03-19-10 Fin minutes - Cook County Health and Hospitals · PDF fileHeather O’Donnell, JD, ... to justify their tax-exempt status under property tax law. ... D. System Productivity

Minutes of the meeting of the Finance Committee of the Board of Directors of the Cook County Health and Hospitals System held Friday, March 19, 2010 at the hour of 9:30 A.M. at John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, in the fifth floor conference room, Chicago, Illinois.

I. Attendance/Call to Order

Chairman Carvalho called the meeting to order at approximately 9:31 A.M., however, a quorum was not reached, so the Committee began to receive information until a quorum was present. At approximately 9:47 A.M., a quorum was reached and the Committee began to consider the items presented. Present: Chairman David Carvalho and Directors Quin R. Golden; Luis Muñoz, MD, MPH; and

Heather O’Donnell, JD, LLM (4)

Board Chairman Warren L. Batts (Ex-Officio) and Director Hon. Jerry Butler Absent: Director Jorge Ramirez (1) Additional attendees and/or presenters were:

Michael Ayres Carlos DeGante Patrick T. Driscoll, Jr. Leslie Duffy William T. Foley Helen Haynes

Randolph Johnston Richard Keen, MD Roz Lennon Dorothy Loving Stephen Martin, PhD, MPH Elizabeth Reidy

Sharla Roberts Deborah Santana Anthony J. Tedeschi, MD, MPH, MBA Sidney Thomas

II. Public Speakers

Chairman Carvalho asked the Secretary to call upon the registered speakers. The Secretary called upon the following public speaker:

1. George Blakemore Concerned Citizen

Miscellaneous Update on March 18, 2010 Illinois Supreme Court decision on Provena case Chairman Carvalho provided information on the March 18, 2010 Illinois Supreme Court decision on the Provena case. In a five person decision, with two Justices recusing themselves, they upheld a lower court decision, which reversed a lower court decision, which reversed a decision by the Illinois Department of Revenue, which accepted a decision by a local tax board. The local tax board located in Champaign County, for a single tax year for a single hospital (Provena), determined that Provena had provided insufficient charity care to justify their tax-exempt status under property tax law. He stated that what this means down the road is unclear, as this case solely relates to one hospital for a single tax year in a single county; however, he noted that legislative efforts have been made to clarify and quantify charity care provided by hospitals in order to justify property tax-exempt status. He expects further efforts and activity to take place on the subject as a result of the March 18th decision.

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Finance Committee Meeting Minutes Friday, March 19, 2010

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III. Report from System Chief Financial Officer (Attachment #1)

A. Carelink Update

Michael Ayres, System Chief Financial Officer, presented an update on the Carelink Policy (included in attachment). This update included suggested changes to the policy; these changes are being suggested as a result of input received by the medical staff, and as a result of further review with regard to implementation. Chairman Carvalho inquired whether the pharmacy co-payments are being collected. Mr. Ayres responded affirmatively, but added that the collections on this are inconsistent. The Committee extensively discussed implementation and enrollment processes. Director O’Donnell inquired whether the System is different from other public systems in ways that make implementation more difficult. Mr. Ayres responded that at other hospitals, the charity care patients are recognized at the front end, and they don’t require the level of paperwork (proof of residency, proof of income, etc.) that the System is requiring in the process of being declared eligible. Further discussion took place on current enrollment methods, and policy suggestions were made with regard to the timing of patient enrollment and how it affects the System’s provision of services (excluding emergency room services). Additional information was presented on the challenges in planning and implementing an efficient and successful System-wide roll-out of enrollment processes. Mr. Ayres noted the timeline presented, and reminded the Committee that Chamberlin Edmonds & Associates agreed to administer this for the System. The schedule indicates that implementation will take place in the middle of June. They are starting the processes on the schedule, such as staffing, training and education; he suggested that the Committee goes back as a group to discuss the recommended changes that are being called for by the medical staff, and to further review the concept of patient enrollment. Mr. Ayres stated that over the next two weeks, he will draft management’s response and a strategy, which he will send to the Committee. Then, time can be spent at the next Committee meeting for a much more extensive discussion. He added that, in the meantime, the implementation process will continue, as this must move forward. Director Butler stated that he supports Mr. Ayres’ plan as stated. William T. Foley, Chief Executive Officer of the Cook County Health and Hospitals System, stated that they will return to the Committee with an operational plan for non-urgent care.

B. MedAssets and Chamberlin Edmonds & Associates Update

Mr. Ayres presented information on the revenue cycle transformation (included in attachment). The Committee reviewed and discussed the information. Chairman Carvalho inquired whether the data on registration errors included instances where a duplicate medical record was created for someone because we couldn’t find them in our system. Mr. Ayres responded affirmatively. Director O’Donnell asked whether the System bills Medicare patients for services. She described a situation in which patients currently enrolled in Medicare personally received bills for services. Mr. Ayres stated that under this example, they would typically be billed for any co-pays, deductibles, and for any services not covered under Medicare. He added that the patient is made aware prior to services being provided if the services are not covered under Medicare. Director Muñoz asked who is spearheading the work on the Charge Description Master. Mr. Ayres responded that Gretchen Ryan, of MedAssets, is heading it up; Cathy Paisano, who works with Ms. Ryan, is the primary contact.

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III. Report from System Chief Financial Officer (continued)

C. Budget Reduction Strategy

Mr. Ayres presented information on the budget reduction strategy (included in attachment). The Committee reviewed and discussed the information. The Committee discussed the financial impact as a result of not reaching the target for Phase I of the reductions in labor planned. Chairman Carvalho stated that the Human Resources Committee has addressed the issue from a personnel standpoint; however the question of the financial impact of this needs to be addressed. Mr. Ayres responded that the financial impact of this issue is significant. He stated that there is a target of $106 million in budget reductions to reach by the end of the year, and this issue impacts reaching that target. Chairman Carvalho stated that with regard to labor costs, the target was to reduce it by $60 million; he asked how the Phase I reductions in labor affected that amount. Mr. Ayres responded that it affected it very little, as the majority of Phase I included the removal of budgeted positions. The budget reduction at this point, from the FTE reductions, is approximately $34 million. From the information provided, Chairman Carvalho stated that $17.4 million and the $18.1 million (totaling $35.5 million), along with whatever else that was supposed to be done throughout the year, should add up to $60 million. He asked whether the remaining goal of $25 million can be reached by the end of the fiscal year, if Phase II does not begin until September. Mr. Ayers responded that it did not seem likely. Chairman Carvalho noted that the Human Resources Committee needed to be informed that the delays in implementing the targeted reductions had created a $25 million shortfall. Mr. Foley added that prior to Phase II, they will be completing a management restructuring.

D. System Productivity Analysis

Mr. Ayres presented information on FTEs per adjusted occupied bed (AOB) calculations (included in attachment). The Committee reviewed and discussed the information. Mr. Ayres pointed out, as noted in the materials, that the calculations do not appear to give enough weight to the size of the outpatient services and therefore understates the adjusted occupied bed, giving the appearance of excessive FTEs per AOB. Although this caveat had always been known, the System is now getting a better idea of the magnitude of the understatement. This will be addressed, as they will refine the calculations and attempt to standardize the AOB calculation. With regard to the incongruence in measurement calculations, Director O’Donnell remarked that there must be another way to benchmark the System in the meantime, in order to compare to other health care entities. She added that the data could be misconstrued, if the System’s data is assembled differently. Mr. Foley stated that this is the standard benchmark. Upon further questions posed by Board Chairman Batts, Mr. Ayres stated that further refining and standardizing the calculations could indicate a sizeable variance in overstated FTEs per AOB; however, he indicated that capturing the outpatient revenue is a key component. During the discussion, it was noted that this information does not include physicians. Director O’Donnell inquired as to the reason for this. Mr. Ayres responded that it is a different calculation, because most hospitals do not employ physicians. The industry norm is on employees alone, so the System calculates the physicians on a different basis. Mr. Ayres stated that this information will also be provided to the Committee in the future. Chairman Carvalho noted that when this statistic is provided in other systems, there is also a revenue side of it. Mr. Ayres responded that physician productivity is not measured by revenue, rather, it is measured in the number of patient visits per session. Chairman Carvalho expressed concern that, if the FTE per AOB ratios had been overstated due to understatements of AOB, the opportunities for savings by reducing FTE per AOB to industry norms had been correspondingly overstated. Mr. Foley replied that he still believed that significant opportunities for savings existed.

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III. Report from System Chief Financial Officer (continued) Lawson Draft of Financial Statements and update on Lawson System Implementation

Mr. Ayres presented a draft of accrual-based financial statements through December 2009, which were prepared from the newly-installed Lawson general ledger. Implementing the general ledger system has turned out to be more of a challenge, and he noted that these are presented for formatting purposes, rather than for evaluation of performance methods. Later on in the meeting, Dorothy Loving will be presenting the financial statements through December 2009 using the old format, due to a number of issues that still need to be addressed. Through the next month, as the County closes its books, they will work to populate more of the data needed. Mr. Ayres provided information on an issue that has arisen that may complicate or delay full implementation of the Lawson System. He stated that in order for this general ledger to accomplish what was expected, much more finite information is needed on payrolls and accounts payable on where expenses were going to be charged down to the department level, with more flexibility in how the System can assign the expenses. The presumption as the System’s needs were being built was that the detailed workings of the payroll and accounts payable shop would be absorbed by the System as efforts moved forward. For the last several months they have been working with the County to figure out how to do that. The County’s position is that the County’s general ledger, which is a J.D. Edwards system, is the ledger of record, and it must hold all the official information. However, the components of the J.D. Edwards system that the County currently uses do not create the kind of detail the System needs. While trying to find a solution to this problem, the County indicated their possible interest in the Lawson System, as the J.D. Edwards system is considered to be antiquated and may not be meeting the County’s needs. Meetings on the subject have taken place as a result, and the County is currently evaluating whether the Lawson System will meet their needs and whether a transition to that system makes sense for them. What this means for the System, is that the System cannot move forward with implementation plans with regard to payroll and accounts payable, until the County completes their evaluation (expected to be completed by June 30th). If the County decides to transition to the Lawson System, the System will not be able to move forward until the County’s implementation is complete. If the County decides to not transition to the Lawson System, the payroll and accounts payable information issue remains. Chairman Carvalho recalled that the County’s process of evaluating, selecting and implementing the J.D. Edwards system was particularly lengthy. Mr. Foley stated that regular meetings are held with Joseph Fratto, President Todd H. Stroger’s Chief of Staff, and Jaye Williams, Chief Financial Officer of the County, in which they have indicated that they seem positive about Lawson, and they acknowledge that the J.D. Edwards system is antiquated. Director O’Donnell inquired whether this issue was discussed when the System decided to select the Lawson System. Mr. Ayres responded that this occurred prior to his tenure. John Morales, Chief Financial Officer of John H. Stroger, Jr. Hospital of Cook County, and formerly Cook County Comptroller, recalled that the subject was brought up, but there was no definitive conclusion. Staff changes at both the County and System may have impacted resolution of the issue.

