Unexpected Increase in Charity Care Disclosed at Health and Hospitals System Board Meeting

COOK COUNTY HEALTH AND HOSPITALS SYSTEM BOARD OF DIRECTORS MEETING

November 20, 2015, 10:30am 

Chairman Hill Hammock noted that the CCHHS Finance Committee immediately preceded the Board meeting (9-10:30am) due to scheduling issues which prohibited it from being convened during the prior week.  He determined that the Finance Committee report would not be repeated during the full Board of Directors meeting as all but one Director was able to attend the Finance Committee.

He stipulated that Director Marsh, who could not attend the Finance Committee, was free to pose any questions she thought were warranted for her to be fully informed on all Board actions.

Committee Reports:

Finance Committee:  Director Marsh asked several questions about the $72,099,000, 3 year contract (4-1-16 through 3-31-19) with Valence Health which is replacing IlliniCare as the current 3rd party administrator of CountyCare (Medicaid).  Doug Elwell, Deputy CEO, responded that this was a competitive bid selection and is expected to save CCHHS $10-15 million per year.  Some of the reasons for the savings include bringing in-house some services that IlliniCare was tasked with including Behavioral Health care integration which will now be the responsibility of the individual provider.  Mr. Elwell concurred that the primary reason for severing the contract with IlliniCare, mid-contract period, was the increasing direct competition of IlliniCare’s managed care health plan with CountyCare which was felt to represent a conflict of interest.  Dir. Marsh questioned the level of diversity on the Board of Valence Health and diversity in the other levels of management and contracts with minority owned businesses.  Mr. Elwell and Chair Hammock indicated that Valence met CCHHS’s diversity policy. She asked whether this was the most costly outside contract that CCHHS was signing.  Mr. Elwell replied that it was second to the Cerner contract which was the largest.

  

Doug Elwell reported that October revenues were down due to lower numbers of patient hospitalizations, although length of stay was not decreased, meaning there was a need for better managed care interventions.  CCHHS is still owed $120 million by the State of Illinois (not paid due to budget impasse) and he said CCHHS may have to loan funds to the State to obtain Federal matching funds for Medicaid and other programs.  Director Lerner cautioned about the future when the State will be required to pay 10% of the cost of the newly eligible PPACA members (ObamaCare) by 2020; “the system can not look the same”.

Charity care has unexpectedly increased from what was thought to be a plateau in 2014. This is due to:

1. overflow from other hospitals that have restricted charity care; 
2. patients with an Affordable Care Act plan with unaffordable high deductibles are coming to CCHHS and refusing to complete charity care forms so their care can not be counted as charity for calculating the Federal Disproportionate Share Hospital payments.  Most of this will be considered “bad debt”.

Director Velasquez noted that 17 of the 20 healthcare cooperatives created under the ACA have failed and these patients will be coming to CCHHS.

Chair Hammock noted that the CCHHS 2016 budget was approved by the Cook County Board.  He asked Mr. Elwell whether CCHHS would be able to stay within the budget in 2016 and Elwell responded that he predicted a “breakeven”.

Quality and Patient Safety Committee:  Dr. Das reported that there were no real improvements in the metrics, including patient willingness to recommend Stroger Hospital.  Multidimensional interventions including rounding on the wards by staff are on-going.

  

CEO Shannon reported that they expect the JCAHO inspection before the end of November and all departments are devoting extraordinary care and time to prepare.  Dir. Gugenheim pointed out that the inspectors look at trends and therefore, the slow improvement will overcome the less than optimal metrics.

Special presentation on Group Purchasing Organizations (GPO) which allow group purchasing by member hospitals/groups of supplies, pharmaceuticals, services at a discount taking advantage of the economy of scale. The speaker stated that the 5 top GPOs cover the majority of healthcare in the USA.  Value of GPOs include lower cost, better reliability and transparency of the process. GPOs are free to the member hospitals and charge the vendors for being a part of the group. In addition to major set discounts, hospital members may earn a dividend/rebate (called patronage) based on volume.  CCHHS earns over 1 million dollars a year in this “rebate”.  A 1986 Federal statute grants GPOs a “safe harbor” from the “kickback” laws.

