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WHY YOU SHOULD CARE ABOUT COOK COUNTY HEALTH CARE
Cook medical system at critical crossroads

Sunday, February 25, 2007
Special to suffredin.org
by Judith Graham

Now that the budget battle is over, Cook County's public health system stands at a critical crossroads.

Down one path lies the status quo: Well-documented financial neglect. Administrative mismanagement. Waste and inefficiency.

This route virtually guarantees that resources will continue to be squandered and the county's long tradition of medical excellence severely compromised, experts said.

Down another path lies reform: An embrace of professional management. Responsible stewardship of limited resources. A commitment to medical excellence.

It's the route that leaders throughout Chicago are recommending to the county with a considerable sense of urgency.

"We're making a plea: Do what is needed to keep Cook County in the forefront of medical delivery to the poor," Rep. Danny Davis (D-Ill.) said in an interview last week. "Bite the bullet and really manage properly. Satisfy the public that you're really running a top-flight ship. Restore confidence in the system."

That's going to be hard, given the extraordinary turmoil at hand. Deep budget cuts are imminent. Thirteen clinics will close and hundreds of doctors and nurses will lose their jobs, leaving behind distraught patients.

Morale is rock-bottom, pessimism widespread.

"It's shocking what's happening to our public health system," said Dr. Quentin Young, co-chair of the Regional Healthcare Safety Net Council and former chairman of the department of medicine at Cook County Hospital.

Long-term trends also are bleak. Even as the ranks of people with no medical coverage or inadequate insurance expand, available financing is falling short. New federal regulations jeopardize hundreds of millions of dollars in funding that has kept county facilities afloat for years.

Five years of deficit spending for the health bureau have consumed financial reserves, and officials privately express concern that next year's budget deficit will be even worse.

"This is a long-term, not a short-term crisis," said Patrick Lenihan, executive director of the Northern Illinois Public Health Consortium.

The entire Chicago area should be concerned, he and other experts said. Without a strong medical safety net for the poor and medically needy, the burden of illness will increase, causing enormous pain and suffering, inflating medical costs and contributing to social ills such as unemployment.

What, then, can be done to preserve this health-care system that serves hundreds of thousands of the region's neediest and most vulnerable residents every year? What might leadership look like, going forward?

Health experts offer several suggestions:

- Don't forget the patients. Patterns of care will be disrupted because of budget cuts at county facilities, and patients will face adjustments to new providers, longer waits for care and difficulty finding transportation to new locations. Leaders should try to minimize the impact, when possible.

- Fix financial systems and start collecting all revenues due for services. By the county's estimate, more than $250 million in bills for services were never sent out last year.

- Bring in professional management and overhaul human resources. These are key recommendations from an independent commission appointed late last year to evaluate the county health system. "You've got to have people with experience running this system," said Dr. Larry Goodman, a commission member and president of Rush University Medical Center.

- Start serious planning. The nature and distribution of medical need in the region has changed as more poor people live with long-term chronic illnesses and migrate to the suburbs, said Dr. Kevin Weiss, director of Northwestern University's Institute for Healthcare Studies. The county should evaluate the extent of these needs, how its existing services match up, and where gaps exist, he said.

- Work with the city and other counties. The county doesn't have to do the planning alone; the city and collar counties should be partners in the effort, Weiss suggested. By some estimates, one in every 20 patients served by Cook County hospitals and clinics comes from the collar counties or beyond. That argues for Cook County to work with other counties on regional planning and potential regional solutions, said Laura McAlpine, interim executive director of the Health and Medicine Policy Research Group, which has launched a regional safety net project.

- Reach out to other institutions that deliver care to the uninsured and underinsured. The county isn't alone in serving this population: Private community clinics and hospitals such as Mt. Sinai and the University of Illinois at Chicago Medical Center also are deeply involved. "The needs are horrendous, but [the] county isn't the only player out there," said Dr. James Webster, president of the Chicago Board of Health. "Everyone needs to sit down and say, This is what I'm doing, this is what I can do."

- Rethink the menu of medical services that the county provides. Given severe financial constraints, it may no longer be possible for the county to provide a full spectrum of inpatient and outpatient care. Instead, the county should consider contracting out for more services, several experts said.

"They don't have to be everything and do everything, but they do need a plan," said Donna Thompson, chief executive of Access Community Health Network, the largest chain of clinics in the Chicago area.

In all the changes the county makes at medical facilities going forward, the quality of care should be a major focus. The county has long been known for top-notch care, but that's becoming harder to sustain as institutions are starved for resources, including staff and equipment.

"Things are getting worse, but no one seems to care or be paying attention," said Margaret Davis, executive director of the Healthcare Consortium of Illinois.

Physicians who work at the county system supply several examples. The once-famous burn unit at Stroger Hospital, which has lost verification (a form of accreditation) from the American Burn Association, has only one burn surgeon. The hospital also has lost accreditation for its pathology residency program because of insufficient staff and resources.

"If you decide you need a burn unit, if you're convinced trauma is part of your core mission, then fund it," said one physician who asked not to be identified for fear of losing her job. "And if you can't fund it, don't do it."

By state law, Stroger is supposed to have four full-time specialists in high-risk maternal/fetal medicine staffing its perinatal network; it has only one. And only one full-time vascular surgeon is employed at the hospital's renowned trauma unit.

Stroger Hospital is struggling to get X-rays read because of staff shortages. "Even though we have made modest improvements, the problem continues," said Stroger senior attending physician Dr. Gordon Schiff in January testimony to the Cook County Board. "Inevitably, there will be cancers missed, bone fractures overlooked, treatable infections undetected until they are much more advanced."

Physicians don't want to see this kind of deterioration continue. Now, it's up to county officials and management to make sure it doesn't.



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