fallen is because fewer people are smoking and also because of the recession. Commissioner Moreno argued that business is coming to Chicago, while Commissioner Peraica countered that conventions are no longer bringing their business to Chicago. Commissioner Peraica continued to question the county budget, calling the Board's attention to the Public Safety Fund, which was $35 million over budget due to salaries and a high personnel turnover. According to Cook County CFO Jaye WIlliams, the increase in salary payments are due to an increase in personal services.
Commissioner Gainer brought up an additional budget concern regarding Health and Hospital systems. She questioned whether the county is paying a standard rate to hospitals, or a reduced rate, citing the county's recent payment of $35,000 to Christ Hospital, which contained no discount. Finally, Commissioner Peraica proposed an amendment to repeal the entire county sales tax. A suggestion was made to bring his proposal to the Finance Committee. The motion to do so was passed with eleven yays and six nays.
--Submitted by Observer Stephanie Polito
Thursday, January 14, 2010
Board of Commisioners Meeting - January 12, 2010
The Board Meeting was called to order at 10:20am by President Stroger and after an hour of reading tributes and honors to various persons and groups the Finance Committee meeting was convened.
Comm. Peraica raised a concern about payment for private attorneys related to a Shakman case. Mr. Driscoll of the State's Attorneys office explained that a particular witness needed their own representation in this case and therefore county attorneys could not be used. This led to discussion of county compliance with the Shakman Decree. Comm. Peraica and Collins asked once again why it is taking so long, and costing so much for the county to come into compliance. Mr. Driscoll explained that the county continues to work towards compliance and that all the claims have been adjudicated. Comm. Daley stated that it is the Judge who will determine compliance. Comm. Sims and Murphy also got into the discussion stating that money should not be spent on Compliance Officers but go towards fixing the Human Resources Dept. so that hiring could be done the right way. They again requested that a desk audit of all positions in the County be done. Comm. Silvestri stated that the debate centers around those persons who occupy policy making positions since those are the positions that are "Shakman exempt", but these still seem to be undefined. The commissioners also sited the inability to comply with the orders of the Duran Decree (deals with Cook County Jail) due to the complexity of the issues involved. Mr. Driscoll stated that he thought Duran was an easier fix than Shakman.
Comm. Peraica also raised questions about the monitoring of contract minority participation. The office of Contract Compliance stated that they do monitor all contracts for minority participation and verify that the contract is carried out as outlined in the bid for the contract. Comm. Peraica wanted to know if contracts are also monitored if they are increased mid-contract. He also questioned why and how often contracts are being increased mid-contract, being particularly concerned with contracts at the JTDC. Comm. Murphy stated that she did not like the allegations that were being made at the meeting. Comm. Collins expressed concern with food contracts. Comm. Daley stated that if anyone had information about contracts that were not being carried out properly, they should turn that information over to the IIG.
The remainder of the agenda was dealt with in a routine fashion.
The following New Items on the agenda were referred to committees:
Comm. Peraica raised a concern about payment for private attorneys related to a Shakman case. Mr. Driscoll of the State's Attorneys office explained that a particular witness needed their own representation in this case and therefore county attorneys could not be used. This led to discussion of county compliance with the Shakman Decree. Comm. Peraica and Collins asked once again why it is taking so long, and costing so much for the county to come into compliance. Mr. Driscoll explained that the county continues to work towards compliance and that all the claims have been adjudicated. Comm. Daley stated that it is the Judge who will determine compliance. Comm. Sims and Murphy also got into the discussion stating that money should not be spent on Compliance Officers but go towards fixing the Human Resources Dept. so that hiring could be done the right way. They again requested that a desk audit of all positions in the County be done. Comm. Silvestri stated that the debate centers around those persons who occupy policy making positions since those are the positions that are "Shakman exempt", but these still seem to be undefined. The commissioners also sited the inability to comply with the orders of the Duran Decree (deals with Cook County Jail) due to the complexity of the issues involved. Mr. Driscoll stated that he thought Duran was an easier fix than Shakman.
Comm. Peraica also raised questions about the monitoring of contract minority participation. The office of Contract Compliance stated that they do monitor all contracts for minority participation and verify that the contract is carried out as outlined in the bid for the contract. Comm. Peraica wanted to know if contracts are also monitored if they are increased mid-contract. He also questioned why and how often contracts are being increased mid-contract, being particularly concerned with contracts at the JTDC. Comm. Murphy stated that she did not like the allegations that were being made at the meeting. Comm. Collins expressed concern with food contracts. Comm. Daley stated that if anyone had information about contracts that were not being carried out properly, they should turn that information over to the IIG.
The remainder of the agenda was dealt with in a routine fashion.
The following New Items on the agenda were referred to committees:
- an ordinance concerning social networking during meetings
- establishing a Diversion Program for mentally ill inmates at the jail
- conducting a feasibility study for a Bond Loan Fund for qualified arrestees
- establishing an Independent Civil Service type Board for hiring Shakman exempt employees
- an ordinance concerning cannabis possession
The meeting went into Executive Session at 12:50pm to discuss issues concerning Homeland Security, and the observer left at that time.
Cynthia Schilsky - Observer
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