Dir. Lerner wondered what happens when the GPOs consolidate leading to a monopoly.  Dir. Marsh asked whether providers (physicians) had input into the selection of vendors/vendor products and was told “yes”.

Report of the Cook County Department of Public Health (administratively a part of CCHHS)

Dr. Terry Mason presented a powerpoint of the services provided by CCDPH including food establishment inspections, environmental health, vector control, etc.  The lead poisoning prevention program and lead abatement plan is undertaken when the lead level is greater than 10 micrograms/dl. Paint used prior to 1978, still present in many of the older CC buildings, often contained lead. Dir. Lowry, who served in the past as commissioner of Chicago’s Department of Buildings, was concerned that the high level of lead that triggered abatement exceeded the threshold for federal grants and could be a health catastrophe. She indicated that a level of 2 micrograms/dl is the safe level. Dr. Mason agreed, but added that it was very expensive to undertake lead abatement and the money was not available.

The meeting adjourned to closed session at 1:20pm.

Submitted by Susan Kern,MD, LWV CC Health Issues Committee

Opposition to Tax on Cable TV and E-Cigarettes; $2 Million for Restorative Justice; Tax on Corporations Paying Less than Living Wage; and Lost Animals Raised at Public Meeting

2016 Cook County Proposed Budget:  Public Hearing at the County Building, November 3, 2015

Lawrence Msall, on behalf of the Civic Federation, after complimenting the County government for the actions taken with regard to criminal justice reform, health care, and rationalizing the workforce, said that with regret, the Civic Federation could not support the proposed budget. The opposition was mainly to the 1% increase in the sales tax that the Board had approved this summer, and on which this budget is based.  The Civic Federation cited the competitive disadvantage the Board was creating for the many businesses in Cook County, particularly those on the County’s borders. 

However, in response to a question by Commissioner Suffredin, the Civic Federation thinks the $30 million in additional taxes and fees that are part of this budget proposal are reasonable.  This was clearly not what the Commissioner wanted to hear, as he expressed his concerns about these revenue proposals.   Subsequently, the Chamber of Commerce expressed its opposition to extending the amusement tax to (or rather eliminating the current exemption for) cable television.  There were several other speakers similarly expressing opposition, as well as one speaker in favor.  Chairman Daley stated that in talking with the individual Commissioners, it seemed unlikely that the Board would pass the expansion of the amusement tax, so the Commissioners will have to come up with proposals to cover the $18 million projected from this tax, either through other new revenues or through cost cuts.

Several speakers also voiced opposition to the proposed tax on E-cigarettes. 

Several speakers called on the Board to increase the $500,000 for restorative justice programs in the budget to at least $2 million. The dialogue between a couple of the Commissioners and one of the speakers got a little heated at one point, as the Commissioners explained that they supported more money for restorative justice programs, but also were faced with trying to balance the budget.  The speaker argued that if the County would stop spending so much on the jail, it could fund restorative justice, which would do much to reduce the jail population.  Commissioners pointed out that they have a responsibility to see that there is sufficient money for the jail in order to protect the public from those committing crimes.

Several speakers spoke in support of a proposed ordinance (the “Responsible Business Act”) that would impose a tax on employers who had 750 or more employees making less than a “living wage.”  Chairman Daley pointed out that this proposal is not part of the budget, and has been referred to a Board committee for separate consideration.

Several speakers also urged that the focus of the Animal Control Department of the County be expanded to include helping owners find their lost pets. 

One speaker complained about the Health & Hospitals System treating undocumented immigrants.  Chairman Daly stated that the mission of the County’s health system has always been to treat everyone.

