Cook County Health CEO Dr. Jay Shannon has repeatedly sounded the alarm on the climbing amount of medical care the government-run health system provides for no pay.
The tab of so-called uncompensated care is projected to reach nearly $600 million in 2020 — nearly double the amount in 2014. The majority of the tab is charity care, or medical care Cook County Health’s two hospitals provide to patients who are typically uninsured and don’t pay.
On Monday, Shannon underscored his big challenge to a packed luncheon at Maggiano’s in the Loop for City Club of Chicago, a public affairs speaking forum.
At one point during his presentation, he described slides that highlighted sections of discharge papers from two patients who were referred from other hospitals to Cook County Health. The practice of sending patients to other hospitals — particularly uninsured patients with expensive illnesses — is known as dumping.
“Here are a couple of examples from last week,” Shannon said. “But I want you to understand that these happen every day.”
One patient was in the middle of treatment for advanced colorectal cancer that was spreading to her liver. She was at a hospital that provided less than $3 million in charity care in 2017, Shannon said. The patient needed more tests and a surgery referral, but she didn’t have insurance. That caused a delay in the patient’s follow-up care, according to the summary Shannon read.
But he said the woman’s referral was misleading.
“This isn’t a delay,” Shannon said. “She was discharged and showed up that day with this discharge summary in our emergency room.”
“Follow up at Cook County,” he read from the patient’s discharge summary. He said the health system would be lucky if the patient’s first year of her treatment only cost around $100,000.
Shannon stopped short of publicly naming the hospitals the patients came from. But his point was clear: “We have to see more effort from the other hospitals in Cook County. We simply have to.”
He said he planned to send a note to the CEO of every hospital in the county asking them to step up and provide more charity care, so that the county’s government-run hospitals don’t have to shoulder the financial burden on their own.
How uncompensated care at Cook County Health swelled
Cook County Health’s ballooning amount of charity care is partly fueled by other public and private hospitals throughout the county that have been providing less.
In 2017, Cook County Health’s flagship John H. Stroger, Jr. Hospital on the Near West Side provided $281 million in charity care — 51% of all the charity care provided by hospitals in Cook County that year, a WBEZ analysis of state records shows.
There are other factors, too. For one, county patients who want to keep or join Medicaid, which is government health insurance for low-income and disabled people, have had a hard time doing so because of an application backlog at the state Medicaid agency.
Democratic Illinois Gov. JB Pritzker is hustling to fix it by hiring more workers to process Medicaid applications. In the meantime, the county patients still see their doctors. But now they might not have insurance, so the county doesn’t get reimbursed for taking care of them.
CEO to hospitals: Treat more uninsured, or pay up
Cook County Health is the medical safety net for the region. Besides Stroger and Provident Hospital on the South Side, it has a network community clinics that are getting new facilities or a face-lift. The network is a hub with a long history of caring for people who have nowhere else to go.
So the issue of Cook County Health providing a disproportionate amount of charity care compared to other hospitals in the region isn’t new. But it’s getting worse, and it’s financially straining the system.
The issue of uncompensated care has long been a problem for Cook County’s health system, though it isn’t discussed much by politicians. But in an unusual move, Democratic Cook County Board President Toni Preckwinkle, who runs county government, spoke out about the issue before and during her speech about the county’s proposed 2020 budget earlier this month.
Like Shannon, she’s publicly implored other hospitals to step up and treat more uninsured patients instead of sending them to Cook County. But legally, they don’t have to. And some hospitals that mainly treat the poor and uninsured can’t afford to, either.
During his speech on Monday, Shannon laid out some potential solutions to his vexing financial concerns. Besides new rules that would require other hospitals to do more, Shannon also ticked off a list that included getting more money from county, state and federal officials. He could also curb services at Cook County Health, which he said would send patients to the very hospitals that refer them to the county.
After the speech, Shannon said his letter to hospital CEOs aims to “sensitize” them to his challenges, though he doesn’t expect any immediate reaction.
“It’s simply saying we can no longer continue to bear the disproportionate burden of charity care that we do, without one of two things happening,” Shannon said.
Hospital CEOs can send Cook County Health money for the uninsured patients they refer, he said, or they can treat more themselves.
Kristen Schorsch covers Cook County politics for WBEZ. Follow her @kschorsch.