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Plan to overhaul Cook County health system set for vote
Independent board to vote Friday on new strategic plan

Thursday, June 24, 2010
Chicago Tribune
by Judith Graham

Put more medical services in needy communities. Emphasize care that keeps people healthy or minimizes illness. Develop partnerships with other clinics and hospitals. Become more customer-friendly.

Those are the pillars of a new strategic plan for the Cook County Health & Hospitals System to be voted on Friday by its independent governing board. The blueprint then goes before county commissioners in July.

While complete details aren't available yet, the plan is the most important effort in years to address the public health network's long-standing problems, among them inefficient operations, long waits for care, abysmal financial management and a poor record of improving the community's health.

"We know we need to redesign in a major way the way we provide our services," said Bill Foley, the system's chief executive.

The plan emphasizes serving more patients in outpatient clinics in city neighborhoods while reducing Cook County's historical reliance on expensive inpatient hospital care, a shift that drew praise from health experts.

"This is a very necessary, progressive and positive set of moves, and it's long overdue," said Dr. Kevin Weiss, a professor at Northwestern University's Feinberg School of Medicine who authored a highly critical 2006 report on the county's health system.

"They're emphasizing access to care, which I think is right" given the extent of need in Cook County, said John Bouman, president of the Sargent Shriver National Center on Poverty Law, based in Chicago.

The county health system is the medical provider of last resort for almost 800,000 county residents who don't have health insurance, providing nearly $500 million in free care every year.

Under the plan, the county would begin offering specialty services — such as consultations with orthopedists, endocrinologists and urologists — at county clinics in Cicero and Cottage Grove and at a new clinic in Arlington Heights or Des Plaines.

Similar arrangements may also be reached with dozens of private clinics in Chicago and its nearby suburbs. "We could provide the specialty care while they provide the primary care," Foley said, describing potential partnerships.

Donna Thompson, president of Access Community Health Network, the largest chain of health centers serving low-income patients in the region, said her organization was interested in this kind of relationship.

"Real people are waiting in real lines for service," she said, noting a significant shortage in specialty medical care for people without insurance or financial resources.

More than 4,000 patients are waiting for colonoscopies and gastrointestinal consultations at county facilities, while nearly 3,000 women are in line for gynecological checkups and almost 2,000 are on hold for CT scans, MRIs and X-rays.

Joyce Johnsonsmith, 67, has been trying to get an eye exam through the health system for more than two years. Every time she makes an appointment, she said, the doctor is too busy to see her. After experiencing physical trauma in 2008, she had to wait a year to get a CT scan of her head.

"I was so frustrated, so scared," said Johnsonsmith, a retired county worker who lives on a small fixed income.

Most controversial in the new strategic plan is a proposal to convert Provident Hospital and Oak Forest Hospital into large outpatient centers, a move that could endanger jobs at the two underused medical centers and that has drawn strong union opposition.

"Our concern is that people won't have access" to needed hospital care, said Christine Boardman, president of Service Employees International Union Local 73, which represents 1,500 workers in the health system.

The situation surrounding Provident Hospital — a pioneering African-American hospital with deep roots on the South Side — is especially complex. If negotiations under way over a possible relationship with the University of Chicago Medical Center are successful, the institution would remain largely intact.

But those talks have been rocky. If they fail, the proposed strategic plan would significantly scale back services at Provident, which would keep its ER open and retain a few dozen hospital beds for patients who need to stay overnight.

The county began the process of closing Oak Forest's long-term care unit several years ago. The fewer than two dozen patients who remain would be placed in nursing homes and rehabilitation facilities under the plan; the facility's ER and hospital beds would close.

"That concerns us because this is an area where medical needs are growing," said William McNary, co-director of Citizen Action/Illinois.

Foley acknowledged that to take care of county patients, "we would really need to build relationships with other hospital providers" on the Far South Side.

Also controversial, given the county's precarious finances, is a proposal to spend $143 million over the next five years on capital improvements for the health system: renovating facilities, strengthening services at Stroger Hospital, rebuilding the Fantus Health Center and building a new clinic in the northern suburbs. The sum would come from county coffers.

Another $310 million is slated to overhaul health system operations between 2011 and 2015, an expenditure expected to be offset by savings at Provident and Oak Forest hospitals. Whether those savings will materialize remains an open question.

"There will be considerably greater convenience for most patients," said David Dranove, professor of health industry management at Northwestern's Kellogg School of Management. But costs don't necessarily plummet when a hospital is converted to outpatient care, he said.

The county health system's 11-member independent board was appointed two years ago to govern the network, freeing it from political meddling that made it a patronage haven and hampered effective management. Earlier this month, Cook County commissioners voted to make the independent board a permanent body.

If the board approves the strategic plan as expected, it will go before county commissioners, who are responsible for authorizing funds for the system. Commissioners may vote on the blueprint next month or defer a vote until after a new board president is elected later this year.

Timing is important because the medical landscape is set to change dramatically with the rollout of national health reforms. Hundreds of thousands of poor, uninsured adults — the county health system's core clients — will gain insurance cards and the ability to choose medical providers for the first time in 2014.

If large numbers of people elect to leave the county health system, that could prove devastating. "We've got to improve our services and improve our infrastructure or we'll lose a large part of our patient base," Foley said.

Currently, many people chafe at the kind of experience Lynn Crenshaw said she had when she was hospitalized this year for rectal cancer and encountered nurses who wouldn't respond to her requests for help. "I was born at Cook County Hospital, I've been going here for 41 years, I love the doctors, but some of the staff, they're rude beyond belief," she said.

The county health system will be moving "in the right direction" if it adopts the new strategy that has been proposed, said Terry Conway, a former official at the system and current managing principal at Health Management Associates.

If the plan passes, the concern is whether the county has the commitment and the resources to pull off implementation. "It's a great long-term vision, but getting there is going to be really hard," said Margie Schaps, executive director of Chicago's Health and Medicine Policy Research Group.


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