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III. Report from System Chief Financial Officer (continued) E. Status of Payments Received from St. Anthony’s Hospital

Mr. Ayres provided an update on the status of payments received from St. Anthony’s Hospital. He stated that they are paying the System on time.

F. Payer mix comparison – July 2008 to date

Mr. Ayres presented the FY2010 Revenue Report – CCHHS Variance Analyses for the 1st Quarter of FY2010, ending February 28, 2010 (included in attachment). This information included a payer mix comparison from December 2008 to date. He noted that this year’s budget was designed around a four percent increase in volumes in some categories. They began to see a drop-off in revenue; upon further review, it appears that the drop-off is heavily weighted to the number of days the System sees a patient. Since Medicaid is a per-diem payer, for every day the System reduces the length of stay or for every admission that is declined, there is an offset in the per-diem payment. In general, the Medicaid patient population has been declining. It was noted that patient enrollment in Medicaid has increased, and it was speculated that once enrolled, the patients may be going elsewhere for their health care services. The Committee reviewed and discussed the information. Director O’Donnell inquired whether overall volumes have remained the same. Mr. Ayres responded in the negative, and reviewed the information provided in the materials that related to the question. On an annualized basis, the projection is that revenues will be short by $47 million. When coupled with the shortfall in savings from productivity increases discussed earlier in the meeting of $30 million, the current projected net shortfall is approximately $60-70 million. Management will be developing plans to address this problem. With regard to how this relates to strategic plan initiatives, Mr. Foley stated that this is an area that they are trying to address – how to make services more accessible, fix what is broken in the System, and focus on areas such as customer satisfaction to attract more Medicaid patients. He provided an example in which the System is actively working with community partners to address this type of issue. He stated that Dr. Anthony Tedeschi, System Interim Chief Operating Officer, is currently heading up a team engaged in this type of efforts with Alivio Medical Center; they are already seeing an increase in referrals as a result. Mr. Foley also noted the work being done around performance improvement that is expected to impact the shortfall and the trend.

IV. Recommendations, Discussion/Information Items

A. Minutes of the Finance Committee Meeting, February 19, 2010

Director O’Donnell, seconded by Director Golden, moved to accept the minutes of the Finance Committee Meeting of February 19, 2010. THE MOTION CARRIED UNANIMOUSLY.

B. Presentation of Year-to-Date Financials through December 2009

Dorothy Loving, Executive Director of Finance, presented the Year-to-Date Financials through November 2009 (Attachment #2). The Committee reviewed and discussed the information. Chairman Carvalho noted that there is no breakdown for the Ambulatory and Community Health Network of Cook County. Mr. Ayres responded that it was intended to be included, and stated that it would be included in the future.

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IV. Recommendation, Discussion/Information Items

B. Presentation of Year-to-Date Financials through December 2009 (continued)

Chairman Carvalho requested information on the County’s methodology of allocation of the different types of revenues. He provided an example with regard to property tax revenue, stating that the collection of this occurs twice a year. He asked whether the County distributes this revenue upon collection, or holds and distributes this revenue intermittently. As the System’s financial statements are currently cash-based, how is this anticipated revenue reflected? Ms. Loving responded that on an accrual-basis, once they have the final numbers, they intend to accrue that annual amount monthly.

C. Purchasing Performance Improvement Update

Dr. Tedeschi, provided an introduction to the item. He stated that the Purchasing Department is working to continue integration of the purchasing function from the County into the System, and is committed to making continued improvements. Leslie Duffy, System Director of Procurement, presented the Supply Chain Management – Performance Improvement update (Attachment #3). The Committee reviewed the information. Carlos DeGante, Director of Contract Management Systems, provided information on the processes used to issue and solicit Requests for Proposals (RFPs). This information included the methods used to identify and to notify potential vendors. Chairman Carvalho noted that further thought should be given to the subject of how to further communicate opportunities and increase the number of potential vendors, thereby making the process more transparent and competitive. Mr. DeGante provided an update on efforts to streamline processes and tracking mechanisms related to transmittal submission for contractual Board approvals. He also provided an update on the monthly notification process, in which they extract all of the expiring contracts by location from their database, and forward the information to each department to notify them of contracts that will be expiring. Chairman Carvalho asked how far in advance departments are notified that their contract is expiring. Mr. DeGante responded that departments should be notified six months in advance. Dr. Tedeschi reviewed the overview of the 120 day improvement plan included in the materials. He reminded the Committee that the 120 days are up in June. During the overview, he referenced the materials management plan, and stated that this comprehensive plan will help them plan out and move toward a “just in time” inventory, in order to reduce some of the warehouses currently being used to store inventory. He stated that the draft plan for this is expected to be presented at the next Finance Committee meeting.

V. Action Items

A. Contracts and Procurement Items (Attachment #4)

Dr. Anthony Tedeschi introduced the items presented for consideration. He informed the Committee that request number 18 was being withdrawn from consideration, as this request continues to work through the Contract Compliance review process. Mr. Foley asked that request number 26 be held at this time, as additional work needs to be done. Additionally, he stated conditional approval is being requested for request numbers 24, 25 and 27, pending confirmation from Contract Compliance.

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V. Action Items A. Contracts and Procurement Items (continued)

The following individuals provided additional information on the requests presented for consideration: Mr. Ayres; Dr. Stephen Martin, Chief Operating Officer of the Cook County Department of Public Health; Dr. Richard Keen, System Director of Surgery; and Sharla Roberts, representing the County’s Department of Contract Compliance. During the discussion of the requests, Dr. Martin requested leave to provide information on an important grant that was awarded to the Cook County Department of Public Health. Leave was granted. Dr. Martin stated that several months ago, his department applied for an obesity/chronic disease grant from the federal government under the federal stimulus of last spring. He announced that his department is one of the forty-four jurisdictions selected from across the nation to receive this nearly $16 million grant funding. He stated that First Lady Michelle Obama was expected to make the national announcement of the grant awards at 12:00 P.M. this day, followed by the System’s announcement at 2:15 P.M. He noted that the funds will not be coming through the System, rather, they will be working with partners who are the fiscal agent (Public Health Institute of Metropolitan Chicago). The Committee returned to the consideration of the items. Extensive discussion took place on request number 11, which was a request to increase and extend the contract with Star Detective and Security Agency for one year, for the provision of security services at Provident Hospital of Cook County. Following the discussion, the item was withdrawn so that the request could be re-submitted with a shorter extension period. Director O’Donnell, seconded by Director Golden, moved the approval of request numbers 1 through 31, as amended, under the Contracts and Procurement Items, with the exception of request numbers 11, 18 and 26, which were withdrawn from consideration, and with the conditional approval of request numbers 24, 25 and 27*, pending confirmation from Contract Compliance. THE MOTION CARRIED. Chairman Carvalho abstained and voted PRESENT on request numbers 1, 2, 3 and 12. *Note: Request number 27 was withdrawn at the CCHHS Board of Directors Meeting of March 26, 2010.

B. Proposed resolution (OFHCC– MB Financial Bank accounts signatory update – Attachment #5)

Director O’Donnell, seconded by Director Muñoz, moved the approval of the proposed resolution to update the signatories authorized for Oak Forest Hospital of Cook County bank accounts at MB Financial Bank. THE MOTION CARRIED UNANIMOUSLY.

C. Proposed resolution (OFHCC– Suburban Bank & Trust accounts signatory update – Attachment #6)

Director O’Donnell, seconded by Director Muñoz, moved the approval of the proposed resolution to update the signatories authorized for Oak Forest Hospital of Cook County bank accounts at Suburban Bank & Trust. THE MOTION CARRIED UNANIMOUSLY.

D. Any items listed under Sections IV and V

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VI. Adjourn

As the agenda was exhausted, Chairman Carvalho declared the meeting ADJOURNED.

Respectfully submitted, Finance Committee of the Board of Directors of the Cook County Health and Hospitals System XXXXXXXXXXXXXXXXXXXX David Carvalho, Chairman

Attest:

XXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary

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Cook County Health and Hospitals System Minutes of the Finance Committee Meeting

March 19, 2010

ATTACHMENT #1

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Finance Committee Update CareLink UpdateCareLink Update

March 19, 2010

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Self-Declaratory Bridge to Care Link

• Require a temporary policy to bridge the gap between th t O t ti t S lf D l t Li it f Li bilitthe current Outpatient Self-Declaratory Limit of Liability policy and the future implementation of the Outpatient Care Link policyp y

• During Care Link implementation CCHHS requires a standardized Self-Declaratory Limit of Liability procedure to continue to address low dollar outpatientprocedure to continue to address low dollar outpatient services• Initial Care Link implementation will address inpatients

• Self-Declaratory Limit of Liability policy will be phased out once Care Link is fully implemented

1Page 11 of 121

Care Link Approved/Proposed Changes

Topic Previously Approved Recommended Change0%-250%= 100% discount 251%-350%=50% discount 351%-450%= 25% discount

scess

Federal Poverty Income Levels351% 450% 25% discount Over 450% not eligible No Change

Eligibility Periods

12 months of retroactive eligibility in most cases as well as periods shorter than 12 months based on temporary disability

All patients eligible for 12 months and retroactive eligibility limited to 3 months from the date of application. This would help ensure patient compliance with application process.

