Cook County happy with health leaders

John Cookingham found a $300,000 comma in Palatine.

The chief financial officer of the Cook County Bureau of Health made the revelation Tuesday at the bureau's budget hearing as a way to illustrate some of the steps he and others have taken to try to turn around the bureau's finances.

The comma was supposed to be part of the billing code submitted to Medicaid for reimbursement of services to poor patients treated at the county's Vista Health Center in Palatine. Without it, Medicaid was rejecting all Vista reimbursement claims submitted by the county.

When Cookingham and his staff realized the mistake and fixed it, they immediately were reimbursed $300,000 for past services, and have continued to collect reimbursements for Vista patients since then.

"It was as simple as putting a comma between 'Cook County' and something else," Cookingham told county commissioners.

Cookingham, bureau Chief Operating Officer Tom Glaser and bureau chief Robert Simon made their presentation as party of annual hearings where budget requests are defended.

After reducing from 8,501 full- and part-time employees in December 2006 to 6,904 now, the bureau is asking for 690 full-time employees back.

And after cutting $130 million from its 2006 budget in 2007, the bureau is looking for $96.9 million of that funding back. That represents a substantial portion of the $239 million total county budget deficit that Cook County Board President Todd Stroger is trying to raise through new taxes.

Cook County commissioners, who have largely been critical of those tax hikes, nonetheless Tuesday seemed to endorse Simon and his team's efforts to turn the place around.

"You're doing an outstanding job," said Gregg Goslin, a Glenview Republican who was highly critical of Simon's predecessors.

Joseph Mario Moreno, a Chicago Democrat, said he felt the entire bureau needed a total restructuring.

"I believe that's what's happening," said Moreno.

As part of their reformation efforts, Simon and others have begun instituting measures at the hospital that are standard elsewhere, but were not done prior to their arrival. Financial statements, for example, are now compiled monthly.

The team has also centralized purchasing of medical supplies for the system's three hospitals and 16 clinics so as to increase their buying power and receive better rates.

Although Simon and others are on track to increase only slightly collected patient fees by about $770,000, they have done so in a year when outpatients decreased greatly. The county saw 746,000 outpatient visits in 2006 and just 665,000 in 2007.

Additionally, because of board members' delay, the trio was not put in place until three months into the budget year. They also were not allowed to hire an outside company to increase collections of insurance and Medicaid bills until after the mid-year -- largely because board members wasted months fighting about which company to hire.

Simon, Glaser and Cookingham have also identified areas in the hospital where no Medicaid reimbursement claims were being submitted at all, such as for radiology procedures. If they are successful in collecting reimbursements for those activities this year, the increased patient fees could go even higher, Cookingham told commissioners.

Not everybody is happy with Simon. Commissioner Forrest Claypool, a Chicago Democrat, said he still believes there's waste and patronage in the bureau, and a special blue-ribbon panel enlisted by Stroger himself concluded much the same in its recommendation that the bureau be turned over to another board.

Collecting payment

Health bureau officials say recent improvements have decreased the portion of reimbursement claims that Medicaid rejects from 76 percent in March to just 15 percent now, although total collections are only slightly higher than last year. Here's what's been happening with patient fees at the bureau:

Projected Actual

patient patient

revenues revenues Shortfall

2006 $428.2 million $331.9 million $96.3 million

2007 $385.7 million $332.6 million* $53.1 million

2008 $352.7 million N/A N/A

*year-end estimate based on current year-to-date collections

Source: Cook County Health Bureau

County rumble

Cook County Commissioner Forrest Claypool and Bureau of Health Chief Robert Simon will face off today on public radio over whether the county's public health system is being run efficiently. The debate comes after Simon challenged Claypool to define where he would make cuts instead of raising taxes.

Where: WBEZ 91.5-FM

When: 8:45 a.m. today