Health and Hospital Systems Board Meeting, August 9, 2012

The meeting was called to order by Acting Chairman Jorge Ramirez.  A vote of the membership chose David Carvalho as Chairman and Ramirez as Vice-Chairman, each a one-year term.  Carvalho, a deputy director for the Illinois Department of Public Health, then chaired the meeting. The four new board members introduced themselves: (1) Carmen Velasquez, executive director of Alivio Medical Center; (2) Rev. Calvin Morris, retired executive director of the Community Renewal Society; (3) Dr. Doreen Wiese, president of the American Indian Association of Illinois; and (4) Ed Michael, retired executive vice president of diagnostics at Abbott Laboratories.  Carvalho asked that new members identify their committee preferences, and reminded them that “we are serving ALL residents without respect to their ability to pay.”  The audit was approved, noting that there had been major improvements since 4 years ago.

Gina Besenhofer, system director, supply chain, presented contracts for approval, including contracts to procure (1) Stryker knee systems; (2) HIV genotyping by Siemens Healthcare; (3) temporary admin staffing; (4) translation of remittance notices into format useful to hospital system; (5) maintenance and repairs at CCHHS; (6) PET/CT imaging; (7) radiopharmaceuticals to nuclear medicine departments; (8) maintenance of AIX mainframe by IBM; (9) courier services to pick up patient fluid samples; (10) professional services for 2 clinical pharmacists; (11) physical, occupational and speech therapy; (12) maintenance of Pysix drug dispensing equipment; (13) maintenance of HVAC system; (14) orthopedic surgery services from residents at Midwestern University.   The board members posed questions concerning competitive bidding process, costs, reasons for needing the services, duration of contracts, compliance with Minority and Women-Owned Business Ordinance requiring that providers must comply directly or indirectly with provision that they be 25% minority-owned and 10% women-owned.  Carvalho explained CCHHS participation in GPO, a Group Purchasing Organization, with other hospitals nationally to secure better pricing.  Dr. Raju said CCHHS now has a new computerized monitoring system for contracts.  All contracts were approved by the board.

Dr. Raju addressed the $152m budget gap.  Some of the deficit will be offset by the Medicaid waiver (still pending); improved physician billing and collection; IT changes; and consolidation of billing. When will the CCHHS budget be ready for approval by the full Cook County board?  The finance committee will meet soon, then submit its budget for approval by the full CCHHS board.  Carvalho pointed out the importance of having the CCHHS board involved in negotiations with the full Cook County board, not cut out of the process and informed at the end.

Anna Ashcraft, Director of Real Estate Management for Cook County, explained that the ground floor of Oak Forest Hospital will be renovated by December as a regional health center. Additionally, 176 acres of Oak Forest property were conveyed to the forest preserve district, now to become Oak Forest Heritage Preserve, opening this fall, to be entered through the Oak Forest Hospital entrance where parking will be available.

The board adjourned to closed session at 10 a.m.

Submitted by Linda Christianson, League Observer

Health and Hospitals System Board Meeting May 29, 2012

The meeting was called to order at 7:40am by Chairman Batts when an adequate number of members arrived for a quorum and lasted only slightly over an hour before going into closed session to consider Human Resources concerns. The one action item of note was a change to their Rules of Organization and Procedure that will make it easier for the committees of the board to have a quorum present. The change will allow the committee chairperson to designate an elected director who is present at a committee meeting but not actually a member of that committee to serve as a substitute member of the committee for that meeting only in order to attain a quorum. This change was approved.

Dr. Bruce Siegel from the National Association of PublicHospitals and Health Systems (NAPH) was a guest speaker at the meeting. His association is based in Washington DC, has about 140 public health system members, and advocates for safety-net hospitals. He presented the following statistics to the board.

In the 10 largest cities in the US, Public Hospital Systems provide:

            1/3 of Outpatient Visits

            1/4 of Emergency Room Visits

            40% of trauma care

            63% of burn care

            1/5 of all uncompensated care

            1/4 of training of US physicians

He also provided the following comparative information on the payer mix for all US hospitals, all public hospital systems and CCHHS specifically. Mr Batts stated that while he knew that the payer mix was always reported to be unbalanced at CCHHS he had never seen statistics that showed it so starkly.

