Finance Committee

Here is the notice of the meeting, which you can also access at:https://cookcountyhealth.org/wp-content/uploads/CCHHS-FY2021-Prelim-Budget-Public-Hearings-Notice-09-01-20-and-09-09-20.pdf https://t.co/owlWeVQ4Ft

You can access the livestream of the meeting via @CookCtyHealth Facebook: https://www.facebook.com/pg/Cookcountyhhs/about/?ref=page_internal

The Finance Committee will be discussing the FY Budget for 2021, according to the material uploaded on Cook County Health’s website.
https://cookcountyhealth.org/about/board-of-directors/board-committee-meetings-agendas-minutes/

Here is the link to the presentation:
https://cookcountyhealth.org/wp-content/uploads/Item-VB-CCH-Proposed-FY21-Preliminary-Budget-Presentation-08-28-20.pdf

Here is the link to the proposed FY21 Preliminary Budget:
https://cookcountyhealth.org/wp-content/uploads/Item-VB-CCH-Proposed-FY21-Preliminary-Budget-08-28-20.pdf

The committee will also discuss Provident Hospital: https://cookcountyhealth.org/wp-content/uploads/Reimagining-Provident-Hospital-1.pdf

There are seven board of directors members to the Finance Committee: https://cookcountyhealth.org/about/board-of-directors/ https://t.co/0wtawjrggZ

The meeting began at 9:00am by Chief Robert G. Reiter, Jr. He asks the Secretary of the Board Deborah Santana to take roll call attendance. Six of the seven committee members are present including three extra board members: Mary Driscoll, Ada Mary Gugenheim and Mike Koetting. https://t.co/hgmci6MbkG

Reiter tells Deborah they could barely hear her. Reiter asks Deborah if they have any public testimony today. Deborah says they do not.

Reiter then says they are moving right along to the Finance Committee meeting minutes from July 23, 2020.
https://cookcountyhealth.org/wp-content/uploads/Item-IIIA-Minutes-27.pdf

He says they “were approved by the board…but are being presented for the committee’s review in discussion if necessary.”

He asks if there are any corrections to them. None.

Reiter then says Interim Chief Chief Business Officer Andrea Gibson will begin her presentation on the FY2021 Proposed Budget.

Gibson says this proposed budget was presented at the board meeting last week August 20, 2020. “It is a balanced budget and it factors in the identified deficit of $187 million that was identified in June. Since June we have found ways to balance the budget.”

Gibson discusses the numbers. She says there are some competing dynamics going on in the budget.

“For County Care, we are seeing increases in the budget…There are more people moving to Medicaid and the state suspended redeterminations…”

The budget capitation revenue. claims payments and staff associated with supporting that level of membership are going up.

Gibson says Correctional and Public Health there are increases in the budget.

“Correctional Health has to do with distancing requirements in the jail and the need to staff more locations on the campus.”

Public Health is about the “contact tracing grant of $40 million that was received earlier this year.”

https://www.chicagobusiness.com/health-care/cook-county-gets-40-million-covid-19-contact-tracing

“It will flow into next year to hire close to 400 people to support contact tracing effort.”

The main reductions were on the provider side excluding County Care, Correctional and Public Health.

The deficit is $187 million - it was projected in June. https://t.co/3IgxgEKH0T

These are the categories on how they addressed the deficit.

Gibson starts of with Expenditure Reductions. In June, they had layoffs to save $10 million. “Initiative to replace expensive agency with staff.” It impacts: nursing, care coordination and medical technician staff. https://t.co/xpHLl3eOvY

She starts off with Stroger Hospital.

-Consolidated facility of Physical Therapy from Provident to Stroger at old Cook County Hospital known as Harrison Square.

-Suspending inpatient pediatrics due to low volume. Less than two average daily census. https://t.co/d1NcoiskzH

“In result, we are proposing suspending that unit.”

-Consolidated sleep lab services at Provident. Not offered at Stroger.

