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Preckwinkle counters IG report on Cook hospitals, says system continues 'to reform and modernize'
Thursday, May 17, 2018 Chicago Tribune by Gregory Pratt
County Board President Toni Preckwinkle on Wednesday acknowledged problems with Cook County Health and Hospitals System’s billing procedures, but took issue with an inspector general report that found estimated revenue losses of $165 million over three years due to widespread errors.
Preckwinkle, who spoke alongside Health and Hospitals System CEO John Jay Shannon, said other recent financial audits found that the system’s finances were healthy and in good standing. Nevertheless, she said, the Health and Hospitals System is “developing competencies” when it comes to addressing billing changes brought on by the national Affordable Care Act and has seen improvement.
“While there’s work that needs to be done to address some of the issues the (inspector general) found, it’s important to remember that the county’s hospital system has worked to reform and modernize its operations,” Preckwinkle said. “It continues to do so.”
Cook County Inspector General Patrick Blanchard issued a report recently identifying widespread issues in the system's bureaucracy — from mistakes during patient scheduling and registration to billing lapses. Blanchard identified $165 million he said the hospitals lost due to various problems, including unmotivated workers and doctors who have “not fully embraced the necessity of accurate coding” for patient service, which affects bills.
Blanchard’s report also said that his office interviewed hospital staffers who suggested there are “a significant number of registration clerks, coders and billers who do not possess adequate self-motivation or the required skill sets and knowledge base” to do their jobs.
Preckwinkle pointed out that the amount of money paid to the hospital system by county taxpayers has shrunk from nearly $500 million in 2009 to a bit over $100 million today.
She said Blanchard’s report oversimplified an “incredibly complex issue.” All hospitals at any given time have “uncollected receivables” that can fluctuate dramatically.
Blanchard, however, said Preckwinkle’s comment is accurate “but unrelated to the issues” in the report, which is money that has been written off. Blanchard said his office stands by its estimate that the hospitals lost out on $165 million in money it wrote off and said his report clearly explains how his office came to its figures.
Shannon said he was unclear on how the inspector general reached the figures in his report and couldn’t comment on the dollar amount. A Health and Hospitals System spokeswoman previously told the Chicago Tribune that the loss over the last three years could be fairly estimated at $79.5 million to $132.5 million.
“Is it correct on the big picture of we can do better around revenue capture?” Shannon said. “I’m sure it’s correct.”
In his remarks, Shannon pointed to broader changes for the hospital in recent years. Before the Affordable Care Act, the hospitals took in “very few insured patients” and were largely paid on a fee-for-service basis by Medicaid.
Now, the contracting and insurance landscape is much more complicated for the hospitals, Shannon said.
“These contracts have required complexities and expectations around every step of billing,” Shannon said. “We’ve built up a staff that is learning the complexities of that billing, and we’re happy to say that in the last four years, we’ve been able to see signs of competence of that within the organization.”
He noted that the hospitals saw less money written off as a loss in 2017 than in 2016.
“The fact that the inspector general pointed out we are imperfect in some of the very complex steps around revenue capture, in a skill and competency set that for our health care organization is less than four years, is not a surprise to me,” Shannon said. “It’s something we will continue to try to improve on.”
Preckwinkle and Shannon both criticized the inspector general for not interviewing the top financial officials at the Health and Hospitals System.
Asked about the criticism, Blanchard said his office didn’t think it was “necessary,” as top officials had previously spoken at board meetings. Instead, Blanchard said, his office spoke directly with people who deal with the issues “on the ground.”
Blanchard agreed that the hospital system has shown improvement and said he expects it will continue to get better at collecting revenue.
“We’re hoping to just shed some light on that issue and encourage the system to continue to work toward improving their procedures,” he said.