Commissioners question Cook County's salary increases while raising taxes and fees

Cook County Committee & Board of Commissioners’ Meeting Wednesday, October 28, 2015

The Board meeting was called to order at 11:15 a.m. but the actual conduct of business started at 1:50 and ended at 2:50.  This writer found the meeting process one of the most confusing observed.  Perhaps it had something to do with the number of budget hearings that Commissioners attended in the days prior to the formal Board Meeting and the inability to get the morning Committee meetings concluded on time.

Major Discussions/Decisions of Note are: 

1. Resolution #15-4297 passed out of the Finance Committee and was approved by the full Board.  It is a contract with Blue Cross and Blue Shield for $884,195,500 over a 3 year period ending in 2018. This covers 22,000 employees and 33,000 dependent lives and includes all Cook County government employees, the Forest Preserve, and the Housing Authority.  By the end of the contract, employees in total will pay for approximately 10% of the total cost of insurance.  Currently the Health and Hospital Systems employees are included in the county’s PPO network but not the HMO.  They are negotiating for the HMO [in competition with HHS’s County Care]. 
2. Resolution #15-5145 changing the Medical Examiner Ordinance, passed out of the Finance Committee and was approved by the full Board.  In addition to language updates [dropped the anachronistic Office of the Coroner reference], it gave authority to the new Medical Examiner to enter into cooperative agreements with other agencies having laboratory facilities without going to the Board for permission, and changed the accounting method for the fee fund.  The Board did ask for an email notice when entering into agreements.
3. Resolution #15-6190, proposed by Commissioner Fritchey, was sent to the Finance Committee.  The resolution calls for a county-wide referendum to abolish the office of the Cook County Recorder of Deeds.  The CC League of Women Voters spoke in favor of sending the resolution to committee to give the public time to review and comment.  We will closely follow this resolution. 
4. Resolution #15-5847, authorizing the Sheriff’s office to appoint a Cook County Gun Violence Coordinator was passed out of the Criminal Justice Committee and approved by the Board.  

Other Board Business

1. The CFO of HHS reported that as of the end of the 3^rd Q, HHS has $14 million budgeted surplus.  It is waiting for a $100,000 million Federal and State pass through from the State. 
2. County Clerk David Orr asked for and received a transfer of funds to purchase electronic pollbook computer equipment to serve precincts larger than 1,000 registered voters. 
3.  State's Attorney, Anita Alvarez, received approval to renew a grant for 2 staff members to work on a uniform bond court screening process thereby allowing for diversion into treatment courts and decreasing the time offenders spend in custody. 
4. Alvarez also received a 3-year $900,000 Federal grant to strengthen the response to victims of sexual assault, domestic violence, dating violence, and stalking who are enrolled in colleges located in Cook County including Chicago. 

Public Speakers and Consent Calendar Highlights: 

1. The Board saluted two Chicago officers that save a baby’s life by foregoing protocol and driving the infant directly to the hospital rather than waiting for an ambulance. 
2. The Rev. Jesse Jackson was honored on his 74^th birthday for his civil rights and community work. 
3. Representatives of the Black Funeral Directors Association requested a reconsideration of the ordinance authorizing a charge of $500 to Funeral Homes that pick up deceased individuals and deliver them to the County Morgue because families cannot pay the funeral home for a burial and the funeral home is not legally able to store bodies.  It was noted that the storage fee was imposed to discourage use of the Medical Examiner’s office which has limited capacity.  Commissioners Boykin and Steele promised to continue to find a solution for the Funeral Directors as they are caught in the middle.  One suggestion is that the family can gift the body to the Anatomical Society and bypass the ME’s office.  Another:  When the individual dies at home, rather than calling a Funeral Director, call the police to pick up the body and deliver it to the morgue.

Finally, there was much discussion on the number of higher than expected salary increase percentages for several individuals and departments.  Several Commissioners asked the HR Department to prepare a list of those employees receiving a salary increase higher than the standard 6.5% combination of cola and step.  It was noted that two individuals received $31,000 and $36,000 respectively and among three individuals the raises totaled more than $200,000. The point was raised because of the recent Sales Tax increase and the proposed increase to the Amusement Tax.

