Cook looks to collar counties

When officials in the collar counties talk about Cook County, it's often mentioned as the place where tax dollars go to die.

But Cook County Board President Todd Stroger recently sat down with collar county officials to show them another view: Cook County is where some collar county residents go to stay alive -- literally.

Stroger presented figures showing collar county residents have been using Cook County Bureau of Health facilities at the expense of Cook taxpayers.

And while the bureau of health's own leaders acknowledge that the main county hospital, Stroger Hospital, was mismanaged for years by leaving insurance, Medicaid and Medicare reimbursements uncollected, they say they're serious now about leaving no money uncollected or "on the table."

For the collar counties, that would mean paying the bills for their indigent residents who cross county borders and end up in the Cook County system.

For the 18 months from January 2005 through June 2006, poor collar county residents accounted for nearly $20 million in patient charges at Stroger Hospital, county leaders say.

"That's only the ones we could (identify)," said Robert Simon, chief of county bureau of health.

He said many out-of-county patients coming to Cook give fake addresses for fear of being turned away.

In addition to that number are 254,000 prescriptions for out-of-county residents that Cook County fills each year.

Put in charge last year of a health-care system that was bleeding red ink, Simon tried to address the problem earlier this year by unilaterally refusing care to non-Cook County patients. But his boss, Todd Stroger, overruled him, reversing the order.

While Stroger wants to see that financial loss stemmed, he didn't want to do so at the expense of people who needed health care, he said, and he preferred to negotiate with collar counties for contributions.

That is easier said than done, particularly from counties whose impression is that Cook County is a morass of waste and inefficiency.

Before Stroger met with collar county officials on Friday, the Daily Herald interviewed several collar county leaders who were dubious, at best, that Cook County deserved their help.

"The counterpoint to that is McHenry County is subsidizing CTA," McHenry County Chairman Ken Koehler said before the meeting. "There is no sympathy from this county board president."

"They better provide me with parking (for the meeting)," added the no-nonsense Republican.

And Lake County Department of Health chief Dale Galassie noted prior to the meeting that Cook County's billing problems were known far and wide.

Further, he said, Lake County health agencies don't refer patients to Cook County.

"Charging a collar county for services rendered to an individual (who) just appears (at Stroger Hospital) on their own is not going to go very far with the collars," he predicted.

But after meeting with Stroger, Simon and the hospital's financial guru, Tom Glaser, the two were more receptive.

"I went there skeptical," admitted Galassie. "It was very worthwhile. It was eye-opening, and the public perception of what's taking place in Cook is different than what the reality is.

"What they are asking of us was nothing more than having us help to cover the costs for Lake County residents. And that's perfectly reasonable," he added.

Koehler seemed a little more receptive too.

"There's a serious issue here," he said after emerging from the meeting with Stroger on the 35th floor of the county administration building.

Cook County, Koehler said, deserves a lot of credit for providing as many services as it has to so many people for so long.

Part of what may have impressed other county leaders was that the approach taken didn't just consist of Cook County with its hand out.

Simon and Galassie said they are going to compare notes on Lake County patients who use Cook County services, and try to talk to those patients to get them to utilize Lake County's health-care network where possible.

But that won't work everywhere. Smaller counties, like Kendall County, have no hospitals whatsoever, let alone a public one.

And even in Lake County, where Galassie is confident his system can serve all of its patients, specialty care -- like heart surgery or other highly technical procedures -- is still something people turn to Cook County for.

Although he has no hard figures to show it, Simon estimates that 90 percent of that $20 million spent on out-of-county patients is specialty care.

Those patients, if they're poor and uninsured, realistically can't go anywhere else, Simon said.

While Simon doesn't believe collar county health departments deliberately refer patients to Cook County, individual doctors do, he said.

That's because the doctors know if the patient tries to get care at a private facility, they'll often be told they can only be seen if they pay cash.

And a person showing up in a private hospital's emergency room with a cancerous tumor in his throat is not entitled to treatment unless that tumor poses an immediate emergency -- such as blocking off the airway, he noted.

Typically, it's those types of cases that end up at Cook County, he noted.

While private hospitals in the collar counties do some charity care, their profit margins are often too small to take on the big cases, he said.

"They'll go bankrupt," he said.

That's why, he added, it makes sense for the collar counties to work with Cook County. If Stroger Hospital goes under, those hospitals will be next hit, he said.

And if the collar counties work with Stroger Hospital, they can often get the care or prescriptions cheaper through Stroger Hospital than they could on their own, Simon said.

There may be another reason it would behoove the collar counties to play ball. Some Cook County Board members are suggesting the county cut off drugs and services to non-county patients in non-emergency situations.

If Stroger doesn't make progress, they may pass binding resolutions dictating that the services stop.

But getting collar counties to contribute will mean turning around their perception of Cook County.

Galassie said he saw evidence of progress during his visit Friday.

"They (Cook County) are absolutely administratively making significant strides. The irony is they're not doing anything on the PR. (public relations) side," he said.

Time for collar counties to pay up?

The Cook County Bureau of Health, under pressure to increase the amount of fees it collects from patients, is trying to collar other counties to help out. The theory is that Cook taxpayers subsidize surrounding counties' health-care systems by caring for indigent collar county patients. Here's a look at how many collar county residents have used Cook County's John Stroger Hospital.

Time period: Jan. 2005 to June 2006

County No. of Avg. cost Total cost

patients per patient

DuPage 576 $12,277 $7,071,552

Lake 364 $12,763 $4,645,732

Will 287 $12,760 $3,662,120

Kane 269 $13,405 $3,605,945

McHenry 54 $16,946 $ 915,084

TOTAL 1550 $12,839 19,900,433

Source: Cook County Bureau of Health