Cook County Health and Hospital System Finance Meeting Feb. 15, 2013

The meeting was called to order by Chairman O’Donnell at 7:30 a.m..  During the public comment period, a citizen complained that the $149,000 contract for media outreach approved in January d was $1,000 short of the $150,000 needed for a vote by the Finance Board. Chairman O’Donnell replied that all issued contracts are in compliance with the law.

Gina Besenhofer, Executive Manager of Supply Chain Operations for CCHHS, introduced Jacky Gomez, the new director of Compliance, to the Board, and then proceeded to introduce Contracts and Procurement items for Board approval.

The first item was a grant increase of $35,004 from the U.S. HHS Administration for diagnosis, treatment, and rehabilitation of patients with Black Lung disease which would bring the total grant to $333,000.  

Item two was the approval of payment of $2,496,000 for the purchase of insurance covering against potential liability for the cost of services relating to organ transplants required by persons who enroll in the County Care Program.  Dr. Ram Raju, Chief Executive Officer of CCHHS, explained that the CCHHS hospitals do not do organ transplants, but would be required to do so by the Affordable Care Act 1115 waiver.  He said that having this insurance would enable CCHHS to send a County Care patient to a facility specializing in organ transplants if it was necessary, and the insurance would take care of the cost of the transplant.

Dr. Raju said it was unknown whether they could have zero or four transplants in a year.  The County Care plan only provides $313 per month per patient.  The transplant insurance allows CCHHS to control costs.  Director Michael asked if this was the best price for this type of insurance and Dr. Raju  said it was.

Payment to the Olenick Consulting Group, LLC for International Classification of Disease-10 (ICD-10) training and education was for $357,180.  This training was necessary to be ready for the huge investment and operation level of County Care.  CFO John Cookinham said the Coding Project was very detailed.  Dr. Raju said it was difficult to be doing the new County Care enrollment and the new Coding System simultaneously, but they could not postpone the Coding because they needed to move forward faster.  Director Michael asked how they could improve the Coding throughout the System.  Director Cookinham said it was necessary to reeducate the coders and that outside studies of the hospitals showed that in-patient coding had improved.

Payment for professional services from Health Management Associates for $718,363 is an amendment, extension, and increase to the original contract. Dr. Raju said he had underestimated the CCHHS needs, and that there was more that needed to be done than originally thought.  Director Michael thanked Dr. Raju for his explanation but said what was difficult to understand is why there was an urgency to extend the contract for a month, when they could just wait and see how much more was needed.  Dr. Raju assured him that they needed to pass the one month extension now because of the Waiver.

Payment for the professional services of Susan Greene and Associates at $540,000 is to enroll applicants in the County Care program under the 1115 Waiver. A contract with More Direct, Inc. for computer blade servers and storage was for $1,974,999.20.  A contract with More Direct, Inc. for Cisco network gear in Phase II of the Network Refresh Capital Project was for $944,915.  A GE Healthcare contract for DMS software maintenance was for $280,428.  A contract with More Direct, Inc. for Fujitsu 6130Z scanners was for $235,630.46. A contract for service of the MUSE/Mars Systems hardware and software maintenance was for $185,373.46.

In discussing the contracts, Director Michaels said they needed to do a write up for replacement of IT equipment since they are replacing very old equipment and there are risks.  

All of the contracts were approved by the Finance Committee.

Dorothy Loving, Executive Director of Finance, presented the January financial reports.  She said that Revenue was very low. Director Cookinham said that all County Clinics are now included within the 35 mile radius, except Sengstacke.  He also said the Budget needs further realignment.  Director O’Donnell said the Board has been working on decreasing Expenses.  Dr. Raju said they have been looking at re-alignment of the Expenses of Oak Forest since it is a huge campus and the Board is spending lots of money in maintenance.  He said in the next ten years the buildings will be much older.

Ms. Loving said there has been an uptick in the dismissal of final patient bill. Director Cookinham said the goal is to be at 100 days or less.  There was a need to continue meeting with Information Systems.  Dr. Raju said there is a built-in delay of a 90 day notice.  This year they are down to 109 days versus 279 days last year.  Dr. Raju does not think they will ever reach a 50-60 day level.  He said public hospitals vary by state with some at a 60 day notice.  

Director Carvalho said that when the Affordable Care Act begins, everyone must be enrolled in some program. Dr. Raju said some people do not want insurance and CCHHS needs to figure out what to do with 500,000 people and how to care for them.  Director O’Donnell said a Public Hospital must care for everyone, not only in the County, but also Statewide.  Director Carvalho replied that by October eligible residents must be enrolled under AFCA, Medicaid, or Carelink.  He said the State is going through some of the same process.  He asked if someone at 138% poverty level in the state will still have co-pays if Cook County doesn’t have co-pays.

Dr. Raju said it took 60 days to collect all the bills and submit them, and two weeks to get the money which gave CCHHS a two and a half month lag.  He said everyday the obligations and approvals must be tracked and that the complexity makes this a time-consuming job.  He said they have to understate their total obligations, but yet track every obligation. 

Chairman O’Donnell said that the Finance Committee needs a more useful financial tool.  Director Carvalho said they need to manage for oversight.  He said they need to have projections and know why they don’t come true.  Dr. Raju said they must create a model in the next several months.  Director Carvalho said that Price-Waterhouse was also offering to assist.  It was decided that Directors O’Donnell, Carvalho, and Michael will come up with a discussion and plan for projections and assessments.
 

Susan Greene reported on the Section 1115 Medicaid Waiver Demonstration Project known as County Care and said they have 12,000 applications completed.  The goal was to obtain 500 applications per day, but yesterday was the first day they attained that goal with 511 applications. Ms. Greene said they try to remove the burden from the applicant by having the office look up the birth certificate information. She said the Carelink targeted outreach has been very successful.  Those persons eligible for any type of insurance are not eligible for Carelink.  Ms. Greene said there had been a wide geographic enrollment and she will be training Cook County enrollers trying to get to the center of applicants.  She said at the point of application, people pick the site where they want care.  Ms. Greene continued that the approval rate by the State is exceeding 90% because of the excellent fill-outs and the training of the workers. Director Velasquez said they needed the enrollment numbers as soon as possible.  Dr. Raju added that there was 92% approval rate by the State.  Ms. Greene said there were 60 different application leaders who were supposed to report each Wednesday, but they often did not do so because they were waiting for the completion of more applications. Director O’Donnell inquired about those who were enrolled, but were getting care elsewhere.  Dr. Raju replied that 8% might be enrolled at Stroger but were getting care elsewhere and that this was something that had to be worked on.

Mr. Cookinham, Chief Financial Officer, presented the January financial report.  He thinks the Waiver is important, but only a portion of the overall Revenue budget.  He believes that at the end of February, due to the Waiver Enrollment, expenses might by higher.  Director Michael said that they didn’t know what the Revenue calendar was through the year.  Mr. Cookinham said he can provide a monthly projected Revenue, and also on a weekly basis.  He said these were Dashboard options.  Director Michael said he would like to see the Predicted Revenue and Variances, and the reasons for the Variances such as less usage, or delays. Director Carvalho said there are always Variances, but they must have explanations.  Dr. Raju said the Patient Revenue should be divided equally through the year, but there is a need for seasonal variation.  Director Carvalho said that predicted Revenues, Actual Revenues, and Variances shown with explanations on a monthly basis were necessary to see whether the System was in difficulty, or doing well.

Chairman O’Donnell adjourned the meeting at 9:30 a.m..

Submitted by Eleanor Prince