The meeting was opened at 8:00 by Interim Chairman Jerry
Butler.
During the public comment period, a citizen stated that
CCHHS Board members needed to attend all Board and Committee meetings and be
unbiased and prudent with the public’s money.
Furthermore, the person stated that Board members were not informed, not
enlightened and not engaged.
Two neonatal nurses objected to the limitation of neonatal
beds for pregnant women to 28 beds, and capping the number of babies cared for
at 54. They felt this policy jeopardized
the health of women, and minimized a program which is coveted by other
hospitals, as well as shrinking the visibility of the program and sending
people to other hospitals, which begins a downward spiral of total hospital
care. Dr. Jay Shannon, Chief of Clinical Integration, said the
hospital did a study earlier in the year to determine what was a safe level of
operation while using aging nurses. He
answered affirmatively to Director Hammock’s question if all babies were
covered by Medicaid. Dr. Raju’s answer
was that the caps were related not to a financial question but a safety
issue. The nurses replied that there
were no aging nurses. Dr. Raju stated
that the neonatal nurses were nearing retirement, had the highest overtime,
and that overwork compromises the safety of patients.
Gina Besenhofer, Executive Director of Supply Chain Operations,
stated that she would need extra time in the September meeting to explain the
contracts process. The first seven
contract proposals were for renewals of grants. All seven contracts carry a line on their
deferred liability, the risk assumed in case the contract is not renewed. This is determined by the operation, cost,
and mandated health need, and is generally for six months. These contracts were considered:
- Contract renewal #1 was for $3,252,089 for Supplemental Nutrition for Women, Infants, and Children to be provided by the Illinois Dept. of Human Service.
- Contract #2 renewal was for $272,614 for Supplemental Nutrition for Women, Infants, and Children, also to be provided by the Illinois Department of Human Services.
- Contract renewal #3 is for $1,129,626 for Bioterrorism Preparedness and Response to be supplied by the Illinois Department of Public Health.
- Renewal grant #4 for $648,980 was for Case Management for High-Risk infants to be supplied by the Illinois Department of Human Services.
- Renewal grant # 5 for $153,878 from the IDPH was for the Cities Readiness Initiative.
- Renewal grant #6 for $77,338 from IDPH was for Lead Poisoning Case Management with Environmental Inspections and fees for service.
- Contract #7 was for $3,400 for Summer Food Inspections from the IDPH and will include fees for services.
- Contract #8 is an Amended and Increased contract for $304,380 for behavioral health management from PsycHealth.
- Contract #9 is an Increased contract for $135,000 for temporary staffing services from Maxim Staffing Solutions to cover costs for CountyCare, the Medicaid Demonstration Project of which the Residential Mental Health unit will be a part.
- Contract #10 for $32,359,335 with Siemens Medical solutions is for hosting, support, and consulting services.
- Contract #11 for $486,461 with UpToDate, Inc. is for clinical information access for physicians and other clinical staff, and
- Contract #12 for $486,461 with RelayHealth is for service on electronic pharmacy claims re submission.
Chairman Carvalho asked Ms. Besenhofer to compute how scopes of new contracts differ from past contracts. Ms. Besenhofer said initially CCHHS bought the Siemens System they immediately needed. Director Carvalho said that subsequently they found the Siemens System purchased was grossly inadequate, and that the same thing occurred with the Cerner System, and now CCHHS was attempting to catch up to the needed point. Mr. Oder, Ex-Officio Board Member, pointed out that this $32 million contract for Siemens is three times the past cost, and wondered if future revenue would be able to handle this escalating cost. Dr. Raju pointed out there was dire need to build a system, and that there was need to have adequacy.
It has also been determined, said Ms. Besenhofer, that the
State of Illinois was incorrectly processing CCHHS claims, and that the State
now owes CCHHS $7.1 million. CCHHS is
looking for a vendor to ensure that the State is reimbursing them correctly and
in an up to date manner for their expenditures.
All hemophiliac care in the state is being moved to CCHHS and there will
be more costs for the building of a County Residential Mental Health facility.
After discussion concluded, all twelve contracts were passed unanimously.
Steven Glass, the new Director of Managed Care, said that as
of August 11, 2013, 88,200 applications under the Affordable Care Act 1115
Waiver had been processed, 64% from the County, 31% from FQHC’s, and 5% from
Cermak. At the end of July, the State
had processed 55,000 applications with an 88-90% approval rate. 500 applications are being submitted per day, and the State is processing 375 per day.