-Gibson mentions again reducing agency, contractor and overtime costs. “Reason for position increases in the Stroger budget.”

-Corrected the turnover percentage. “It was 15% of payroll in 2020…[Now] it is reasonable at 7.5% to allow filling of vacancies rather than holding them.”

Gibson shares some of the work nursing has done on agency. Reduce agency expenses by cutting hours. https://t.co/rNc5iDYMIw

Gibson moves on to Provident. Overall budget going up and position count going down.

Main Drivers are:
1. Near South and Woodlawn Consolidation into Sengstacke. The expectation is that they will be a Provident clinic and bring in 42 positions. https://t.co/8LZTK0ceW1

1. Converting Emergency Department to a Standby Emergency Department. “More keen to urgent care and reflective of the type of patients and conditions we see in the emergency rooms.”

2. Planning to staff inpatient volumes. Typically range between 8-12, rather than 25.

Gibson comments that what they are trying to do at Provident is “booster the outpatient activity and have more short stays in inpatient unit. And more activity for same day surgery.”

1. Longterm plan is to pursue a new Provident construction. Certificate of Need (CON) 2019.

These are the outpatient services available at Provident.

*Lifestyle Center and Renal Dialysis Services coming online later this year. https://t.co/f3VGrzKMVl

Gibson moves on to Outpatient Clinics,

Reductions in the budget and in the positions:
1. Consolidation of Near South and Woodlawn Clinics into Sengstacke-Provident.

1. Morton East Health School-Based program and Child Advocacy Center health services program support. https://t.co/kfE2gpCNKa

1. Represents the final year of $1.5 million Access to Care grant

Gibson moves on to discuss transitioning of service - Oak Forest.

Clinic at Oak Forest shifted to Blue Island in June. Revenue operations cycle moved to Matteson also in June. https://t.co/runoaejnGD

Working on moving the Department of Public Health to their central Stroger campus this fall. Along with moving the outpatient pharmacy services to Blue Island Center this fall.

The final presence at the Oak Forest Campus is the mail order pharmacy - they are working through options. “Departing from this campus does allow us to save on utility and maintenance expenses.”

She discusses the reductions in force. Had expected a higher number of layoffs. https://t.co/JQ76PjOKZR

They did some layoffs in June for non-union, 130. “The anticipation is that these would happen by December 1st.”

Moves on to CCH Provider. “These are the budgets consolidated into one place. Position count is going up, but the overall budget is increasing.” https://t.co/gcahN6wbE5

Moves on to Correctional Health. As mentioned earlier, the “distancing requirements requires additional staff.” 92 additional positions for #COVID19. https://t.co/bAoTrQY96N

Moves on to Public Health. Variety of sources of fund.

“Contact tracing is the biggest variant for us. It is taking most of the focus of Department of Public Health.” https://t.co/Tx8D1lOlqr

Moves on to tax allocations. “On the left, the bar is the total tax support. For 2020, the tax allocation was $83 million. And we were able to negotiate a $30 million increase to help offset the costs of correctional and public health.” Improvement of this current year. https://t.co/mWDSMT2u56

For County Care there are a few dynamics imbedded in this budget. Expecting 356,000 members on average. Expecting $204 million in domestic spent for County Care patients. Also expected to peak this fall. https://t.co/aX67nmgePB

“In December, when the state resumes redeterminations we would expect some declines after that. But overall we would expect a higher membership level compared to this year.”

