Commissioners voted for renovation of the historic Cook County Hospital Main Building for administrative office use for the Cook County Health & Hospitals System (CCHHS). Once renovated, the building will replace the 1900 West Polk facility, which will be demolished. This is the most affordable and lowest risk option. The estimated cost is $107,700,000. TIF funds will be sought.
The memory of Commissioner Carl R. Hansen was honored by passage of a resolution. Hansen was on the Board from l974 to 2006. Commissioners stated that his sense of duty and responsibility to the taxpayers of Cook County was widely known. He did not shrink from debate.
The state of Illinois lacks resources and is passing responsibility to Cook County. This is becoming a major problem. The end of the Duran and Harrington Decrees will save some money and enable some cases to end. [From a Sheriff's Office press release:
"...the Cook County Board voted to move forward with plans to settle the Duran Consent Decree, an agreement governing jail conditions which took effect in 1982 after a lawsuit was filed in 1974. It has since hovered over the jail and cost taxpayers millions in attorneys and monitoring costs.
The settlement discussions would find an end brought to the Duran Decree, as well as an older Harrington Decree governing mental health care. In its place, the U.S. Department of Justice would agree to a new set of monitoring standards making the Cook County Sheriff responsible only for corrections issues at the jail."]
Four County mental health consultants were appointed to report on compliance at a cost of $600,000. They will report back to the Board in four months, though they have an eighteen month time frame.
The Board discussed Court Decrees at length. State's Attorneys have discussed bench marks and costs for new decrees. The budget will be in the Health Dept. or Jail Dept.
CCHHS experienced a $4 million deficit in December. Stroger Hospital has a very large deficit. Oak Forest and Provident Hospitals have had fewer patients than anticipated and therefore have had a 54% drop in revenue. Michael Ayers, the health system Chief Financial Officer, stated that he believes the deficit can be overcome in the future because CCHHS is getting Disproportionate Share Hospital, or DSH ("dish"), payments to replace reduced Medicare and Medicaid funds. DSH payments are federal financial assistance to hospitals that serve a large number of low-income patients and the uninsured. In addition, CCHHS finances should be improved by the closure of some neighborhood facilities.
--Submitted by Arline Doblin
Cook County Health and Hospitals System February 26, 2010 Board Meeting
As part of its on-going education, the Board heard details of the Internet Referral Information System, or IRIS, that has been implemented in recent years. It tracks patient visits and referrals. Visits decreased in 2007 with budget constraints and are resuming growth at about 10% per year.
Delays in referrals within the CCHHS reflect a need for more specialty services. Even nationally, referrals are disorganized, but the use of electronic records expedites the process. In Cook, there is a no-show rate of 40%, which wastes resources. Some problems can be attributed to an unstable patient population, some of whom do not have phones to receive reminders of appointments. An automated phone system calls with reminders 10 and 2 days before appointments. The backlog for colonoscopy referrals is especially high.
CEO Foley reviewed the progress in meeting Leadership Team goals. The assessment of management restructuring will be completed by the end of March. Centralization of functions brings purchasing and contract compliance within the system with HR in process. Building and Trades will now be centralized within the Health and Hospital System, rather than being handled by other County administrative offices. Participation in Graduate Medical Education needs review. Attention was drawn to the many affiliations with other hospitals, some of historic origin, not all explainable. This is an area where guiding principles are needed. Currently, an affiliation with University of Chicago is being explored with a view to a mutually beneficial use of Provident Hospital, now underutilized. A proposal will be brought to the Board in March.
Work continues on the Strategic Plan with a deadline of May; different scenarios will be presented. Areas under scrutiny include the Community Needs Analysis which should clarify where to target services, looking at socio-economic and health profiles. Data is available now on where patients come from. CCHHS through the Ambulatory Care Network and the separate Federally Qualified Health Centers (FQHCs) provides primary care throughout the County, but there are pockets of need for out-patient primary and specialty care. Closure of inpatient services at Oak Forest and Provident Hospitals remain under discussion. The negotiations with U of C regarding Provident will affect any such decision. A Board Retreat to consider all the data is tentatively scheduled for the April 30th meeting.
Minutes of the various Committees were approved. The Finance Committee reported an increase in Medicaid patients. The Group Purchasing Organization, or GPO, for pharmaceuticals satisfactorily dealt with the required minority member inclusion. A lease of Hinsdale property (the former TB Hospital) was also approved.
