Cook County’s public health system expects to provide an estimated $544 million in medical care this year that it won’t get paid for — the highest amount in at least six years.
The outcry from county leaders has been consistent for years: This tab is unsustainable.
“Where does it end?” asked John Daley, a veteran Cook County Board commissioner. “We’re at a point now, when you look at these numbers, you can’t continue this.”
Daley proposes this potential solution: Consider merging the county health system with the University of Illinois’ UI Health, the other public health system in the region. It’s just a few blocks from the county’s flagship hospital, John H. Stroger Jr., on the Near West Side.
Daley is head of the county board’s finance committee, and the county is in the midst of putting together its 2020 budget. The new fiscal year starts Dec. 1. The health system, known as Cook County Health, makes up nearly half of the county’s roughly $6 billion budget. Its financial health is significant to the county’s bottom line.
Dr. Jay Shannon, Cook County Health’s CEO, said he’s not opposed to talking to other health systems. But he noted how different the county and the University of Illinois’ health systems are.
For one, they take care of different types of patients. Stroger is a medical anchor for uninsured patients. The hospital provided $281 million in medical care it didn’t get paid for in 2017 — 51 percent of all the so-called charity care provided by hospitals in Cook County that year, the most recent state records show. There are nearly 70 public and private hospitals throughout Cook County.
U of I provided about $9 million in charity care in 2017. The hospital treats far more patients who have private insurance than Stroger does.
The county health system and U of I also have different charters, governance and missions, Shannon said.
“Although we’ve talked in the past with the University of Illinois about where we might have some aligned interests and things, it’s been hard to connect those pieces because of those differences,” Shannon said.
A UI Health spokeswoman did not return requests for comment.
A stubborn trend
Uncompensated care is a mix of two buckets. The first is free treatment that doctors provide to people who are typically uninsured (this is charity care). The second is debt that accrues from insured patients who can’t afford their bills, and from insurance companies that won’t reimburse the health system.
Cook County Health’s stubborn trend of ballooning uncompensated care is partly fueled by other public and private hospitals throughout Cook County that won’t treat more patients for free, a WBEZ analysis of state records shows. In fact, collectively, other hospitals in recent years have provided less charity care, while the county health system’s two hospitals combined provided more, records show.
Hospitals don’t have to provide charity care. But they usually do to help keep what can be lucrative property tax breaks as part of a hospital-friendly 2012 Illinois law.
Cook County Health’s uncompensated care tab has climbed dramatically. It totaled $536 million in 2013, then dropped to $314 million in 2014, a year after launching its CountyCare Medicaid health insurance for people who are low-income or disabled.
But the amount of uncompensated care has risen every year since. The bulk of the tab is charity care Cook County Health provides that it doesn’t get paid for. The rest is bills the health system can’t collect.
The health system expects to finish the budget year on Nov. 30 with $544 million in uncompensated care. That’s $42 million, or about 8 percent more compared to last year — and 73 percent more than five years ago.
Shannon attributes the projected increase in uncompensated care this year to several factors. They include patients whose Medicaid applications got caught up in the state’s cumbersome application process, causing them to lose their insurance for a time. Those patients still came to Cook County Health and doctors treated them, but they didn’t get reimbursed.
Shannon also suggested more uninsured patients might be seeking care because the health system has improved access with new facilities and expanded clinic hours.
Still, Shannon said, “we have reached a point that we’re not going to be able to sustain. Whether that just simply means longer waits for individuals to get service or whether our own challenges with providing those services are going to lead people to seek services at other facilities, I don’t know.”
Cook County Health is hustling to make services more efficient and to collect all the money its owed from patients and insurers.
The persistent headache comes at a hectic time for Cook County Health leaders. With the county’s budget season underway, Shannon must appease commissioners who already are angry about another issue. In June, Cook County Inspector General Patrick Blanchard released a report that raised serious questions about how the health system operates its CountyCare Medicaid program. The report alleged Cook County Health owed doctors, hospitals and others hundreds of millions of dollars. The health system has disputed some of the findings and hired giant auditing firm Deloitte to review Blanchard’s report.
As Cook County Health leaders work to mend their relationship with county commissioners, they’re also forging ahead with an ambitious three-year strategic plan. The roadmap is focused on growth to provide more access to medical care for patients, and also to generate much-needed revenue for the health system.
Cook County Health is a medical safety net, considered to be the last resort for poor and uninsured patients. The system has two hospitals — flagship Stroger and smaller Provident Hospital on the South Side — and a network of urban and suburban clinics.
Kristen Schorsch covers Cook County politics for WBEZ. Follow her @kschorsch.