Cook County Health and Hospitals System Board of Directors Meeting July 31, 2015

Chairman Hammock called the meeting to order at 9:00 am

Public Speakers:  Over 10 speakers representing the Pediatrics Department at CCHHS, including Attending Pediatricians, Residents, medical students, newly graduated residents, pediatricians from the community, pediatric nurses, representatives of faith-based organizations (United Methodist Church, and the Pastor of the Oak Forest Hospital), representative from child protective services, and a Hispanic member of the community who presented her comments via an interpreter rose to object to the rumored closure of the Pediatric in-patient department.  They alluded to an article printed in Crain’s Chicago Business, July 20, 2015 “Kids are Skipping Stroger;Cook County hospital considers phasing out its pediatrics ward” which reported that CCHHS is considering phasing out its inpatient pediatric unit at Stroger and was weighing whether to consolidate its residency training program in pediatrics into another program and focusing its primary pediatric care at outpatient sites.  It reported that the Stroger pediatric unit of 40 staffed beds had an average occupancy of 26%.

The public speakers stressed that: the Pediatric Unit was cost effective and brings in revenue;  Claims were made that the Rush Children’s Hospital (next door to Stroger) “was sucking patients from CCHHS”;  lauded the Stroger Burn and trauma care for children, supported the pediatric residency which trained physicians who would take care of the indigent.  

CEO of CCHHS, Dr. Shannon responded (after 45 minutes of public speakers) that ”the future of CCHHS is ambulatory care, in the Medicaid managed care model, not highly specialized in- patient care.  No Board decisions on the pediatric unit have been made at this time.  The Board will act on behalf of the entire community.”

Picketers with placards and police presence were present outside of the building.  The Board room was packed with members of the pediatric department with a prominent media presence including videotaping of the presentations.

Employee Recognition:  Graduates of the Leadership Development Project were present and acknowledged by the Board.

Annual Meeting Business:  Chairman Hammock was affirmed as Chair of CCHHS Board of Directors and Commissioner Butler as Vice-Chair.

Board and Committee Reports 

 

Quality and Patient Safety Committee

Director Guggenheim and Dr. Das reviewed the May, 2015 Metrics for Stroger Hospital which show that there continues to be a challenge in improving quality metrics including: surgery start on-time (52%) and OR room turn around time, influenza and pneumococcal vaccination (48 %) and patient experience/willingness to recommend the hospital  (71%).  The metrics are little changed from May 2014.

The CORE Center for HIV/Hepatitis /other infectious diseases shows excellent metrics.

Managed Care Committee

Director Lerner and Steven Glass reviewed a few key Metrics:  County Care membership has been drifting lower over the last 4 months from a high of 183,415 in May to 172,873 in July 2015 which are primarily ACA adults and fewer FHP patients.  This is attributed in part, to failure of members to complete the redetermination process which Medicaid requires to insure that they are still eligible for the program.  Membership is still 10% over the budget which is a positive.  More competition may be entering the marketplace in competition with CountyCare as other large health organizations are forming managed care organizations.

Audit and Compliance Committee

Cathy Bodnar reported that the CCHHS audited financial statements for the year ended November 30, 2014 showed exceptional audit results. 

Human Resources Committee

Gladys Lopez reported that nurse hires are higher this year (249) vs 2014 (139) and that the “time to hire” has decreased to 127 days.

Finance Committee

Director Collens and Doug Elwell reported that the 2016 CCHHS budget was being worked on. 

Mr. Elwell noted that CCHHS needed to grow its Medicare business; recent salary contract agreements would result in increased expense to CCHHS; the CCHHS facilities and equipment were aging and would require capital improvements; prescriptions, especially newer very expensive drugs, will be difficult to purchase at a discount and will result in increased cost to CCHHS; uncompensated care will continue to be expensive.  He suggested that CCHHS units that were unused for many years could be closed vs converted to ambulatory care vs consolidated with other units.  Janitorial services which have repeatedly received poor patient ratings on surveys should be assessed for the FTEs per space they clean and outside vendors should be investigated. 

Director Wiese asked whether the Board could be given data on the number of “contract employees” vs. CCHHS employees there were and the cost. Mr. Elwell stated that vendors are paid according to industry standards.  Director Wiese also noted that there were significant parking problems on the CCHHS campus with up to “300 patients a day turned away”. 

Director Junge asked whether there was a proposal to decrease FTEs at CCHHS?  Mr. Elwell responded that the goal was to staff with FTE numbers that were the industry standard.  Dr. Shannon added that they were looking at utilization of services and staffing accordingly. 

 

Mr. Elwell reported that the cost of Cermak is increasing because of enhanced services provided via CCHHS.  The cost of the CC Public Health Department (administratively under CCHHS) was increasing because they were not being awarded sufficient new grants which would contribute to the income.  He added that they were not garnering sufficient grants because of their difficulty in fulfilling them in the past.  Director Marsh requested an overview presentation on the Public Health grant process.  Director Gugenheim responded “why not combine the CC Dept. of Public Health with the Chicago Dept. of Public Health which has been proposed since 1989!  Nothing happens.”

Action Items

Dr. Fagen noted that Stroger Hospital Department Chairs need to be reappointed every 2 years according to the JCAHO standards.  There has been a lapse in reappointments which she recommended the Board to undertake at this time.  The Board moved to reappoint the Chairs.

Report of the CEO

Strategic Plan Update:  CEO, Dr. Shannon explained that the population that CCHHS was serving had changed over the decades despite the same physical facility.  CCHHS needs to change with the different demographics, healthcare industry and local standards.

Provident Hospital has been part of CCHHS for 22 years.  In the past it was a busy hospital but currently its 25 acute care beds have an average occupancy of less than 50% with a $36 million annual loss.  The ER is well used with 36,000 visits a year.  They have a prestigious eye facility.  Much of the building is not in use. The facility and equipment are old and would require $19 million in upgrades plus $11 million to purchase diagnostic imaging equipment.  Analysis shows that the catchment service area around Provident contains 682,000 individuals with good Medicare/dual eligibility/CountyCare mix. 

Dr. Shannon suggested that Provident be repurposed into a regional outpatient center focused on the Eye center, diagnostic imaging, bariatric surgery, orthopedics and prenatal care.  The cost of a new, “green” building which would be more cost effective to operate and equipment is projected to be $50 million. Directors Marsh and Lerner asked “why not partner with an existing hospital rather than going it alone?”  Director Estrada asked whether the Cook County Planning Commission had reviewed this proposal and evaluated the demographics of the area to make sure this was a good idea.  Director Junge questioned whether the ER visit numbers were not really “clinic type medical needs vs. a true ER level of health care need”.  Dr. Shannon replied that “this is an opening discussion, no firm decisions made”.

The meeting was adjourned to closed session at 11:45am.

Submitted by Susan Kern, MD