The turn down rate is mainly due to income discrepancies. The CountyCare plan should be completed by
April 1, 2014 for legislation by the State, with plans to have it fully
operational by October 1, 2014.
Aaron Galeener, CCHHS
Budget Director, presented the Preliminary 2014 CCHHS Budget, noting that this
is the earliest presentation ever, and asked that the Board approve it by
September 17th so Dr. Raju could submit it to President Preckwinkle
of the Cook County Board by September 23rd. He also noted that they must submit a bed
count by September 11. Public Hearings will take place the week of August 19-23
and then the Budget will be submitted to the CCHHS Board on August 23rd. It is planned that the Board will submit the
FY 2014 Budget to the Cook County Finance Committee by September 11.
Dr. Raju detailed the highlights of the 2014 Preliminary
Budget. First, there will be continued
transfer to a patient centered delivery model with financial responsibility.
Secondly there will be a 30% reduction of financial reliance on the County
Board from $485 million to $175 million.
Third, there will be an investment in human resources for a robust and
efficient human resources department with IT investment in real data, and
investment in patient experience with adequate staffing. Dr. Raju said with the expectation of
CountyCare, they can fully implement a medical home, and that they have already
hired a Nurse Recruiter.
Mr. Galeener said key principles of the 2014 CCHHS Budget
showed no service reductions, an investment in Patient Experience, an improved
infrastructure, reduced taxpayer burden and dependency on County funding. Mr. Galeener said by 2014 they expect 100% federal reimbursement. He said total revenue will increase by $238.6 million due to
CountyCare payments from the federal government increasing by $271.2
million. BIPA (Benefits Improvement Act
of 2000) will decrease by $30 million and there will be other decreases in DSH
(Disproportionate Share), Meaningful Use Payments, and Medicaid patient fees as well as physician billing and contract revenues.
The
federally funded ACA CountyCare managed care program accounted for 48% of CCHHS revenue. The 2014 Budget is $150.3
million higher than the FY2013 Budget. Dr. Raju said they conservatively estimate the CountyCare
population for 2014 at 56,131 patients, saying that any extra monies received from the
federal government must be returned to the County.
Mr. Oder said he had some major reservations
on the FY 2014 budget because underpayments in 2012 added $75 million to the
CCHHS Budget, and revenues were underestimated in the first 8 months of 2013
by $135 million. He said there was a need to be realistic. Dr. Raju replied that CCHHS had been $165 million short and that the shortage had now been decreased to about $75
million. This problem, he said, has been
due to the state cash flow. Dr. Raju
continued that with State Medicaid, CCHHS only received $.48 on the dollar of
expense, but with the new federally funded CountyCare under the Affordable Care
Act, expenses will be fully compensated. He added that the new Budget has no
personnel lay-offs or reduced services.
Director Carvalho said there are huge opportunities and huge
risks ahead, and that the numbers chosen were down the middle. Dr.Raju said they are expecting 60,000 new
enrollees for the CCHHS, and need even more to stave off leakage because
it affects the cash flow. Director
Carvalho stated that the State is not only processing their claims, but CCHHS
gave the state the money in advance, to set-up the unit to process the claims.
John Cookinham, Chief Financial Officer, presented the final
July 2013 financial statements. Average
patient days were 92 in May but were 103 in July because they had to write-off
15.7% of cost due to CountyCare patients already in System not being approved
for membership, a Medicaid shortfall, and a $7 million shortfall in the
Pharmacy. In July 2013 costs were $322
million YTD and collection was $297 million YTD. Mr. Cookinham said they were planning to get
an advance of $30 million from DSH by November.
Statistics on page 32 of the July 2013 financial statement showed that
58% of the patients served were uninsured, and that adjusted patient days
showed the System as being below budget.
In answering Director Carvalho’s question as to where the
System is in terms of Expenses and Revenue, Mr. Cookinham said the Revenue to
date is somewhat short of $24 million, but by year end Expenses will not exceed
Revenue. He said that this year they
have come close to appropriations, but will have a cash discrepancy of $40
million by the EOY. Answering Director
Gugenheim’s question on self-pay, Mr. Cookinham said they only receive $5 to $6
million per year in true self pay.
The meeting was adjourned at 10:35 by Acting Chairman Butler.
--Submitted by Eleanor Prince
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