Payer	All Hospitals	Public Hospitals	Cook County HHS
Commercial	37%	19%	8%
Medicare	39%	24%	11%
Medicaide	16%	36%	32%
Uninsured	6%	18%	49%
Other	2%	3%	--

With 49% of patients at CCHHS being uninsured, the system will continue to have challenges going forward.  Under the Affordable Care Act the Disproportionate Share Hospital (DSH) subsidy for those hospitals that have been providing a disproportionate share of “charity care” is due to be ratcheted down.  The Board continues to await the Supreme Court ruling on the Affordable Care Act as the decision will impact future planning.

Don Howard, the HHS Chief Information Officer, gave a transition report on the status of the IT systems as he is leaving after serving for 10 years. He stated that the transformation of the system has been ongoing and will continue and there is a good team in place to carry on the plans that have been developed. Upgrades to Provident and Oak Forest will need to be developed in accordance with future plans for those sites.

Mr. Carvalho asked Dr Raju about state legislation that has been approved that will have an impact on the system. Dr. Raju stated that the state's Medicaide waiver, changes to the definition of charity care, and the cuts in Medicaide will need further analysis.  These issues will be more fully discussed at the next CCHHS Finance Committee meeting. At 8:45am the board went into closed session.

Cynthia Schilsky

LWVCC Observer

Cook County Board Meeting April 17, 2012

Upon this observer's arrival at 9:40 am, the Committee meetings were already in session.  President Toni Preckwinkle called the meeting to order at 10:15 a.m. Tim Beuher, the newly appointed Commissioner of Building and Zoning, was introduced and recognized for his outstanding experience and ability.

Several resolutions were introduced and approved including one recognizing the serious problems relating to heroin addiction and the County's commitment to work to alleviate it; another recognizing the Sandburg High School State Champions Boys Wrestling team, the Sandburg State and National Champion Cheerleaders Team and the Whitney Young State Champion 4A High School Women’s  Basketball Team; and one recognizing a World War II decorated veteran.

During the Finance Committee Meeting, there was extensive discussion about the bills for Shakman compliance cases and how much longer this process and expense would continue.  It was pointed out that this problem started in 1969 but the County fought it for many years, and the compliance process did not begin until 1992.  The President’s Office is nearing compliance but there is still work to be done.

Discussion during the Finance Supplemental Agenda, Commissioner Silvestri indicated that a solution to allow closing of bond courts on the weekends had been achieved.  Those arrested would be delivered by the local authorities to either the Markham or Maywood facilities and the County will provide transportation to 26^th Street thus saving the municipalities the transportation and overtime expenses.  These two locations were picked because they have appropriate facilities to hold the arrestees and the other county buildings do not.  Commissioner Silvestri explained that county funds had been found to cover the costs since the closings were slated to save $1.6 million annually.

This was followed by the Revenue Report for the 1^st Quarter.  Collections were $521.4 million against an anticipated collection of $521.8.  The Treasurer’s office was up six million plus and the Clerk of the Court’s office was down, due in part to lag time in processing.  Revenue is 14.9% higher than last year. 

Under Health Services it was reported that billing has improved and accounts receivable has increased.  They are ahead in Medicare receipts and are working to solve problems in medicaid.  They are still working on getting the 1115 Waiver [which allows states to have flexibility in administering medicaid plans], which is critical to significantly improving payments for services by qualifying clients for medicaid services. Health Services has hired 54 people including 17 nurses and are interviewing to fill additional nursing positions.

Discussion of a contract for $1.35 million with W.W. Granger for availability in emergency/unexpected situations for maintenance, repair and supply resulted in a prolonged discussion of “why”.  Homeland Security and other agencies explained the need to be able to respond to emergencies, such as flooding or a pandemic, without having to waste time in responding to the problem with vital equipment.

The CFO reported that a legislative coordinator had been hired for $65,000 to process grants and perform other work.  This led to a discussion of the hiring of an attorney who would represent the Board of Commissioners.  The President’s office has not yet hired such an attorney, and this led several Commissioners to state that this attorney is for the Commissioners, should not report to the President’s office and they will work to resolve this disturbing difference.

The meeting had not adjourned when the observer departed at one o’clock. Those Commissioners not present for the meeting were Commissioner Goslin, Commissioner Daley after the first hour, and Commissioner Garcia.

Cook County Board Meeting January 18, 2012

The County Board Room was filled to capacity with people protesting the Immigration and Customs Enforcement (ICE) Detainer Ordinance.  This observer arrived at 9:55 am and was denied entrance until 10:45 am due to overflow capacity in the chambers.  While the observer waited in line, Commissioner Garcia came out to address the crowd and promised that the policy wording would be returned to committee.

