Cook County Forest Preserve District Board Meeting, September 11, 2012

President Preckwinkle called the meeting to order at 10:14 AM.  Roll was called and an invocation was made.  Commissioners Collins, Murphy, Gainer, and Beavers were absent.

The president welcomed everyone to the Chicago Botanic Garden, where the meeting was held. Sophia Siskel, Executive Director of the Garden, gave an update on the garden work and plans for the future.

Resolutions were passed honoring 9/11; Billy Casper, Jr. on running the district golf courses; John Elliot, Education Program Manager, on his retirement; and Poplar Creek Forest and Charles Hanson Woods Nature Preserve selected for the Environmental Conservation Award,

The meeting recessed to the Finance Committee meeting. Commissioner Goslin presided.  The committee approved disbursements and committee reports from Litigation, Workman’s Compensation, and Revenue Report (pool fees up, license fees up, golf revenue up from last year).

Lots of discussion, all positive, about the proposed ordinance to have a goal that not less than 25% of contracts awarded be given to Minority and Women owned Business Enterprises.  This ordinance has a sunset of 6/2016 but can be renewed if it proves effective.  This is a first for the Forest Preserve and many commissioners asked that their names be added to the ordinance, along with Commissioner Garcia who proposed it.  This ordinance was passed unanimously.

Back in the regular board meeting, the most important item was the purchase of land adjacent to Orland Grasslands in south Cook County for $8 million. This adds 160 acres to Forest Preserve lands.

Also, professional services in the amount of $87,000 were  approved for a consultant to set up a program for the new MBE/WBE ordinance.

The meeting adjourned at 12:17 PM.

--Submitted by Observer Peggy Kell

Cook County Hospital Quality and Patient Safety Committee Meeting, August 21, 2012

This meeting served essentially as an orientation for the new members of the Committee, most of whom are also new to service on the Hospital’s Board. Dr. Mason, the new System Chief Medical Officer, gave a report prior to the arrival of the observer. 

Ms. Russell, System Interim Chief Nursing Officer, reported that the system is facing a wave of nurse retirements: in 2013, 196 nurses will be eligible to retire after 25 years of service and another 43 after 30 years of service.  While there are obviously pension consequences to this large group of retirees, Ms. Russell reported on it as something to be considered in maintaining the quality of patient care throughout the system.

Dr. Mason then showed the group a video explaining the responsibility of the CCHHS Board for the quality of care at the hospital.  The Board (like hospital Boards everywhere) was originally an honorific and philanthropic Board only, with quality and patient care concerns left to the medical staff.  However, a 1960s court decision (the Darling case) found that a mistreated patient could hold the hospital, and not merely its doctors, liable.  As a result, hospital Boards now have responsibility for overseeing the medical staff as well as hospital management.  These oversight responsibilities are discharged at CCHHS through its committees.  Committee member Driscoll asked why the Quality and Patient Safety Committee no longer received Mortality and Morbidity reports–are the Committee’s discussions discoverable in court?  CCHHS Associate General Counsel Helen Mason promised to research and respond to the question in writing.  She noted that those reports are discussed within a committee of the medical staff.  The Committee agreed informally that it doesn’t need to see details of individual cases but wants to know about processes for correction, perhaps through an annual or half-yearly event report.  Ms. Mason assured the Committee that the Board will see all public reports.

Dr. Das, System Interim Director of Quality and Patient Safety, then briefly reviewed the status of the hospital’s accreditation.  He explained that the accreditation process for public hospitals was new, and that Stroger had submitted its application supported by the hospital’s strategic plan and the WePLAN 2015, which prescribes actions in accordance with the strategic plan.  The Joint Commission will pay an accrediting site visit in July, 2013.  At the moment, only 80 of the nation’s 3000 public hospitals are accredited; Cook County intentionally submitted Stroger to the process early, and hopes to be accredited next year. 

Dr. Murray, Director of the Department of Public Health, then explained  that the Board of Health oversees all state-certified health departments.  In Cook County, there are 6 of these: Chicago, Evanston, Oak Park, Skokie, Stickney, and Cook County itself, which covers the rest of the county.   

She then reviewed a series of Health Department reports, offering the following details:

     •    The Department is now benchmarking indicators for lead poisoning.   In the coming year it will expand its role from screening and treatment to prevention and education.

     •    The Department handles food safety inspection for unincorporated Cook County and on contract for 34 suburban communities.  This is a revenue generator.  It doesn’t usually check farmers’ markets because it is worried more about meat contamination than about produce.

