Cook County Board of Commissioners Meeting March 11, 2015

The meeting was called to order at 11:15.  

Commissioners Gainer and Murphy were absent.

The consent agenda moved quickly ending at 11:55.  

The Oak Park - River Forest State Champion Wrestling Team was honored as was 

La Casa Norte (an organization dedicated to serving the homeless) and condolences 

were expressed for Reverend Patel; he was honored for his service to the community.

15-1516 - Is a proposed resolution protecting access to comprehensive reproductive 

    health care and supporting increased funding levels.  This was moved to the Legislative

    Committee.

15-2113 - A proposed change to the Board’s rules of procedure which would allow a 

    commissioner to register a “no” vote to an item approved by voice vote at a meeting by 

    notifying the Clerk within 24 hours of the end of the meeting.  This was moved to the 

    Rules Committee.

15-2114 - Calls for the Legislation and Intergovernmental Affairs Committee to hold a 

    hearing to discuss opiate/heroine addiction and it’s impact on the criminal justice and 

    the health system in Cook County.  This was moved to the Legislation Committee.

The Meeting moved quickly with very little discussion occurring on items.  Commissioner 

Fritchey did question a subsidy to a (presumably profitable) business like Empire Carpeting.

Commissioner Tobolski responded with “no one would come here without tax incentives” 

meaning that the area for this business’s location is a depressed part of the community. 

The meeting was adjourned at 1:00.

Submitted by Pat Lind

Cook County Health and Hospital System Quality and Patient Safety Committee Meeting March 17, 2015

Attending: Chair Mary Gugenheim; CCHHS board members Hill Hammock, Dr. Erica Marsh, Wayne Lerner (by phone), Emilie Junge; QPS members Pat Driscoll and Pat Merryweather.

Meeting called to order by Chair Mary Gugenheim at 10:30.  Chief Quality Officer Dr. Krisha Das said Prieto Clinic is prepared for a visit by the Joint Commission and plans are in place for all ambulatory clinics to be visited.  The Joint Commission visit to Stroger Hospital is likely to occur between May and September.

Dr. Das presented data on CCHHS quality, safety, and patient satisfaction.  Stroger Hospital ranks below standard for operating room efficiency; there were questions and concerns regarding the incidence of pressure ulcers in the intensive care unit; Stroger Hospital overall patient satisfaction continues to be about 60%, vs. goal of 85%; Ambulatory & Community Health Network (ACHN) community clinics overall patient satisfaction about 70%. On time surgery starts were at about 30%. Peter Daniels, COO for hospital-based services, explained that break times and lunch hours of staff contributed to this low percentage, and that steps are being taken to remedy this.

Dr. Das presented an explanation of CCHHS linguistically appropriate care services, beginning with an initial language screening revealing that about 2/3 of patients have adequate written language skills, with about 1/4 Spanish-speaking among the entire patient population.  Materials are available for patients with low literacy skills as well as signage and 21 interpreters, 17 Spanish, 4 Polish, 3 more to be hired in Spanish.  In 2014, there were 50,000 requests for Spanish interpretation, most by phone at a cost of  $ .85 per minute, a total of about $750,000 in non-reimbursable costs for the year.

Dr. O. Ukoha, President of Stroger Hospital Medical Staff, asked that each patient have 2 pieces of ID "to make sure the right procedures are done on the right patients."

The meeting adjourned to closed session at 11:45.

submitted by Linda Christianson

Meeting of Cook County Health and Hospitals System Finance Committee February 20, 2015

The entire committee attended the meeting: Chair Lewis M. Collens and Directors Jerry Butler, Ric Estrada and Ada Mary Gugenheim in person; Board Chair M. Hill Hammock, Director Dorene P. Wiese and non-Director Committee member Steven Scheer by phone.

Two public commenters pointed out that contracts slated for extension as part of the committee agenda were exceptionally expensive–for instance, the McKesson company is paid $13 million to collect $32 million in accounts receivable, a rake-off of nearly 40%, while the industry standard is between 4% and 7.5%. Procurement Chief Doug Elwell explained that these interim contracts would last only until May 31 while the System prepared to bring their functions in-house; Chair Collens added that the contracts were arranged four years ago, before there was an independent Hospitals board, and would not be approved today.

Several directors pressed Elwell about whether it would be possible to do the necessary hiring before the end of May, given that filling single vacancies takes nearly six months. Elwell acknowledged that the timetable was ambitious but noted it’s easier to fill 50 identical new positions (which can all be posted at once) than to refill 50 vacancies. He also acknowledged that bringing accounts receivable and other functions in-house might not save any money but stressed that it would improve the quality and consistency of coding, which is essential for collecting reimbursements.