Formal observation began at 10:45.  All commissioners were present except Commissioner Suffredin.  It appeared there had been a series of resolutions concerning retirements and football before observation began.

The Finance Committee, a subcommittee of the whole, convened.  Commissioners Sims, Murphy and Collins voted against all payments to the attorneys working under the Shakman decree. The Deputy Chief Financial Officer, Takashi Reinbold, addressed the fretting about the Shakman decree by observing that the Sheriff’s office was in substantial compliance, and that the Forest Preserve and Recorder of Deeds were getting there quickly.  He predicted the Shakman expenditures would end soon for these offices.

2011 Cook County revenues overall are down $166.3 million relative to 2010.  Most of this is due to health revenues being down.  Without Stroger Hospital, revenue decline was just $9.5 million.

Cook County Health and Hospital Systems CEO Dr. Ramanathan Raju, declared he was embarrassed by the poor results.  He attributed the dramatic decline in revenues to several things:  the large increase in unemployed and no-insurance people seeking care at Stroger Hospital; the fact that Illinois State government had not yet paid $39 million in Medicaid payments to the system; and the financial consolidation of the three hospitals in the system. 

Physician billing just started December 1 where the hospital should get reimbursements from the highest value medical practitioners.  Dr. Raju reports that 28% of its Medicaid applications failed.  This points to the need for better training of personnel who put together the applications.

A 2014 rule in the Patient Protection and Affordable Care Act will allow uninsured people who receive no Medicaid to get it.  Cook County is asking the federal government for a waiver to be able to sign people up early for Medicaid, as many large counties have already done this in Texas and California.  Currently 60% of Stroger’s in-patient and 85% of its out-patient populations are “self-pay/no-pay”, which essentially means Cook County will not be reimbursed for their care.

Commissioner Silvestri asked about the Price Waterhouse contract that has been ongoing.  The contract allows data entry personnel to be charged at $300 per hour.  Dr. Raju will definitely be eliminating the contract.  Commissioner Daley asked about Cook County receiving Medicaid monies directly from the federal government rather than have to wait for the state to make payments.  Comm. Daley remembered this was allowed in 1998.  Dr. Raju will investigate.

An amendment to the responsible bidder process, requiring that contractors pay fair wages, use responsible and trained workers, and other measures, was discussed. Commissioners Collins, Beavers, and Butler complained that the requirement for apprenticed labor eliminated many minorities.  Other commissioners voted to pass the amendment, arguing that even unions are hiring untrained cheaper workers.

After the Zoning Committee was convened by Commissioner Silvestri, the regular Board meeting agenda continued.

A Comcast agreement for all unincorporated Cook County franchise fees to be consolidated and to be paid to the County was approved.

A six month complete review of Bail Bonds by the Cook County Judicial Advisory Council to be presented back to the Board was approved.

Agenda Item 6 concerning charging parking fees at Cook County courthouse facilities, was returned to the Finance Committee for further review to make sure that excluded categories of individuals who would not have to pay parking were finalized.  Commissioners appeared to be in agreement that fees should be charged and disabled veterans and handicapped persons should be exempt.

There was much discussion about an amendment to the ICE detainer.  Commissioner Gorman objected to letting felons out on the street, and that Cook County has not honored ICE detainer requests and in several cases felons have been released and left the country.  Commissioner Garcia called for a roll call vote to send it back to Committee.  Commissioner Daley wanted to make sure the Sheriff can weigh in on what to do and how to respond.  Part and parcel of the ICE detainer requests from the Federal Government is the bail bond issue.  Comm. Murphy said that everyone should have an opportunity to post bond--if ICE wants Cook County to detain illegal immigrants they should pay Cook County to house them.  Comm. Schneider wanted to pass a decently amended ordinance.

President Preckwinkle reminded everyone that in this country people are innocent until proven guilty.

Commissioner Silvestri said we have an obligation to protect people and treat people equally.  The Board voted to send the Amendment to the Legislative Committee with only Commissioner Gorman opposed.

  

The Board approved joint code enforcement between the City of Chicago and the County.  Commissioner Fritchey pointed out that sometimes the City has instituted ordinances that “steal” income from the County.

The meeting was adjourned at 2:20pm.

