Failure to bill costs Cook health system; Officials say total for unpaid services at least $250 million

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Chicago Tribune
By Judith Graham, Tribune staff reporter. Tribune staff reporter Mickey Ciokajlo contributed.
January 14, 2007

Cook County's enormous health system failed to bill patients for at least $250 million in medical services last year, and that helped throw the system into a state of financial crisis, county officials confirmed Friday.

County spokesman Steve Mayberry said the failure-to-bill estimate is conservative, spanning a period between October 2005 and October 2006.

It's unclear how much of that money the county could have collected and whether the underlying problem was administrative incompetence, negligence or a combination of other factors.

Still, the "financial systems at the county are a disaster," said Patricia Terrell, former deputy chief of the county health bureau.

Now, some health professionals fear that patients will end up paying the price. On Tuesday, County Board President Todd Stroger will release his long-anticipated budget for 2007, a document expected to propose deep cuts to the health bureau as part of an effort to close a $500 million hole in the county budget.

Though Stroger has suggested he has some flexibility on the budget, he has recommended that $140 million be slashed from the health bureau's $832 million budget.

Critics have charged that the health bureau is larded with patronage, but Terrell said, "Believe me, patronage isn't this big a problem. There's no way to make changes of this magnitude without real danger to patients." Terrell now works for Health Management Associates, a consulting firm.

Nor is it easy to figure out how to make cuts, and where, on such short notice, without raising the potential for significant unforeseen consequences.

"The theory behind this is that there's a big, fat, bloated bureaucracy," said Dr. Saul Weiner, senior investigator at the Veterans Administration Midwest Center for Health Services and Policy Research. "That's probably true, but the question remains, will they cut in the right places? For instance, will they get rid of people because they're easy to fire or because they don't have the skills to do the job?"

Doctors at Cook County hospitals and clinics may be most vulnerable to job cuts because they don't have contracts and haven't been able to unionize.

Nurses signed a four-year contract last October that calls for seniority to prevail in any layoffs. Civil service workers also have rules protecting jobs by seniority.

What might make the most sense for the health bureau strategically and financially may not be feasible politically, some medical experts suggest.

In December, the previous interim chiefs of the health system, Drs. Carolyn Lopez and Linda Rae Murray, proposed that one way to slice 17 percent from the budget would be to close Provident Hospital on the South Side and shut all 26 community clinics. Their estimates suggest those moves could save about $140 million.

Provident sees only 60 to 80 patients on an average day, but Stroger still took pains last week to insist that the South Side hospital, an important institution to the African-American community, would not be shut.

"Yes, Provident is underused, but I think that argues for getting people to use it more," said Dr. Carl Bell, a South Side physician and chief executive of Community Mental Health Council. "Once you destroy infrastructure, it's real hard to get it back."

That's what worries other health experts about plans to close up to half of the county's community clinics, announced last week by County Health Chief Dr. Robert Simon. Although the move could save money short-term, expenses could increase long-term if people delay getting care and end up in county hospital emergency rooms with complications that require costly treatment, several experts said.

In another twist, an independent group of health-care experts whom Stroger appointed last year to examine the future of the health system won't have time to make its recommendations before Stroger lays out his budget plans Tuesday.

"I am hopeful that the decisions currently being made won't make what we're doing moot, but I do have to say that I'm concerned," said Dr. Quentin Young, the group's leader and a former county doctor.

The group is scheduled to produce a final report by the end of March.

Dr. Whitney Addington, a past president of the Chicago Board of Health, said he was in "profound despair" over developments at the health bureau.

"Where are the mayor, the governor, Sen. [Barack] Obama, Sen. [Dick] Durbin, and Jesse Jackson? Why aren't they speaking out on behalf of the people who are going to get hurt by all this?" he asked.

The answer is political leadership doesn't want to take on Cook County leadership, Addington suggested.