The new supply chain management contract, by contrast, is expected to save $2-3 million per year, though it will be expensive in the short term because the old and new systems have to be run simultaneously. A third contract to provide necessary software support to an existing system was roundly criticized: why wasn’t such support included in the original 2011 contract? To which the answer was, “We blew it,” apparently because hardware is in the System’s capital budget and software in its operations budget. The committee instructed Elwell to supply information about both in the future.

As if to emphasize the improved contracting procedures, Elwell recused himself from presenting a contract with HMA, for which he previously worked, though he’d had no part in negotiating the agreement. CEO Dr. Jay Shannon presented instead, noting that under Procurement’s scoring system for quality, HMA had 20% more points than its closest competitor, and that the scoring system was proctored by Procurement officers not involved in awarding the initial score. All standard business practice, but revolutionary at CCHHS.

The Committee then reviewed balance sheets, noting that the system “has a small profit once the County subsidy is figured in,” though at $9.7 million in a multi-billion dollar budget the profit is little more than “a rounding error.” The meeting’s financials appear at www.cookcountyhhs.org/wp-content/uploads/2014/11/02-20-15-Finance-scan-Minutes.pdf.

Highlighted financial data, though the year doesn’t close til March 1:

• Collections take an average of 37 days vs. 58 days in 2011.
• Very briefly the System had 93 days’ worth of cash on hand, versus a recommended 100 days; it’s since slipped back into the 80s but is still better than in 2012 or 2013.
• The Unrestricted Fund Balance (cash, versus assets in Restricted Fund Balance) is starting to rebound: it went from $168 million in 2011 down to $95 million in 2012 and $36 million in 2013, but improved to $88 million last year.
• Procurement goals for the year are less outside staffing (adding 130-200 jobs and resolving conflicts with labor), remote hosting of hospital data to improve quality, and lab automation, a possible source of earned revenue from other hospitals. The System will also consider how to improve patient transport and whether to provide on-site dialysis instead of referring those patients to other facilities.
• Overall strategic issues: the size and design of clinics, the central campus redevelopment for which five proposals have been received, and the possibility of risk-sharing with existing managed care groups. One possible partner could bring the System 90,000 patients if the System is willing to assume some of the partner’s risks.

The metrics presented were not, as directors noted, as clear as those presented to the Human Resources Committee, which saw a detailed step-by-step account of the hiring process and progress in reducing how long it takes. (HR attributes much of the delay to the Shakman decree.)

But a few items came through:

• The System gets 40% of the primary care provided under County Care but only 7.6% of the specialty care, when specialty care is where hospitalizations come from. This may be because CCHHS doesn’t provide adequate support services for specialists, e.g. scheduling. Ellwood proposes making specialists available at the System’s Federally Qualified Health Centers (clinics) to connect patients long-term to those specialists.
• The System’s fixed costs are high enough that extra patients cost very little.
• Because the proposed Rauner Medicaid cuts are to special payments the System rarely receives, those cuts won’t hurt the System directly; but the cuts to the County’s revenue from the state could be devastating.

Steven Glass, the director of Managed Care, then explained the complicated process of redetermining whether individuals qualify for Medicaid. 50% of Medicaid patients must be in coordinated care under the Affordable Care Act, so it’s essential to make sure they still qualify. They’re automatically re-enrolled every year but on a different timetable they must demonstrate that they’re still poor, and the whole thing is a 4-month process. Of the patients the System loses, 60% of them fail to go through the necessary I’m-still-poor process, despite assists from the Illinois Medicaid Redetermination Project and new cooperative efforts with the state’s Department of Children and Family Services and the city’s Department of Human Services. The System informs people about the Medicaid requirements, putting messages on every prescription and discharge notice and giving Primary Care docs data on who hasn’t re-upped so they can follow up with their own patients. Unfortunately, CCHHS isn’t allow to sign up uninsured people in the Emergency Room and then get paid for those emergency services.

To reduce the System’s dependence on Medicaid patients subject to these complex requirements, Glass talked about the important of risk-sharing with Primary Care Physician networks: if we share risk with them, they make us their designated provider of, e.g., liver scans. The System has the city’s most advanced scanner which makes it possible to avoid biopsies–“every hospital should be referring cases to us for scanning.”

