The meeting was called to order
by Chairman O’Donnell at 8:05 a.m. Directors Carvalho, Michaels, and
Ramirez were also present.
During the public comment period, a citizen complained about the lack of
African-American Directors on the Board and the lack of representation and
contracts for African-American citizens.
Gina Besenhofer, Supply Chain
Operations, Executive Manager, presented contracts to be paid from
appropriations:
- $18,500,000 for 3rd party administrative services for the 1115 Waiver for $18,500,000 to be paid to Automated Health Systems (AHS).
- $12,000,000 for pharmacy benefits and management services for $12,000,000 to be paid to Catamaran.
- $1,460,000 for amending and increasing a contract with Siemens for professional services, utilization, and recurring fee.
- $549,557 for perinatal software maintenance from GE Healthcare, and
- $184,040 for service maintenance and repair for cooking, warehouse, and waste disposal equipment to Emerald Restaurant Services.
The Committee approved all contracts.
John Cookinham, CFO, reported on
the Year-to-Date Financial Reports.
He said amounts for free care were approximately $20,000,000 per month. In Accounts Receivable, the
outstanding days of Revenue Outstanding (Patient Days) was 116 days at the
beginning of the year with a big improvement down to 110 days. As of this last Friday it was 97 Days. Currently self-pay statements are being
suspended until County Care payments are fully payable and paid.
Mr. Cookinham pointed out that 30% of
Medicaid patients had been converted to County Care (the Affordable Care Act
1115 Waiver) and that Commercial patients (those patients with their own
personal insurance) was “really growing.”
Self Pay and Free Care patients stayed about the same.
Mr. Cookinham said the way to attract
more Commercial patients was to improve Patient Experience by trying to
schedule appointments, giving more telephone responses, giving more free
service such as group screenings, and giving employee incentives to use
hospital services. Director Michaels
echoed the need for excellent patient satisfaction as County Care enrolls
people.
Mr. Cookinham noted that the Adjusted Patient Days are a little below budget due to the
14% decline in Patient Days. Dr. Jay
Shannon noted that when patients were there for observation they cannot charge
them as a Patient Day. Further
discussion ensued on the low use of Provident Hospital because ambulance runs are not served there, and acutely ill patients are transferred to Stroger. Mr. Cookinham further noted that ER was right
on budget and Oak Forest was slightly below budget.
Board discussion ensued regarding
patient length of stay. Some patients
are kept because they have no place to go.
The longest length of stay is from Commercial patients. Provident is an outlier with some patients
in need of continuous care. Stoger has
many long term patients in trauma and burn units. Dr. Shannon said there would be improvement
in patient length of stay if the records were better recorded. This would affect Case Management which would
impact Quality and Safety and Case modality.
Dr. Shannon said they need clarification each day on coding, which in
the end, pays for itself.
Director Carvalho said the Case
Mix Index is derived from coding and that there was some dissonance between
data and incidents. Dr. Shannon replied
that Case Mix drives reimbursement.
Susan Greene, Susan Greene
Associates, stated that it would take a real cultural change to maintain the
rate of patients choosing CCHHS as their medical home. The Finance Committee agreed that Patient
Satisfaction was paramount. Patients are signing up patients for the 1115 Waiver, but then going
elsewhere. Chairman O’Donnell said it is
not acceptable that patients don’t like the way they are treated.
Susan Greene continued by saying
that the good news is that they have signed up 56,000 applicants for the 1115
Waiver at the rate of 500 per day, and 8,450 in the first 24 days of May. She said that in April the State of Illinois
had 50 persons examining applications, and they have just added 17 more people,
and that by June and July, the State will have 100 persons on the staff to
process applications. Ms. Greene stated
that County Care members want and demand accurate diagnosis and really good
care. To avoid no-show applicants for
the Waiver, applicant workers try to fit into the patient’s schedule rather
than the reverse situation.
Ms. Greene said that she hopes to
transition her 1115 Waiver training team out by July. She continued that 27% of approved applicants
are couples new to the County and FQHC System, and they want to stay in the
CCHH System. Ms. Greene said there was a
high demand for good Care and Coverage, and people were finding CCHHS. She continued that the age distribution was
constant with only 20% of applicants under the age of 25 and more women
applying than men. Race and ethnicity
were not known. Ms. Greene stated that older
people need more health care and that those who need care sign up first.
Ms. Besenhofer gave an update on Global Healthcare Exchange (GHX) and the need for full integration and said they will still need two to
three years to fully implement the process.
She added that the double work was not sustainable much longer, but that
the integration with County Care was easy. She hoped that HHS would have the same system
as the County. Dr. Hota said that
Meaningful Use was over $15,000,000 for stations processing Medicaid and
Medicare and that they need to increase the number of Procedures since they
were dependant on Medical payers and providers.
Mr. Cookinham gave a report on
the gross changes in payer. The financial amounts paid by Commerical Insurance had dropped from 2.7% to
2.3%, even though the percentage of Commercial patients was rapidly
growing. The Medicaid and Medicare
Managed Care are not growing, but they do not pay as much. Dr. Raju reported that most of Medicare
Managed Care will be moved to County Care, and that it was essential to have a
good Managed Care department. Director
Carvalho stated that under the 1115 Waiver everyone is assigned to a Managed
Care hospital and may not be assigned to CCHHS, but they want to come to CCHHS
for opinions and special care so CCHHS must have a strategy for this situation. Dr. Raju said the ER must serve patients that
are not enrolled here, but then they must go to their home hospital.
Cookinham continued that CCHHS is
ahead of the budget by $8,000,000 for collections over expenses. In the Operating Budget, they need to fill
more positions. Director Michaels said
it was difficult to project Revenues and that made it necessary to manage the
Expense side better.
The meeting was adjourned at 10
a.m..
---Submitted by Eleanor Prince, CCHHS Finance Board Observer
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