Cook County Health and Hospital Services Board Meeting June 27, 2014

After the public speakers, Chairman David Carvalho adjourned to closed session for discussion to secure a vote to approve the appointment of  Dr. Jay Shannon as the new CEO of CCHHS.  The vote was unanimous, with applause from attendees.

Committee Reports: Dr. Munoz, reporting on the Audit and Compliance committee meeting, noted that audit firm McGladrey noted a weakness in the CCHHS audit due to difficulties in financial reporting on CountyCare.  Dr. Munoz said processes are being put in place to correct this problem.   

Director Wayne Lerner asked whether the full board might be able to meet directly with the auditor, and Carvalho agreed to arrange that.  Lerner requested that hard copies of the audit be distributed to the full board, and this request was also approved.  Lerner also asked whether, by approving the minutes of the meeting, the board was also approving the audit itself.  General Counsel Elizabeth Reedy said that according to the bylaws, if you approve the minutes, you're also approving the report.  Munoz said there has been no practice previously of the full board reviewing the audit.  The County board is the entity that actually approves the financial statement. In this situation the CCHHS board approved the minutes of the meeting, but made it clear that they were not, by so doing, approving the audit report.  

Director Lewis Collens reported that in the Quality and Patient Safety Committee meeting, Dr. Das said that the Stroger Hospital ER average wait time dropped from 140 to 82 minutes.  The CORE Center reports HIV suppression at 59% compared with a 25% national average.

Carvalho commended the Commercial Club, where he spoke yesterday, for having adopted the transformation of CCHHS, encouraging more than 70 entities to donate pro bono time.  Vice Chair Jorge Ramirez commended Carvalho for preparing the public for the budget's shrinking in one area, while possibly expanding in another.

Dr. Shannon, commended the second cohort of 11 CCHHS employees' having graduated from the 12-week "Cook County University" training program. With respect to the Cook County budget, FY2015 projects a $168 million shortfall. The 2014 budget shortfall will be $86 million, with $67 million of that related to the health fund. An improvement plan is in place to reduce costs. In June, a 3-year record 113 vacancies were filled, including 26 nurses.  Dr. Shannon recognized Dr. Robert Weinstein, departing head of the Department of Medicine. Finally, Dr. Shannon acknowledged both Dr. Raju and Toni Preckwinkle for their guidance during his period as interim CEO.

Carvalho noted that new committee appointments are made in July; board members should communicate their preferences.

The board adjourned to closed session at 9:35.

submitted by Linda Christianson

Cook County Health & Hospitals System Board of Directors Meeting, May 30, 2014

The meeting was called to order by Vice Chair Ramirez.  

Committee Reports:

      Human Resources Committee Meeting 5-16-14:  Minutes of this meeting included a report by Chief of HR, Gladys Lopes, who presented a comparison of CCHHS job vacancies filled for fiscal year 2013 Dec--April [269 ] and 2014 Dec--April [216].  The graphical data was confusing to me and I was uncertain of the  number of total vacancies  that became available or the % of vacancies filled/ time to fill vacancies. Board Chairman Carvalho requested that information be provided on the number of new nurses hired from outside the organization. Update on labor negotiations was conducted in closed session.

      Finance Committee Minutes, 5-16-14:  Update on 1115 Medicaid Waiver/CountyCare by Steven Glass, Executive Director of Managed Care. For the most recent 6 months, applications initiated fluctuate month to month, with a decrease in April. Applications submitted are slightly increased or level (7000—8000/month).  Applications approved fluctuate wildly month to month but appear to be decreasing (from 9000/month in Nov. 13 to 7000/month in April 14. 

• CountyCare members by age group are: 60-64 (12%), 50-59 (32%), 40-49 (18%), 30-39 (13%), 19-29 (25%).  49.1% are female, 50.9% male. 
• Ethnicity was not reported by 56.3% of CountyCare members. Of those reporting:  28.4% black,  12.6% white, 2% Asian, 0.4% Hispanic, 0.3% American Indian. 
• Health Needs Assessment: 59% no medical home, 51% have not seen provider in 12 months, 85% unable to obtain medications, 24% hospitalized in past 6 months,19% concerned about  “place to stay tonight”.
• Top 10 Diagnoses in descending order:   hypertension, high cholesterol, diabetes, tobacco use, general medical exam, obesity, asthma, depression, sexually transmitted disease.   

The number of CountyCare prescriptions filled has increased over the last 12 months from 5379/month to 125,799/month requiring a transfer of funds ($13,330,817) to the Managed Care Dept. to cover the increased expenditures with average per member per month drug cost of $95.     

Board Chair Carvalho noted that as patients become eligible for Medicare, there is some data that CountyCare/Medicaid loses these patients who are free to use any medical provider. A strategy of retention should be considered. He also asked Steven Glass and Dr. Shannon how the System would be able to provide quality care at a reduced cost per person. They indicated that now that they have identified “high risk” populations from the above data on diagnosis, pharmacy use and health needs assessment, they can focus on preventative care to these groups.

    

CCHHS Chief Financial Officer presented a Financial Report:

There was a net operating loss year-to-date as of 1-31-14 of $49,447,000, but when added to the non-operating revenue, the net loss was reduced to $17,924,000.  CCHHS cumulative patient income breaks down by source as: Medicaid 68% (43% of which is CountyCare/1115 Waiver), Medicare 23%, Commercial 8% and Self-pay 1%.

Quality and Patient Safety Committee Minutes, May 27, 2014:  Joint Commission survey of the Ambulatory and Community Health Network of Cook County cited a number of deficiencies which are being promptly addressed and corrective action reports have already been submitted to JCAHO.

  

Dr. Michael Kelly, Chief of the Division of Neurology, provided a presentation on a Stroke Program.  For CCHHS to become a certified primary stroke center a number of upgrades to the radiology suite, ICU and specialist physician/provider staffing 24/7.

Director Lerner asked how the CountyCare population would be managed for stroke prevention.  Dr. Kelly responded that perhaps the incidence of stroke could be cut in half if all of its patients were within range with their blood pressure, diabetes and cholesterol, and did not practice risky behaviors with drugs.  He stated that the mean age of stroke patients at Stroger Hospital is 58 and nationally 70, that 12% of Stroger stroke patients are under the age of 45.

Dr. Ukoha, President of the Stroger Medical Staff reported that the creation of an internet portal for use by patients to access their medical records is being implemented. He raised the concerns of the medical staff regarding proposed changes to the County’s pension plan which is being discussed by legislators in Springfield.  The changes may lead to poor retention of physicians. This concern was echoed by Dr. Wakim of Provident Hospital .

Contracts and Procurement Action Items : Discussion on a new contract for janitorial cleaning management service by the Board indicated that the previous contract was not acceptable resulting in  several JCAHO deficiencies at the Community Care Clinics related to janitorial services.  

Vice Chair Ramirez indicated that he would be working with Dr. Fagen, Chief Medical Officer, Department Chairs and Clinics on the budget, particularly the “pension/early retirement issue”.

Interim CEO of CCHHS, Dr. Shannon reported:  
The Illinois Dept Public Health inspection of the dialysis unit led to a 3 year re-certification.

 
 Fresh produce purveyors will be providing produce “at cost” to the cafeterias and CountyCare Clinics to improve the diet and health of patrons. 

 Dr. Shannon introduced and acknowledged the physician of the year, the nurses of the year and resident’s research day winners who were presented to the Board.

The meeting adjourned to a  closed session.

Submitted by Susan Kern