Next Steps

The Finance Committee finished its last department meeting on Nov. 2, and has one more public hearing at the Maybrook Courthouse at 6:30 pm on November 5.  Chairman Daley indicated that the deadline for the Commissioners to submit amendments to the proposed budget would likely be next week, but had not been finalized.  Check on the budget calendar.  A meeting of the Finance Committee to vote on these amendments and the resulting budget will then be held, followed by the Board meeting to vote on the budget, as amended.

-- submitted by Priscilla Mims, League Observer

Cook County Health and Hospital Systems Board Meeting October 30, 2015

Chairman Hill Hammock welcomed new board member Mary Richardson-Lowry.

Cook County Commissioner Robert Steele addressed the board as a public speaker. “Communication is HORRIBLE between this body and the Cook County board.  We are ONE!  I am the public face. I should be attuned; I am offering to be a communicator. It’s what I am here for as a public official.  It’s my responsibility to be your partner under chair Butler. I represent areas where clinics are slated to be redeveloped; I am here to help drive membership. Your culture, your staffing is NOT GOOD below here.  If we don’t get it right now, these buildings will be EMPTY.  I am your face in Washington, D.C.”

Committee Reports

Managed Care Executive Director Steven Glass reported that 99.7% of all CountyCare patients now had been assigned to a medical home; usage has increased; and ER admissions have decreased.  Claims reveal little change in use of services; 6 months are required to get a claim processed.   

Glass presented the results of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, established by the US government in 1997 surveying patients on their experience with their healthcare plan and services, assessed primarily by mail in early 2015 with respondents about 50/50 male/female.  Of these, 2/3 rated their health good or excellent.  Of respondents, 75.2% reported that they received needed care; 79% reported getting care quickly; 89%, good doctor communication; 89%, good customer service; 76%, shared decision making; 83%, good coordination of care; 69% received needed information; 94% reported ease of filling out forms; 76% reported receiving health promotion and education.  

These outcomes compare favorably with other healthcare providers nationally, though Executive Director Dr. Jay Shannon cautioned that many of those surveyed may never have seen a specialist, and “the data are soft.”  CountyCare also compared favorably with other Illinois healthcare plans.

Finance. Deputy CEO Doug Elwell explained the 2 sole source contracts.  Clayco received a $946,410 contract to do the planning for the new $90m Fantus Clinic. CCHHS prepared the purchase order for this contract. The County will fund it, and it had joint approval. 

Elwell presented a summary of current CCHHS finances: it has 57 days of cash on hand vs. 96 days at the same point in 2014 due to slow state payments; overtime is slightly lower at 7% vs. 8% last year; bad debt has risen to $185,000 from $168,000 last year; inpatient days have decreased from 8700 in 2014 to 8400 this year; monthly ER visits have dropped from 12,800 last year to 12,420 this year.  The charity write-off has dropped from $279,000 last year to $217,300 this year.  He explained that a very low number of CCHHS employees use CCHHS because of their insurer.  “We’re going to fix that,” Elwell said.   

CountyCare has a $9.7m profit, and CCHHS as a whole is showing $14.7m in profit for the year.  Costs for Cermak Clinic and JTDC are due to rise from $62m to $85m to fill unfilled positions and raise psychiatry salaries. The CCHHS budget shows $125m received from the County, but it’s actually $164m including pension costs.   

Elwell discussed Capital Asset Management: CCHHS has not had a solid inventory of equipment, but a new document to be completed by June 2016 will detail the age and condition of equipment as a guide in upgrading and replacing dated equipment at the hospitals and clinics.

Human Resources.  Director Gladys Lopez showed a 55% increase in vacancies filled over the same period in 2014, 68% of which were clinical.  She is working with unions to move departing staff into existing positions, so there are fewer external candidates.  Filling an appointment now requires 122 days.  Lopez said there were 804 vacancies, but the budget shows 1100; Hammock asked her to clarify this discrepancy.  A concern is the high staff turnover at Cermak Clinic, Lopez explaining that staff there use Cermak as a gateway to the system.  She is preparing a customer satisfaction survey.

