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

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

Health and Hospitals System Board Meeting January 30, 2015

Public Speakers. A series of public speakers complained that contracted CCHHS service provider Sodexo has failed to manage effectively, with insufficient measures of performance, leadership turnovers, patient abuse, and poor performance leading to an infestation of bedbugs at Stroger Hospital. CEO Dr. Jay Shannon responded that this is an issue of serious concern. COO Peter Daniels said there have been 276 disciplinary actions against Sodexo since July of 2011 when their contract was initiated.

Recognition.  Dr. Shannon recognized Provident Hospital for its 3-year accreditation by the Joint Commission.

Committee Reports.  Board Chairman Hill Hammock has asked each board committee chairperson to present relevant metrics each month to summarize status and to highlight issues that emerge at committee meetings.  In addition, the metrics of one of the four committees will be particularly highlighted at each board meeting as a way of understanding the full scope of the issues.  Board meetings may now require 3 hours.

Quality and Patient Safety. Committee Chair Mary Gugenheim introduced Dr. Das, who presented process measures showing high compliance with appropriate procedures for various afflictions; composite compliance rose to about 95% during FY14 for Stroger Hospital.  Regarding patient experience at Stroger Hospital, no change in 2014: about 60% overall patient satisfaction, only 40% satisfaction with patient environment (noise and cleanliness are key issues), 80% with communication with doctors, 70% communication with nurses.  Dr. Das said Stroger's overall patient satisfaction level ranks with the lowest 20-30% of hospitals nationally.  Between March and September there will be an inspection of the 16 CCHHS-affiliated clinics to prepare them for certification by the Joint Commission as Medical Home Models.  Concerns were expressed regarding slow hiring at Provident, as well as parking problems.

Managed Care.  Committee Chair Wayne Lerner presented data showing that CCHHS is falling behind on CountyCare membership recertifications, attributing the problem to delays at the state and to fewer re-enrollments by younger people.  Forty percent of  CountyCare patients are cared for by CCHHS, 60% by others.  CountyCare represents more than 50% of CCHHS total revenue, a problem if more patients are seeking care elsewhere.  Another concern is that CCHHS is now caring for the patients most at risk.  Already it is caring for 3,000 of the sickest children in the county, according to Deputy CEO Doug Elwell.  "We need to get our share of healthier patients," Lerner commented.

Human Resources.  Committee Chair Dorene Wiese introduced HR Director Gladys Lopez whose data showed 874 vacancies filled in FY2014 (an increase over FY2013), of which 75% were clinical, 25% nonclinical.  Reasons to leave CCHHS: 8% discharged, 25% relocation, 61% retirement.  In FY2014, there were 6,016 staff, of which 2844 were Black, 1291 Asian, 1102 White, 607 Hispanic, 6 American Indian, unknown 226; female 70%, male 30%; average age of staff 49; 3,465 staff at Stroger Hospital.  Lopez said the greatest hiring challenges were finding physical therapists, occupational therapists, and physician assistants. She said 60-90 days is the LEAST amount of time required to fill positions due to barriers of credentialing, time to schedule interview, then report and respond.  Dr. Marsh pointed out that many applicants might well have moved on by then.

Finance.  Chair Lewis Collens' data showed a cash improvement of $101,764 compared to FY13, but key FY14 metrics were under budget, including CountyCare net income with a shortfall of over $24 million and CCHHS net income with a shortfall of $34 million as of October 31.  Financial data regarding contracts with outside providers will be available at future meetings.  Contracts were approved subject to approval by the full Cook County board.

CEO Report. Dr. Shannon reported that the redevelopment for the central campus will incorporate a new building with ambulatory services and office space; RFPs are due February 9.  Stroger Hospital is preparing for review by the Joint Commission.  Dr. Shannon alluded to a recent Crain's article citing only 27% bed occupancy at Stroger Hospital, noting that Stroger is a trauma center with 6 types of ICU beds.  Lerner pointed out that the market is moving toward a need for fewer beds; some partnerships with other hospitals may be possible.  Dr. Shannon welcomed Dr. Erica Marsh and said there is still one board vacancy.  He met with Senator Durbin and five representatives in Washington DC to stress the importance of continued Medicaid funding.  CCHHS now has new linear accelerators providing radiation therapy to cancer patients.

Meeting adjourned at 12:10.

Submitted by Linda Christianson

Proposed 2015 Cook County Executive Budget: October 20, 2014 Department Meetings

Board of Review:  The Board is headed by 3 Commissioners elected by district.  The Board rules on appeals by property owners of assessments from the County Assessor.  The Board touted that it completed its work by the necessary deadline so that 2^nd installment property tax bills could go out on time for the 3^rd year in a row, after many years of being late.  In response to questions from Commissioner Gainer, the Board stated that the rate of appeals that got reductions from the Board was running between 60 and 72%.  Commissioner Gainer asked that the Board provide information by commercial vs. residential on the total number of appeals, the number that were successful, the amount of the reduction in the assessed value.  Commissioner Gainer expressed concern that those not sophisticated enough to appeal are paying higher taxes as a result of all the successful appeals.  Commissioner Daley wanted to know the rate of successful appeals by township.