Submitted by:  Diane Edmundson, Observer

Reviewed by:   Laurie Morse, Observer

Hiring practices questioned during Inspector General's Office Budget Review

2016 Cook County Budget Hearings: Office of the Independent Inspector General

Tuesday, October 27, 2015

The mission of the Office of the Independent Inspector General (OIIG) is to detect, deter, and prevent corruption, fraud, waste, mismanagement, unlawful political discrimination (Shakman patronage issues) and misconduct in the operation of Cook County government.  There are currently 17 employees in the office with one job opening. Mr. Patrick Blanchard is the Inspector General, he has two deputy Inspector Generals. There have been 310 complaints to this office for the current year; this is an increase from last year.  OIIG works with the Cook County Ethics committee, and also covers the Health and Hospital system and Forest Preserve.

Most of the questions and comments by commissioners during the budget hearing related to referring candidates for jobs within County government. There was concern about the hiring practice and how applicants are selected for interviews.  Commissioner Deborah Sims stated that one of her constituents sent in applications for a job 32 times and never even had an interview or a response from the Cook County HR Department.  There was discussion of creating a person to oversee the hiring practices of the Health and Hospital Systems since they employ the largest number of people in Cook County. Cook County Jail is second.

Most commissioners seemed pleased with the work of this office. Patrick Blanchard is satisfied with OIIG budget.

Submitted by Nancy Marcus

Commissioners question CEO for nearly 3 hours on proposed 2016 budget as CCHHS evolution remains front and center

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

Cook County Health and Hospitals System Board of Directors Meeting, September 25, 2015

Chairman Hammock called the meeting to order at 9:00 am. Present were Directors Velasquez, Collens, Gugenheim, Lerner, Estrada, Marsh, Junge, Wiese and Commissioner Butler.

Public Speakers:  Mr. Blakemore complained that the CCHHS  Board Finance Committee for Sept. 2015 was cancelled.  He stated that he learns from this financial information which is supposed to be open to the public.  How could he, as a citizen, know how the money was being spent when the meeting is not held.  He asserted that leadership were political appointees, working with the unions. 

Board and Committee Reports

Finance Committee:  Doug Elwell indicated that the committee did not meet this month due to “timing issues”.

Contracts totaling close to $12 million were reviewed and approved.  All were by competitive selection method except for a $205,000 contract for micro catheters used in neuro-interventional cases and one for $187,605 for immunology testing which were sole source due to lack of comparable acceptable vendor.

A $7.5 million, 3-year, contract for marketing & advertising services to support CCHHS ($3.75 million) and CountyCare ($3.75 million) was awarded by RFP/competitive selection to Res Publica Group,LLC, Chicago. Director Estrada was concerned about the lack of minority representation on the Board and mid-management of this company.  Director Junge said that this company should reach out to the Labor Union leadership to support the ad campaign.  Director Wiese mentioned poor CountyCare advertising on the North Side.  Mr. Elwell responded that they use zip codes with the highest Medicaid populations as marketing priority areas.  

Mr. Elwell reported that due to the budget deadlock in Springfield, the State of IL has not paid CCHHS in 3 months with  $250,000,000 owed (primarily Medicaid).  In response,  CCHHS is withholding payments to IL (permissible per contract with the State).

Days of  cash on hand have dropped due to this situation.  The contract with the State requires CCHHS to pay Vendors for the 1^st 3 months of suspended payments from the State and employees but not Vendors after 3 months.

Bad debt/charity write-offs have dropped from over $300,000 in 2013 to around $152,000 in 2015.

Other Metrics:  ER visits continued to slowly drop; fewer inpatient days; steady to slightly decreased outpatient visits.  CountyCare total membership continues to drop slowly (trending for the last 5 months) but is leveling off at 168,968 and remains above Budget.  CountyCare’s goal is to capture $263,000,000 of Medicaid payments but is at $126,000,000 due to the use of non-CCHHS facilities by CountyCare members (CCHHS must pay these other hospitals/ERs/Clinics from the Medicaid payments).  Mr. Elwell noted that the FQHCs (Federally Qualified Health Centers) have outpaced CCHHS clinics in cleanliness, updated facilities, and front desk demeanor.

