I. Chairman
Hammock called the meeting to order at 9:00am
II.
Public
Speakers: There were 6 speakers representing the public. A representative from the Service Employees
International Union (SEIU) Local 73 representing the Health Care Professionals,
Hospital Technologists, Service Employees and Hospital Technicians of CCHHS complained
that labor contracts had expired and the new negotiated wages and healthcare
changes which had already been approved by the Cook County Board were being
held up by the CCHHS Board. Chair
Hammock responded that the Board required comprehensive comparative metrics
from other hospitals to determine the criteria for a decision. This data was now available and a vote would
be taken later in the meeting.
Nurses
from Stroger Hospital and Cermak and SEIU representatives for the nurse’s union
contract spoke. They stated than there
were insufficient nurses per patient leading to unsafe practices. CCHHS had cut nursing overtime leading to a
more severe shortage, there were over 200 nurse position vacancies and wages
were inadequate. One of the nurses from Stroger
Hospital stated that “a strike vote by the nurses” had been taken and
introduced a representative who served the Chair of CCHHS Board with a
formal notice that the nurses will begin picketing. Chair Hammock responded that filling
vacancies was a high priority for the CCHHS Board as reflected in the monthly
metrics on vacancies.
A citizen spoke complaining that
Oak Forest Hospital had been closed and the patients moved to nursing
homes. “There is not enough money spent
on real health care”, “the CCHHS
leadership don’t receive their health
care at CCHHS, and they should! Its good
enough for the poor.”
III.
Employee Recognition:
CEO Dr. Shannon recognized
the CCHHS/Stroger physicians from the “internal medicine jeopardy team” who had
progressed to the national semi-finals.
He acknowledged an ophthalmologist who was listed as one of the “40
under 40” by the Ophthalmology Association.
IV.
Board and Committee Reports
A. Minutes of the CCHHS BOD from 4-24-15 were
approved
B. Quality and Patient Safety Committee Meeting
5-12-15
Dr.
Das reviewed the metrics of quality measures and 12 month trending pointing out that
on-time OR start was only 17% (target 80%) at Provident Hospital and the
“patient experience and willingness to recommend the hospital” was 71% at
Stroger and 67% at Provident Hospital (target: 85%). This represented a small improvement from the
previous 60-70% for Stroger but little change for Provident Hospital. Director
Dr. Marsh requested better trending to understand any improvement, not just
monthly variations. Director Weise
asked whether a survey of CCHHS employees on whether they would recommend the
hospital might be useful. Director Gugenheim reported that Provident Hospital
had been granted full accreditation by JCAHO.
C. Audit and Compliance Committee
Director
Velasquez reported that IlliniCare, Medical Director malfeasance (as reported in the press) was being addressed. Cathy
Bodnar reviewed the CountyCare oversight structure (grievances, complaints,
appeals etc.). Fraud Waste and Abuse
program training is on-going for staff.
Only 8 allegations of FWA were validated in the previous year. Director Lerner requested a deeper evaluation
of the metrics to include rate of 1) repeat allegation by type and 2) what was
the outcome. Cathy Bodnar noted that the
prescription abuse program included restricting a member to a single pharmacy
if there was a pattern of abuse and working with the member personally.
D. Managed
Care Committee
Steve
Glass reported that CountyCare membership in May 2015 was 183,415 exceeded the
goal of 155,860 but that the “total member months was only at 97.6% of
budget." In the last 6 months (Dec.
2014—June 2015) CountyCare has doubled in size and is now the 2nd
largest Medicaid managed care organization in the area (2nd to
Family Health Network). Director Junge
asked what % of the of membership are due to auto enrollment versus actively
choosing CountyCare. Mr. Glass responded
that he would follow-up with the State of IL who would have this
information. State of IL sent out new
annual re-enrollment letters to members in February, 2015, with a 60 day deadline for member
redetermination which at this time, is reported as 8,000 who had Medicaid
cancellation.
Director Lerner asked for sources of Medicaid cancellation and the response was that there were multiple reasons including 1) members not completing the process of redetermination and 2) members now employed and no longer meets Medicaid eligibility or another such change in status. Member/provider surveys required by the CCHHS contract for Medicaid with the State of IL shows only 99 member responses with 44% worried about where they will stay tonight and 32% worried about food availability.
E. Human Resources Committee
Director
Wiese and Gladys Lopez reported that they are focusing on filling vacancies
particularly nursing ones which are reported in the monthly metrics. Lopez noted that compared to May, 2014 when
216 CCHHS vacancies were filled, in May, 2015, 448 were filled.
F. Finance Committee
Mr.Elwell
reviewed the contracts that required action and all were approved
with the exception of item #14, “First
Transit,Inc” providing transportation
benefit for the Managed Care System,
contract $8,000,000 which required
further fact checking prior to approval. He reported that CCHHS has YTD
($23 million) income loss with a poor operating margin compared to
other hospitals. The
“plant/buildings/equipment” are aging
and now 17 years old and “going in the wrong direction”. There has been inadequate funding for renewal
of this capital equipment, most of which dates from the opening of the new
Stroger Hospital.
Overtime is very high at 8% of worked hours costing CCHHS $40
million. It should be less than
5%. Monthly Inpatient days (9,225 vs
8,315), emergency room visits (14,261 vs 12,887) and outpatient registration
(7,821 vs 7,543) are all down
significantly from 2014 but there is no decrease in the overtime!
Mr. Elwell stated that there needs to be
realignment of CCHHS managers with the new business model of managed care. All positions must be looked at to determine
whether they are needed.
Director Marsh
inquired about wait time in ER. Elwell
responded that no one is left in the ER waiting room, they are placed in exam
rooms waiting for the physician to see them.
Director Lerner asked about
metrics on nursing FTEs per occupied bed.
Elwell responded that they are working on an automated system for
nursing documentation to derive the metrics from.
V.
Board Education
A
comprehensive focus area power point presentation and overview of the responsibilities of the Cook County Department of Public Health, a component of
CCHHS, was given by COO of CCDPH Dr.
Terry Mason. It will be posted on-line
on the CCHHS web site.
VI.
Action Items
The
Board adjourned temporarily to Executive Session for 20 minutes to discuss the
SEIU union negotiated wages and healthcare changes for CCHHS employees
including SEIU Local 73 Health Care Professionals, Hospital Technologists,
Service Employees and Hospital Technicians.
The open BOD meeting was reconvened and it was announced that the Board
had approved the contracts. These do not include the more
comprehensive nurses' contract.
VII.
Report from the
Chairman of the Board
Chair
Hammock noted that the Board has invested tremendous efforts into recruiting
nurses.
VIII.
Report from the
CEO Dr. Shannon
Dr.
Shannon rebutted the comments made by various nurses/union representatives
public comments. He
stated that there are appropriate nursing levels at CCHHS based on the acuity
of the patient care derived from national standards and metrics. Most hospitals no longer base nurse staffing
on a specific ratio of nurse to patient, which is what the union wants, but on
acuity of care. CCHHS has used “floater
nurses” to cover periodic shortage rather than overtime. He disagrees with the nurses’ union demand for
a wage increase of 5% for each of the next several years and the demand that
seniority not performance serve as the criteria used for retention. “We are far apart on the terms for the new
nursing contract”. Dr. Shannon
indicated that the Union must give CCHHS 5 days notice of a strike. He feels that the BOD could obtain a legal
stay of the strike action. However the
CCHHS BOD are creating contingency plans to maintain nurse staffing of CCHHS
Hospitals and clinics.
The meeting adjourned
at 1:15 pm.
Submitted by Susan Kern, MD, observer for LWV Cook County, Health Issues
Committee
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