Cook County Commissioners Approve Strategic Plan for County Health System

July 14, 2010

On July 14, 2010, Cook County Commissioners approved by a vote of 9 to 3 a strategic plan to reorient the County’s health system more toward outpatient care and away from inpatient hospital services.

The five-year plan calls for closing the emergency room and inpatient facilities at Oak Forest Hospital. At Provident Hospital, the emergency room would remain open, but most inpatient beds would be eliminated.

Savings from these steps would be used to expand outpatient services across the County’s health system, including developing both Provident and Oak Forest as super clinics known as Regional Outpatient Centers. Stroger Hospital would continue to provide inpatient care, with a rebuilt Fantus Clinic on the Stroger campus serving as a third Regional Outpatient Center.

The plan is designed to increase the delivery of healthcare services to County residents by improving access to preventive care and reducing costly emergency room visits and hospitalizations. Total outpatient visits are projected to increase by 50% from 2009 to 2015, from 600,000 to 900,000.

The plan does not result in any financial savings to the Cook County Health and Hospitals System (Health System). In FY2015 the plan is projected to generate roughly $4.5 million in extra cash, roughly ½ of 1% of the projected operating budget of $864.9 million. Even after taking the actions set forth in the strategic plan and implementing performance improvement measures to boost revenues and cut costs, the subsidy provided by the County is expected to be roughly $330 million in FY2015, around the same level as in FY2010. These numbers do not include capital costs estimated at more than $200 million, which will be paid by the County.

The plan, which has been in the works for 14 months, was approved on June 25, 2010 by the Health System’s independent Board. The vote in favor of the plan on July 14 by County Commissioners was technically a vote by the County’s Health & Hospitals Committee. However, the Committee is composed of all of the members of the County’s Board of Commissioners. The Committee’s action is expected to be approved at the next meeting of the County Board on July 27.

The July 14 meeting of the Health & Hospitals Committee lasted for three hours, with more than a dozen public speakers testifying on the strategic plan. Critics, including patients at Oak Forest, Health System employees and labor union representatives, were particularly concerned about the proposal to close Oak Forest’s emergency room, which handles more than 30,000 patients a year. They said other hospitals in the south suburbs would not welcome uninsured patients and were likely to stabilize the patients’ condition, as required by federal law, and then send them to Stroger.

Health System officials said they planned to make arrangements with hospitals near Oak Forest to handle patients who need emergency room care. However, they said that the majority of those seen at the ER at Oak Forest could be treated more efficiently at the clinic to be located at the site. Officials said inpatient operations at both Oak Forest and Provident are too costly, with about 40 beds occupied a day at Oak Forest and slightly more at Provident. Negotiations are continuing with the University of Chicago Medical Center to keep inpatient services open at Provident.

Civic Federation President Laurence Msall testified in support of the Health System’s strategic plan as a step in the right direction toward delivering the best healthcare possible, given the limited resources available. Mr. Msall commended the Board for implementing the strategic planning process, which relied on outside professionals to assess how well the Health System served the needs of the community and what improvements were possible, again given limited available resources.

The Health System is proposing its strategic plan at a time of great uncertainty for healthcare providers in the United States. While the precise impact of national health reform on the Health System is difficult to forecast, it is clear that a more focused, cost-effective County health operation will be in a better position to meet the challenges that lie ahead.

Although supportive of the planning process, the Civic Federation is concerned that the Health System has proposed a plan with no net cost savings.

In the end, Commissioners have to decide whether this plan is affordable in light of the County’s precarious financial condition, or whether additional restructuring to cut costs might be necessary.