All patients would pay a $10 co-pay per clinical Patients above 250% of FPIL would pay $15 per

cess

Sol

utio

nstie

nt A

cc Clinical Service Co-paysAll patients would pay a $10 co pay per clinical service

Patients above 250% of FPIL would pay $15 per visit/day.

Pharmacy Co-paysPharmacy co-pays $6 per prescription up to a daily maximum of $20

Leave current pharmacy co-pay of $4 per prescription in place, but with a maximum of $12 per day.

Required residency in Cook County for at least 30days prior to submission of an application for Require Cook County residency for at least 30

Patie

nt A

ccPa Cook County Residency Requirementsdays prior to submission of an application forCareLink assistance.

Require Cook County residency for at least 30 consecutive days prior to the date of treatment.

Income GuidelinesIncome was categorized as Countable and Exempt for the purpose of determining income Removed exempt income criteria.

Third Party FundingPatients with insurance were eligible for CareLink in certain situations.

Removed "Enrollment in Health Insurance" section. Patients with insurance would not be eligble for CareLink.y g g

Medicare Part DRequires that patients utilizing the pharmacy be enrolled in Medicare Part D

Recommend removing this requirement because it's too difficult to administer, many patients are not enrolled in Medicare Part D and would go without their medications.

2Page 12 of 121

Finance Committee Update Revenue Cycle TransformationRevenue Cycle Transformation

March 19, 2010

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Agenda

• Project Status and Timelinej

• Work Stream Updates

• Cash ImprovementCash Improvement

1Page 14 of 121

Revenue Cycle Re-Engineering Project StatusWorkstream % Complete Owner Status

Patient Access:Retraining of Registration staff 29% S. WrightHospital Department CC/PA Rollout 17% J. Kieltyka

ED 86% M. BurdenLab 24% R. MannSurgery 4% M BurdenSurgery 4% M. BurdenRadiology 7% R. SingletaryInpatient 1% M. Burden

Ancillary Clinic CC/PA Rollout 7% J. KieltykaCommunity Clinics 8% R. SingletaryCore Clinics 26% M. McKinnieFantus Clinics 3% M. BurdenH it l Cli i 3% M M Ki iHospital Clinics 3% M. McKinnieSpecialty Clinics 0% R. Mann

Develop and implement Discharge process 2% R. SingletaryRollout Quality Registration process 15% R. MannDevelop and implement Pre-Visit process 53% R. MannDevelop and implement centralized Scheduling 0% R. MannDevelop and implement Referrals process 14% R. Mann

Case Management:Implement payer required utilization review for all affected cases. 60% C. LeenheerPurchase & implement InterQual and Milliman case management standard utilization review criteria 40% C. LeenheerDevelop & implement with CCHHS a clinical documentation improvement initiative (CDI). 5% C. LeenheerDevelop & implement a case management department to include utilization review, discharge planning, and clinical denials management

5% C. Leenheer

Financial Counseling:

Key for Status Ratings: Green - On target to meet scheduled task delivery dates; Yellow - Task delivery dates at risk to go off schedule; Red -

gImplement Financial Counseling services to all self-pay emergency department patients. 100% E. DeLaCruz

Implement 100% referral of all inpatient and observation self-pay patients at all three facilities 100% E. DeLaCruzImplement outpatient walk-up centers at Stroger, Provident, and Oak Forest in order to provide service to patients visiting the outpatient clinics

10% E. DeLaCruz

Implement CareLink program for inpatient and outpatients system wide. 45% E. DeLaCruz

2

y g g y ; y g ;Significant issues causing task delivery dates to be off schedule

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Revenue Cycle Re-Engineering Project StatusWorkstream % Complete Owner Status

Revenue Integrity:Develop & implement a System standard Charge Description Master (CDM) 100% K. IzzanoHospital Department CC/PA Rollout 45% K. Izzano

ED 99% K. IzzanoLab 38% K. IzzanoSurgery 17% K. IzzanoSurgery 17% K. IzzanoRadiology 47% K. IzzanoPharmacy 26% K. Izzano

Ancillary Clinic CC/PA Rollout (249 Total Cerner Locations) 14% K. IzzanoCommunity Clinics (68) 22% K. IzzanoCore Clinics (28) 44% K. IzzanoFantus Clinics (49) 7% K. IzzanoH it l Cli i (43) 11% K IHospital Clinics (43) 11% K. IzzanoSpecialty Clinics (39) 1% K. Izzano

Develop & implement a charge master maintenance process 20% K. IzzanoDevelop & implement a charge reconciliation process 25% K. IzzanoDevelop & implement a charge audit function 0% K. IzzanoHIM:Implement a single vendor transcription service solution for improved quality and turn around time 100% I. DieudonneMonitor & manage to achieve reduction In DNFB and outpatient exception holds 75% I. DieudonneDevelop & implement departmental credentialing standards requiring coding certification 45% I. DieudonneDevelop & implement training and performance management process 40% I. DieudonnePatient Financial Services:Develop & implement standardized financial reporting/KPIs of Accounts Receivable 50% D. DiCarloImplement standardized cash posting and reconciliation processes 10% D. DiCarloDevelop & implement training and performance management process for receivables management 13% D DiCarlo

Key for Status Ratings: Green - On target to meet scheduled task delivery dates; Yellow - Task delivery dates at risk to go off schedule; Red -

Develop & implement training and performance management process for receivables management 13% D. DiCarloImplement centralized billing office (CBO) 8% D. DiCarloDevelop & implement a standardized billing process resulting in timely and accurate billing 10% D. DiCarloVendor Account Management 15% D. DiCarloAged Account clean up 20% D. DiCarloDenials reporting 30% D. DiCarlo

3

y g g y ; y g ;Significant issues causing task delivery dates to be off schedule

Page 16 of 121

Patient Access

• Successes• Quality Indicators

Indicator Baseline Current Target

Oak Forest Registration Errors 273/month 120/month 10/month

Outpatient Bill Holds $3.1MM $1MM $250k

Medicare Secondary Payer Questionnaire Compliance – Fantus 38% 91% 98%

Medicare Secondary Payer Questionnaire Compliance – ACHN 69% 98% 98%

• Registrar Re-Training• 60% of staff scheduled for one day training session

Emergency Department Accounts not discharged within 48 hours 67 2 0

Insurance information – Trauma 54% 93% 98%

y g• For completed sessions, 77% of staff passed the end of session exam

• The remaining 23% will retake the one day training session

• Challenges• Pre Visit Services Unit not stood up due to reduction in force finalization• Open Management positions for Training, Oak Forest, Provident and ACHN

• Knowledge Transferd l d d l h d ll d h• Brenda Lloyd and Jamil Ahmad (Directors), Lilliana Castro (Manager), and three

CCHHS Trainers are working side by side with MedAssets to implement process improvement, develop training materials and deliver same to line level staff

4Page 17 of 121

Case Management

• Successes• Long Inpatient Stays

• Decreased inpatient stays greater than 20 days by 144%• Decreased inpatient stays greater than 20 days by 144%• Decreased inpatient stays between 11 and 19 days by 17%

• Inpatient Denials Backlog• Appealed $1 9MM in denied Commercial claimsAppealed $1.9MM in denied Commercial claims

• Successfully overturned $1.4MM in claims representing $982k in cash payments

• Initiated Observation patient status workgroup• Initiated Medical Necessity review of all one-day inpatient stays

• Challenges• Interqual contract in final stages of negotiation

• Knowledge Transfer• Laura Wahlfeldt (Director) is working with MedAssets to develop,

train, and implement revised department policies, procedures, and accountability measuresaccountability measures.

5Page 18 of 121

Financial Counseling

• Successes• Single source Medicaid Eligibility vendor – Chamberlin Edmunds “CEA”

• Inpatient eligibility implemented 10/1/2009 at Stroger, Provident and Oak Forest p g y p / / gHospitals

• Emergency Department eligibility implemented by 2/23/2010 resulting in a 15%-18.5% take rate

• See following three slides for greater detailI di C P li• Indigent Care Policy

• Re-drafted CareLink policy and procedure to ensure implementation success• Drafted a Self-Declaratory Limit of Liability policy to bridge CCHHS from the

current LOL process to the final CareLink implementation.

• Challenges• CareLink implementation deadline of 5/31/2010 moved to 6/15/2010• CCHHS Mang/LOL staff not yet moved to Pre-Visit services because of reduction in force

process

• Knowledge Transfer• Linda Battle (Director) working with MedAssets to develop, train, and implement

department policies, procedures, and accountability as well as day to day management of the Financial Counseling vendor.

6Page 19 of 121

CEA - KPI: Approved Accounts – Feb. 2010

As expected, total monthly approved accounts have dramatically increased since the contract expansion. February’s shortfall relative to the adjusted target is very small on a percentage basis and due primarily to slower than anticipated approvals, specifically with accounts originating from Oak Forest, Provident, and approvals, specifically with accounts originating from Oak Forest, Provident, and in the Stroger non-disability category. Stroger OB and disability approvals were very strong.

16 357380400

357400

Approved Accounts Approved Accounts

Provident45

OakForrest40

StrogerNon-Dis41

StrogerOB 50

75

8522

16 357

200

300

d A

ccounts

40

74

30

84

41

183

220

288

357

200

300

ed A

ccounts

StrogerDis 204

160

-29

28

0

100Appro

ved

160

1

155

14

9

160

19

161184

232

160 156

0

100

Appro

ve

Disability

Non-Disability

OB

160160

00

AverageMonthly

Approved Accountsin 2009

(pre-expansion)

TailContraction

StrogerNon-

Disability

Stroger OB StrogerDisability

Provident Oak Forest FebruaryActual

ApprovedAccounts

AdjustedBudget

Approvals

0Average

Approved Accounts in 2009 (pre-expansion)

Oct 09 Nov 09 Dec 09 Jan 10 Feb 100

y

TotalDisNon-DisOB

156155

10

183160

914

2201611940

2881843074

3572324184

7

Page 20 of 121

CEA - KPI: Pending Inventory Expected Value (Cumulative)

Expected value of the pending inventory added since starting the new scope of work has exceeded pro forma targets by over 35% or $9.4M. While much work remains to get these accounts approved, billed and paid it is clearly a positive indicator of future cash resultsindicator of future cash results.

