Cook County Health and Hospitals System

Board Meeting April 29, 2011

The meeting was called to order at 7:40am by Chairman Warren Batts. There were 2 public speakers.

• Mr. Blakemore stated his desire that HHS Contract Compliance be independent from the downtown office since HHS is an independent board they should keep this function separate from the county.
• A representative of AFSCME 31 made an appeal to the board concerning suspension of the WIC program. He stated that the program serves 23,000 women and children and is compliant with the strategic plan and wanted to know why the county program was being suspended and turned over to other non-profit agencies.

The Human Resources Committee reported that significant challenges continue with staff recruitment in part due to the "displacement" issue of union employees. It is still unclear how many positions are available to be filled. Further concerns from the HR committee meeting were to be discussed in closed session.

Mr. Carvalho reported for the Finance Committee. Physician billing continues to be problematic. Coding is an important component of the billing process and the problems seem to be more an issue of incomplete coding information than inaccurate coding. It has now been determined that HHS should plan to outsource the coding function and will issue an RFP within the next 5 months. After 18 months of attempting to handle the coding function internally they have been unable to make the process functional. Management is working with the union on this issue and they are required to notify the bargaining unit 5 months in advance of taking action to outsource.

During his report Mr Carvalho addressed the concerns of the 2 public speakers. He stated that HHS has brought the purchasing function in house and had intended to bring Contract Compliance in house as well but with the change in administration and leadership at the county they now feel that perhaps it is not necessary to create an HHS office of Contract Compliance. He said that they have had discussions with Ms. Hall, the Director of Contract Compliance, and she stated that political considerations play no role in the choice of minority and women contractors for the county.

As to the WIC Program Mr. Carvalho stated that he spoke with Dr. Martin, Director of CC Dept. of Public Health, concerning this program. He explained that the WIC program is actually a state program for which the CC Dept. of Public Health was a vendor. IDHS regularly seeks vendors and CC has historically been a vendor. The amount of money the county has received in the last several years has not covered the cost of the program and Dr. Martin has determined that it is no longer cost effective for the county to run a WIC program. Since it was not clear to the Board whether the discontinuation of this program needed board approval the issue was deferred to the next board meeting.

Dr. Carvalho reported that since the amount spent in overtime has been of concern to the CC Board the committee has been investigating the causes and ways to reduce overtime. He introduced Dr. Tedeschi and representatives from the Nursing Dept. to discuss their report on the OT issues. (They had a power point which the observer was not able to see since I was in the adjacent room listening to the meeting but the report is accessible online with the HHS Board information.) It was reported that OT is being used to cover staffing shortages due to displacement (necessity to relocate union employees before hiring from the outside) and LOAs (emloyees on Leave of Absence). HR can recruit but not hire during the displacement process and while the end date for displacement has been changed many times it was stated that the process should be completed by May 20 as long as there are no additional displacements and then nurses can be hired. Stroger is the most understaffed. As of April 1 there were 1200 vacant positions in HHS with 500 being at Stroger. CNA's are now being hired and previously there were few CNA positions. It was reported that in nursing alone there were 237 employees on LOA. Management of LOA and FMLA have been significant problems since they do not have the resources to mange it well and are looking to outsource this function. Another issue is that HHS has very few part- time positions which relates largely to benefits since the county does not have a good pro-rated benefits system for part-time employees. Hiring challenges were summarized as branding of CC (perception of instability), compensation (inability to compete in salaries), and hiring process technology issues.

An Action Plan for dealing with OT was outlined that included:

1. Completing the displacement process and filling 150 vacant positions in the next 3 months
2. Developing a system to manage the OT better with an electronic system
3. Partnering with the county to manage LOA and FMLA
4. Implementing a system wide nursing float pool
5. Bringing OT spending within budget by July 2011.

Michael Ayres, HHS CFO, stated that at the last County Board Meeting the Revenue Report indicated that HHS was still under their revenue estimate for the year. He indicated that he has since done a critical look at their budget and he is predicting a shortfall of $30-4om for the year. This is due to outstanding medicaide money, a physician billing system that is still not up and running and medicare billing concerns. He further stated that if they are unable to move ahead with the Strategic Plan (conversion of Oak Forest Hospital to an outpatient facility) they may also have to adjust the expense side of the budget as well before the end of the year.

A resolution was approved recognizing William Foley for his 2 year tenure as CEO of HHS as this was his last Board Meeting before he leaves CCHHS on May 6. Chairman Batts reported that Dr. Terry Mason will serve as interim CEO.

Authorization to establish a not-for-profit corporation to raise funds for CCHHS to carry out their mission was requested. It would be called the Cook County Health Foundation and would have a board that would be independent of the county and the independent board. The purpose would be to raise money to support county health services. No action was taken on this.

Mr. Foley reported that a rehearing has been scheduled for May 10 concerning the closing of the Oak Forest inpatient beds. He stated that this part of the Strategic Plan continues to be a challenge since there has been miscommunication about what is planned for Oak Forest. It is not really closing - but changing the nature of the services offered at the facility.

Mr. Foley recognized the Board for their courage in dealing with the issues at CCHHS. He outlined the following priorities for the board going forward:

1. Get past the layoffs and displacement process - rebuild morale and address employee satisfaction
2. Need to implement the Strategic Plan with the changes at Oak Forest being critical
3. Build infrastructure to move system forward ie. hiring process
4. Address revenue shortfall
5. Work with the county administration on the Independent Board structure and function
6. Enhance the image of CCHHS

Neil Khare from President Preckwinkle's office presented the CC Performance Management Initiative which he made clear is very important to the President. The Initiative is intended to provide good timely accurate data so management can make decisions and will make Cook County government transparent and accountable. There will be quarterly reports that will tie performance indicators to budget. There are 2 groups that are providing pro bono consulting services to assist departments in the process of goal setting so that robust goals can be established that are outcome oriented. By 2013 the system will be operational and the quarterly reports will be published. Senior management at the hospital has been trained and the training will continue with all union leadership.

The meeting went into closed session at 10:08am.