Board member Wayne Lerner praised Dr. Shannon for his presentation at the budget hearings, along with Communications Director Caryn Stancik.  Lerner expressed amazement at the challenges facing CCHHS.

Dr. Shannon said there would be a mid-November vote on the FY2016 budget, after the public hearings. He reported that CCHHS will begin a marketing campaign in multiple languages; in early 2016, a pilot community triage center will open; and there is now a 3-chair dental service at Prieto Clinic.

The meeting adjourned to closed session at 11:45.

Submitted by Linda Christianson

Cook County Health and Hospital Systems Board Meeting August 28, 2015

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 3^rd 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.

submitted by Linda Christianson

Cook County Health and Hospitals System Board of Directors Meeting July 31, 2015

Chairman Hammock called the meeting to order at 9:00 am

Public Speakers:  Over 10 speakers representing the Pediatrics Department at CCHHS, including Attending Pediatricians, Residents, medical students, newly graduated residents, pediatricians from the community, pediatric nurses, representatives of faith-based organizations (United Methodist Church, and the Pastor of the Oak Forest Hospital), representative from child protective services, and a Hispanic member of the community who presented her comments via an interpreter rose to object to the rumored closure of the Pediatric in-patient department.  They alluded to an article printed in Crain’s Chicago Business, July 20, 2015 “Kids are Skipping Stroger;Cook County hospital considers phasing out its pediatrics ward” which reported that CCHHS is considering phasing out its inpatient pediatric unit at Stroger and was weighing whether to consolidate its residency training program in pediatrics into another program and focusing its primary pediatric care at outpatient sites.  It reported that the Stroger pediatric unit of 40 staffed beds had an average occupancy of 26%.

The public speakers stressed that: the Pediatric Unit was cost effective and brings in revenue;  Claims were made that the Rush Children’s Hospital (next door to Stroger) “was sucking patients from CCHHS”;  lauded the Stroger Burn and trauma care for children, supported the pediatric residency which trained physicians who would take care of the indigent.  

CEO of CCHHS, Dr. Shannon responded (after 45 minutes of public speakers) that ”the future of CCHHS is ambulatory care, in the Medicaid managed care model, not highly specialized in- patient care.  No Board decisions on the pediatric unit have been made at this time.  The Board will act on behalf of the entire community.”

Picketers with placards and police presence were present outside of the building.  The Board room was packed with members of the pediatric department with a prominent media presence including videotaping of the presentations.

Employee Recognition:  Graduates of the Leadership Development Project were present and acknowledged by the Board.

Annual Meeting Business:  Chairman Hammock was affirmed as Chair of CCHHS Board of Directors and Commissioner Butler as Vice-Chair.

Board and Committee Reports 

 

Quality and Patient Safety Committee

Director Guggenheim and Dr. Das reviewed the May, 2015 Metrics for Stroger Hospital which show that there continues to be a challenge in improving quality metrics including: surgery start on-time (52%) and OR room turn around time, influenza and pneumococcal vaccination (48 %) and patient experience/willingness to recommend the hospital  (71%).  The metrics are little changed from May 2014.

The CORE Center for HIV/Hepatitis /other infectious diseases shows excellent metrics.

Managed Care Committee

Director Lerner and Steven Glass reviewed a few key Metrics:  County Care membership has been drifting lower over the last 4 months from a high of 183,415 in May to 172,873 in July 2015 which are primarily ACA adults and fewer FHP patients.  This is attributed in part, to failure of members to complete the redetermination process which Medicaid requires to insure that they are still eligible for the program.  Membership is still 10% over the budget which is a positive.  More competition may be entering the marketplace in competition with CountyCare as other large health organizations are forming managed care organizations.