80,000,000

40,000,000

Cumulative Gross Remittance Pipeline Accrual

Cumulative Expected Remittance Pipeline Accrual

Feb 8 907 656

Feb 12,320,115

Jan 13,294,591$44,538,280

$63,092,074

40 000 000

60,000,000

Feb 5,079,610

Feb 6,789,620

Jan 7,396,804$25,398,050

$34,836,928

20 000 000

30,000,000

Feb 8,907,656

Jan 8,907,656

Dec 8,907,656

Nov 8,907,656

Oct 8,907,656

Dec 13,829,448

Nov 13,185,449

Oct 10,462,471

20,000,000

40,000,000Jan 5,079,610

Dec 5,079,610

Nov 5,079,610

Oct 5,079,610

Dec 7,627,613

Nov 7,252,021

Oct 5,770,870

10,000,000

20,000,000

, ,

Budget Actual0

, ,

Budget Actual0

* Expected values calculated using remit rates per account of:Provident, $10,140 Oak Forest $11 990

* Expected value = gross remit dollars multiplied by expected yield (approval rate * conversion rate).

8

Oak Forest, $11,990 Stroger-Disability, $19,187 Stroger-Non-Disability, $12,817 Stroger-OB, $4,250

Page 21 of 121

CEA - KPI: Remit Dollars

Cash recovered for CCHHS by CEA in January 2010 handily exceeded the Q4 monthly average of $2.5M. We expect this to continue to grow in coming months eventually leveling off between $6.5 – $7.5M per month.

5,000,000 300

Actual CCHHS Gross Remittance and Invoiced Accounts

156 183 220 288 357100%

Approved Account Aging

Non-Disability

InvoicedAccounts

OB

Non-Disability

$2,522,175$2,700,139

$2,275,453$2,590,933

$3,421,593

$4,520,146

3,000,000

4,000,000

it D

olla

rs

150

200

250

ed A

ccou

nts

22%

1%

24%

1%35%

59%

87%60

80

ount

s Appr

oved

Disability DisabilityDisability

DisabilityDisability

Accounts

Disability

Q4 2009 Oct Nov Dec Jan Feb0

1,000,000

2,000,000

Rem

0

50

100

Invoic

e

78% 75%65%

41%0%

13%

Oct Nov Dec Jan Feb0

20

40

% o

f Acc

o

PaidWritten Off

PaymentPending

MonthlyAvgAverage Remit Per Account

TotalDisNon-DisOB

175175

00

136136

00

103103

00

175156136

2221392657

150150

00

TotalDisNon-DisOB

$15,429$15,429

$0$0

$16,731$16,731

$0$0

$15,553$15,553

$0$0

$19,510$19,434$25,319$8,893

$19,781$15,039$24,427$31,485

9Page 22 of 121

Revenue Integrity (Charge Capture)

• Successes

• Standard Charge Description Master (CDM) implemented 1/4/2010 • Standard Charge Description Master (CDM) implemented 1/4/2010 including updated 2010 compliant coding

• Effectively deleted 60,000 corrupt lines and replaced with an 8,000 item compliant and complete file

• Enhanced charge capture implementation progressing well

• Challenges

• Open Charge Description Master Manager positionOpen Charge Description Master Manager position

• Physician requested education on Evaluation and Management documentation requirements and subsequent charge selection

• Physician selection of diagnosisy g

• Knowledge Transfer

• Steven Kulhanek and Dorothy Richardson (Managers) are working with MedAssets to develop, design, train, and implement policy, procedures, MedAssets to develop, design, train, and implement policy, procedures, and system changes that result in improved charge capture.

10Page 23 of 121

Health Information Management (HIM)

• Successes• Oak Forest and Provident Hospitals transitions to outsourced transcription p p

services resulting in 100% compliance with 2-12 hour turn-around times• All eligible coding staff are signed up to complete the coding credentialing study

course• HIM now coding Trauma Emergency Department records for Evaluation and

M t iManagement services• Discharged Not Final Billed related to coding activity is now less than $8MM

• Challenges• Open coding and filing positions at Stroger Hospital• Open coding and filing positions at Stroger Hospital• Labor Relations imposed limitations on System’s ability to distribute work

regardless of work location resulting in increased over-time and contract services expenses.

Knowledge Transfer• Knowledge Transfer• Gerri Magee, Sue Porzel, and LaDwyna Williams (Directors); and Melodie

McHugh, Kathy Kelly, and Eva Thorne (Managers) are working with MedAssets to develop, train, and implement department policy, procedures, and productivity measures.productivity measures.

11Page 24 of 121

Patient Financial Services

• Successes

Indicator Baseline Current Target

Total Discharged Not Final Billed 20 MM 9 MM 7 MM

Outpatient Bill Holds 38 MM 25 MM 4 MM

Days in Accounts Receivable > 1,000 (A) 700 (A) 70

Accounts Receivable Over 90 Days Old 90% 70% 35%

(A) – Inclusive of significantly aged accounts with little to no value. The target excludes aged zero value accounts.

• Claimed Medicare bad debt on the FY09 cost report• Standardized cash posting transaction codes System wide

(A) Inclusive of significantly aged accounts with little to no value. The target excludes aged zero value accounts.

• Challenges• Centralized Business Office (CBO) in doubt

• Standardization of process, policy, and systems not easily achieved without a CBO

• Open Management positions at Stroger

• Knowledge Transfer• Pamela Wright (Manager), Jamie McPeek-Johnson (Director), and Liz Dornheker

(Manager) are working with MedAssets to develop, train, implement and set bili f li i d d i d i bl accountability for policies, procedures, and improved receivables management

12Page 25 of 121

Cash Benefit to DateThe original estimates

were based on previous Medicaid per

diem rates

The revised estimate is based on new Medicaid per diem rates effective

year 2

YearProject

Description

Original Estimate

(Low)

Original Estimates

(High)

Revised Estimates

Implemented

Benefit

1Revenue Cycle Transformation

18,090,000 20,100,000 20,100,000 33,915,443


29,970,00 33,300,000 16,650,000 (B) 36,683,867


23,940,000 26,600,000 13,300,000

TOTAL $72,000,000 $ 80,000,000 (A) $50,050,000 $70,599,310

(A) – Decline due to reduction in Medicaid Reimbursement Rates(B) – Excludes FMAP

• MedAssets billed fees $17MM

13

MedAssets billed fees $17MM • FTE assigned to CCHH = 47.5

Page 26 of 121

Memorandum To: CCHHS Finance Committee From: Michael Ayres, Chief Financial Officer Subject: Reduction Strategy for 2010 Budget Date: March 18, 2010 In the development of the 2010 Budget it was recognized that the system would have to reduce its operating expenses by approximately $80 million. The strategy at the time of budget submission was to reduce labor costs by $60 million and supply expense by $20 million. The labor reduction would consist of approximately 692 authorized but vacant positions and 658 occupied positions. During the budget approval process the County Commissioners elected to reduce the sales tax by .5% effective September 2010. It was estimated that CCHHS would need to reduce its budget by an additional $26 million for fiscal 2010. The total reduced expense requirement then approximated $106 million. Management continues to develop and implement plans to reduce the operating budget by the required $106 million. The table below identifies those areas where reductions are expected to occur.

Budget Reduction Categories ($ in millions)

Target Reduction $106.0Phase 1 Vacant Positions $18.1Phase 1 Terminations 17.4Line of Credit Avoidance 4.0Supply Chain Savings 20.0Strategic Operations Avoidance 20.0Oak Forest Phase 2 Reduction 3.4Provider Reduction 9.0Management Restructuring 12.9Total reductions 104.4Excess/(Deficit) $(1.6)

Schedules are currently being developed that will be presented monthly showing the progress management is making in implementing the savings. Through February 28, management estimates that we have implemented $MMM in savings. file: MDA/my briefcase /board/finance committee/March 19/budget reduction memorandum

Page 27 of 121

Memorandum To: CCHHS Finance Committee From: Michael Ayres, Chief Financial Officer Subject: Draft Full-Time Equivalent per Adjusted Occupied Bed Calculations Date: March 18, 2010 Attached is a draft copy of the calculation of full-time equivalent employees per adjusted occupied bed throughout the Health System. The calculation applies the actual productive and total hours paid per employee to their home operating unit and allocates the corporate office employees over each of the operating units based on the proportion of the operating units FTEs to total system FTEs. The schedule also assigns outpatient specialty clinics affiliated with each of the hospitals to that hospital and includes agency nurses to the hospital in which they were assigned. This process attempted to align employee effort with the location in which it was performed. Yet to be included in the calculation are the consultants, non-nursing temporary and outsource employees. The calculation of adjusted occupied bed is based on the ratio of inpatient revenue to total revenue. Because of the health system's past practices in how revenues were determined and their relative amounts, this calculation does not create a ratio that is comparable to other health care providers. Specifically, the calculation does not appear to give enough weight to the size of the outpatient services and therefore understates the adjusted occupied bed. As a result, when comparing to other large safety net hospitals, our FTEs/AOB we appear to be excessive. Over the next 30 days we will refine our calculations to include all FTEs assigned to the working units and attempt to standardize the average occupied bed calculation. The report is useful in its current form as a gross measure FTEs and will allow for further analysis and understanding of how they respond to changes in volume and productivity strategies. file: MDA/board/finance committee/March 19/FTEs per AOB draft.

