Ten public speakers spoke in support of retaining the
pediatric unit at Stroger Hospital, defending its specialized care of
HIV-infected babies and moms that might not be available to these lower-income
patients elsewhere, its high quality training provided for interns, and drawing
attention to the loss of revenue should the unit be closed. CCHHS chair Hill Hammock responded, “We have
not taken any action on this yet. We
depend on hospital staff for input.”
COMMITTEE REPORTS
Quality and Patient
Safety: Safety Officer Dr. Krishna
Das presented metrics showing on-time surgeries at 50%; 66% willing to
recommend Stroger Hospital; 63% of ACHN (Community Clinics) patients satisfied with their move
through their patient visit. Dr. Das
said staff are receiving ongoing customer service training.
Human Resources:
HR Director Gladys Lopez reported 88 vacancies filled in July and anticipates
filling another 300 this year. The
average time to hire was down from 133 to 127 days in the 3rd
quarter.
Managed Care:
Steven Glass, E.D. of CountyCare, reported 170,834 members in July, a decrease
he attributed to the arduous annual recertification process. 99.6% of members are now assigned to a
“medical home;” more are being kept out of the ER. Hill Hammock asked for comparative data to
other U.S. public hospitals. One in five
patients is readmitted for the same affliction within 30 days, most often
detox. Eighteen percent of CountyCare
members are currently assigned to ACHN clinics; many new ACA adults already had
another medical home, but the hope is to make the ACHN clinics the “clinics of
choice” for CountyCare patients.
Finance: Deputy
CEO Doug Elwell explained large contracts, $185m to Cerner Systems for
additional modules including remote hosting; $295m for pharmaceutical
distribution including negotiated drug purchases; $3m to Access to Care
program, possibly to be reduced to $1.5m, a program providing low-cost primary
health care services to uninsured persons at 200% or greater of poverty in
suburban Cook County.
Budget: Finance
Chair Lewis Collens reported that CCHHS held two modestly-attended budget
hearings, with speakers supporting the CORE and Prieto centers, as well as the
Access to Care program, and proposing budget cuts to $1.5b. Dr. Shannon said CCHHS will need to make
changes quickly to survive financially, including the need for a greater
percentage of insured patients, and credited better managed care for the improvements
already made.
Doug Elwell led the board through CCHHS accomplishments,
priorities, budget drivers and assumptions before presenting the numbers. Among CCHHS accomplishments are (1) improvements in filled vacancies; (2) expansion
of CountyCare; (3) improved access to outpatient services; (4) the new Patient Support Center receiving 1300
calls per day, with extended hours, nursing support, and scheduling of
community-based primary care appointments; (5) the new MRI and linear
accelerators allowing for 7000 MRIs annually and 50-100 radiation treatments
daily; (6) 1.9m prescriptions filled annually; (7) 14-bed four flex unit opened
for short stays; (8) decreased Stroger Hospital wait time 35%; (9) Cermak
Clinic residential treatment unit fully operational, housing 1,000 detainees
daily.
CCHHS Priorities
for FY16: (1) improve utilization of CCHHS services by County; (2)
relocate/improve community-based clinical services; (3) expand behavioral
health services; (4) use more efficient inpatient and outpatient staffing
modules; (5) find opportunities to bring services in-house, save $5m by
maximizing the effectiveness of existing contracts; (6) new facility investment
on central campus.
FY16 Budget Drivers:
(1) maintain the mission to serve all in need; (2) unprecedented competition
for 70% of our patients who are insured; (3) increase outpatient capacity; (4)
continue to improve CCHHS financial position; (5) reduce percentage of
detainees with mental/behavioral health issues.
2016 projected Payer
Mix: self pay 32%, Medicaid 43%, Medicare 11%, commercial insurance 4.5%.
