Wednesday, December 19, 2012

December 18, 2012 Cook County Board Meeting

Telephones & Technology at the Court and the CTA

Commissioners absent:  Collins

Commissioner Daley was surprised by a resolution commemorating his 20 years as a Cook County commissioner.  (I believe there was cake!)

Forrest Claypool head of the CTA presented the FY 2013 Program and Budget and described some changes to the system made recently.  The senior fare will be raised 15 cents to be exactly half-fare.  The Red line reconstruction has awarded 30% of its contracts to disadvantaged south side businesses with 60% of those being black-owned.  There will be increased transit service to the Leighton Criminal Courts building and a re-opening of a stop at Loretta Hospital.  Disabled rider access will be made easier to use.

Lydia Murray,  Chief Information Officer, explained the changes negotiated with Securus telephone system used in the courts and jails.  The rates charged for collect calls made by defendants and detainees have been dramatically lowered with the goal of the County no longer making a profit on these phone calls  by the end of 2013.  This will give defendants and detainees more time to talk with their families, friends and attorneys without  paying high costs.

 Consolidation of Microsoft technology contracts among several departments has produced savings of $150,000.  The Landbank ordinance to be discussed next month is designed to turn foreclosed/abandoned land into productive property.  There has been a big drop recently in the use of electronic monitoring of adult defendants.  It appears there is miscommunication between the court, probation, sheriff, and judges regarding this issue.  Increased use should reduce costs for Cook County and better serve the defendants.

Future meetings  of the Cook County Board (in 2013) have been reduced to approximately every 3 weeks instead of every 2 weeks as is now the case.  Finance, Building & Zoning, and Roads & Bridges  committees will meet at 10:00am with the regular Board meeting beginning at 11:00am.



Saturday, December 15, 2012

Forest Preserve of Cook County December 5 2012

At this meeting two newly purchased properties were added to the Forest Preserve holdings, in keeping with the budget and policies adopted in the recent past. These are in Sauk Village. 

There was also discussion of the budget and cash flow, with the pronouncement that the Forest Preserve administration remains confident of their 2013 forecasts.  Property Taxes are coming in on target, and licensing fees are increased due to more aggressive follow up on expired licenses than had been done in the past.  In addition, pool receipts were high due to a hot summer, better controls, and new programs instituted this year.

The Forest Preserve Board has put forth a new fee structure for services which is more transparent than in the past and is in line with market rates of similar services in the area.  Some fees are rising slightly while many remain substantially the same.

Thursday, December 6, 2012

Cook County Board Meeting, December 4, 2012



The Meeting was called to order at 10:15 am by President Toni Preckwinkle.  All commissioners except Beavers and Tobolski were in attendance.  A delegation from Russia is in the United States to observe government meetings and was in attendance.  Commissioner Gainer commended these elected officials for several reasons including the fact that they do not collect a salary.

*Special Drivers License for Undocumented Immigrants:  Over the weekend, the League asked its members to call their Illinois legislators to urge support for allowing Illinois to provide temporary visitor driving licenses which would then allow drivers to obtain insurance.  On Thursday, The Cook County Board overwhelmingly passed a resolution in support.   It has the backing of a wide range of supporters including the Insurance and Health Care Industries and the Sheriffs and Police Chief Associations.  The Bill is expected to pass and be signed into law by the Governor.

* Implications of State Pension Reform:  Prior to the meeting, Commissioner Gainer held a Finance Subcommittee on Pension to discuss the possible implications of pension reform legislation that may be discussed by the Illinois General Assembly.  Over the past ten years the Cook County Pension Fund has dropped in its funded status from 88.8% to its 2010 valuation of 60.7%.
    
*The Finance Committee:  The controller gave a hopeful revenue report.  The County’s revenues are up $9.8 million over 2011 including sales tax which is up $8.8 million even with the reduction in the tax rate.  Recovery of patient costs at the Health and Hospitals System continues to be a major drag on the bottom line.

* Cost of Phone Service for Inmates:  The Reverend Jesse Jackson commended President Preckwinkle for working to reduce the very high cost of collect calls for inmates.  He asked for open hearings to learn more about what best practices are recommended.  Currently the cost per minute is over 40 cents.  The Administration has recommended reducing that to 23 cents per minute.  As a comparison, inmates in the Federal prisons pay 7 cents.  The jail holds a large number of women inmates, many with children.  Studies show that the ability to stay in touch lowers recidivism rates upon release.

*Other News of Interest:  The Board gave the Department of Risk Management the authority to resolve Workers Compensation Cases not to exceed $25,000. Commission Simms in particular but also Commissioners Murphy and Collins expressed concern with previously granted approval to give increased procurement authority to the Purchasing Department.  Two resolutions were referred back to committee.  This subject will likely come up again as the two resolutions were for rather routine purchasing authority.  The Cook County Board will meet on a 3 week schedule instead of a two-week schedule beginning "soon."  The number of meetings will be reduced from 24 to 17.