Page 28 of 121

FTE per AOB Total Productive Total Productive Total Productive Total Productive Total ProductiveAvg FTE Avg FTE Avg FTE Avg FTE Avg FTE Avg FTE Avg FTE Avg FTE Avg FTE Avg FTE

STROGER 6.98 4.63 6.73 5.64 6.96 5.51 7.35 6.29 8.40 6.73

PROVIDENT 9.28 6.24 8.67 7.36 8.73 7.16 10.96 8.96 9.39 7.69

OAK FOREST 11.42 7.00 9.06 7.75 9.22 7.37 10.25 8.33 10.19 7.67

WEIGHTED AVERAGE 7.80 5.03 7.27 6.12 7.47 5.95 8.20 6.90 8.77 6.97

System FTE per AOB (includes Core) 9.06 5.91 8.50 7.13 8.75 6.91 9.61 7.96 10.10 8.03

Total FTE Total FTE Prod FTE Total FTE Prod FTE Total FTE Prod FTE Total FTE Prod FTE Total FTE Prod FTE

STROGER 3,779.49 2,511.56 3,548.99 2,991.36 3,666.92 2,918.72 3,231.57 2,762.72 3,681.33 2,955.68 PROVIDENT 626.25 421.47 596.78 509.31 600.60 495.40 695.52 568.27 594.27 487.39 OAK FOREST 1,086.05 666.07 936.01 805.62 951.68 764.66 996.42 809.28 987.18 744.13 CERMAK 403.37 277.28 381.49 335.97 409.60 335.59 407.30 324.24 406.48 324.78 ACHN 179.06 101.99 179.17 102.49 216.92 102.41 218.37 139.84 174.65 139.71 CORE 57.99 37.28 58.39 52.87 57.47 43.86 57.69 44.78 56.72 46.24 DPH 181.59 98.82 187.32 142.65 159.84 126.91 162.76 129.43 161.51 122.57 Total 6,313.80 4,114.48 5,888.14 4,940.28 6,063.03 4,787.56 5,769.63 4,778.57 6,062.15 4,820.50

600.30 696.60 692.55 692.55 600.30 600.30

AGENCY AND CONSULTING (NURSING REGISTRY ONLY)

Facility Jan-10 Feb-10 Jan-10 Feb-10

STROGER 12.59 11.41 12.59 11.41 PROVIDENT 12.37 14.58 12.37 14.58 OAK FOREST 0.60 1.28 0.60 1.28 CERMAK / JTDC 6.00 5.75 6.00 5.75 ACHN 21.90 13.40 21.90 13.40 Total 53.46 46.42 53.46 46.42

Grand Total FTE and Nursing Registry/Facility

Facility Total FTE Prod FTE Total FTE Prod FTE Total FTE Prod FTE Total FTE Prod FTE Total FTE Prod FTE

STROGER 3,779.49 2,511.56 3,561.58 3,003.95 3,679.51 2,931.31 3,242.98 2,774.13 3,692.74 2,967.09 PROVIDENT 626.25 421.47 609.15 521.68 612.97 507.77 710.10 582.85 608.85 501.97 OAK FOREST 1,086.05 666.07 936.61 806.22 952.28 765.26 997.70 810.56 988.46 745.41 CERMAK 403.37 277.28 387.49 341.97 415.60 341.59 413.05 329.99 412.23 330.53 ACHN 179.06 101.99 201.07 124.39 238.82 124.31 231.77 153.24 188.05 153.11 CORE 57.99 37.28 58.39 52.87 57.47 43.86 57.69 44.78 56.72 46.24 DPH 181.59 98.82 187.32 142.65 159.84 126.91 162.76 129.43 161.51 122.57 Total 6,313.80 4,114.48 5,941.60 4,993.74 6,116.49 4,841.02 5,816.05 4,824.99 6,108.57 4,866.92

Cook County Health ServicesFor PPE (1/2/10, 1/16/10, 1/30/10, 2/13/10 and 2/27/10)

DRAFT

PPE Feb 27 (#5)PPE Feb 13, 10 (#4)

PPE Feb 27 (#5)PPE Jan 2, 10 (#1) PPE Jan 16, 10 (#2) PPE Jan 30, 10 (#3) PPE Feb 13 (#4)

PPE Jan 2, 10 (#1) PPE Jan 16, 10 (#2) PPE Jan 30, 10 (#3)

Page 29 of 121

Memorandum To: CCHHS Finance Committee From: Michael Ayres, Chief Financial Officer Subject: Lawson Draft of Financial Statements Date: March 18, 2010 Attached is a copy of the draft accrual-based Financial Statements for the Cook County Health Facilities for the period ending December 31, 2009. The material has been prepared from the newly installed Lawson general ledger. These statements begin the process of converting the Health System's accounting and reporting process from the governmental cash to accrual for its expense and revenue recognition. The Health System is, however, totally dependent upon the County's ability to provide information in order to allow the statements to be completed. Therefore, their completeness and timing is totally dependent upon the material received from the County. In one of Please review the material at your leisure and let me know if there are any changes to their format that you would like to see. I will provide you with a more detailed presentation of the January statements the following meeting. File:MDA/board/finance committee/March 19/Lawson financial statement memorandum.

Page 30 of 121

Page 31 of 121

Page 32 of 121

Page 33 of 121

Page 34 of 121

January February March April May June July August September October November December

Finance (AC, AM, AP)

SCM (RQ, PO, IC, WH ‐ Handhelds)

HR/Pay (BN, HR, LP, PA, TR)

2010

ORIGINAL GO‐LIVE

2011

CCHHS New Fiscal Year

CCONE Lawson Implementation Timeline

CRP 1 (2 wks)CRP 2 (2 wks) CRP 3 (4 weeks) CRP 4 (4 weeks)

Payroll Parallel Testing

End User Training

Unit Testing Integration Testing

Build

Design

Cook County Lawson ERP Proposed Integration Design Assessment

*All Halt Pending Decision on Cook

County Lawson ERP

Current Project Timeline

Obtaining agreement on operational integration requirements is a pre‐requisite to the CCHHS Lawson project. Preliminary impact to the current CCHHS Lawson project would require joint discussions and agreement between CCHHS & County on the revised Lawson Go‐Live Timeline. The original timeline as indicated above is no longer an achievable goal given the outstanding design considerations.

3/22/2010CONFIDENTIAL: This document, including any attachments, is for the sole use of the intended recipient(s) and may

contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. 1 of 2Page 35 of 121

3/22/2010CONFIDENTIAL: This document, including any attachments, is for the sole use of the intended recipient(s) and may

contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. 2 of 2Page 36 of 121

FY 2010 Revenue Report CCHHS Variance Analyses for the

1st Quarter, FY 2010, Ending February 28, 2010 The FY 2010 Revenue Report for the three months ending February 28, 2010 identifies an unfavorable variance of $15.8 million for the Health Systems Patient Fees. The variance has been analyzed to determine the root causes, what actions can be taken to reverse the variance and what the potential impact will be by fiscal year-end. While there are a number of factors that are affecting the revenue, the four primary causes year-to-date are changes in volumes, payer mix, pharmacy reimbursement and the continuing Medicaid recoupment program. Each of these will be discussed in detail below. Volume Variance

CCHHS Key Operating Statistics Three Months Ending February 28, 2010

YTD

Actual YTD

Budget YTD 2009

Actual Admissions 7,800 7,774 7,681

Patient Days 36,709 38,556 39,550 Emergency Room Visits 45,150 50,255 48,624

Clinic Visits 156,993 149,890 140,772

The year-to-date admissions are above the budget by 26 admissions and last year's actual by 119. However, patient days are 1,757 below budget and 2,841 under 2008 actual. Emergency room visits are below both the budget and prior year while clinic visits are exceeding both categories. The implication for the Health System lies in which classification of payers is being impacted by these changes in volumes. If the change occurs in Medicaid, Medicare or commercial insurance, reimbursement will decline. Because we are paid a per diem by Medicaid, a decline in Medicaid patient days is has a disproportionate impact on revenue. The most effective measure to determine the change is through an analysis of the payer mix as determined by revenue generated by each payer class. Payer Mix – The Health System records revenue in four primary categories -- Medicaid, Medicare, commercial insurance and self-pay. The table below shows the change that has occurred between fiscal years 2009 and 2010. The biggest drop has occurred in Medicaid. During December there was a 9.4% reduction in Medicaid revenue while January and February showed reductions of 7.1% and 5.6%, respectively, over the prior year. While there was an increase in Medicare and commercial insurance, these revenues were not enough to overcome the Medicaid reductions. The payer mix shift is reflected in the claims data submitted to Medicaid. There was a 9% reduction or 17,676 reduction

Page 37 of 121

in claims submitted to Medicaid the first three months of fiscal 2010 compared 2009. This equates to a loss in revenue received of roughly $10.56 million for the three months.

Payer Mix Dec ‘08 Dec ‘09 Change Jan ‘09 Jan ‘10 Change Feb ‘09 Feb ‘10 ChangeMedicaid 38.5% 29.7% -9.4% 35.0% 27.9% -7.1% 34.4% 28.8% -5.6% Medicare 8.0% 12.2% 4.2% 8.6% 10.3% 1.7% 8.8% 10.5% 1.7% Commercial 5.0% 5.4% 0.4% 5.7% 6.2% 0.5% 6.0% 6.1% 0.1% Self Pay 48.5% 53.3% 4.8% 50.7% 55.6% 4.9% 50.8% 54.6% 3.8% Disproportionate Share Settlement Offset (Recoupment) – The Health System continues to reimburse the State for the DSH settlements that occurred in 2009. The amount repaid during December 2009 through February 2010 was $3.18 million. Initially, it was anticipated that the recoupment would occur in 2009, however at the end of the year, $3.8 million still remained. These funds are being taken out of current year revenues. Pharmacy Revenues – An agreement was reached with the state in November 2009 that modified permissible payments for the pharmacy program. While no recoupments were required, the agreement called for a substantial change in what would be allowable for payment. This change has an estimated annual impact of roughly $7 million reduction in revenue that was not considered in the budget. The first three months of this year's impact is estimated at $1.75 million. The Health System has deferred revenues of approximately $1.16 million for January 2010. Contract changes are in the final approval stage and the January, February and March services will be billed by early April. The deferred revenues for the three months of approximately $1.5 million should be received in late April or May. In summary, of the $16.99 million of the year-to-date Patient Fee variance, Medicaid revenue reductions as a result of volume changes account for approximately $10.6 million. The reduction in gross pharmacy revenue is a result of new billing guidelines implemented by the state for $3.3 million however, we estimate $1.2 million to be paid in April. Finally, the unanticipated Medicaid recoupment of $3.1 million make up the balance of the very. The impact on the budget is shown in the following table.

