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  Cook County Hospital fills more outpatient prescriptions every day than are filled at 26 Walgreen's drug store combined.

Outpatient focus core of new Cook Co. health plan
HEALTH SYSTEM OVERHAUL | Proposal would cut inpatient care at Oak Forest, Provident hospitals

Monday, July 12, 2010
Chicago Sun-Times
by Lisa Donovan and Monifa Thomas

Cook County's health system is looking at a dramatic overhaul, shifting away from costly inpatient care at two hospitals in favor of more extensive outpatient services.

While the move is being praised by health experts, a new strategic plan that lays out the overhaul is likely to face strong opposition when it's introduced to the full Cook County Board this week, particularly ahead of November's elections.

Under the five-year plan, Oak Forest Hospital would discontinue all inpatient care and become a regional outpatient center that would provide a wide range of primary care services.

Inpatient services would also be scaled back at Provident Hospital, 500 E. 51st, but the emergency room and a few short-stay beds would stay open. Provident could retain more of its existing services, though, if a partnership is brokered with the University of Chicago Medical Center.

Inpatient care reductions are expected to generate $72 million in savings that would be used to beef up primary and specialty services and compensate community hospitals for treating displaced patients from Provident and Oak Forest.

The hospital system would also spend $202 million on capital improvements, such as rebuilding Fantus Health Center at 621 S. Winchester and building a new outpatient clinic in the northwest suburbs.

More outpatient centers should translate to shorter waits for mammograms, colonoscopies and other routine exams, hospital system CEO William Foley said.

"We feel strongly that we're expanding services, not taking services away," he said. "We're placing our services where our patient population is to make it more accessible."

The plan, the culmination of a year-long $950,000 study with Chicago-based Integrated Clinical Solutions Inc., was unanimously approved last month by the independent Cook County Health and Hospitals System Board. On Tuesday, it is scheduled to be introduced to county commissioners, who will have the final say on whether the plan advances.

Dr. Quentin Young, a longtime health-care reform advocate and former chief medical officer of Stroger Hospital, called the planned reorganization "very forward-looking" and said the emphasis on preventive medicine is the right one.

"Obviously, you want to have a skilled hospital when that need arises, but the real solution to the county's care of the population it serves is properly placed outpatient clinics," Young said.

He added that it's critical for the county hospital system to form solid partnerships with private hospitals that would be able to treat patients who would be displaced from Oak Forest and Provident hospitals.

Dr. Kevin Weiss, a professor at Northwestern University's Feinberg School of Medicine who wrote a scathing report on the county health system in 2006, called the plan a "double-win" that will improve the financial health of the hospital system and provide better care to patients.

But Harry Mitchum, who said he once waited in Provident's emergency room for eight or nine hours to see a doctor, wasn't sure what to make of the proposed changes.

"People who live over here, they want to come here to this hospital. They don't want to have to go to the West Side," for an extended hospital stay, Mitchum said, referring to Stroger Hospital.

And while there are other hospitals nearby, Provident is part of the countywide system that everyone knows will see patients who have no money to pay for health care, said Mitchum, who has diabetes and hypertension.

Cook County Commissioner John Daley, a Southwest Side Democrat, said the key to this plan's success is changing some patient attitudes, including seeing a doctor for regular checkups instead of waiting until they're gravely ill to go to the emergency room.

That was the goal of expanding the county's clinic system over the years, Daley said, "but we still have a lot of people who wait to the last minute."

"How do you draw people in so they're not showing up in the emergency rooms? It's something all hospitals are dealing with . . . and, yes, it will be a hurdle here."

Commissioner William Beavers said Provident needs to continue offering obstetric and gynecological services, not cut them as the plan calls for, and Oak Forest needs a true emergency room, not just a walk-in ER. His district is sandwiched between the 113-bed Provident and 115-bed suburban Oak Forest hospitals.

"If these were full-service hospitals, they would pay for themselves," Beavers said.

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