The meeting was adjourned at 12:40 p.m.  Submitted by:  Diane Edmundson

Monday, December 3, 2012

Health and Hospitals Systems Board Meeting November 29, 2012



The meeting was called to order by Chairman David Carvalho at 7:40 am.  Michael Newman of AFSCME complained during the public comment period that the union was not notified of the need for additional staff once the Medicaid waiver was approved.

Board/Committee Reports: 
Quality and Patient Safety Committee chair Ed Michael congratulated staff on the overall positive finding by Joint Commission on Accreditation of Hospitals (JCAH). He also reported on the development of a Quality Dashboard to focus the entire organization on “big dot” items needed in the coming year.  Heather O’Donnell, finance committee chair, reported that Automated Health Systems will facilitate the Medicaid waiver, an $8m contract.  Human Resources committee chair Quin Golden reported that hiring is moving forward, labor contracts have been approved.  Carvalho said “all resources of the county system will be brought to bear” on hiring.

Action Items:  
Dr. Raju said that hiring is moving forward quickly. The goal is to hire 500 FTEs into the system in the next 3 months, then 400 FTEs in the 4 months after that.  With respect to revenue collection, “Jumpstarting is so vital, we cannot fall back on our current collection process.”  Carvalho explained that the 3-year contracts with temp workers have a cancellation feature.  The county does not have to spend all the funds. If FTEs can come on earlier, the county can release temps, but the key is BILLING.  Carvalho pointed out that coders are not certified and have low accuracy, and that skilled coders are critical now that Medicaid reimbursement is based on accurate codes for services provided. The Medicaid reimbursement rate was readjusted last July.  System Chief Financial Officer John Cookinham explained that reimbursement has focused on inpatients and needs now to focus on outpatients.  The county now has 120 days of revenue outstanding and is far short of $42m goal in patient revenue as it continues to serve 4,000 patients per day.  

The board recognized Dr. Michael Puisis, Chief Operating Officer of Cermak Clinic, for his 30 years of service to the county and for providing “excellent quality to the patient population.”

JCAH Consultant Roberta Fruth spoke of JCAH history going back to 1910, and how the organization partners with Centers of Medicare/Medicaid Services (CMS).  JCAH was given “deeming” status in 1965 when the US government funded Medicare/Medicaid but did not have expertise to evaluate services they were funding. The board’s role is to assure patient safety and quality, and has ultimate oversight over licensed professionals.

Dr. Raju spoke of the impact of caring for patients who live outside the county, amounting to 7% of total system care/  The cost of this care is not billable.  He also mentioned the disproportionate amount of charity care provided by CCHHS as a whole, emphasizing that this burden should be shared.

Susan Greene, Interim Director of the Office of Managed Care and Clinical Tranformation, spoke about the implementation of CountyCare, which will provide services for the newly-eligible Medicaid recipients.  To be eligible patients must live in Cook County, be 19-64, have an income below 133% of poverty, not be eligible for state-plan Medicaid or be on Medicare, have a Social Security number, be a legal immigrant or US citizen.  The covered services mirror standard Medicaid and include hospital ER, inpatient services, drugs, lab, x-ray, hospice services, and dental services for 19-21 year olds.  Patients will have a “patient-centered medical home” at one of 13 selected Federally Qualified Health Centers and be linked to a pharmacy.

--Submitted by Linda Christenson

Monday, November 19, 2012

Cook County Board Meeting, November 14, 2012

The meeting was called to order at 10:15 am by President Toni Preckwinkle.  All commissioners except Steele and Beavers were in attendance.

All court orders, compensation claims, and employee injury compensation claims presented were approved.  Reappointments were deferred with the exception of Stanley Rakestraw's approval to the Metra Board of Directors.

The Reporting Lost or Stolen Firearms Ordinance was accepted.

A Pay Ordinance that would change the way part-time people appointed to various boards are paid, was discussed at length.  A roll call vote was taken on eliminating benefits, pensions and capping the per diem at $500 per day up to $12,000 per year for those serving on the Employees Appeal Board.  The motion was approved and will be in effect as of June 1, 2013.

Discussion began about applying the same measures to the Zoning and Building Board.  This board meets more often. A long discussion followed about capping the per diem at $500, with a maximum of $20,000 per year. This substitute language created many unanswered questions about grandfathering those still serving a term into the current language. The roll call vote failed and the item will be deferred to the next meeting.

Proposed substitute language for those serving on the Sheriff's Merit Board was also deferred to December 18th to gain more information about state statutes. Commissioners Suffredin and Gainer are leading the effort. All members of the board agreed that changes must be made to all three of these boards;  pensions and benefits will be eliminated.