Summary Impact Year-to-date Annual 2010 Budget $74.26 M $259.0 M Medicaid volume reduction $10.56 M $36.5 Pharmacy revenue reduction $3.25 M $7.0 M Medicaid recoupment $3.18 M $3.8 M Total $ 57.27 M $211.7 M Change $16.99 M $47.3 M

Page 38 of 121

At the end of three months, if the significant volume trends were to continue, the Health System would anticipate a budget shortfall approximating $47.3 million by year-end. file:MDA/briefcase/board/finance committee/March 19/16 March draft three-month revenue variance analysis

Page 39 of 121


March 19, 2010

ATTACHMENT #2

Page 40 of 121

Cook County Health and Hospitals System

Income Statement for the Month Ended December 31, 2009

As of March 18, 2010

Page 41 of 121

Index

1. Mission Statement 2. Attestation Statement 3. Management Discussion and Analysis

4. Income Statement

5. Cash Receipts – Actual vs. Budget

6. Utilization Factor

7. Payer Mix

8. Disclosure Checklist

Page 42 of 121

COOK COUNTY HEALTH & HOSPITALS SYSTEM

MISSION STATEMENT The Cook County Health and Hospitals System will deliver integrated health services with dignity and respect regardless of a patient's ability to pay; and, Foster partnerships with other health providers and communities to enhance the health of the public; and, Advocate for policies, which promote and protect the physical, mental and social well being of the people of Cook County.

Page 43 of 121

Board of Directors Cook County Health and Hospitals System The accompanying monthly financial statement package of the Cook County Health and Hospitals System, for the one month ended December 31, 2009 and the related Management's Discussion and Analysis, Income Statement, Cash Receipts, Utilization Factors, Payer Mix, for Each Facility have been prepared by Management who is responsible for their presentation and disclosure. These statements have not been compiled, reviewed or audited by independent accountants. CCHHS maintains an internal control structure designed to provide reasonable assurance that assets are safeguarded and that transactions are properly executed, recorded and summarized to produce reliable records and reports, To the best of Management's knowledge and belief the statements and related information were prepared in conformity with generally accepted accounting principles and governmental accounting standards using the modified accrual basis of accounting and are based on recorded transactions and Management's best estimates and judgment. William T. Foley, Chief Executive Officer ___________________________________ Michael D. Ayres, Chief Financial Officer ___________________________________ Dorothy M. Loving, Executive Director of Finance ___________________________________

Page 44 of 121

Summary The Cook County Health and Hospitals System year to date financial results finished the one month of the fiscal year under budget by $1,415,460. The overall unfavorable revenue at the end of one month was $27,088,772. Expenses were below budget by $25,673,313 or 25.1%. Operating Revenue Fees at the end of December collected from patient services were over budget year to date by $776,805 or 3.2%. Other Revenue at the end of December exceeded the budget by $218,193 or 45.6%. Total Operating Revenue at the end of December was under budget year to date by $13,667,902 or 26.4%. Operating Expenses Operating Expenses at the end of December were below budget by $25,673,313 or 25.1% broken down as follows: Salaries and Wages – ($8,790,883) or (18.0%) Benefits – ($1,245,668) or (18.0%) Supplies – $12,339,482 or 99.9% Purchased Services, Rental, and Other - $13,955,884 or 97.0% Utilities - $9,414,498 or 88.7% System Expenses per Adjusted Patient Day A comparison of year to date expenses per adjusted patient day to the budget is as follows: Institution Budget Actual Variance Stroger $4,993 $3,579 28.32% Oak Forest $3,929 $3,154 19.73% Provident $5,014 $3,718 25.85% This information is an integral part of the accompanying consolidated financial statements

Page 45 of 121

Non Operating Revenue Non operating revenue at the end of December was below budget by $13,420,870 or 35.4%. The largest shortfalls from budget are for property taxes. This information is an integral part of the accompanying consolidated financial statements

Page 46 of 121

3/18/2010 3:40 PM

Cook County Health and Hospitals System of IllinoisPreliminary Statement of Revenues and Expenses vs. Budget - Modified Accrual Basis

For One Month Ending December 31, 2009 (UNAUDITED)CONSOLIDATED

Total for the One Month Ending

December 31, 2009BUDGET

Difference Favorable

(Unfavorable)

Difference as % of Budget

Operating revenue

Patient Service Revenue 25,389,475$ 24,612,670$ 776,805$ 3.2%

FMAP - 3,250,000 (3,250,000) -100.0%

Inter-Governmental Transfers (IGT) - 10,916,667 (10,916,667) -100.0%

NetDSH 12,440,153 12,500,000 (59,847) -0.5%

Total Patient Service Revenue 37,829,628 51,279,337 (13,449,709) -26.2%Other revenue 259,925 478,119 (218,193) -45.6%

Total operating revenue 38,089,553 51,757,455 (13,667,902) -26.4%

Operating expenses

Salaries and wages 57,712,656 48,921,773 (8,790,883) -18.0%

Employee benefits (Excludes Pension Expense) 8,177,883 6,932,215 (1,245,668) -18.0%

Pension Expense 5,451,313 5,451,313 - 0.0%

Supplies 13,482 12,352,964 12,339,482 99.9%

Purchased services, rental & other 429,008 14,384,892 13,955,884 97.0%

Depreciation 3,388,775 3,388,775 0 0.0%

Utilities 1,195,621 10,610,119 9,414,498 88.7%

Services contributed by other County offices 355,339 355,339 - 0.0%

Less: Unallocated budget reduction for 0 0 - the year of $44,199,636

Total operating expenses 76,724,077 102,397,390 25,673,313 25.1%

Operating Loss (38,634,524) (50,639,934) 12,005,411 -23.7%

Nonoperating revenue (expense)

Property taxes (55,093) 11,330,454 (11,385,547) -100.5%

Sales taxes 18,752,951 18,570,251 182,700 1.0%Cigarette taxes - 2,218,023 (2,218,023) -100.0%

Interest Income - - -

Interest Earnings Transfer Out - - - 0.0%

Pension plan contribution 5,451,313 5,451,313 - 0.0%Services contributed by other County Offices 355,339 355,339 - 0.0%

Total nonoperating revenue 24,504,510 37,925,381 (13,420,870) -35.4%

Income (Loss) before other revenue, expenses, gains, losses, and transfers (14,130,014) (12,714,554) (1,415,460) -11.1%

Change in net assets (14,130,014)$ (12,714,554)$ (1,415,460)$ -11.1%

These consolidated financial statements should be read only in connection with the

accompanying Management Discussion & Analysis Page 1 of 5

Page 47 of 121

3/18/2010 3:40 PM

Preliminary Combining Statement of Revenues, Expenses,and Changes in Net Assets of Operating Accounts - Modified Accrual Basis

For One Month Ending December 31, 2009 (UNAUDITED)

COMBINEDJohn H. Stroger, Jr

HospitalOak Forest

Hospital Provident Hospital Total

Operating revenue

Patient Service Revenue 22,244,774$ 1,659,379$ 1,485,322$ 25,389,475$

FMAP - - - -

Inter-Governmental Transfers (IGT) - - - -

NetDSH 9,984,520 1,207,047 1,248,586 12,440,153

Total Patient Service Revenue 32,229,294 2,866,426 2,733,908 37,829,628 Other revenue 260,310 (3,617) 3,232.05 259,925

Total operating revenue 32,489,604 2,862,809 2,737,140 38,089,553

Operating expenses

Salaries and wages 44,377,454 6,910,293 6,424,909 57,712,656

Employee benefits (Excludes Pension Expense) 6,288,285 979,189 910,410 8,177,883

Pension Expense 3,876,363 827,781 747,169 5,451,313

Supplies 726 18,262 (5,506) 13,482

Purchased services, rental and other 389,942 23,438 15,627 429,008

Depreciation 2,794,734 338,651 255,390 3,388,775

Utilities 792,501 235,222 167,897 1,195,621 Services contributed by other County offices 204,998 73,303 77,038 355,339

Total operating expenses 58,725,004 9,406,140 8,592,933 76,724,077

Operating Loss (26,235,400) (6,543,331) (5,855,793) (38,634,524)


Property taxes (39,546) (6,773) (8,774) (55,093)

Sales taxes 13,494,316 2,303,001 2,955,634 18,752,951 Cigarette taxes - - - - Interest income - - - - Interest Earnings Transfer Out - - - - Pension plan contribution 3,876,363 827,781 747,169 5,451,313 Services contributed by other County offices 204,998 73,303 77,038 355,339 Total nonoperating revenue 17,536,131 3,197,313 3,771,066 24,504,510 Income (Loss) before other revenue, expenses, gains, losses and transfers (8,699,269) (3,346,018) (2,084,726) (14,130,014)

Change in net assets (8,699,269)$ (3,346,018)$ (2,084,726)$ (14,130,014)$

These consolidated financial statements should be read only in connection with theaccompanying Management Discussion & Analysis Page 2 of 5

Page 48 of 121

3/18/2010 3:40 PM



John H. Stroger, Jr., Hospital of Cook CountyTotal for the One

Month Ending December 31, 2009

BUDGETDifference Favorable

(Unfavorable)


Operating revenue

Patient Service Revenue 22,244,774$ 18,382,771$ 3,862,003$ 21.0%

FMAP - 2,437,500 (2,437,500) -100.0%


NetDSH 9,984,520 9,375,000 609,520 6.5%



Operating expenses

Salaries and wages 44,377,454 35,939,317 (8,438,137) -23.5%

Employee benefits (Excludes Pension Expense) 6,288,285 5,092,601 (1,195,684) -23.5%

Pension Expense 3,876,363 3,876,363 - 0.0%

Supplies 726 9,645,357 9,644,631 100.0%

Purchased services, rental and other 389,942 9,845,469 9,455,526 96.0%

Depreciation* 2,794,734 2,794,735 0 0.0%

Utilities 792,501 10,133,924 9,341,423 92.2%Services contributed by other County offices 204,998 204,998 - 0.0%