Cermak Health Services and the Dept. of Public Health show cost overruns due to salary & benefit expenses; CCHHS shows significant excess overtime use which is costly.

  
The Minutes of the Board of Directors Meeting 8-28-15 approved

 Human Resources Committee Meeting:  Gladys Lopez  reported a 6.2% employee turnover rate, which she said was within the industry standard.

 Audit and Compliance Committee:  Cathy Bodnar reported a program which includes better oversight of Vendor compliance including CountyCare vendors.
  
Managed Care Committee:  Mr. Elwell reported on CountyCare metrics:  
HIV patients: 34% use CCHHS pharmacy (goal 80%).  However, there is better utilization of CCHHS pharmacy by HIV patients on maintenance prescriptions with extended supply of 84 days:  56% (goal 85%).  100% of patients have been assigned a “medical home”.  Readmission within 30 days of discharge  is 22% (benchmark is 10%), mainly due to patients with substance abuse issues.   Director Lerner commented that the Metrics for CountyCare should have higher goals with tighter control going forward.  Director Marsh asked the proportion of patients admitted via the ED vs directed admissions from a physician/medical home.  Mr. Elwell and Dr. Shannon responded that close to 90% were admitted from the ED.

IlliniCare (the third party administrator for CountyCare) is now in competition for the same population as CountyCare.  They have 143,461 members vs CountyCare 165,848.  This is why the RFP for a new 3^rd party administrator restricts IlliniCare from bidding.

Quality and Patient Safety Committee:  Director Gugenheim reported that the Press Ganey survey questions (Center for Medicare and Medicaid Services instrument to measure patient perceptions of care and used to publicly report hospital performance)  always cite cleanliness as a problem area for CCHHS.  Dr. Das noted that they are embarking on a customer service training  intervention in response to low rates of patients recommending CCHHS.

An operating room performance project is underway with the goal of increasing on-time OR starts (goal 80%)  and decreasing the time to turn an OR room over for the next case (goal 30 min).  The main OR does 11,350 cases/year, of which, 20% are trauma related and are therefore a large component of the 28% of urgent cases (which complicates OR room scheduling).  Timed studies starting with patient arrival to patient being wheeled out of the OR have identified staffing opportunities to reduce delays, as well as facility and equipment issues that are being addressed.

Identifying the surgeon/anesthesiologist etc. who may be tardy, are being posted to encourage timeliness. 

Action Items

CCHHS submittal of documentation to the Illinois Health Facilities and Services Review Board  for:

• Provident Hospital to reduce ICU beds from 11 to 6 
• Provident Hospital to not re-open the Obstetrics Unit

Report from the Chairman of the Board:  Chair Hammock asked the Board to re-evaluate the metrics that are being used by their Committees to insure that they are still relevant, and identify new ones to add.  In particular, ambulatory care metrics should be included.

Report from Chief Executive Officer:  Dr. Shannon reiterated a pivot by CCHHS to focus on ambulatory care. He mentioned a partnership with The Greater Chicago Food Depository (GDFD) with their screening of children and families for “food insecurity” and working collaboratively to connect them with safety net organizations such as SNAP and WIC (food stamps).  GCFD fresh produce trucks will be stopping at CCHHS clinics to support nutrition/diet interventions.

Meeting adjourned to Closed Session at 11:55 am

Submitted by Susan Kern, MD

Cook County Board Meeting and Committee Meetings September 9, 2015

The Committee meetings for Wednesday, September 9 were as follows: Labor Committee, Rules Committee, Finance Committee, Zoning and Building Committee, and Criminal Justice Committee.  

Criminal Justice Committee: 

Proposed Ordinance 15-4648 sponsored by Commissioner Boykin, this ordinance is to appoint a Cook County Gun Violence Czar to lead a Cook County Gun Violence Task Force.  The Task Force, made up of representatives from other County officials, such as the Chief Judge and Sheriff, along with Commissioner Boykin and another representative appointed by President Preckwinkle, would be charged with holding hearings and gathering information in order to submit recommendations to the Board within 6 months. Boykin withdrew this ordinance and plans to work on it further with the support of other commissioners.