A resolution was approved to provide for the transfer of funds from the moter fuel tax fund to the public safety fund.

There was a discussion regarding the need to set up an 11-member independent board for Human Rights.

A language change regarding the Cook county Board of Ethics composition and powers was approved.

A Legislative Electronic Document Management System has been adopted that will be an automated workflow solution that enables paperless creation along with a consistent and individual numbering system that will eliminate confusion among County legislative bodies.

The meeting was adjourned at 12:25 pm.

--Submitted by Pat Lind


CCHHS Quality and Patient Safety Committee Meeting, November 13, 2012

The meeting opened with a comment from a member of the public, a regular attendee, who in this case objected to the closing of Oak Forest Hospital and pointed out that the Committee had no black members. (County Commissioner Butler was once again absent.) Note: the staff who meet with the Committee are overwhelmingly non-white, including blacks and South Asians.

Dr. Mason reported that the Joint Commission had made its accreditation site visit ahead of schedule on November 2. (The federal Center for Medicare and Medicaid Services [CMS] uses the Joint Commission to evaluate and approve hospitals on its behalf.) Formal findings will be available in January, but the results were mostly positive.
  • The hospital received no CMS Condition Citations (which would require correction before restoration of Federal reimbursement). 
  • The hospital received Direct Impact Citations (calls for improvement) in life safety, including employee exposure to hazardous materials and lack of adequate smoke detectors. It also received Direct Impact Citations having to do with documentation of care and the related issue of cooperation among disciplines (e.g., the emergency room and the surgical department). Dr. Mason stressed that the issue was not quality of care but reporting, and noted the need for additional personnel to bring reporting up to snuff.
  • The hospital also received an Indirect Impact Citation for bylaws issues, including the fact that currently the Medical Executive Committee can override the full staff in considering bylaws amendments. Dr. Goldberg reported that the medical staff will vote in 10 days on a bylaws revision permitting the staff to bring amendments to the Board even if the Executive Committee disapproves, and that he will bring the approved revision to the December Board meeting.

Response plans are due to the Joint Commission by December 17 (for Direct Impact Citations) and January 1 (for Indirect Impact Citations), but the hospital has four months to provide supporting data showing that the plans actually solve the problems identified.  Chairman Michael asked about the 1-3% of patients, about 30 per month, who wait more than 24 hours in the Emergency Room. Nursing Chief Russell responded that these patients are monitored closely and receive an "almost-inpatient level of care," but the requirement is to complete a broader assessment, including various cultural issues, within 24 hours. Michael asked how many additional nurses it would take to do that for the ER’s 45-60 daily patient load; Russell said she needed 3 additional nurses short-term, and more long-term if the hospital wants a dedicated ER admissions team. ER Chief Dr. Shadur uses tracking reports to identify the 2 patients who wait an exceptionally long time, so it should be possible to conduct a full assessment at the 18-hour mark to assure its completion within the mandated time.

Medical records continue to be "delinquent" (updated belatedly) because old charts can’t be sent electronically, and because of some system bugs now being worked out by Chief Information Officer Dr. Hoda. Again the Committee asked if the medical staff needs more training in the system and if there’s a training department to provide it; again Dr. Mason replied that the system has only one half-time trainer. He will report on record-keeping progress at the December meeting so the Committee can determine whether additional training staff is required.. Dr. Hoda said there are training hours included in the hospital’s latest contract for Electronic Medical Records, so teams are going out to clinics on training tours. In the next month or so he’ll know how effective that approach is and whether there’s actually a training deficit.

Mindy Malecki, Assistant Director for Management, reported that a draft disclosure policy would come to the Committee in December, once the legal department and Dr. Raju sign off on it.

Dr. Mason then showed another video, "Boards and Dashboards," with the latter term meaning a display of levels of performance for the staff to improve and the Board to assess. Two types of dashboard are in common use: the strategic, which measures progress against major goals, and the comparative, which measures progress against competitors or regulations. Though Boards must refrain from intervening in clinical care, they can measure quality by attending to outputs such as mortality rates.

For a strategic dashboard, each major goal (or "Big Dot," or "breakthrough quality aim") comes with a certain number of drivers--items contributing to its achievement--each of which in turn consists of a number of projects. So, for instance, for the goal "Reduce Mortality," the drivers might be Teamwork, Evidence-based medicine, and End-of-life care, each with specific projects.

The monthly "run chart" (dashboard report) should show projects and results for each driver. If insufficient progress is being made, Board and staff alike must ask, "Are we not executing our plan, or do we need a new plan?" Perhaps the projects aren’t getting done, or perhaps the projects don’t really affect the drivers or the drivers don’t really affect the goal. Every goal should include three stark measures: How good? By when? As measured by?

On a comparative dashboard, the Board should see any regulatory measures from which the hospital is deviating, and should be provided with an Exception Report for this purpose. This doesn’t have to happen every month, but it should occur regularly and must occur annually in advance of setting the following year’s quality goals.