Audit and Compliance Committee

Cathy Bodnar reported that the CCHHS audited financial statements for the year ended November 30, 2014 showed exceptional audit results. 

Human Resources Committee

Gladys Lopez reported that nurse hires are higher this year (249) vs 2014 (139) and that the “time to hire” has decreased to 127 days.

Finance Committee

Director Collens and Doug Elwell reported that the 2016 CCHHS budget was being worked on. 

Mr. Elwell noted that CCHHS needed to grow its Medicare business; recent salary contract agreements would result in increased expense to CCHHS; the CCHHS facilities and equipment were aging and would require capital improvements; prescriptions, especially newer very expensive drugs, will be difficult to purchase at a discount and will result in increased cost to CCHHS; uncompensated care will continue to be expensive.  He suggested that CCHHS units that were unused for many years could be closed vs converted to ambulatory care vs consolidated with other units.  Janitorial services which have repeatedly received poor patient ratings on surveys should be assessed for the FTEs per space they clean and outside vendors should be investigated. 

Director Wiese asked whether the Board could be given data on the number of “contract employees” vs. CCHHS employees there were and the cost. Mr. Elwell stated that vendors are paid according to industry standards.  Director Wiese also noted that there were significant parking problems on the CCHHS campus with up to “300 patients a day turned away”. 

Director Junge asked whether there was a proposal to decrease FTEs at CCHHS?  Mr. Elwell responded that the goal was to staff with FTE numbers that were the industry standard.  Dr. Shannon added that they were looking at utilization of services and staffing accordingly. 

 

Mr. Elwell reported that the cost of Cermak is increasing because of enhanced services provided via CCHHS.  The cost of the CC Public Health Department (administratively under CCHHS) was increasing because they were not being awarded sufficient new grants which would contribute to the income.  He added that they were not garnering sufficient grants because of their difficulty in fulfilling them in the past.  Director Marsh requested an overview presentation on the Public Health grant process.  Director Gugenheim responded “why not combine the CC Dept. of Public Health with the Chicago Dept. of Public Health which has been proposed since 1989!  Nothing happens.”

Action Items

Dr. Fagen noted that Stroger Hospital Department Chairs need to be reappointed every 2 years according to the JCAHO standards.  There has been a lapse in reappointments which she recommended the Board to undertake at this time.  The Board moved to reappoint the Chairs.

Report of the CEO

Strategic Plan Update:  CEO, Dr. Shannon explained that the population that CCHHS was serving had changed over the decades despite the same physical facility.  CCHHS needs to change with the different demographics, healthcare industry and local standards.

Provident Hospital has been part of CCHHS for 22 years.  In the past it was a busy hospital but currently its 25 acute care beds have an average occupancy of less than 50% with a $36 million annual loss.  The ER is well used with 36,000 visits a year.  They have a prestigious eye facility.  Much of the building is not in use. The facility and equipment are old and would require $19 million in upgrades plus $11 million to purchase diagnostic imaging equipment.  Analysis shows that the catchment service area around Provident contains 682,000 individuals with good Medicare/dual eligibility/CountyCare mix. 

Dr. Shannon suggested that Provident be repurposed into a regional outpatient center focused on the Eye center, diagnostic imaging, bariatric surgery, orthopedics and prenatal care.  The cost of a new, “green” building which would be more cost effective to operate and equipment is projected to be $50 million. Directors Marsh and Lerner asked “why not partner with an existing hospital rather than going it alone?”  Director Estrada asked whether the Cook County Planning Commission had reviewed this proposal and evaluated the demographics of the area to make sure this was a good idea.  Director Junge questioned whether the ER visit numbers were not really “clinic type medical needs vs. a true ER level of health care need”.  Dr. Shannon replied that “this is an opening discussion, no firm decisions made”.

The meeting was adjourned to closed session at 11:45am.

Submitted by Susan Kern, MD