Patient metrics:

• Membership increased 11% in January, to 96,000, less than budgeted because signup started late; Glass says he expects to catch up to budget later.
• “We were down in capitation [number of members] but captured most available Medicaid fee-for-service.”
• CCHHS is the third-largest health plan in the county.
• It’s not clear the System is getting its fair share of new ACA enrollees: 275,000 at one point of which we got zero? Are they all in the suburbs?
• The System’s membership growth is among the older population which is more expensive to care for–we keep those patients and lose the younger ones.

Submitted by Kelly Kleiman

Forest Preserve District of Cook County Report from the First Quarter 2015 meetings

The highlight of the first quarter 2015 meetings was the centennial FPDCC board meeting in February, described below. 

January 20, 2015 Meeting

15-0081:  Proposed resolution authorizing execution of the Illinois Law Enforcement Alarm System, a mutual aid agreement between FPDCC and other law enforcement entities.  FPDCC may be called to assist  police departments and vice-versa.  Example: FPDCC provided police during  the NATO conference in Chicago a couple years ago.  FPDCC has informal relationships with fire departments as well.

15-0114:  Intergovernmental agreement with the University of Illinois Extension, for educators specializing in conservation & experiential program training for staff as well as public outreach.

15-0116:  Partnership agreement with "Fishin' Buddies", an organization providing recreational outdoor programs for underserved youth.  Originally a fishing program for children residing far from forest preserve property, the programs now include an intensive, 4-week boot camp for high school youth, a fishing derby, & winter outdoor education activities for elementary & middle school students. There is a 20- year relationship between FPDCC & this non-profit.  The district contributes ~$34,000, about half of the operating costs. 

15-0117:  Acquisition of three tax delinquent properties in the area adjacent to the Joe Louis Golf Course and Whistler Woods Forest Preserve in Riverdale.  The properties will provide direct access to the future Cal-Sag Trail, as well as the Little Calumet River and the Calumet Boat Launch.

15-0138:  Once again, the FPDCC has earned the Government Finance Officers Association's Certificate of Achievement for Excellence in Financial Reporting for their Comprehensive Annual Financial Report.

February 11, 2015 Meeting

The holdings of the FPDCC are referred to as an "emerald necklace" surrounding Chicago.  The design of that emerald necklace was the work of landscape architect Jens Jensen and architect Dwight Perkins. 

At the actual 100th anniversary commemoration of the FPDCC, which occurred at the February 11, 2015 meeting, the descendants of Jensen & Perkins were presented with plaques in appreciation of the vision of their forbearers.  Events marking the centennial actually began in June 2013 with a program at the Chicago Cultural Center.  Panelists at a subsequent program at Spertus College examined the relationship between human nature and the environment. And last summer, 3000 people attended the Millennium Park showing of a PBS film on Jens Jensen.

Also presented with plaques were the Loyola University authors of a new "Explore the Forest" activity book (#15-0156).  Developed specifically for the FPDCC centennial, these books are available for free to youth & families at the nature centers, information & health fairs, commissioners' offices, & other appropriate venues.

Though some business was transacted, the meeting was largely a love-fest: commissioners talking about what the forest preserves meant to them growing up and now, and expressions of admiration for the turnaround of the district by Superintendent Arnold Randall and President Toni Preckwinkle.  The "old days" of the FPDCC being the dumping ground for patronage workers is gone.  The meeting concluded with both a photographer and videographer making panoramic sweeps of everyone in attendance as part of the official record & archive. 

Preceding the February 11 FPDCC board meeting, the elevator lobby was abuzz with activity: visitors viewed a photo exhibit documenting the history of the forest preserves, naturalists brought an owl & snake from the nature centers & answered questions, there were giveaways (calendars, pins, pens), and the media were there. After the board meeting we were all treated to cupcakes. 

Noteworthy official business matters include:

15-0151:  Receipt & filing of the Natural and Cultural Resources Master Plan developed in partnership with the Prairie Research Institute of the University of Illinois. 15-0152:  Proposed contract not exceed $500,000 in 2015 to execute parts of the plan.

15-0152:  Illinois Dept. of Natural Resources $1,063,500 grant (to be matched 100% by FPDCC) for improvements to Dan Ryan Woods.  Improvements include nature play & outdoor recreation elements such as walking paths & trails, adding exercise stairs to the sledding hill so it can become a year round fitness challenge site, converting a nonfunctioning wading pool into an outdoor nature classroom, creating a treehouse/nature viewing platform.