--Submitted by Nancy Staunton
Following an invocation by Bishop Demetrius of the Greek Orthodox Church, Chicago, and the Pledge of Allegiance, Cook County Board members debated whether the county should enter into a contract with USI Midwest, a financial insurance company. Commissioners questioned whether the risk tolerance level for the county should be raised. Commissioner Schneider suggested the county sign a one-year contract with USI Midwest, after which officials would prepare an RFP. Commissioner Gainer requested that Jaye Williams, Cook County CFO, provide the Board with information necessary to prepare the RFP. Commissioner Schneider addressed the commissioners' inability to access RFPs before making such decisions as the current one under discussion with USI Midwest, and expressed his belief that commissioners should be able to examine RFP information before making such important decisions. Commissioner Butler stepped into the discussion to clarify that the commissioners wish access to the responses of RFPs, and are concerned with the confidentiality of this information. A vote was taken with 15 yays and 1 nay from Commissioner Peraica, who informed the Board that the county knew three years ago that the risk level needed re-evaluation but did nothing to solve the matter. Commissioner Silvestri expressed concern about the process through which the insurance was obtained. Commissioner Gainer pointed out that 50 companies provide the insurance the Board is looking to purchase. Ms. Williams, who said there were only 8 other companies which offer the insurance, offered to add additional companies to her list of potential carriers.
Commissioner Silvestri applauded veteran officer Michael McCotter's contributions to the Chicago Police Department, and voiced congratulatory wishes for McCotter's appointment by Governor Quinn to the Chief Public Safety Officer at the Illinois Department of Corrections.
The Board discussed the county audit report, and County Auditor Laura Burman addressed the Board's questions on 20 missing forms when the audit was conducted.
Commissioner Daley motioned to pass the tax levy for 2010. Methods of appropriation for each department were addressed. Commissioner Daley noted that the tax levy has remained at the same level since 1994. A vote was taken and the motion passed with 15 yays and 2 absences.
Considerable discussion followed concerning a federal grant from the Department of Energy (through the American Recovery and Reinvestment Act of 2009) to promote energy conservation in Cook County. Commissioner Claypool asked Maurice Jones, Director of Planning and Development, how the incentives contained in the grant will be determined. Mr. Jones will provide this information to Commissioner Claypool. Commissioner Murphy asked Mr. Jones to explain the role of the CTA in the grant.
The topic then turned to the request from the Recorder of Deeds to sell information from its office. Commissioner Schneider questioned whether the projected $350,000 in profit from the sale of the Recorder of Deed's information was the maximum profit the county might receive from such a sale. Commissioner Schneider suggested that other companies besides Fidlar Technologies, Inc. may be interested in purchasing such data.
Finally, the Board addressed the county's $104 million debt owed to the Pension Board. An attorney representing the county requested permission from the Board to negotiate the debt in the form of a short-term note with a 2.7% interest rate, and a lump sum settlement. Commissioner Peraica suggested the county use the $200 million savings from the Health and Hospital Board to pay the $104 million debt. Commissioner Butler asked whether the county is current in its pension payments for 2008, 2009, and 2010, to which Commissioner Moreno answered in the affirmative. A roll call vote was taken and the motion passed, with 13 yays, 1 nay, and three absent. The meeting was adjourned.
--Submitted by Stephanie Polito
Jeanene Johnson, Director of the Office of Performance Improvement, gave an overview of activities and progress. The staff of three, specializing in finance, operations, and IT, oversee consultants with a goal of improving all business functions and becoming unnecessary as the management team grows. They will store all records on a restricted access website for future use. Their target is $105 million in reduced expenses. Some focus areas are lab consolidation and pharmacy formularies.
Ten employees will be funded to participate in relief efforts in Haiti for 10 days each.
CEO Foley reported on system leadership goals. The Strategic Plan and 5 year financial plan should be completed by June for approval by the Board. It will include management restructuring to achieve the budget reduction of $105 million (400-500 positions). It will include attention to cultural diversity, patient satisfaction and staff morale. A Board member reminded him that productivity is basic to budget reduction; the director of the Ambulatory & Community Health Network (ACHN) provided data that showed some improvement, e.g., the increase in patients seen per primary care physician session. Concerns continue regarding referrals to specialists. Financial statements will be provided next month. Management is in preliminary discussions with University of Chicago to explore shared use of Provident Hospital.
The Finance Committee Report noted that the Graduate Medical Education study showed inadequate documentation to claim reimbursement due to poor record keeping. Payment systems are still challenging. Systemic issues still need attention.
The Board adjourned to closed session to discuss relevant issues.
--Submitted by Observer Nancy Staunton