Strategic dashboards are more useful because comparative data are always 6+ months out of date. In addition, if staff are rewarded or punished based on comparisons, they’re apt to argue about the quality of the data instead of improving the quality of care. Finally, comparative data make the Board complacent: doing well 50% of the time might look good compared to other systems, but in a system serving 100,000 patients that means 50,000 people are being harmed. Beware of measuring "the cream of the crap." Now that the Joint Commission inspection is done, Chairman Michael asked Dr. Mason to identify next steps. He proposed and the committee agreed on creating the 2013 Quality Aims and the dashboard to go with them. Committee member Dr. Munoz urged using the Joint Commission’s findings as a guide for the coming year, and de-emphasizing comparisons with other hospital systems. But he also asked the Committee to consider the hospital’s overall objectives for service: "We can’t deliver every service to everyone at every level. We need to find our areas of excellence and not deliver redundant care." The Chairman noted the task is to choose which priorities to focus on in 2013: "We don’t need to complete everything in one year."
  
After much discussion among Board members, Chairman Michael concluded that three items (hospital-acquired conditions, readmission and patient satisfaction) be considered by the full Board to serve as the Big Dot goals. He also suggested spending the Committee’s December meeting looking at other providers and identifying useful comparisons. He asked Dr. Hoda to advise the Committee about whether it’s looking at the right measures, and whether its sources of information are valid.
The Committee then accepted the 2011 Department of Public Health annual report and the reports on the hospital’s planning for emergencies and for the NATO meeting.

Dr. Wakim then reported that the gastro-intestinal initiative at Provident was going well, and that they were preparing to establish a fund specifically to support the GI unit there. They’re still staffing up the pulmonary clinic, a joint initiative of the city and county. He asked the fate of the existing strategic plan (the answer seemed to be, it’s about to be superseded by the new goals) and of Provident itself now that the Medicaid waiver has been approved (no answer).

After approving the minutes of the October 16 meeting and the recommended medical
appointments, the Committee adjourned at 1:20 pm.

--Submitted by Kelly Kleiman

Friday, November 2, 2012

Cook County Board Meeting, November 1, 2012



The meeting was called to order at 10:45 a.m. by President Toni Preckwinkle.  All commissioners except Murphy and Reyes were in attendance.   

A Pay Ordinance that would change the way part-time people appointed to various boards are paid, including the elimination of health and pension benefits, was moved to the Finance Committee. The sponsoring Commissioners need time to find more support even if it means a compromise that would make the changes applicable to new appointees while grandfathering current members.  Commissioners Suffredin and Gainer are leading the effort.   The change would affect several influential political appointees that now receive full time pay and benefits for part time service.  

The Regional Transportation Authority wants a $30 million Bond Issue to help offset a $30 billion backlog of deferred maintenance projects.  The RTA initiated a 6-county area Transit Study that will be ready by April 2013 and will make recommendations for a better integration of the CTA, PACE, and Metra services; funding streams for both capital and operating budgets; and a fair distribution between the three regional transit services.  Currently the state owes the region $400 million in transportation funds.Ridership is up 5% but the fair box makes up only 25% of transit costs. 

Electronic Monitoring:  The Sheriff’s office, the Courts, and the Administration are close to issuing an RFP that calls for the consolidation of electronic monitoring equipment under one vendor contract.  “Getting it Right” is important to President Preckwinkle’s goal of reducing the county jail's nonviolent population.  We have written before on the huge cost to the County to hold nonviolent offenders either before, during, or after sentencing.  

News of Interest
Kurt Summers, Chief of Staff for the President is leaving this month.  The Commissioners overwhelmingly lauded his contributions to reforming Cook County Government.

Veterans Day is November 11.  Cook County has 260,000 living veterans which is the largest Vet population in the state. 

Lane Tech High School won the national 2012 Blue Ribbon award – one of two in the entire state and one of 307 across the nation.  Quite an accomplishment!

The meeting was adjourned at 1:40 p.m. 

 Submitted by  Diane Edmundson

Cook County Departmental Budget Hearings October 31, 2012

State’s Attorney’s Budget
State’s Attorney Anita Alvarez stressed that the proposed budget for her department does not reflect what is needed but the realities of what money is available.  While the American Bar Association says that the average case load for prosecutors should be no more than 150 criminal or 450 misdemeanor cases, her assistant state’s attorneys average 217 criminal or 940 misdemeanor cases.  Staffing shortages result in longer case times. There is a backlog in the appellate division, which has resulted in her asking assistant state’s attorneys to volunteer their free time to help write appellate briefs so that court deadlines are met.  She said that she had just heard about a proposal to create a Gun Court, and if that does come into being, she may be coming back to the County Board for more money to staff it.


--Submitted by Priscilla Mims