The last Cook County Board meeting started with Dr. Simon, interim Chief Bureau of Health. He had many overhead presentations showing what the Cook County Bureau of Health does, and what it needs. He was proud of the neonatology unit working with 20% less doctors and much sicker patients than most neonatonlogy units, and doing better than them. He was also very proud of the CORE center, where they treat HIV patients. He went on to say that 1 out of three Cook County patients are treated there along with 1 out of every 5 in the State.
Dr. Simon went on to say that the trauma unit has 75% of its patients as blunt trauma, either from construction accidents, other accidents, or car accidents. He said that 40% of trauma cases come to Cook County and they have a 99.5% mortality rate which is the highest of anyone.
Dr. Simon said costs he can't control that keep going up are pharmaceuticals and capital expenses. The things that are also contributing to increased expenses are the uninsured and under insured which are continuing to rise. He gave an example of the person working at White Hen, or the Laundry mat do not have insurance even though they are working. He said that they need more primary care clinics, especially for these people who will only be treated for injury at a hospital, but need to be screened for cancer, stroke risk, and heart trouble. He sees that the cases of cancer, stroke, and heart attack will increase without more primary care centers for screening.
Dr. Simon showed a map where Oak Forest Hospital is and where there is more and increasing poverty, all in the vicinity of Oak Forest Hospital, thus making his point of increasing services there.
Commissioner Forrest Claypool asked what Rahn Emmanueal and Dick Durbin are doing to help with Federal aid, and they were quoted as saying that there are so many layers of patronage jobs that this is inhibiting aid. Dr. Simon disagrees with this, and says there is too few in management. Commissioner Tony Peraica went on to say that isn't the Hospital loosing aid due to vacancies, which are 50% at Oak Forrest Hospital, 25% at Providence, and a whole wing was closed at Stroger Hospital? And that the ER is busting at the seems, so shouldn't they be looking at other facilities to partner with like the VA, profit and non for profit to help out? Commissioner Moreno said that that is being worked on in his committee, and Peraica said he did not know about the committee meeting, where Commissioner Jerry Butler said that's how they wanted it, and everyone laughed. Commissioner Bulter went on to say that the Bureau of Health generates more money than the corrections and detention centers. Commissioner John Daley went on to say that 47% of the patients are self pay which means that they don't see a dime from them, and other hospitals only see 8% of these patients. Commissioner Larry Suffredin went on to say that money for health care is being siphoned off to fund the war and Durbin and Rahn should work on this. Suffredin also brought up the fact that there are 804 ambulance bypasses and do most come to Cook County which is almost never on bypass and is this why there is an increase in the ER. Dr. Simon went on to say that he also oversees Rush ER and he does not remember them going on bypass. OK, so if Simon is still overseeing Rush, how can he be doing this and Cook County Bureau of Health and do both well?
The IT person Julie, talked about the "Superbill" and had an overhead presentation. She said she is working with Cerner. This Superbill replaces paper and must have the physician, procedure(s), and diagnosis.
John Cookinham, CFO Bureau of Health said that many patients were not being billed and that they were going to an outside vendor, bills were returned and then were outsourced to research addresses.
76% of state bills were rejected, this comes to 58,000 patient bills. He went on to say that an error without a space between Cook and County caused a lot of rejection. He also found a lot of things were not even billed for. He went on to say that 40% of patients were eligible for medicaid/medicare and that a vendor will try to help in the eligibility. Bill 10-11 is supposed to help reimburse in undocumented care. Cookinham went on to say that he needs at the ACHN 93 FTE (Full time employees, 31 FTE in billing, 5 FTE reimbursemnt,11 FTE general accounting, 124 FTE in registration and admitting at a cost of 350 million dollars for all of this.
Commissioner Earlean Collins went on to ask Cookinham questions, which he could not answer. Why did they not bill for part D medicare? Because they did not negotiate with part D. What services were not being billed for? Radiation therapy, for example. Collins wanted to know why they keep finding out all these things that are not being billed and have been going on for years. Collins said 5 vendors help bill, and how do you spend money on electronic superbill, and why have things not been looked at from A to Z before? Some vendors have not communicated with each other, and they are under contract that is why they still have them. It costs each Cook County resident 43 dollars a year and they will need another 21 dollars a year to fund the Health Bureau properly.
Commissioner Roberto Maldonado said the superbill is a scary term, and many patients got a bill and need service so they don't go back for treatment because they owe money, instead of trying to see if they are eligible for medicaid, or other federal reimbursement.
Collins worked with the State to see if they can get an office at the Health Bureau to help people with Medicaid eligibility.
Commissioner Joseph Moreno, said that these billing problems are outrageous, and now this group has to fix years and years of problems but now are finally finding out all this information. Commissioner Joan Murphy asked if Springfield can expand the recoveries period but was told that the Federal Government has to approve it. Commissioner Murphy went on to say that some towns share post offices with neighboring towns, which are across the County border and they receive higher out of county bills because of their post office address and not their physical address. Commissioner Schneider went on to point out that the Bureau of Health is already 60 Million dollars short this year. Commissioner Schneider wanted to know why there is no contract for the workers compensation vendors are being paid so much, and why without a contract. The vendors he was referring to are Advocate, 76,000 dollars, Risk Management Association, 565,000 dollars and Spectrum 9,000 dollars. Schneider went on to say that these are no bid contracts then.
An approval for $475,000 came up to settle a claim when two Cook County Sheriff Officer's were coming home from a wedding, while off duty and intoxicated decided to pull out a gun on two innocent victim and shoot, and a judge approved this. Commissioner Peraica said they should fight it but Commissioner Peter Silvestri said it would cost a lot more in legal fees especially since a judge approved it.
The next thing that came up was that the IRIS system was extended another 90 days and that President Stroger approved this and now they have the bill. Commissioner Sims reminded people that at the budget meetings, it was her, Daley, Moreno, Maldonado and Butler who said they will have to raise revenue. And now that people are coming here saying they don't have enough money and are short, the commissioners will have to remember this for the next budget.