--Submitted by Observer Amy Little

CCHHS Board Meeting - October 27, 2011

The meeting was called to order at 7:40am by Chairman Batts. Four public speakers began the meeting. One speaker objected to the two proposed Price Waterhouse Coopers contract extensions on the agenda stating that the costs should have been included within the scope of their original contract. He stated that he runs a similar business and the costs cited would normally be included in an initial contract for such services. A Stroger physician presented the ongoing challenges of providing good patient care and the Mental Health Specialist IIs again appealed to the board to not eliminate their positions at Cermak Hospital to be replaced by MHSIII.

In approving the minutes of the Finance Committee three items were exempted from the approval as they were awaiting approval of Contract Compliance. Director Carvalho asked for guidance from the State's Attorney on whether waiting for Contract Compliance keeps the contract from moving forward. Now these contracts will have to wait another month for board approval and he asked that those submitting such contracts indicate if delay in approval will impact service delivery.

Mr. Cookinham, interim CFO, was asked to provide an update on the backlog of pending medicaide claims with the state. He stated that the rejection rate is about the same but he did not give a percentage and said the processing for 2011 has about three more weeks to go. Director Carvalho stated that he had heard that the county process was qualifying those patients who had medicare, insurance, or some source of payment and then all others were being sent to the state to sort out whether they would qualify for medicaide or not. He wanted to know what the percentage of payments that were not being sent anywhere was. Mr. Cookinham said he would check on this but he didn't think that the process was to just send them all to the state to see if they qualified.

A Shakman Compliance Monitor is to be hired and will report to Cathy Bodnar, CCHHS Chief Compliance Officer.

A representative from the Procurement Office reported on changes that have been made to the CCHHS Procurement Policy so that it will be in compliance with the changes in the Cook County code that was approved by the CC Board and went into effect on October 7. The major changes include:

• Approval by the board only necessary for contracts over $150,000
• Quarterly reports to the board on purchases less than $150,000
• All purchases are to be listed on a website
• Supply Chain Managment will be able to terminate contracts in accordance with terms in contracts and can amend contracts up to $150,000
• Requests for bids will now be posted on the internet not in newspaper

Dir. Carvalho requested that the log of complaints of interference with the supply chain process also be posted on the internet. A motion was made to amend the policy accordingly. The amendment was approved as was the policy.

The board was asked to ratify the changes that were made to the CCHHS budget in the President's Executive Budget that was presented to the board on Tuesday. Dr. Raju, CEO, stated that his team had worked with the President's office to come to a compromise on the budget and he had made changes that would not reduce serves or personnel but would challenge them to be more efficient. He intended to review all contracts going forward and hoped that the budget would pass with no further amendments as he needs to focus on other matters and not spend months enmeshed in budget struggles. In further discussion it was noted that this budget reflects another quarter cent reduction in sales tax and there will be another reduction next year. In order to preserve quality services the system will need to focus on the issues of increasing revenue and keeping patients coming to CCHHS. Also it was pointed out that they will have to address the often avoided issue of productivity which has plagued the system and that encompasses management issues and infrastructure issues that are wide spread. The revised proposed budget was approved. Chairman Batts said there are two public hearings scheduled for public comment on the revised HHS budget. Transcripts of the hearings will be provided to the CC Board. The public hearings that the CC Board is holding will not address the HHS portion of the budget.

Chairman Batts also stated that he has a donor for the Foundation that the board has set up but they need to get the Foundation Board up and running so they can accept the money. They still need to find outside persons to serve on the board although they have a list of potential members.

Cathy Bodnar, Chief Compliance Officer, gave a presentation on the CCHHS Conflict of Interest Policy.

Dr. Raju, the newly hired CEO, reported that his vision for CCHHS is that they will continue to do good work and become a national model for excellent care. There will be challenges since these are difficult economic times and it will take time. He stated that the Nominating Comm. for the board met and has submitted 3 names to President Preckwinkle to fill the position on the CCHHS board left vacant by the resignation of Andrea Zopp. He also said that Provident Hospital had an excellent Joint Commission report and he commended the staff for their work.

The meeting went into closed session at 9:50am to discuss collective bargaining agreements. The observer left at that time.

Health and Hospital Systems Board Meeting

December 17, 2010

The meeting was called to order shortly after 7:30am by Chairman Batts. Only 1 public speaker before the Board got to the business of Committee Reports.