15-0153:  Bid recommendation for removal of 1.8 acres of tree & brush across a rare dune & swale habitat at Wentworth Woods in Calumet City to promote the growth of native ground layer vegetation.  The work will be funded by a $43,000 U.S. Fish & Wildlife Service grant (and a $43,000  match by FPDCC) provided through the Great Lakes Restoration Initiative.

15-0159:  Proposed partnership agreement with Openlands for a large-scale restoration project at Deer Grove West in Palatine.  Deer Grove was the first preserve acquired by the forest preserve district in 1916.  Originally 500 acres, the tract is now 1,800 acres.

15-0161, 15-0162, 15-0164, 15-0165, 15-0166:  Disbursements of ~$1.3 million for construction work on the campgrounds, particularly overnight camping facilities

March 10, 2015 Meeting

Significant discussion centered on two topics:  a proposed increase in the weekend parking fee at the Chicago Botanic Garden (15-0147, introduced at the January board meeting) and the Natural and Cultural Resources Master Plan (15-0151).

Last year more than 1 million people visited the Chicago Botanic Garden (CBG).  Admission to the garden is free:  you can walk in, bike in, take a Pace bus, or drive.  But there is a $20 parking fee for Cook County residents who aren't members; and non-member visitors from outside Cook County pay a $25 parking fee.  CBG has proposed a $5 increase in the parking fee for non-members who visit on weekends, as a means of encouraging visitors to come on weekdays instead.  Weekend traffic backups on the Edens Expressway and Lake Cook Road are not just frustrating and inconvenient for visitors & those living in the vicinity, they are dangerous.  CBG has had to hire the Highland Park police for traffic control and increase security personnel.  CBG is looking at a wide range of alternatives to alleviate congestion, but will likely need to build another lot (~$1.4 million).   

 Weekends are popular because visitors work during the week, and special events are usually held on weekends. Commissioners were skeptical that the $5 weekend surcharge would compel visitors to come on weekdays. Nevertheless, because admission is free the increase was adopted on a vote of 13-2 (Commissioners Fritchey & Boykin opposed). 

Highlights of the Natural and Cultural Resources Master Plan were presented by two of its authors from the Prairie Research Institute at the University of Illinois, Urbana.  The plan can be accessed at http://fpdcc.com/preserves-and-trails/plans-and-projects/natural-and-cultural-resources-master-plan/. Of particular interest to this reporter is the section on archeological sites: "To date, approximately 1,200 archaeological sites have been recorded in Cook County. About 550 (or nearly 46 percent) of these are located on FPCC property...Furthermore, less than 20 percent of the forest preserves have been systematically surveyed..." (page 48).  Should you choose to view the presentation & Board discussion, it can be found at 1:12-1:29 on the video.

In addition to the CBG parking increase, other financial matters of interest include (1) approval for refinancing of bonds to take advantage of lower interest rates (15-0178:  Ordinance authorizing the issuance of up to $17 million general obligation unlimited tax refunding bonds and up to $3 million in general obligation limited tax bonds was proposed at the February meeting.); (2) approval of the 2015 tax levy which remains at the same rate as 2014 (15-020); and (3) discussion of the $437,000 cost overrun (due to a combination of factors, many of which could not have been anticipated) for construction of the overnight campground in Palatine (15-0200).

Each month a Corporate Fund Analysis of Revenue and Expenses is presented by FPDCC's chief financial officer.  The March report reflected data as of January 31, 2015.  Compared to this same period in 2014, revenue was down $47,000 (due to weather & fewer fines being assessed), and expenses were down $224,000.  Year-to-date, however, expenses exceeded revenue by ~$136,000.  This is not a cause for concern, however, as tax payments from the first installment have not yet been received by FPDCC.

15-0223, 15-0224, 15-0226:  The 2014 Minority Business Enterprise/Woman Business Enterprise reports for the FPDCC, Brookfield Zoo, and Chicago Botanic Garden, respectively, were filed and referred to the Contract Compliance Committee.

15-0135:  Proposed ordinance on overnight campground fees.  New construction & upgrades are ongoing. As described at the January meeting, the fees are competitive with other area campgrounds, programming is offered, and non-profits receive a 50% discount.    

15-0228:  Miami Woods & Prairie Volunteer Stewards filed their 2014 report on ecological restoration activities.  Commissioners Goslin & Suffredin lauded the stewards & their achievements, and commended their model for engaging volunteers and accomplishing significant restoration.  

Submitted by Sheri Latash