There were two speakers who spoke in favor of this ordinance. Commissioner Boykin reiterated the fact that there is too much violence. He stated that 80% of African Americans are victims of gun violence even though they make up 25% of the population.  He also stated that there could be an allocation in the budget of $200,000 to finance the Task Force.

There was much discussion as most of the Commissioners had reservations concerning this ordinance.  Many questioned whether the money could be found within this fiscal year.  In addition, they felt that more community support, education, parental support and jobs are needed to control violence. Zelda Whittler, Undersheriff, was asked to comment. She stated that they are working with many law enforcement agencies including law officials from the city and suburban areas to address this issue. She stated the Sheriff would participate in the Task Force.

Proposed Resolution 15-4728, sponsored by Commissioner Boykin, calling upon the Justice Advisory Council and the Department of Procurement to report to the Cook County Board of Commissioner on the scoring criteria for the Justice Advisory Council’s Violence Prevention Grant Awards and the role played by community violence levels in determining violence prevention grant recipients. Resolution was approved.

Please note all reports referred to are available on the Cook County web site. Go to http://cook-county.legistar.com and click on “meeting details”.

General Meeting:

Public Testimony: Reference to item 155308 and 15-5311 (proposed ordinance on Cook County Service Occupation Tax). Speakers stated they were opposed to a tax increase stating that $10 an hour is too little to live on making this tax increase difficult for them. They want a fair wage of $15 an hour.

The following were items of interest:

15-5141, proposed by Commissioner Boykin, calls upon the Cook County Medical Examiner to modify its reporting of Gunshot homicides to include specific classifications of victims as to Hispanic, Latino or Spanish origin.  In other words not just list them as Spanish but their origin. This was withdrawn because the medical examiner already has the software to do this.

15-5308 and 15-3011, proposed by Commissioners Fritchey, Boykin, Schneider and Suffredin to roll back the newly approved sales and service tax of 1.75% after 1 year to 1.25% on Jan. 1, 2017, and back to 0.75% on Jan. 1, 2018.  Was referred  to the Finance Committee.

15-5262 presented by John Jay Shannon, MD, Chief Executive Officer. Cook County Health and  Hospitals System (HHS), proposed  HHS preliminary budget for 2016 fiscal year. During the Public Testimony portion of the meeting, there were many speakers, doctors and nurses who spoke in support of retaining the in-services Pediatric Unit at Stroger Hospital.  Dr. Shannon stated that there has been no decision to close the Pediatric In-Services Unit at Stroger, but a consolidation of services, such as combining the Pediatric Emergency Room with the regular emergency room, will happen. He stated that with advancements of care and access to ambulatory care such as “Kid Care,” there are opportunities for patients receiving care closer to home.  Dr. Shannon stated that there is constant review as to whether the services being offered throughout HHS are what are needed or whether other services would better fit the needs of those needing care.

Commissioners Gainer and Sims had concerns about the cancellation this summer of the contract with the current administrator of Medicaid eligibility for HHS.    The current administrator is Illinicare, which has its own managed-care program and which is in competition with HHS and its managed-care program, County Care, for Medicaid recipients.  Dr. Shannon said that while there was no evidence of impropriety on the part of Illinicare, there was concern for the future.  Dr. Shannon said that Illinicare will stay on through early 2016, providing sufficient time to find a replacement and transition smoothly.  This item was referred to the Cook County Board’s HHS Committee.

15-5225,  submitted by Clerk David Orr,  seeking approval to eliminate 74 voting precincts in suburban Cook County, changing the number from 1,673 to 1,599 a reduction of 4%.  The estimated savings in 2016 is $200,000.  This was approved.

Also approved at the Board Meeting were the following items that the Board’s Technology Committee, which met the day before, had voted to recommend to the Board:

15-4067, a contract for $30 million for an Integrated Tax & Mass Appraisal System, to integrate the functions of the Recorder of Deeds, Assessor, Board of Review, Clerk, and Treasurer relating to the property tax system.

15-4318, a $66 million contract for an E-Business Suite platform to allow for process improvements and analytics for finance and human resource functions across the County.

15-4488,  which amends the contract with the existing provider of telephone service at the County Jail to lower the costs for detainees to make calls.

The meeting ended around 3:30

Respectfully submitted

Nancy Marcus and Priscilla Mims.