Budget Assumptions
for FY16: (1) inpatient volume to drop 5%; (2) outpatient volume to increase
15%; (3) ER visits to stabilize; (4) CountyCare membership to stabilize at
180,000. Board member Wayne Lerner
pointed out the need to be aggressive in keeping CCHHS market share
growing. Hill Hammock asked about
ability to retain annual $160m Disproportionate Share Hospital (DSH) payment.
Board member Emilie Junge spoke of the need for adequate parking. (5) lower direct support from Cook County
taxes post ACA; (6) invest in new clinical services to remain competitive; (7)
new Fantus Clinic to be located within Stroger Hospital at a cost of about
$10m; (8) new regional ambulatory center to serve Provident community projected
to cost $40-$50m (County has funds set aside for this) to open after 2016; (9)
identify options for a more efficient cost effective regional ambulatory center
to serve south suburban population; (10) expand behavioral health services to
reduce ED visits/hospitalizations. The
hope is to replace 3 clinics per year; the new third party CountyCare
administrator is expected to yield savings; more care coordination is beginning
to be done at the provider level, particularly by nurses.
Revenue Assumptions:
(1) CCHHS offers the best ophthalmology care in Cook County; this service can
grow; (2) outpatient specialty surgeries can grow; (3) operations improvements
can save money. $276m in fee for service
revenue is anticipated in FY16. The per-patient-per-month fee is negotiated
with Medicare each year.
Revenue Enhancement:
(1) improve preauthorization for Medicaid; (2) put coders in clinical areas to
capture more accurate diagnoses; (3) e-consult for early communication between
CCHHS specialists and other primary care physicians; (4) increase number of
exam rooms; (5) open clinics on Saturdays.
Revenue by Source:
CountyCare $952,421,286, accounting for 62% of FY16 budget; Cook County Health
Fund Allocation $125m, down from $164m in 2015;
Revenue by Expense:
(1) FTE estimated count 6,736 (stable, but to include more coders); (2) $13m
maintenance and utility cost; (3) pharmacy and medical supply price up; (4)
unreimbursed care costs include $86m for correctional health, $15m for public
health, and $370m in uncompensated care.
EXPENDITURES
FY2014: $1,371b
FY2015: $1,712b Projected
FY2016: $1,714 billion
FY2016 by category:
Hospital Based
Services $716m; CountyCare $646m; Admin $128m; Ambulatory Services $123m;
Correctional Health $86m; Public Health $15m.
Projected Budget stable 2017-2018 based on (1)
hospital-based population drop (2) CountyCare income drop; (3) admin same; (4)
ambulatory care increase; (5) correctional health decrease due to decreased
jail population; (6) public health increase.
Board Chair Hill
Hammock commended Elwell and budget team for its carefully considered projections:
“This is the most thorough, transparent,
effective budget I’ve seen; it’s the way we’re going to get through this ACA
transformation.” Budget was unanimously approved by the board
and must now have final approval by the Cook County Board.
ACTION ITEMS:
request for board approval of CCHHS administration’s submittal of documentation
for Provident Hospital to the
Illinois Health Facilities and Services Review Board for the following: (1) Notice
of intent – to continue intensive care unit (ICU) service with reduction from 11 to 6 beds; (2) certificate of
exemption – not to re-open the
Obstetrics Unit; change status of services from suspended to discontinued.
Dr. Shannon explained that in 2011, Provident suspended
critical care; no ambulances stop at their ED; Provident can’t compete with
FQHCs and other hospitals in Obstetrics, only serving 800 patients per year at
Stroger. Women now don’t choose Provident; a critical number of deliveries is
needed to justify the cost. Board member
Carmen Velasquez opposed closing the unit; board member Emilie Junge said she
had not been given enough information to make a confident decision. Collens pointed out that these services have
not been available for 4 years, and patients have found other sources during
those years; data indicate that adequate services are available at other area
health facilities; the budget would be impacted by continuing these
services. Since the Illinois health
Facilities Review board won’t meet again until November, it was decided to
postpone the decisions on Provident until the September CCHHS board meeting,
and to provide more data on this matter to board members.
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