Assessor:  The proposed budget reduces employee county by 23, but  only a slight reduction in the budget.  The Assessor explained that a number of those positions had only been budgeted for $1 in last year’s budget, so eliminating these positions did not result in a large $ reduction.  The Assessor touted the Fraud Unit which has gone after those trying to take senior or homeowners’ exemptions that they are not entitled to.  So far $5.1 million have been collected and $4.1 million are in the process of being collected by this Unit.

Treasurer:  The Treasurer touted the fact that taxpayers now have 9 payment methods for their property taxes vs. only 2 when she took office in 1998.  The headcount is down 65% since 1998 and the Treasurer’s goal is to get down to 60 people.  Commissioner Gainer raised concerns about the new state law which moves the tax sales earlier and the expected resulting increase in the “sales in error” which could cost the County as much as $30 to $50 million.  Purchasers of properties under the tax sales do have to pay a fee that goes into a fund in the event the property should not have been sold for nonpayment of taxes, but this fund currently is quickly depleted and the County has to pay any remaining costs associated with the sale in error, which includes interest on the payments made by the purchasers.  It was implied that the date of the tax sales was moved up as a result of the strong lobbies of the purchasers in Springfield.

Recorder of Deeds:  The proposed budget for 2015 is down by $680 thousand and 9 FTEs.  A work flow analysis had been done and the Recorder expects to further streamline the processes within the department.  Commissioner Gainer asked how long it will take to digitalize all the files, and the Recorder answered about 10 years.  Commissioner Gainer wondered whether the Recorder needed a special purpose automation fund, like the Treasurer has, but the Budget Director explained that the special purpose GIS fund can be used for this.

Department of Human Rights & Ethics:  The Director reported on the improvements in this department, which was tainted by scandal under the prior Administration, since she took over almost 4 years ago.  There has been a 72% reduction in the backlog of cases in 2014, and the goal is that by the end of 2015, there will be no cases older than one year.  Commissioner Gainer asked about coordination with equivalent offices at the State and Federal levels.  The Director said that the County cross-references to see whether the same case is at the State and/or Federal level and the government offices divide up any duplicates.  The Director stated that there are federal dollars available for handling cases if this department is found to be equivalent to the Federal department.  This is in the process of being reviewed.

Department of Human Resources:  There are 2 remaining issues left to be found in compliance with the Shakman Decree and the Director of HR stated that the County was close to finalizing these.  One new initiative for 2015 is an executive development program.  The Director stated that it is hoped that the major unions’ contracts for 2012-2016 will be resolved by the end of 2014.  Commissioner Suffredin expressed concern whether there was sufficient money in this budget to take care of any resulting increases.  The Budget Director stated that the budget does reflect the expected outcome of contract negotiations.  Commissioner Gainer asked about the provision in the Budget Resolution which allows the Chief Judge to transfer money among the different funds under the Juvenile Temporary Detention Center (JTDC) without having to go back to the Board in the event the JTDC is moved under the Chief Judge’s control from the Federal Court’s. Commissioner Suffredin explained that this is similar to what was done 2 years ago to allow the newly elected Recorder of Deeds to revise the budget submitted by her predecessor. Commissioner Suffredin stressed that in both cases, the total budget could not be increased, just a movement of dollars among funds. Further, any new contracts to employ outside services would have to come before the Board. 

Department of Homeland Security and Emergency Management:  Commissioner Gainer asked about the plan for dealing with cyber-security. The Director said that that area is moving from the Bureau of Technology to his Department, and a new team is being built. His Department will be responsible for all systems under the President and for the court system and HHS. However, any systems that are entirely for a particular elected officer will be the responsibility of that elected official. But the Department could propose standards that the Board could enact that would apply to all areas in the County.

Office of the President and Justice Advisor Council (JAC):  The current lower level of the jail population as compared to last year tracks with the increase in the number of judicial orders for electronic monitoring which began at the same time as the President wrote seeking assistance from the Illinois Supreme Court in September of 2013.  Commissioner Sims mentioned that she and Commissioner Fritchey have had problems with the awarding of grants by the JAC.  The JAC is intentionally giving smaller grants to help smaller organizations that may not have the capacity to obtain larger grants, but it was suggested that the RFP (request for proposal) should indicate that.  Commissioner Suffredin asked what was being done to give judges more information so good decisions can be made concerning bail and alternatives to incarceration prior to trial.  The Budget Director pointed to the proposed budget for the Chief Judge which adds 27 positions for electronic monitoring and for the new “2^nd look” program.  In addition, more there is more money for the “no place to stay” program under the Sheriff’s budget for those who otherwise could not go on electronic monitoring because they have no place to stay.

Commissioner Gainer asked about the status of the President’s motion to the Federal Court to take over the Sheriff’s authority to release those in jail due to overcrowding.  The motion is still pending.

