Finance Committee Chairman Jorge Ramirez called the meeting to order at 8:05. Also present were Board Chairman David Carvalho, Directors Lewis M. Collens and M. Hill Hammock, and Donald Oder, Ex-officio.
A citizen spoke saying that the Finance Board should plan for changes in advance and set up approaches to extending and increasing contracts.
Gina Besenhofer, Supply Chain Executive Manager, introduced three contracts for Extension and Increase. The first contract was to AmeriSourceBergen Drug Corporation for $70,000,000 to continue medical and surgical needs for 15 months during an automation review to see which drug wholesaler will best suit the needs of the health system. The second contract to Susan Greene and Associates for $698,550 was to increase and assure the coordination, and promote the quality and efficiency, rather than volume, in the 1115 Waiver Demonstration Project (CountyCare Program). The third contract to Smith Medical Partners, LLC for $540,000 was for a medication which is only available through this manufacturer. The increase on this contract was needed due to the increased demand from the patient population.
Discussion ensued on the first contract. David Carvalho, Chairman of the CCHHS Board, wanted to know why the pharmacy automation review wasn’t done in 2012. Ms. Besenhoffer stated that automation is continuing to change in the pharmacy market, and that there is a need to integrate this system with the current total system. Ms. Besenhofer stated that CCHHS has a good partnership with AmeriSource and that CCHHS intends to implement the Pharmaceutical automation system as soon as possible. Rhonda Yates, Head of Pharmacy, said they need a year to observe all the options and determine which program is the optimum automation with the clinicians.
Susan Green, in response to Contract #2, said that as of July 12 they had taken 76,000 applications for the 1115 Waiver and now CCHHS needs to begin establishing a Managed Care System. This extended contract will transfer knowledge to new payers in the months ahead as CCHHS transfers out of County Care, works with Dr. Shannon to set up the new program, and sets up a Demonstration Site with a Managed Care internal structure and funding determined through utilization management. It was noted that all new expenditures over $10,000 must be approved by the Board, and those expenditures under $10,000 need only internal approval.
The three contracts were unanimously approved by the Board.
Susan Greene, stated that the 1115 Waiver applications have an 86-89% approval rate by the state and that the state has a backlog of 25,000 applications. 30% of the applications have been submitted by the FQHCs (Federally Qualified Health Centers). As of last week the application rate was currently 550 a day and the State of Illinois has 103 processors on the CCHHS campus office on Hoyne where they are processing 373 applications per day. Ms. Greene stated there are ongoing discussions with the state for the Demonstration Site, and that the new Executive Director of Managed Care will start next week. Ms. Greene stated that this is her last meeting as Director of County Care. The Board thanked Ms. Greene for her outstanding work.
Ms. Besenhofer reported on Emergency Purchases of personal computers for Managed Care, and temporary bus transportation since the bus company contracted has declared bankruptcy.
John Cookinham, CFO, said they hope to have the 2014 CCHHS preliminary Budget ready for agreement somewhere between the 1st and 15th of August. Budget Director, Aaron Galeener said Board approval would be needed by August 23rd, before being sent to the President of Cook County in October for a final vote by November. Chairman Carvalho said in 2012 the CCHHS Board had only one week to examine the 2013 budget before voting on it and this year they need more than a week. CFO Cookinham presented the Financial Report as of June 30, 2013, noting that the budget is on a cash basis and is loaded into the County's J.D. Edwards (JDE) electronic format. Mr. Cookinham noted that CCHHS tries to stay in compliance with the Budget. He said CCHHS prepares the bills and the County pays them. Mr. Cookinham also said the County is trying to replace the JDE System, but that will take 2 to 3 years.
When asked about the discrepancy that $306,000,000 of free care was given in 2012, and $342,000,000 was written off in the same year, CFO Cookinham replied that 50,000 people were identified as not being able to pay and were placed in Carelink and not sent a bill. Other patients are sent three statements and if they don’t pay, the bill is sent to a collection agency and generally written off. He stated that the situation is much improved. Several years ago few patients were screened, and they had to write off $2 billion. Difficulties continue to occur screening patients who come in at night.
Most U.S. hospitals with a different patient mix have 68 Patient Days. At CCHHS accounts are written off at 120 Days. The CCHHS target at the beginning of the year was 100 days and by the end of June it was 97 days. Director Cullen said that in a corporate setting there was a huge difference between 68 and 97 Patient Days. Cookinham replied that CCHHS was a stand alone hospital dealing with cash. Two years ago the System was at 274 Patient Days and then at 112 at the end of 2012. He said that 80% of Outpatients and 60% of Inpatients had no insurance.
The Cash Collections Reports YTD showed CCHHS was $7,500,000 behind Budget largely due to the cost of the 1115 Waiver applications not being processed quickly by the State of Illinois. Up to June 30, 2013, the CCHH System saw 344,500 patents with an average of 1,586 patients per day. Director Carvalho told the new Directors Cullen and Hammock their insight was needed on financial statements and problems inherent in the System.
Committee Chair Ramirez adjourned the meeting at 9:40 a.m..
--Submitted by Eleanor Prince.
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