2016 Cook County Budget Hearing: Health and Hospitals System, Oct. 22, 2015
Dr. Shannon, CEO for the Cook County Health and Hospitals System
(CCHHS), appeared before the County Board to present the CCHHS budget for 2016.
In his presentation he emphasized that the Affordable Care Act has been a “game
changer” for the system, as, for the first time in history, a majority of the
patients being served are now insured (70% have some type of coverage). The
desire to maintain the mission of serving all in need while having increased
competition for patients who now with insurance have choice of where they get
their health care is the underlying concern.
Dr. Shannon further described how health
care is changing from an acute care model to an outpatient ambulatory care
model. Also, Cook County medicaid patients are now required by the state to be a
part of a managed care system. These changes have resulted in the CCHHS Board
rethinking how their services are best rendered and how their facilities are
most efficiently and effectively utilized to deliver services.
The viability of
CCHHS depends on its financial success and therefore they now use national
benchmarks to gauge their progress as they move towards implementing an
expanded ambulatory system that is located county wide rather than hospital
centered as it has been in the past. Changes within the system still need to
take into account limits imposed by existing staffing models and physical space
constraints.
Revenue concerns he noted: the general decrease in
hospitalization of patients and how this impacts hospital income as well as the
yearly redetermination requirement for medicaid recipients.
The CCHHS proposed budget for FY16 is $1.7B with an
anticipated “subsidy” from Cook County of $125m (anticipated decrease of $34m
from 2015). It includes staffing throughout the system of 6736
FTE’s (a decrease of 11 from 2015) and assumes that County Care will maintain a
membership of about 170,000 members.
Concerns raised during commissioner questioning:
•
Correctional health in the jail and in JTDC
continues to be a challenge. One development is Community Triage Centers
that will be staffed 24/7 and located in the community to assess individual
arrestees with minor offenses who can perhaps be treated at these sites and
diverted from jail. A pilot is anticipated to open in early 2016 on the south
side of Chicago.
•
The Access to Care program had a
decrease in funding in this budget and Comm. Suffredin and Schneider both
expressed concern over the cut. Dr. Shannon stated that Access to Care, a
program that provides community based medical care for uninsured persons, has
also been impacted by the ACA and thus that program is also undergoing changes.
•
Comm. Steele expressed concern that the cultural
shift within the system was not being effectively communicated to the staff
within the system. Dr. Shannon said that as the staffing model is
changing, they are working with the unions to try to ensure that employees will
be able to find positions within the system. He stated that 200 new nurses have
been hired and many nurses have changed to different positions.
•
Comms. Steele, Sims, and Garcia expressed concern
that a new Trauma Center that has been proposed for Holy Cross
Hospital would introduce unwanted competition to Stroger’s Trauma Center. Comm.
Sims wanted to know if Dr. Shannon would be opposed and he stated that there
was a process in Illinois to determine the need for another Trauma Center. When
he did not express opposition, she wanted to know if he had been involved in
planning discussions and he stated he was not involved. When asked if he had
concerns, he stated that whatever solution concerning another Trauma Center had
to have staying power as opening a Trauma Center was a big deal and so was
closing one.
•
Comm. Boykin wanted to know why they were giving
people raises when taxes are being raised to cover such raises. Comm. Sims
wanted to know who developed the salary schedules. Dr. Shannon stated that 90%
of the employees are union and the salaries are determined during
union negotiations. They have done salary comparisons with other hospitals and
Comm. Sims asked to have that information shared with the commissioners. Comm.
Moore wanted to know why Physical Therapists (who have doctoral degrees) made
less than drivers. No explanation was provided.
•
When asked about the closing of the pediatric
inpatient beds, Dr. Shannon reiterated that they are committed to
investment in ambulatory care and primary care for pediatric patients as the
demand is for ambulatory pediatric specialists not inpatient services.
•
They have also made investments in dental
clinics and hope to expand this service. There are now 5 dental clinics
operating.
•
Comm. Sims and Comm. Arroyo asked about minority
hiring. Dr. Shannon stated they do make an effort to ensure a diverse
work force but there is a lot of competition in this area for competent staff
and the County salary schedule is not always competitive and people go elsewhere to work.
•
Comm. Morrison wanted to know what would happen
if CCHHS did not meet their projected revenue from County Care.
Dr. Shannon stated that they continuously monitor using metrics and would
decrease cost if revenues were not as expected. Dr Shannon stated again that
this is going to be a tumultuous time in health care as all medicaid clients
are moved to managed care and the switch is made to a focus on ambulatory care but
he is committed to their mission and doesn’t think they should close up shop.
•
Comm. Gainer asked what they spent on outside
attorneys for litigation. Dr. Shannon stated that they turn any
litigation over to the State’s Attorney and if outside attorneys are hired it
is done by the SA’s office.
Dr. Shannon ended the nearly 3 hour questioning by stating again
that CCHHS is trying to make the pivot from a single campus to a countywide
full service system for patients.
Dr. Shannon’s slide presentation can be found by clicking on
CCHHS Budget Presentation under Attachments.
--Submitted by Cynthia Schilsky
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