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

Preckwinkle Runs First Board Meeting December 14, 2010

Today being the first board meeting of the new Preckwinkle administration, there were lots of changes: new calendar, new seating arrangements, new rules and procedures, new committee assignments, and a very speedy meeting. Done before noon! New commissioners Tobolski, Garcia, and Fritchey tried to keep up with the fast pace of approving resolutions, ordinances, contracts, expenses; audience members were madly flipping agenda pages to follow along.

Some major expenditures included more pass-through grant money from the federal government to Project Shield, which is part of Homeland Security. The Johnson Controls contract was extended for another year, which brings the total expenditures to $25, 884,644.00 since 2008. This controversial project is in the last of three stages--now concerning inter-operable mobile, video, and data network system for first responders throughout the county.

Concerns by Comm. Gainer, Beavers and others about pay raises and salary adjustments for administrators at the Health and Hospital System (HHS) delayed their approval. Human Resources Dept. head Sova was asked to provide a written rationale and Auditor Berman will do a review of salaries at HHS once she is given the scope and number of employees to be reviewed. This will be determined by Pres. Preckwinkle's office.

Numerous departments requested vehicle purchases. These were referred to committee where some type of centralization of fleet management can be considered. Pres. Preckwinkle and Comm. Gorman were both concerned that vehicles be purchased in or near Cook County and that purchases be consolidated. This is intended to reduce costs and unnecessary duplication.

There was some concern by Comm. Gainer and Collins regarding foreclosure legal aid and mediation help. They asked for a report on how many Cook County people were actually helped, and in which way, by the $241, 000.00 fund delegated for this purpose.

Pres. Preckwinkle declared a moratorium on Capital Improvements projects and expenditures (except for health and safety) until they can be evaluated.

Retiring Chief Administrative Officer Mark Kilgallen was praised for his 29 years with the county. He will be replaced by CAO Robin Kelly in the Preckwinkle administration.

Cook County Health & Hospitals System Board Meeting October 28, 2010

Stroger Hospital, 5^th floor Conference Room, 7:30 am

Board and Committee Reports

Finance Committee reported on the operating budget submitted to the County for public hearings. It requests appropriations of $817 million (a reduction from 2010 of about $48 million). Based on the revenue and expense projections, the required subsidy from Cook County would be approximately $217 million (almost 30% less than in 2010). The Board position has been to seek a cut in subsidy rather than across the total appropriation. The reduction will result in a loss of services of approximately 1000 Full Time Equivalent (FTE) positions. The budget process is anticipated to last until February.

Meanwhile, the CCHHS intends to proceed with implementation of its Strategic Plan.

Audit and Compliance Committee noted several policy revisions in process, notably the gift policy. Many departments are involved. Resolution is expected by December.

Quality and Patient Safety Committee reported on several services. With no in-patient psychiatric services at Stroger, the ER is inundated with cases. Obstetrics (OB) services at Provident have been suspended. Other improvements were noted with recognition that quality depends on staffing.

Resolutions were passed celebrating the 100^th anniversary of Oak Forest Hospital and the 50^th anniversary of Provident Hospital's Women's Auxiliary Board.

CEO Foley reported on progress on Leadership Goals. Under performance improvements, the Knowledge Web on the Internet has established a webpage for each department for internal use. Among operational improvements, lab consolidation has occurred, bringing testing from the clinics to Stroger, with anticipated savings of $5 million over 3 years, as well as more efficiency. Nursing professional development has streamlined 20 affiliation agreements to 10 at all levels, with better schedule monitoring and ability to assess competency.

The Strategic Plan proceeds with 14 teams addressing 350 tasks. The Cook County Ambulatory and Community Health Network (ACHN) team will address computer needs, regional outpatient services at Oak Forest and Provident, and potential expansion of Cicero and Palatine clinics. The consultant, Fantus, is involved in program planning for a new facility which involves County Capital Planning and Requests For Proposals with a target of Certificate Of Need (CON) approval in 2012 and construction in 2014.

The Oak Forest team has a March deadline for CON approval of a closure of inpatient beds in May, with inherent marketing and communications needs. They will also address an expansion of Building E to regional outpatient and specialty services, the development of ER to Urgent Care, and meetings with local hospitals.

The Provident team will address the downsizing of inpatient beds and suspended OB services, along with inherent communications needs, ER transition, the relationship with University of Chicago and collaboration with Federally Qualified Health Centers (FQHC) for primary care.

Overall goals continue: Access (which addresses barriers regarding phone, referral, and staff development), Quality, Service Excellence, and Cultural Competency. Specialized areas will continue to be examined, including ER/Trauma, Urgent Care, Maternal/child, Perioperative, Stroger capacity/length of stay, Staff development and training, and Staff satisfaction.

The meeting adjourned at 9:45 am. The next meeting will be on November 19 at 7:30 am.

--Submitted by Nancy Staunton, Observer

Cook County Board Meeting --November 3, 2010

BUDGET REPORTS BEGIN

Starting the meeting were budget reports from the three transit agencies that receive some funding from Cook County or have board members appointed by Cook County Board. The audience did not have access to the actual budget numbers.

Terry Peterson, chair of the CTA Board stated there would be no fare increases and no service reductions for 2011 and that the budget was lower than in 2008. His concern was that the state of Illinois is late on payments to the CTA. The inspector general office of the CTA costs about $2 million per year, but is considered a good example for transportation oversight. In the future, the CTA and other transportation agencies would like to get away from fare cards and instead have customers use credit or debit cards.

Jim Dodge of the Metra Board presented a $1 billion balanced budget. They will need to move money from capital funds to operating funds this year. There was a concern that lower sales taxes and late funding from the state would impact the operations. There will be no fare increases in 2011 and there will be electric line improvements this year. Dodge stated the Metra Board is "resetting" after the scandals of administration payment irregularities. There is some concern over the type of inspector general office needed for Metra. Commissioner

Suffredin questioned Metra's plans regarding the replacement of 22 bridges and the ensuing disruption for North Shore riders. Dodge indicated the project will be re-planned to possibly cost less and cause less disruption.

PACE also indicated no fare increases or service reductions , but services cannot be expanded at this time. Ridership is down, probably due to higher unemployment. New buses will be hybrids and be smaller, since many buses are now half-empty. ADA (Americans with Disabilities Act) compliance is a large portion of the budget.

The RTA, which is the overriding agency of CTA, METRA, and PACE had concerns about the $300 million that the state of Illinois is behind in paying these agencies. All boards are having to dip into capital funds for operations. Commissioner Peraica expressed concern that the agencies have an alternate budget ready in case the state doesn't come through with the money. He also stated that employee pensions, salary, etc. will doom these transportation agencies.

During the Finance meeting, the revenue report for the last 10 months was presented by the Comptroller, Connie Kravitz. Revenues are currently ahead of budget projections by $4.7 million. However, by the end of the fiscal year it will come out even. Concern was shown about the reduction in sales tax rate, which began July 1st, and that the Health System is still behind in its collections. The county is also receiving more money due to increased foreclosures (fees) and late property tax payment penalties. The next (late) property tax bill will be mailed the week of Nov. 13th and will be due Dec. 15th.

The Board then went into executive session to discuss a lawsuit and this League member left. I missed the discussion on unemployment benefits for recently arrested staff member, Carla Oglesby.