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.

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.

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:

 "...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."]

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 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

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 30^th 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