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Cook County Rx
Hold the line on health care costs

Friday, September 23, 2011
Chicago Tribune
by Editorial

The people who run Cook County's health system are the latest to learn that Cook County Board President Toni Preckwinkle really does intend to hold a hard line on spending. The health system's independent board wants $327.6 million from the county next year. That's $54 million more than it was budgeted to get this year.

Preckwinkle's response: No way. She's offering $243 million.

Preckwinkle shouldn't back down.

Progress on an efficient health system has been made in the three years since Cook County pols reluctantly turned control of the system to the independent board. In 2009, the county shelled out a staggering $417 million to keep the system afloat. The next year it was $274 million, thanks in part to the panel's aggressive move to secure more Medicaid reimbursement. This year, though, the county's costs have spiked, in part because the health board overestimated how much money it would take in from other sources. It is projected to spend $363.8 million from the county this year.

That's the wrong direction.

The total budget for the system in 2012 is projected at $937.6 million, a 2.8 percent rise.

"We can't cut any more without really doing harm to the people we're trying to serve," says Warren Batts, the chairman of the health board.

That's not what we expect to hear from this group of professionals, who are well-versed in budgets and delivering quality health care. Their mission is to provide quality care and set the health system on a sound financial footing, which means it must operate within its means.

We like Preckwinkle's response to the health panel: "In the current financial climate, it is not feasible for the (health system) to receive an additional subsidy from county taxpayers, and we feel that it's important for government bodies to take responsibility for their budget shortfalls."

Credit Preckwinkle for a healthy sense of urgency and resolve to streamline and modernize all facets of county government. That resolve isn't shared by everyone on the Cook County Board, as you can see from the other editorial on this page.

The county faces a $315 million budget shortfall in 2012. We can't count on every county commissioner to recognize that. We do count on the health board to fully deliver on its promises to hike revenue, cut expenses and wring inefficiencies from the system. Glaring proof that it has not: It has been four years since we learned Cook County hospitals didn't even try to bill some patients. Today, the computers still aren't up to speed; the county and its health system can't communicate effectively. Some bills still aren't going out.

So Preckwinkle should stand her ground and remind the health experts they really blew their budget this year. And she should do everything she can to help them make this system cost-effective.

The health system does face a formidable challenge: It's getting more patients who can't pay for care and fewer patients who can.

• 57 percent of the county's patients fall into a category that officials call "self pay." That's a euphemism for "no-pay." The county gives them free care. This share of the patient load has been rising in the last few years, county officials tell us.

That's right. Nearly 6 in 10 people who walk in the door for care can't pay and there is no insurance company or government program that will reimburse Cook County taxpayers for their care. Many of these patients are undocumented immigrants. Some of them live in neighboring counties and travel to Cook for treatment. Bottom line: The county is forced to eat those costs. It has to do a better job of determining who is actually a resident of Cook County and who has the means to pay for care.

• Many of the families who qualify for Medicaid are taking their business to other hospitals. County officials don't know why this is happening. They need to find out. The answer is vital if the health system is to regain Medicaid dollars and boost its cash flow.

We had high hopes when county pols finally turned the system over to the pros. The panel's prime mission: Bring expenses and revenues in line and deliver quality, efficient care. Mr. Batts & Co. have more to deliver.

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