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

CCHHS Board of Directors Meeting July 25, 2014

The meeting was called to order at 8 am.   All Board members were present except for one who attended by speakerphone.

Public Comments: A member of the public in attendance commented that CCHHS has 4 Board vacancies and therefore conducting the election for Chair and Vice Chair of the Board (on the agenda for this meeting) should be delayed until a full Board was appointed. He also stated that “no bid” contracts approved by the Board was not good governance and member/s of the Board have a conflict of interest because they are involved in the contract benefits.

Chair Carvalho responded to the allegations/concerns:  Cook County President Preckwinkle asked that the current Board of Directors of CCHHS stay on until the transition to the new CEO of CCHHS was complete (Carvalho and Gugenheim have completed their 6 year terms of office and are due to be replaced on the Board).  Ordinance defines the process for selection of new Board members.  Civic organizations (10-12) nominate members for the Board.  They normally meet and slate by 6-30-14, but due to the CEO search, this was delayed. 

 

With respect to “no bid contracts”, Chair Carvalho indicated that he was employed by IDPH (although he had recently resigned from that position and had not finalized  subsequent employment) and some contracts may have constituted a conflict of interest.  He rigorously abstained when there was voting on such contracts.

Board and Committee Reports were approved, including the CCHHS Finance Committee minutes from the July 18, 2014 meeting, which showed CountyCare 6-month revenue at $313,555,104 against expenses of $335,485,843, for a net deficit of $21,930,740.

An Amendment to the Rules and Regulations of the Medical Staff, pursuant to the Bylaws of the Stroger Hospital of CC Medical Staff was passed.  A copy of the Bylaw amendment was not available to the non-Board attendees. The discussion by Dr. Shannon, CEO, and Dr Fagen, Chief Medical Officer, indicated that the bylaw amendment dealt with improper transfer of patients from outside hospitals (dumping) to CCHHS in violation of the Emergency Medical Treatment & Labor Act (EMTALA). The process which will now be in place requires the ER to notify the CCHHS Compliance Dept., which then reports the event to the State of Illinois as a possible EMTALA violation.  Only 6 such violations have been reported this year (not known whether they were validated).  In most cases the transferring hospital calls CCHHS to alert them of the transfer. 

One of the Board members asked who was considered a “qualified provider” in the ER  and whether they all followed “practice guidelines”.  Dr. Fagen indicated that Nurse Practitioners and other allied health providers (non-physicians) were allowed to triage, conduct evaluation and management and treat to the extent of their licenses with the exception of evaluation of “chest pain” which required a physician evaluation.

Chairman of the Board Report:  Chairman Carvalho presented an overview of CountyCare with pros and cons of the transition to a managed care model from the previous “fee for service” funded by intergovernmental transfer.  It was relatively positive for the System model. Going forward, the State of IL requires 50% of Medicaid to be managed care with the expectation that 100% of Cook County Medicaid be managed care by Jan. 2015.

Nursing report:  Dr. Shannon introduced the new Executive Dir. of Nursing,  Agnes Therady (from the VA system), who gave a lengthy power point overview of the Nursing Dept.  including organizational chart, past performance and goals.  A Board member asked her how only 22 FTE of outside agency use by the nursing dept. was possible given the 19.2% vacancy rate in the Dept. of Nursing.  She replied that nurses are cross-trained in different disciplines so that they could cover various areas when needed. They are “competency trained/tested” in all of the disciplines they are assigned to cover. Most of the outside agency use was in the CCHHS clinics/non-hospital use.  The high vacancy rate is due, in part, to the older age of the nurses at CCHHS with frequent retirement.  They are working toward achieving “magnet status” for the nursing dept. over 5-8 years of effort.  Agnes’ goals are to improve the “visibility” of the nursing leadership on the wards, to include the patient/their family when there is change of shift/ pass off of care, and to coordinate transfer between inpatient/outpatient setting.