Finance Committee
A contract with Hektoen Institute of Medicine was included for approval. Hektoen oversees research grants within the system and the Board had determined that an agreement between Hektoen and HHS was needed to establish control over the grant monies involved. While it was reported that Hektoen was not satisfied with the contract Director Carvalho, Finance Committee Chair, asked for approval anyway stating that “change is hard.”

The Board had questions about the loss of medicaide revenue as reported in the Financial Statements for September and October – a total of $55m for the year to date. Mr. Ayres, the CFO, stated that he could do some analysis but he had no hypothesis as to why there was a decrease. Mr Foley, CEO for the system, stated that a major issue was the back log at the state in processing of medicaide applications for eligibility. He said they were trying to get an agreement wherein the County would provide funds for processing of eligibility that would presumably result in a net gain of funds if more applicants were found eligible. Further discussion revealed that this fall off in medicaide revenue is not being seen at other hospitals and that there may be other reasons for why the System is experiencing this decrease in medicaide revenue. There was also a reported decrease in patient hospital days which resulted in a discussion of whether the financial reports reflect actual patient days in the hospital or billed hospital days. There seemed to be confusion over the way that patient days are recorded in the financial reports and the confusion did not appear to be resolved.

Audit and Compliance Committee
It was reported that the committee is anxious to get started on the audit of Hektoen.

Chairman’s Report
Mr. Batts received a letter from the leadership of SEIU. They had done a budget analysis of the HHS proposed budget and sent their budget recommendations to the Board and also included suggestions for geographic representation of membership on the HHS Board, a labor/management partnership, and a Safety Net Summit. A response letter from the Chairman was presented seeking Board support. A discussion among the Board members ensued in which they discussed the new administration’s request that they spend only 21% of their 2011 budget request in the first quarter of the fiscal year. The CFO reported that the spending as of the end of 2010 was consistent with this request if they continued in the same pattern. Mr. Foley stated that reductions in spending may be less challenging as the year progresses when parts of Provident and Oak Forest are closed later in the year. It was also pointed out that more revenue is needed in the next few years to get the Strategic Plan moving forward and if that doesn’t happen this Independent Board will be perceived as doing the same old thing. Other directors pointed out that it was necessary to hear what different constituencies were saying and to get the community to work with them, although it was also pointed out that sometimes the community that claims they haven’t been heard is saying “you didn’t do what we wanted you to do”. Another opinion expressed was that you can do all the communicating you want but if you don’t deliver service it won’t make any difference.

Systems Operational Plan Update
A presentation was given by Dr. Schrader from the Emergency Dept. and a representative from Price Waterhouse on Simulation Modeling that has been done in the Emergency Room. Monitoring of all processes in the ER from when a patient walks in to when they are discharged from the ER was done during a 2 week period in October. Analysis was done to determine where processes could be expedited and some changes have already been instituted to decrease wait times and to expedite the time for tests so the patients can be moved through the ER in a more efficient manner. The big obstacle continues to be bed availability for patients that need to be admitted. Mr. Foley said that issue was being addressed in a different way.

Employee Engagement Survey
A system wide Employee Engagement Survey will be done in January. Such a survey has not been done recently and it will provide a baseline for further evaluation of employee satisfaction. It is being conducted by the survey arm of Price Waterhouse Coopers. The computerized survey has 50 questions and will take 20-30 minutes to complete, and participation is not required but strongly encouraged. The survey process will begin on January 12 and run for 10 days, with the hope of presenting the aggregate data results to the Board by March. Training will also be provided to managers so that they can utilize data gleaned to develop departmental goals which are in line with the Strategic Plan 2015 Vision.

HHS System Compensation Review
Mr. Foley stated that there has been a heightened level of concern regarding compensation levels within the HHS. The CC Board approved an ordinance requesting the County Auditor do an audit of the appropriateness of compensation packages in HHS. The President’s office will outline the scope of the audit. They have requested that it include comparisons to other large public hospitals. The CC Board wants this completed by Jan. 19 so they will have the information prior to their consideration of the budget. It was pointed out that comparisons have been done based on similar positions in the Chicago area and not on similar hospitals in other locations. This is consistent with comparisons for other personnel salaries that are also based on location (Chicago) and not type of institution (public hospitals in other cities). The scope remains to be determined, and it is not clear what the President and the CC Board will do with the information once they have it.

Observer left at 9:15am and board was still meeting with 1 remaining item on agenda before going into closed session.

Cynthia Schilsky
LWVCC Observer