Operating Loss (26,235,400) (38,754,620) 12,519,221 -32.3%


Property taxes (39,546) 8,122,939 (8,162,484) -100.5%

Sales taxes 13,494,316 13,362,848 131,468 1.0%

Cigarette taxes - 1,493,567 (1,493,567) -100.0%

Interest income - - -

Interest Earnings Transfer Out - -

Pension plan contribution 3,876,363 3,876,363 - 0.0%Services contributed by other County Offices 204,998 204,998 - 0.0%


Income (Loss) before other revenue, expenses, gains, losses, and transfers (8,699,269) (11,693,907) 2,994,638 25.6%

Change in net assets (8,699,269)$ (11,693,907)$ 2,994,638$ 25.6%



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Oak Forest Hospital of Cook CountyTotal for the One



(Unfavorable)


Operating revenue

Patient Service Revenue 1,659,379$ 3,316,003$ (1,656,624)$ -50.0%

FMAP - 325,000 (325,000) -100.0%


NetDSH 1,207,047 1,875,000 (667,953) -35.6%

Total Patient Service Revenue 2,866,426 7,157,253 (4,290,827) -60.0%Other revenue (3,617) 40,197 (43,814) -109.0%


Operating expenses

Salaries and wages 6,910,293 6,700,415 (209,878) -3.1%

Employee benefits (Excludes Pension Expense) 979,189 949,449 (29,740) -3.1%

Pension Expense 827,781 827,781 - 0.0%

Supplies 18,262 1,303,531 1,285,269 98.6%


Depreciation 338,651 338,651 - 0.0%

Utilities 235,222 282,085 46,863 16.6%Services contributed by other County offices 73,303 73,303 - 0.0%


Operating Loss (6,543,331) (5,231,453) (1,311,878) 25.1%


Property taxes (6,773) 1,376,197 (1,382,970) -100.5%

Sales taxes 2,303,001 2,280,564 22,437 1.0%

Cigarette taxes - 253,042 (253,042) -100.0%

Interest income - - -


Pension plan contribution 827,781 827,781 - 0.0%Services contributed by other County Offices 73,303 73,303 - 0.0%


Income (Loss) before other revenue, expenses, gains, losses, and transfers (3,346,018) (420,565) (2,925,453) -695.6%

Change in net assets (3,346,018)$ (420,565)$ (2,925,453)$ -695.6%



Page 50 of 121

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Provident Hospital of Cook CountyTotal for the One



(Unfavorable)


Operating revenue

Patient Service Revenue 1,485,322$ 2,913,896$ (1,428,574)$ -49.0%

FMAP - 487,500 (487,500) -100.0%


NetDSH 1,248,586 1,250,000 (1,414) -0.1%



Operating expenses

Salaries and wages 6,424,909 6,282,041 (142,868) -2.3%

Employee benefits (Excludes Pension Expense) 910,410 890,165 (20,244) -2.3%

Pension Expense 747,169 747,169 - 0.0%

Supplies (5,506) 1,404,076 1,409,582 100.4%


Depreciation 255,390 255,390 - 0.0%

Utilities 167,897 194,110 26,212 13.5%Services contributed by other County offices 77,038 77,038 - 0.0%


Operating Loss (5,855,793) (6,653,861) 798,068 -12.0%


Property taxes (8,774) 1,831,319 (1,840,093) -100.5%

Sales taxes 2,955,634 2,926,839 28,795 1.0%

Cigarette taxes - 471,415 (471,415) -100.0%Interest income - - -


Pension plan contribution 747,169 747,169 - 0.0%Services contributed by other County Offices 77,038 77,038 - 0.0%


Income (Loss) before other revenue, expenses, gains, losses, and transfers (2,084,726) (600,082) (1,484,645) -247.4%

Change in net assets (2,084,726)$ (600,082)$ (1,484,645)$ -247.4%



Page 51 of 121

Payer Type Actual Budget VarianceMedicaid 15,959,588$ 16,149,038$ (189,450)$ Medicare 5,090,468 3,524,658 1,565,810 Third Party 823,275 882,863 (59,588) Self-Pay 371,443 263,712 107,731

Totals 22,244,774$ 20,820,271$ 1,424,503$

Payer Type Actual Budget VarianceMedicaid 479,406$ 2,509,615$ (2,030,209)$ Medicare 784,230 679,452 104,778 Third Party 208,273 197,783 10,490 Self-Pay 13,413 14,546 (1,133)

Totals 1,485,322$ 3,401,396$ (1,916,074)$

Payer Type Actual Budget VarianceMedicaid 1,309,672$ 3,216,346$ (1,906,674)$ Medicare 275,742 339,726 (63,984) Third Party 49,932 57,372 (7,440) Self-Pay 24,033 27,559 (3,526)

Totals 1,659,379$ 3,641,003$ (1,981,624)$

Payer Type Actual Budget DifferenceMedicaid 17,748,667$ 21,875,000$ (4,126,333)$ Medicare 6,150,440 4,543,836 1,606,604 Third Party 1,081,480 1,138,018 (56,538) Self-Pay 408,889 305,817 103,072

Totals 25,389,476$ 27,862,670$ (2,473,194)$

John H. Stroger, Jr., Hospital of Cook County

Actual to Budget Comparison by Payer TypeYear-To-Date Cash Receipts

Provident Hospital of Cook County

The data reflected in this report comes from the Comptroller's ledger.

December-2009

December-2009

December-2009

December-2009

Oak Forest Hospital of Cook County

CCHHS Totals

Page 52 of 121

Taxes Actual Budget VarianceNet Property Tax Levy (A) -$ 11,330,454$ (11,330,454)$ County Sales Tax 16,484,739 19,012,315 (2,527,576) Cigarette Tax (A) - 2,083,333 (2,083,333)

Total Tax Receipts 16,484,739$ 32,426,102$ (15,941,363)$

Other Supplementary Receipts Actual Budget VarianceDSH 12,440,153$ 12,440,153$ 0$ BIPA - - - FMAP - - - Total Other Supplementary Receipts 12,440,153$ 12,440,153$ 0$

Total Supplementary Cash Receipts 28,924,892$ 44,866,255$ (15,941,363)$

(A) The Comptroller's Office has not finalized the Health System's allocation of the Property and Cigarette taxes.

Year-To-Date Cash ReceiptsSystem Supplementary Cash Receipts

Through December-2009

Page 53 of 121

Cook County Health & Hospitals SystemUtilization Factors

2009 YTD YTD YTD %%J.H. Stroger Hospital December Total Budget Variance Variance

Admissions 1,978 1,978 2,017 (39) -1.9%

Patient days 9,403 9,403 9,794 (391) -4.0%

Adjusted Patient Days 16,410 16,410 15,529 881 5.7%

Emergency Room Visits 9,712 9,712 11,249 (1,537) -13.7%

Case Mix Index 1.2660

Average Length of Stay 5.1 5.0 (0.1) -1.4%

Provident HospitalAdmissions 345 345 400 (55) -13.8%

Patient days 1,365 1,365 1,577 (212) -13.4%

Adjusted Patient Days 2,311 2,311 2,480 (169) -6.8%

Emergency Room Visits 2,856 2,856 3,362 (506) -15.1%


Average Length of Stay 4.0 4.0 0.0 1.2%

Oak Forest HospitalAdmissions 374 374 261 113 43.3%

Patient days 1,561 1,561 1,910 (349) -18.3%

Adjusted Patient Days 2,982 2,982 3,163 (181) -5.7%

Emergency Room Visits 2,456 2,456 2,700 (244) -9.0%


Average Length of Stay - Acute 4.7 6.9 2.2 32.1%

Average Length of Stay - Rehab 16.5 15.2 (1.3) -8.4%

Total SystemAdmissions 2,697 2,697 2,678 19 0.7%

Patient Days 12,329 12,329 13,281 (952) -7.2%

Adjusted Patient Days 21,703 21,703 21,172 531 2.5%

Emergency Room Visits 15,024 15,024 17,311 (2,287) -13.2%

Cook County Health & Hospitals SystemACHN - Clinics

Fantus/Stroger Campus 40,093 40,093 34,692 5,401 15.6%West Cluster 6,598 6,598 6,819 (221) -3.2%South Cluster 5,900 5,900 5,884 16 0.3%

South Suburban Cluster 5,335 5,335 4,233 1,102 26.0%Total ACHN Visits 57,926 57,926 51,628 6,298 12.2%

Page 54 of 121

Payer Mix ComparisonCook County Health and Hospitals System

Prior 13 Months Ending December-2009

8.0%

38.5

%5.

0%48

.6%

8.6%

35.0

%5.

7%50

.7%

8.8%

34.4

%6.

0%50

.8%

8.8%

35.4

%6.

1%49

.7%

9.0%

35.9

%5.

3%49

.8%

8.9%

35.8

%5.

3%50

.0%

9.0%

35.7

%5.

3%50

.0%

9.0%

35.3

%5.

3%50

.4%

9.2%

34.8

%5.

3%50

.7%

9.2%

34.3

%5.

2%51

.3%

9.2%

33.8

%5.

4%51

.6%

9.3%

33.3

%5.

4%52

.0%

12.2

%29

.1%

5.4%

53.3

%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09Jul-0

9

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Medicare Medicaid Commercial Self PayPage 55 of 121

COOK COUNTY HEALTH AND HOSPITALS SYSTEMFINANCIAL STATEMENT DISCLOSURE CHECKLIST

Fiscal Year 2010OBJECTIVE:

DISCLOSURE PRINCIPLES:

Yes, N/A, No? If no, state reason

(immaterial, estimated, etc.)

FINANCIAL STATEMENT REFERENCES:1. Do the financial statements reference footnotes (MD&A) or selected information?

Yes

GENERAL DISCLOSURES:A. Estimates:1. General disclosure about use of estimates (MD&A)? Yes2. Disclosure of possible changes in estimates? Yes

B. Vulnerabilities do to concentrations in following areas disclosed?:1. Customers? Yes2. Suppliers? Yes3. Lenders? Yes4. Products? Yes5. Supply of materials, labor or supplies? Yes6. Location of assets in geographic area? Yes

C. Related parties (FASB 57):1. Known common control and economic dependency disclosure? Yes2. Known transactions with related parties disclosed? Yes

OTHER DISCLOSURE AREAS TO BE CONSIDERED:1. Method of consolidations? Yes2. Accounting changes including changes in GAAP and in estimates? Yes3. Business combinations? Yes4. Discontinues operations? Yes5. Going concern? Yes

Completed by ______________________________________Reviewed by ______________________________________ Date _____________________

Date _____________________

The object of this checklist is to help determine if the form and contents of the financial statements are in conformity with the accounting standards applicable to financial statement basis of accounting.