     •    The Department monitors syphilis and has reduced the extent of spread to 1 contact (.6 contact means no syphilis at all).  Its outreach efforts focus on young people.  The chair asked about drug-resistant gonorrhea, and Dr. Murray replied that the department informs doctors and tries to prevent the ailment through education about safe sex and through contact tracing.  Finding contacts is challenging, though, and the problem can only be solved through wider testing and education.

     •    The Department is identifying the zip codes with the highest-risk infants so as to concentrate its prenatal, neonatal and maternal care resources there.

     •    The Department monitors tuberculosis everywhere in the county but Chicago, and provides care for the entire county (by contract with Chicago).  The proportion of TB cases is up in the suburbs.

     •    The chair asked about pertussis, and Dr. Murray said that communicable diseases in general were not going down, and that she suspected pertussis was under-reported.  This demonstrates, she said, that the county’s vaccination coverage is not what it should be, pointing out that the legal requirement that children be vaccinated for school is ignored.
 
The Department meets with the state Department of Public Health (which can instruct local departments to test more frequently) and with its counterparts throughout the state. “We monitor specific diseases but we’re also concerned about process improvements.”

     •    Commissioner Munoz asked about the flu, and Dr. Murray reported that there has been no human-to-human transmission of swine flu; it has shown up only in children petting hogs at the state fair. 

The Committee approved four reports–Food Access in Cook County; The Suburban Cook County Food System: An Assessment and Recommendations; Communicable Disease Update, August 2012; and Annual Tuberculosis Surveillance Report,2011–which will now be posted on the CCHHS Website.

This fall the Department will update its report on the Strategic Plan and release a Quality Improvement Plan. 

Dr. Wakim then reported on the status of Provident Hospital: within 4 to 6 weeks it will be
prepared to take Stroger’s overflow, and able particularly to provide much more gynecological care. 

The Committee then approved medical staff appointments and the minutes of its June meeting. There being no call for a closed session, the meeting was adjourned.

--Submitted by Observer Kelly Kleiman

COOK COUNTY Health and Hospital System Finance Committee Meeting August 24, 2012

The meeting was called to order by Chairwoman Heather O’Donnell at 9 a.m. George Blakemore for Clean Government, spoke on the need for transparency in government contracts.  Lionel Saffold, SEIU (Service Employees International Union) Local 1, spoke on the need to hire responsible contractors who pay workers according to the contracts.

Four contracts were brought up for approval: 1) an increase to the budget for hiring extra nurses through a nursing agency, 2) a contract to GE Medical Systems for bedside monitors, 3) a contract to Simplex-Grinnell for hospital emergency fire equipment which would result in 18% savings over the previous contract, and 4) a contract with Health Record Solutions.  Board members posed questions on the need for using a nursing agency.  All contracts were approved by the board.  

The Financial Reports through July 31^st were presented by Dorothy Loving, Executive Director of Finance.  It was noted that the number of days of outstanding revenue had decreased since the winter months.  Budget deficits have also decreased compared to the same month in 2011 due to Retroactive Payments moving faster.  After listening to questions and answers, Chairwoman O’Donnell suggested that a training program giving a broad overview of the budget would be helpful for new board members.   The Financial reports were unanimously approved.

Dr. Raju presented the preliminary 2013 CCHHS Budget.  Discussion would be held immediately and the vote deferred to September 5 at a meeting of the entire board.  Dr. Raju said during past years, quality of care was separated from patient satisfaction, but now they plan to work on equating these two factors.  2013 revenue is based on payer mix by surgical procedure.  He said the new budget does not project a higher volume, and that HHSSC has been proactive on the 1115 Waiver for early enrollment by already enrolling 60,000 patients of the 115,000 they expect to enroll and follow through 2014.  As CCHHS does not currently have the ability to track and document  individual costs per patient, Chairman O’Donnell noted the 1115 Waiver gives the County the incentive to do so.

Continuing with the 2013 Budget overview Dr. Raju noted that expenses associated with Oak Forest were moved to Stroger Hospital, and the revenue from Oak Forest Hospital is now credited to Stroger Hospital and ACHN (clinics).  Supply chain savings are expected to be $25 million.  Vacant positions in the system continue to be a problem.  Currently there are 382 positions in the pipeline.  The 2013 budget also allocates an additional $8 million for more information systems.  Chairman O’Donnell asked for monthly reports on the supply chain purchases, waiver implementation with early enrollment, and meaningful use.

2013 Budget hearings will be held on August 28, August 30, and September 4.  The board meeting was adjourned at 10:20 a.m..

 
--Submitted by Eleanor Prince, League Observer     

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