Report of the CEO:  Dr. Shannon noted President Preckwinkle’s open session on the budget of CCHHS the previous week.  CCHHS has a goal to submit its budget to the CC Board by September 2014.  The CC Board Finance Committee requests monthly updates on the Medicaid program finances.  Dr. Shannon also briefly mentioned the “Stroger Campus Redevelopment plan, next generation” with the relocation of the Fantus Clinic, etc.  Finally,  he recognized the Civic Consulting Alliance students present who were observing/shadowing the CCHHS process.

Election of Chair and Vice Chair of CCHHS Board of Directors: The election of Bill Hammock as Chair, and Jerry Butler as Vice Chair was unanimous.

Meeting adjourned to Closed Session.

--Submitted by Susan Kern

Cook County Health and Hospital Services Board Meeting June 27, 2014

After the public speakers, Chairman David Carvalho adjourned to closed session for discussion to secure a vote to approve the appointment of  Dr. Jay Shannon as the new CEO of CCHHS.  The vote was unanimous, with applause from attendees.

Committee Reports: Dr. Munoz, reporting on the Audit and Compliance committee meeting, noted that audit firm McGladrey noted a weakness in the CCHHS audit due to difficulties in financial reporting on CountyCare.  Dr. Munoz said processes are being put in place to correct this problem.   

Director Wayne Lerner asked whether the full board might be able to meet directly with the auditor, and Carvalho agreed to arrange that.  Lerner requested that hard copies of the audit be distributed to the full board, and this request was also approved.  Lerner also asked whether, by approving the minutes of the meeting, the board was also approving the audit itself.  General Counsel Elizabeth Reedy said that according to the bylaws, if you approve the minutes, you're also approving the report.  Munoz said there has been no practice previously of the full board reviewing the audit.  The County board is the entity that actually approves the financial statement. In this situation the CCHHS board approved the minutes of the meeting, but made it clear that they were not, by so doing, approving the audit report.  

Director Lewis Collens reported that in the Quality and Patient Safety Committee meeting, Dr. Das said that the Stroger Hospital ER average wait time dropped from 140 to 82 minutes.  The CORE Center reports HIV suppression at 59% compared with a 25% national average.

Carvalho commended the Commercial Club, where he spoke yesterday, for having adopted the transformation of CCHHS, encouraging more than 70 entities to donate pro bono time.  Vice Chair Jorge Ramirez commended Carvalho for preparing the public for the budget's shrinking in one area, while possibly expanding in another.

Dr. Shannon, commended the second cohort of 11 CCHHS employees' having graduated from the 12-week "Cook County University" training program. With respect to the Cook County budget, FY2015 projects a $168 million shortfall. The 2014 budget shortfall will be $86 million, with $67 million of that related to the health fund. An improvement plan is in place to reduce costs. In June, a 3-year record 113 vacancies were filled, including 26 nurses.  Dr. Shannon recognized Dr. Robert Weinstein, departing head of the Department of Medicine. Finally, Dr. Shannon acknowledged both Dr. Raju and Toni Preckwinkle for their guidance during his period as interim CEO.

Carvalho noted that new committee appointments are made in July; board members should communicate their preferences.

The board adjourned to closed session at 9:35.

submitted by Linda Christianson

Cook County Health & Hospitals System Board of Directors Meeting, May 30, 2014

The meeting was called to order by Vice Chair Ramirez.  

Committee Reports:

      Human Resources Committee Meeting 5-16-14:  Minutes of this meeting included a report by Chief of HR, Gladys Lopes, who presented a comparison of CCHHS job vacancies filled for fiscal year 2013 Dec--April [269 ] and 2014 Dec--April [216].  The graphical data was confusing to me and I was uncertain of the  number of total vacancies  that became available or the % of vacancies filled/ time to fill vacancies. Board Chairman Carvalho requested that information be provided on the number of new nurses hired from outside the organization. Update on labor negotiations was conducted in closed session.

      Finance Committee Minutes, 5-16-14:  Update on 1115 Medicaid Waiver/CountyCare by Steven Glass, Executive Director of Managed Care. For the most recent 6 months, applications initiated fluctuate month to month, with a decrease in April. Applications submitted are slightly increased or level (7000—8000/month).  Applications approved fluctuate wildly month to month but appear to be decreasing (from 9000/month in Nov. 13 to 7000/month in April 14. 

