Contract Compliance Director Shannon Andrews (new to the position) explained that this MBE/WBE/VBE office now includes Veterans (as well as minorities and women) in the effort to increase the use of businesses run by these groups in Cook County contracts. A relatively new ordinance was passed to accommodate this. There are 10 FTE employees in this office. Some accomplishments this year have been to make the registration process easier and more streamlined for these businesses, tracking contract compliance businesses, and having more outreach to minority-, women-, and veteran-run businesses. The City of Chicago and Cook County now have the same requirements which should make it easier for these businesses to comply. This year 19% of contracts have been awarded to minority-owned and 5% to women-owned businesses.
Procurement/Purchasing Agent Lourdes Koss has been working on efficiencies and savings. This department has been training vendors on how to do business with the county. She has been working on quicker bidding process because so many contracts are extended instead of being re-bid on time. The cycle time for all contracts is still too high: 64 days for contracts under $25,000 and 264 days for larger contracts. Much of the department has been restaffed from clerical to professional status and 35% of them are ready to take the qualifying Certified Public Professional Buyer exam.
Several commissioners questioned the use of consulting firm Accenture. Concerns centered around this company getting paid to reduce expenses (for example in electricity use) when they really had no input on lower prices. Another commissioner became angry at "middleman" use for office supplies. Comm. Daley explained that the board had passed an ordinance--"procurement code"--which describes this process. He did not feel the commissioners could exempt themselves from this code.
Kurt Summers, Chief of Staff, Office of the President explained that fiscal responsibility and streamlined methods transparency and accountability were goals of this office. The budget calls for a $1.56 million decrease and lower staff numbers. There are now 16 FTE employees. The President's Office has partnered with 30 companies on a pro bono basis to improve services and lower costs. They have reduced energy usage, produced on-time tax bills to save local governments money, and reduced hiring time. Salaries for new hires are lower than under past administrations. One commissioner expressed concern that there still isn't an attorney hired for the Board of Commissioners to help with ordinance writing and legal research. It was explained that candidates have been interviewed and that several commissioners submitted members of their own staff for this position.
The newly named Justice Advisory Council deals with juvenile justice efforts and criminal justice in general. They have been working on a bond court study to reconfigure bonds for low-risk offenders--reducing bonds so those awaiting trial do not have to remain in jail. Other areas of concern reducing the Juvenile Temporary Detention Center population as it is very expensive to house these youth and seems to be unproductive for their eventual release in society. Fifty fewer youth detainees were held this year than last and the goal is to reduce the population even further. Employment, housing, and healthcare for released detainees/prisoners is also a concern of this department.
The revamped Homeland Security and Emergency Management Department is designed to prepare for any type of incident--natural and man-made--that might arise in Cook County. This department has had a lot of controversy in the past and it appears that reorganization, accountability, and more efficient use of equipment are goals. There is also an increase in obtaining federal grants and in their efficient use.
Thursday, October 25, 2012
Monday, October 22, 2012
Cook County 2013 Budget Departmental Reviews, October 22, 2012
October 22, 2012 Bureau of Finance
(CFO, Revenue, Risk Management, Budget and Management, Comptroller)
Commissioners Absent: Butler, Goslin, Reyes, Murphy, Tobolski
CFO Tariq Malhance presented the balanced budget which had its audits done on time, is paying down the debt, is increasing efficiencies through collaboration with Chicago, and has shown savings in employee health care costs of 1/2 million per month. This and other practices earned them AAA bond rating allowing lower interest rates for borrowing.
Highlights of the budget is that it is down 2% from last year and has a revenue shortfall of $267.5 million (Expenditures-Revenue=Shortfall). The shortfall has been less each year of the last 3 years. This gap is closed by eliminating 462 positions, most of which are vacant anyway; employee health care savings; and a hoped-for waiver of $99 million from the state to add non-paying residents to the Medicaid rolls.
Also some additional new taxes are proposed: an additional $1.00 per pack of cigarettes ($25.6 million); a non-titled use tax for purchases made outside of Cook County by businesses, contractors and residents of Cook County ($15 million); tax on bullets & guns ($1million); gambling machine tax of $800 per machine ($1.3 million).