Clerk:  The Clerk touted that the special purpose Election budget for 2015 is less than it was 4 years ago, the equivalent year in the election cycle. Voter registration in suburban Cook is up by 30,000 and it looks like more people will be voting by mail based on the increase in applications received thus far.  Commissioner Suffredin asked about online voter registration, that is a new program this year.  Statewide, there were 31,000 online registrations and 3,200 in suburban Cook.  Commissioner Sims asked whether there would be more touch screens, which she is a fan of.  The Clerk is not purchasing more, but is looking for the next step in technology.  E-poll books will be in every suburban precinct, with the paper back-up.  The advantage to the E-poll books of voter registrants is that they have up-to-date information and allow for immediate corrections since it is connected to the online database. 

Chicago Board of Elections:  The head of the Board said that there have been no major advances in voting technology yet to replace the touch screens, but that this Board would work with the Clerk to leverage their purchasing power when the time was right.  The  budget is down quite a bit for 2015 because the City of Chicago covers most of the Board’s activities for this year when the only elections in the city will be for city offices. 

-- submitted by Priscilla Mims

Cook County Board Meeting July 23, 2014

President, Toni Preckwinkle, called the meeting to order.

Public testimony at the beginning of the board meeting included a representative of AFSME who represents Adult Probation Officers. He is concerned about providing a fair contract for Adult Probation Officers. There was also a comment presented by Attorney Richard Boykin, Barnes & Thornburg in support of the proposed referendum on mental health services.

Some of the other Resolutions included:

A resolution honoring police officers in Arlington Heights for their bravery on December 12, 2013 by responding to a call concerning a man with a gun. Another resolution in the memory of Agnes Elizabeth Schevers Hamer, mother of Commissioner Gorman was presented.

Criminal Justice Committee report from July 22:

The Juvenile Accountability Block Grant in the amount of $366,240 was approved (funding from the Illinois Juvenile Justice Commission). This Grant will implement programs that will address the following goals: keeping youth out of the criminal justice system when possible, providing effective developmentally appropriate support and services for youth that are already in the system, and will help place youth on a trajectory for positive outcomes that enhance public safety.

A resolution was presented by Commissioner Collins to identify children at risk: those who have a mental disorder who have committed a minor offense be kept out of jail. Resolution was passed.

Two referenda were proposed for the November ballot:

1) A resolution in support of a Cook County Ballot Referendum regarding Mental Health Funding in Illinois

Sponsors: President Preckwinkle and Commissioners Gorman, Daley, Steele, Butler, Fritchey, Murphy, Silvestri, Suffredin and Tobolski

“Shall the General Assembly of the State of Illinois appropriate additional funds to provide necessary mental health services for the people of the State of Illinois.”

2) A proposed Advisory Referendum regarding the Illinois Public Safety Act.

Sponsors: President Preckwinkle, Commissioners Collins, Daley, Garcia, Murphy, Reyes, Sims, Steele, Suffredin and Tobolski

“Shall the Illinois General Assembly enact the Illinois Public Safety Act (Senate Bill 3659) which would require universal background checks for firearm transfers and prohibit the sale and transfer of assault weapons, assault weapon attachments and high capacity ammunition magazine.”

Both were approved for the November ballot.

Other items

Approval of proposed ordinance-Cook County Surplus Highway Property Policy

Sponsor: Commissioner Suffredin

This ordinance concerns remnants of old highways that Cook County owns. This will require the Highway department to transfer surplus lanes of pavement of 1 mile or less and any surplus parcel of land 1 mile or less to the appropriate municipality via an intergovernmental agreement.

Approval of resolution--Cook County Special Purpose Fund Reporting

Sponsor: Commissioner Fritchey

This resolution would require that the director of Budget & Management Services provide to the Cook County Commissioners a quarterly detailed report on the expenditures of the Special Purpose Fund. They will also need to show that the expenditures were appropriate.

Approval of resolution requiring a monthly update on the Cook County Managed Care Community Network

Sponsors: Commissioners Gainer, Daley, Schneider, President Preckwinkle

This will be a monthly report from HHS on Cook County Managed Care to the Commissioners so that they can monitor expenditures and reimbursements.

Also of interest:

F. Thomas Lynch , Director, Enterprise Resource Planning (ERP) presented a proposed contract amendment to allow Denovo to provide for an HR/Payroll Upgrade. There was much discussion on this. Commissioner Suffredin was concerned with the increase of the contract. The new contract begins August 7 so there are no other alternatives. This was passed with caution.

Deanna Zalas, Director of Risk Management presented a contract with PricewaterhouseCoopers, to provide a variety of services for the Risk Management Department and the Bureau of Human Resources including development of a multi-year Health and Group Benefits strategy. There was much discussion among the commissioners. They were concerned about problems when Pricewaterhouse managed the hospital. The commissioners thought that Deloitte was hired to do an evaluation of HIPA & HR. The contract was denied.

Submitted by Nancy Marcus and Linda Christianson