• CountyCare members by age group are: 60-64 (12%), 50-59 (32%), 40-49 (18%), 30-39 (13%), 19-29 (25%).  49.1% are female, 50.9% male. 
• Ethnicity was not reported by 56.3% of CountyCare members. Of those reporting:  28.4% black,  12.6% white, 2% Asian, 0.4% Hispanic, 0.3% American Indian. 
• Health Needs Assessment: 59% no medical home, 51% have not seen provider in 12 months, 85% unable to obtain medications, 24% hospitalized in past 6 months,19% concerned about  “place to stay tonight”.
• Top 10 Diagnoses in descending order:   hypertension, high cholesterol, diabetes, tobacco use, general medical exam, obesity, asthma, depression, sexually transmitted disease.   

The number of CountyCare prescriptions filled has increased over the last 12 months from 5379/month to 125,799/month requiring a transfer of funds ($13,330,817) to the Managed Care Dept. to cover the increased expenditures with average per member per month drug cost of $95.     

Board Chair Carvalho noted that as patients become eligible for Medicare, there is some data that CountyCare/Medicaid loses these patients who are free to use any medical provider. A strategy of retention should be considered. He also asked Steven Glass and Dr. Shannon how the System would be able to provide quality care at a reduced cost per person. They indicated that now that they have identified “high risk” populations from the above data on diagnosis, pharmacy use and health needs assessment, they can focus on preventative care to these groups.

    

CCHHS Chief Financial Officer presented a Financial Report:

There was a net operating loss year-to-date as of 1-31-14 of $49,447,000, but when added to the non-operating revenue, the net loss was reduced to $17,924,000.  CCHHS cumulative patient income breaks down by source as: Medicaid 68% (43% of which is CountyCare/1115 Waiver), Medicare 23%, Commercial 8% and Self-pay 1%.

Quality and Patient Safety Committee Minutes, May 27, 2014:  Joint Commission survey of the Ambulatory and Community Health Network of Cook County cited a number of deficiencies which are being promptly addressed and corrective action reports have already been submitted to JCAHO.

  

Dr. Michael Kelly, Chief of the Division of Neurology, provided a presentation on a Stroke Program.  For CCHHS to become a certified primary stroke center a number of upgrades to the radiology suite, ICU and specialist physician/provider staffing 24/7.

Director Lerner asked how the CountyCare population would be managed for stroke prevention.  Dr. Kelly responded that perhaps the incidence of stroke could be cut in half if all of its patients were within range with their blood pressure, diabetes and cholesterol, and did not practice risky behaviors with drugs.  He stated that the mean age of stroke patients at Stroger Hospital is 58 and nationally 70, that 12% of Stroger stroke patients are under the age of 45.

Dr. Ukoha, President of the Stroger Medical Staff reported that the creation of an internet portal for use by patients to access their medical records is being implemented. He raised the concerns of the medical staff regarding proposed changes to the County’s pension plan which is being discussed by legislators in Springfield.  The changes may lead to poor retention of physicians. This concern was echoed by Dr. Wakim of Provident Hospital .

Contracts and Procurement Action Items : Discussion on a new contract for janitorial cleaning management service by the Board indicated that the previous contract was not acceptable resulting in  several JCAHO deficiencies at the Community Care Clinics related to janitorial services.  

Vice Chair Ramirez indicated that he would be working with Dr. Fagen, Chief Medical Officer, Department Chairs and Clinics on the budget, particularly the “pension/early retirement issue”.

Interim CEO of CCHHS, Dr. Shannon reported:  
The Illinois Dept Public Health inspection of the dialysis unit led to a 3 year re-certification.

 
 Fresh produce purveyors will be providing produce “at cost” to the cafeterias and CountyCare Clinics to improve the diet and health of patrons. 

 Dr. Shannon introduced and acknowledged the physician of the year, the nurses of the year and resident’s research day winners who were presented to the Board.

The meeting adjourned to a  closed session.

Submitted by Susan Kern