Special Purpose Funds are down 13.9%, from $156,221,000 last year to $117,220,000 in the new budget. Full Time Equivalent employee count is down about 400 positions to 21,526 employees for the next fiscal year. New hires in Finance Department are 48 employees. Some new hires will work on Technology and Capital Projects. Others will be in area of tobacco tax enforcement.
There was a long discussion about the approach to revamping technology for the county. Twelve new hires will need to start on preparing the scope of new systems. There were questions on why hiring of these important, high-level positions takes so long. It appears that the Compliance Monitor (and the inspector general and the plaintiffs) of the Shakman decree are taking up to 6 months to decide whether a position is Shakman exempt. These decisions are being negotiated among the parties involved. Also not enough resumes of qualified people are coming in, probably because of the lower pay compared to private business. It was suggested that perhaps a headhunter could be hired to more efficiently find these needed employees.
Risk management, which deals with employee benefits, liability, safety and workers compensation, has also produced some savings in the new budget. They have 22 employees with some of the newer hires dealing with disability leave checks. There have been savings in employee and detainee medical rates. Seventy percent of employees are now in an HMO plan and detainees in the jails have a reduced Medicaid rate. There has been a $293 million reduction in fringe benefit expenditures. There will be exploration in encouraging employees to use the Cook County Health and Hospital System (Stroger Hospital). There was also discussion on reducing the backlog of workers compensation cases by allowing cases under $25,000 to be more quickly processed and spending more resources and time on bigger claims. There has been an increase of about $2 million per year due to the Affordable Care Act mandate to include children up to age 26 on parent's insurance. The benefits package in the county (especially insurance) is considered very generous.
Budget and Management director Andrea Gibson stated that STAR management reports are considered in budgeting for the various elected officials and departments . There will be a growing gap of the budget deficit due to increased wages/benefits, lack of fees in the Health and Hospital System, and debt payments in years 2015-2017.
(CFO, Revenue, Risk Management, Budget and Management, Comptroller)
Commissioners Absent: Butler, Goslin, Reyes, Murphy, Tobolski
CFO Tariq Malhance presented the balanced budget which had its audits done on time, is paying down the debt, is increasing efficiencies through collaboration with Chicago, and has shown savings in employee health care costs of 1/2 million per month. This and other practices earned them AAA bond rating allowing lower interest rates for borrowing.
Highlights of the budget is that it is down 2% from last year and has a revenue shortfall of $267.5 million (Expenditures-Revenue=Shortfall). The shortfall has been less each year of the last 3 years. This gap is closed by eliminating 462 positions, most of which are vacant anyway; employee health care savings; and a hoped-for waiver of $99 million from the state to add non-paying residents to the Medicaid rolls.
Also some additional new taxes are proposed: an additional $1.00 per pack of cigarettes ($25.6 million); a non-titled use tax for purchases made outside of Cook County by businesses, contractors and residents of Cook County ($15 million); tax on bullets & guns ($1million); gambling machine tax of $800 per machine ($1.3 million).
Special Purpose Funds are down 13.9%, from $156,221,000 last year to $117,220,000 in the new budget. Full Time Equivalent employee count is down about 400 positions to 21,526 employees for the next fiscal year. New hires in Finance Department are 48 employees. Some new hires will work on Technology and Capital Projects. Others will be in area of tobacco tax enforcement.
There was a long discussion about the approach to revamping technology for the county. Twelve new hires will need to start on preparing the scope of new systems. There were questions on why hiring of these important, high-level positions takes so long. It appears that the Compliance Monitor (and the inspector general and the plaintiffs) of the Shakman decree are taking up to 6 months to decide whether a position is Shakman exempt. These decisions are being negotiated among the parties involved. Also not enough resumes of qualified people are coming in, probably because of the lower pay compared to private business. It was suggested that perhaps a headhunter could be hired to more efficiently find these needed employees.