COMMENTS:

Note: Management can comply with a disclosure principle by making disclosure in body of financial statements or in the notes accompanying the financial statements. In a compilation engagement, management's election to omit substantially all disclosures applies to all disclosure principles in GAAP financial statements.

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March 19, 2010

ATTACHMENT #3

Page 57 of 121

Finance Committee MeetingSupply Chain Management: Performance ImprovementSupply Chain Management: Performance Improvement

Mar. 19, 2010

Page 58 of 121

Agenda

• Introduction. – A. Tedeschi.

• Supply Chain Management overview. - L. Duffy / P. Wolff.

• RFP Process. – L. Duffy / C. De Gante.

• Board Transmittal/Contract Management Tracking Tool. – L. Duffy / C. De Gante.

• Supply Chain Management 120 Day Plan (Status) L Duffy / A Tedeschi• Supply Chain Management 120 Day Plan (Status). – L. Duffy / A. Tedeschi.

• Questions.

1Page 59 of 121

Team

• Anthony Tedeschi: CCHHS Chief Operating Officer.• Leslie Duffy: Supply Chain Management, Senior Director.• Carlos De Gante: Supply Chain Management, Dir., Contract Management.• Paul Wolff: Supply Chain Management, Dir., Materials Management.

2Page 60 of 121

Supply Chain Management overview

SCM accomplishments include:• Projected operational improvement opportunities: $20M. Identified savings in purchased services, supplies, drugs, and

consumables: $5.5M. Note: Savings realized through: GPO; price negotiation; product utilization; product standardization; inventory management.

• Key Performance Indicators (monthly volume):Key Performance Indicators (monthly volume): • Requisitions: Jan. 2010 = 381; Feb. 2010 = 219.• Contracts: Jan. 2010 = 110; Feb. 2010 = 125.

• Purchase Orders: Jan. 2010 = 422; Feb. 2010 = 224. Mar. 2010 (to-date) = 192.• Time to process PO: 48 hrs. (Note: Jan. 2009 time to process was 50+ days).• Time to process “change orders” and “encumbering requisitions” was 6-8 weeks, now to 2-4 weeks.

SCM initiatives include:• Lab:

• Laboratory supplies (single “primary” distributor); July 2010.• Surgery / Cardiology / Orthopedic:• Surgery / Cardiology / Orthopedic:

• Custom Surgical Packs (standardize); Apr 2010.• Suture Endo-mechanical (standardize); May 2010.• Orthopedic products (standardize); May 2010.

• Food Nutrition:• Food service (single “primary” distributor); Mar 2010.

• Records Management:• Record storage and retrieval; Sep 2010.

• Standard Items & Supply Chain activity :• Laundry & Linen; Jun 2010 Hospital inventory products; Mar 2010• Laundry & Linen; Jun 2010. Hospital inventory products; Mar 2010.• Reduce distribution/delivery (supplier to deliver to storerooms); Sep 2010.• Reduce non-clinical inventory (all sites; one time savings); Nov 2010.

3Page 61 of 121

RFP Process

RFP process:

1. Receive Request for Proposal (RFP) from department. • Obtain authorization to proceed with request (General Counsel).• Obtain authorization to proceed with request (COO).• Purchasing completes a “quality review” of the request.• Purchasing creates a template on ccbhs.org to generate RFP number.

2. RFP is loaded onto ccbhs.org (link to county web site is in-process).• Vendor notification completed.• Advertisement submitted to newspaper.• Requestor drafts addendum to address vendors questions.

3. Proposals are submitted by prospective vendors.3. Proposals are submitted by prospective vendors. 4. Proposals are sent to the requesting department.

• Requesting department evaluates proposals. • Requesting department selects vendor.

5 Proposal is sent to Contract Compliance5. Proposal is sent to Contract Compliance.• Proposal is approved (if vendor meets MBE/WBE) by Contract Compliance.• Notification is provided to proceed with awarding contract to vendor.

6. Notification is sent to the vendor via website.

4Page 62 of 121

RFP Process

RFP process - ccbhs.org:ccbhs.org

5Page 63 of 121

Board Transmittal / Contract Management Tracking Tool

Board Transmittal/Contract Management Tracking Tool:• Daily: Board Transmittals/Contracts are entered into the SCM database.• Daily: Tracking Tool is used to monitor the status (and location) of each Board Transmittal.• Monthly: “Notice of Expiring Contracts Report” is sent to each Department.( ( ) f f(Note: Business units are requested to generate new purchase requisition(s), if necessary, for the contracts due to expire in the fiscal year.)

utio

ns

Sol

66Page 64 of 121

Supply Chain Management 120 Day Improvement Plan

Supply Chain Management 120 Day Improvement Plan – Status Update.

• Contract management system – Complete.Contract management system Complete.

• Develop and implement transmittal management system – Complete.

• Develop and implement transition plan for managing contract compliance internally. – In process.

• Assessment, redesign and implementation of a comprehensive materials management plan – In process.

7Page 65 of 121

Questions

Questions?

8Page 66 of 121


March 19, 2010

ATTACHMENT #4

Page 67 of 121

COOK COUNTY HEALTH AND HOSPITALS SYSTEMITEM V(A)

MARCH 19, 2010 FINANCE COMMITTEE MEETING CONTRACTS AND PROCUREMENT ITEMS

Request # Vendor Service or Product Fiscal Impact

Affiliate / System

Begins on Page

#

1Illinois Department of Public Health

American Recovery and ReinvestmentAct (ARRA) Varicella (chickenpox)Surveillance Grant ($53,500.00) CCDPH 3

2Illinois Department of Public Health

Supplemental Nutrition Program forWomen, Infants and Children ($138,309.00) CCDPH 4

3Illinois Department of Public Health Infant Immunization Initiative Grant ($165,000.00) CCDPH 5

4 DDW and Associates

Maintenance and repair services forthe Infant Security-Nurse Call PagingSystem No fiscal impact PHCC 6

5 Aramark Food services No fiscal impact PHCC 76 Anspach Effort Neurological implants No fiscal impact SHCC 87 Depuy Orthopedic Orthopaedic implants No fiscal impact SHCC 98 Smith & Nephew Inc. Orthopaedic implants No fiscal impact SHCC 109 Synthes Orthopedics Orthopaedic implants No fiscal impact SHCC 11

10 Stryker Orthopedics Orthopaedic implants No fiscal impact SHCC 12

11Star Detective and Security Agency Security services $2,128,647.00 PHCC 13

12Health Management Associates (HMA) Consulting services $250,000.00 System 15

13Virtual Radiologic Professionals Tele-Radiology services $180,000.00

PHCC, OFHCC 16

14 Eligibility Services, Inc. (ESI) Pharmacy billing services No fiscal impact System 18

15 PeopleFirst RehabilitationPhysical, occupational and speechtherapy services

($20,000.00) (net $0 fiscal impact) OFHCC 19

15Allied Health Professionals, Ltd.

Physical, occupational and speechtherapy services

$20,000.00 (net $0 fiscal impact) OFHCC 19

Extend Contracts

Amend and Decrease/Increase Contracts

Accept Grant Award

Accept Supplemental Grant Award

Accept Grant Renewal

Amend Previously Approved Contractual Request

Increase and Extend Contracts

Amend Contract

Page 68 of 121

COOK COUNTY HEALTH AND HOSPITALS SYSTEMITEM V(A)

MARCH 19, 2010 FINANCE COMMITTEE MEETING CONTRACTS AND PROCUREMENT ITEMS

Request # Vendor Service or Product Fiscal Impact

Affiliate / System

Begins on Page

#

16David Gomez and Associates Executive search services $250,000.00 System 20

17Quick Leonard Kieffer International, Inc. Executive search services $200,000.00 System 22

18 NeuroCare, Inc. Sleep diagnostic services $795,780.00 System 23

19Agility Health Professionals, Inc.

Registry services - Physical,occupational and speech therapy $340,400.00

PHCC, OFHCC 24

20 RTG Medical, LLCRegistry services - Physical,occupational and speech therapy $285,000.00

PHCC, OFHCC 26

21Select Medical Rehabilitation


PHCC, OFHCC 28

22 PeopleFirst RehabilitationRegistry services - Physical,occupational and speech therapy $165,000.00

PHCC, OFHCC 30

23Allied Health Professionals, Ltd.


CHSCC, JTDC, PHCC, SHCC, OFHCC 32

24 GE HealthcarePicture Archiving and CommunicationSystem (PACS) $692,182.26 CHSCC 34

25 GE Healthcare

Maintenance and repair services forthe Picture Archiving andCommunication System (PACS) $372,666.00 CHSCC 35

26 Carlo Govia Professional Services $249,600.00 System 36

27 GE HealthcareProvision of temporary ArchivedStored Procedures (ASP) services $108,000.00 CHSCC 37

28 HiQ Analytics, LLC Professional consulting services $76,950.00 System 38

29 Progressive Industries, Inc. Laboratory reagents and consumables $447,125.92 PHCC 40

30Advanced Management Services Midwest, Inc. Custom-made vascular garments $126,783.02 SHCC 43

31GRM Information Management Services

Off-site film storage and retrievalservices $115,718.00 SHCC 46

Enter Into and Execute Contracts

Renew, Amend, Increase and Execute Contract

Amend, Increase and Extend Contract

Award Bids, and Enter Into and Execute Contracts

Renew, Increase and Execute Contracts

Amend and Increase Contracts

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March 19, 2010

ATTACHMENT #5

Page 116 of 121


March 19, 2010

ATTACHMENT #6

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Documents

03-19-10 Fin minutes - Cook County Health and Hospitals · PDF fileHeather O’Donnell, JD, ... to justify their tax-exempt status under property tax law. ... D. System Productivity