And this year? For the first three months of the fiscal year that began Dec. 1, the health care system eked out a $2.1 million budget surplus, driving an overall county budget that also was roughly on target.
Reason to celebrate at least a temporary end to the bleeding? Sure. Reason to declare victory? No. But after so many years of rampant mismanagement, cronyism and corruption at the health system, we'll take it.
The prognosis, although brighter, remains guarded. The health system fell short on collecting patient fees for two of the first three months of the fiscal year. A windfall of federal dollars from a retroactive Medicaid rate hike made up the difference and allowed the health system to post that gain.
Raju says the system will fall short of its budgeted revenue number for this year, but by "much less than" last year's figure.
"No miracle has happened, but we're moving in the right direction," Warren Batts, chairman of the county's health system's independent board, tells us.
Here's what everyone with a stake in this health system — taxpayers included — needs to know:
• A system notorious for not sending doctor bills to patients is now doing so. The system has collected an extra $1 million so far this year; Raju told us he expects to reap $8 million to $10 million this year. Some docs in the past have resisted billing patients whom they viewed as unable to pay — unauthorized acts of charity that flouted county policies. "He has been able to get the doctors to bill for their services more than I ever thought possible," says Cook County Commissioner Larry Suffredin. "I marvel at that."
• Another marvel: A mountain of backlogged hospital bills that hadn't been mailed — $14 million worth for inpatient visits, if you can believe it — has been whittled down. New financial systems coming on line mean that the county "will have a system in place that will bill and collect everything we need to," Raju tells us.
• A system that didn't know enough about its patients — How many come from other counties for care? How many are undocumented and thus ineligible for any government reimbursement? — is now collecting more data on patients. That will help the county seek federal reimbursement and bill patients more consistently.
One key to improving the health system's finances going forward: Attract and retain Medicaid patients. Right now, many Medicaid patients are abandoning the county's health system. Think of them as customers who, when they leave, take their Medicaid payments with them to other health providers. A high percentage of those who remain in the county system are so-called "self-pay" patients — a euphemism for mostly uninsured poor who, in fact, can't pay.