Risk management, which deals with employee benefits, liability, safety and workers compensation, has also produced some savings in the new budget. They have 22 employees with some of the newer hires dealing with disability leave checks. There have been savings in employee and detainee medical rates. Seventy percent of employees are now in an HMO plan and detainees in the jails have a reduced Medicaid rate. There has been a $293 million reduction in fringe benefit expenditures. There will be exploration in encouraging employees to use the Cook County Health and Hospital System (Stroger Hospital). There was also discussion on reducing the backlog of workers compensation cases by allowing cases under $25,000 to be more quickly processed and spending more resources and time on bigger claims. There has been an increase of about $2 million per year due to the Affordable Care Act mandate to include children up to age 26 on parent's insurance. The benefits package in the county (especially insurance) is considered very generous.
Budget and Management director Andrea Gibson stated that STAR management reports are considered in budgeting for the various elected officials and departments . There will be a growing gap of the budget deficit due to increased wages/benefits, lack of fees in the Health and Hospital System, and debt payments in years 2015-2017.
Saturday, October 6, 2012
Cook County Forest Preserve
Unfortunately, at the last minute I was unable to attend the October 3 Board meeting, but it is worth noting that they have published their 2012 Land Acquisition Plan. This will guide spending of the $25 million from bonds that were issued earlier this year. Land Acquisition is one of the only areas in this year's budget where spending was increased, with the intent to take advantage of low interest rates and a depressed real estate market. See http://fpdcc.com/land-acquisition-plan/ for details.
Thursday, October 4, 2012
Health and Hospitals Systems Board Meeting September 28, 2012
The meeting was
called to order by Chairman David Carvalho at 7:35 am.
In her finance committee report, chairperson Heather O’Donnell noted a
concern that grants do not always cover the cost of the service provided, e.g.
WIC, the women’s, infants’ and children’s nutrition program. Carvalho defended the program as central to
the CCHHS mission. Another cited concern
was that Carelink does not always screen outpatients to determine their Medicaid
eligibility. Chief Financial System
Officer John Cookinham said staff was inadequate to screen everyone on a daily
basis, but that the process will change with the 1115 Medicaid waiver, when
outside vendors will do the screening.
Human resources committee
representative Maureen O’Donnell said efforts are in place to streamline the
Shakman hiring restrictions, anticipating many new hires in connection with the
1115 Medicaid waiver.
CEO Dr.
Ram Raju commended the Stroger
Hospital trauma center, saying, “The reputation
of this hospital was founded on the trauma unit.” He showed a video of trauma surgeons in
action following a shooting.
Additionally he praised the new CORE center, and commended housekeeping
staff at all facilities. Dr. Raju promised a budget before
Thanksgiving.
Contracts totaling about $7m were
approved to provide temporary admin and clerical staffing; provide temporary
staff to determine patient Medicaid eligibility and enroll up to 115,000 new
patients; and provide environmental cleaning services.
Dr.
Krishna Das presented portions of the second quarter STAR Report, whose goal is
to measure CCHHS performance over time in
operational efficiency, patient satisfaction, quality/health outcomes, and financial
stability.
Sample data for 2011:
Stroger Hospital: Emergency department volume 138,950 total
patients
Wait to be seen: 172 minutes average; Left without being seen: 12%
% of patients with length of stay greater than 7 days: 19%; goal 15%
Would definitely recommend this hospital: 64%
Would probably recommend this hospital: 29%
Provident Hospital: Emergency department
volume 36,394 total patients
Wait to be
seen: 121 minutes average; Left without being seen: 9.1%
Would
definitely recommend this hospital: 60%
Dr. Das pointed out that 75% of Illinois hospitals have a higher patient satisfaction rating. Carvalho said, “Public hospitals tend to be low in these numbers.” CCHHS readmission numbers are above the national average. Dr. Das concluded that in general, where Stroger Hospital falls short is in areas requiring multidisciplinary services and teamwork. “Half of adverse effects are due to communication.”
Dr. Das presented data from Cermak Clinic showing that health nurses required between 45 and 62 hours to complete a face to face assessment; the goal is 24 hours. About 45% of diabetic patients incarcerated for over 120 days demonstrated control over their diabetes. Core Center data show that 91% of HIV patients are on the most recent viral medications. Of 40,000 outpatients with diabetes, 92.2% were tested, and 22% are in reasonable control of their disease.
The meeting adjourned to closed session at 9:45
--Linda Christianson, LWVCC Observer
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