Moves on to Revenue projections. https://t.co/wF8IR5DGjb

Gibson says she will talk about proposed revenue by source.
Budget is $3.3 billion. County Care value $2.2 billion (on the left). And $1.1 billion for everything else (on the right). https://t.co/VagzdTqv4b

Moves on to Charity Care Cost. Stroger and Provident Hospitals receive the most charity care (on the right). Projection for 2021 (on the left). https://t.co/XVx3pv1tab

Direct Access Program also known as Care Link is a component of the Charity Care program. Expectation that it will cost $177 million in 2021. https://t.co/9RsJHa35f9

Moves on to System Payor Mix By Charges. Expectation remains consistent with 2019. “For 2020, have seen some improvements in the payor mix but not enough to count on it as a trend to build to the budget.” https://t.co/8BCfrZd9kj

Moves on to Major Revenue Changes helping with the budget:
1. Directed payments helping with reimbursements.
2. Amending cost reports to influence rates. Ones that were open, achieve settlements or reimbursements, or have an impact on rate structure. https://t.co/ZWMy6VlGib

1. Newly eligible population. “Undocumented patients over 65 are now eligible in the state of Illinois for Medicaid reimbursement. This program will go into effect this coming December. Potentially going back until any cost that occurred in September.”

https://herald-review.com/news/state-and-regional/govt-and-politics/illinois-to-become-1st-state-to-provide-medicaid-regardless-of-immigration-status/article_2ce0b3d2-b48d-5c2c-932a-e4153cf0d5a8.html

“Opportunity for us to get paid for work we are already doing on a number of patients in care that are in this category. & this actually does help us get paid for work that will otherwise be considered Charity Care.”

Moves on to Revenue Cycle Improvements. Initiatives completed. https://t.co/FvFAEWfWKF

Impact of $5.5 million on the budget:
1-eliminating out-of-network scheduling. Patients that have insurance, but out-of-network for them. Free up capacity for others.
2-Online bill payment.
3-Work on denials.
4-Reworking the process on prior authorizations.

These are initiatives that are not completed yet. Impact on 2021 budget. Includes: prior authorization phase 2, denial management initiatives, and also improve coding initiative to maximize reimbursement rate received. https://t.co/M38Ebs94zP

Moves on to Cook County support of the health system. Slide shows they are increasing in tax allocation (Blue bar). $30 million increase from the county. https://t.co/eMBLEvMQsG

Moves on to historic operating results. Says it is what guided them to approach the 2021 budget. They observed from 2014-2019 that their operating loss has increased. There are multiple reasons that “they are attempting to address in this year’s budget.” https://t.co/ZND4j9AUFy

-loss of reimbursable patients
-growing cost of charity care patients
-deterioration in the revenue cycle performance
-increase in the health system provider budget at the same time there was declining patient volume
-State of Illinois reduction in rates paid to County Care

-increase operation costs at the jail facility

“Between 2014 and 2019, decrease in the operating tax support. Increase in our operating loss - getting worse. amount of that decrease that is an excess of the tax support.” https://t.co/nEgD6ORV8r

Moves on to the Mandate Cost Analysis. Gibson says that the mandated services they are responsible for are public health, correctional health and uncompensated care. There’s an increase in the trend for correctional and uncompensated care in the recent years. https://t.co/UkJ3mYUgZ4

Moves on to Capita Operating Tax Support. Says it is lower than other government systems. Notes that “Parkland does have taxing authority as a few others that are not featured on this chart.” https://t.co/Q4rclJAH0w

Shares the FY2021 Budget Calendar. Gibson’s presentation ended at 9:28am. https://t.co/lc7FFzTQj5

Reiter thanks Gibson. Moves on to public comment. Secretary Santana says there were 22 public comments submitted electronically.

She reads them out loud. Most of the comments are from nurses, doctors and patients. They are regarding closings of hospitals and 2021 budget.

They can be found here: https://cookcountyhealth.org/wp-content/uploads/Public-Testimony-unpag-09-01-20.pdf

The public comment ended at 10:20am.

Reiter says the hearing concludes for today. Meeting adjourned at 10:21am.

The next Finance Committee meeting will be on Wednesday September 9 at 6:00pm. https://cookcountyhealth.org/about/board-of-directors/board-committee-meetings-agendas-minutes/

Thanks for following along! Have a great rest of your day!🙂

If you want more information about this meeting follow this link👇
https://chicago.documenters.org/assignments/finance-committee-1376/