“We recognized we had a substantial deficit and we had to close expenses,” interim CEO Debra Carey said, noting that a lot of levers were pulled—such as improving bill collection, for example—before the system moved to slash employees or service lines. “Frankly, there are only a handful of services we can even consider modifying” due to county mandates and participation in certain government programs.
Cook County Health plans to cut a total of 130 workers across all its departments (46 of the positions were eliminated in June) and reduce its reliance on higher-cost contract workers, according to the system’s proposed budget for fiscal 2021.
In addition to personnel changes, Cook County Health plans to close its Woodlawn and Near South outpatient clinics, moving patients and services to Provident Hospital on the South Side, nearly three miles away.
The move echoes a larger industry shift away from primary care clinics with only a handful of exam rooms, in favor of larger centers with dozens of rooms, as well as a range of specialty and diagnostic services. But it quickly garnered pushback from unions representing workers at the clinics, who plan to protest the budget tomorrow afternoon.
In a statement, Cook County Board President Toni Preckwinkle's spokesman, Nick Shields, said: "Provident is not closing and the emergency room will remain operational. The proposed merger of the Near South and Woodlawn clinics into Provident Hospital will mean more services, with the same doctors that patients have always gone to—now at a new location."
Other planned changes include moving some elective surgeries to Provident from Stroger Hospital on the Near West Side—8 miles away—to free up capacity there. The system also is converting Provident’s emergency department into a standby emergency department, which means a registered nurse is on duty at all times and a doctor is on call.
Unlike most area hospitals, 85-bed Provident doesn’t accept patients via ambulance, so those who show up tend to need less complex care. And with an average of only 12 inpatients per day, the hospital is considerably less busy than others in the area, such as the University of Chicago Medical Center and Advocate Trinity Hospital. However, it’s unclear how Mercy Hospital & Medical Center’s proposed closure next year would affect patient volumes at Provident, three miles away.
The system said plans to build a $240 million, mostly-outpatient facility to replace Provident will remain on hold until a permanent CEO takes the helm. But interim Chief Business Officer Andrea Gibson said the changes at Provident are seen as "an opportunity to bolster the outpatient activity that could serve to support a new Provident construction in the future." She added that a new outpatient dialysis facility and lifestyle center are expected to be completed on the hospital’s campus later this year.
Meanwhile, Stroger is the latest Chicago-area hospital to suspend inpatient pediatric care as more kids get treated in less expensive outpatient settings, while those with more complex needs tend to go to pediatric hospitals with a wider range of specialized expertise.
Between July 2019 and June of this year, Stroger’s 14-bed general pediatric inpatient unit had an average of 1.8 inpatients per day. The hospital’s pediatric intensive care unit will remain open to treat trauma and burn patients.
Even before COVID-19 started spreading in the U.S., the health system was under intense financial pressure from the rising cost of uncompensated care, which includes unpaid bills and free care. From fiscal 2015 to 2019, Cook County Health saw annual charity care alone increase 23 percent to $327 million.
The system expects charity care costs to be about $268 million this fiscal year and $312 million in 2021. The decrease from 2019 is driven primarily by a dip in patient volumes amid COVID-19, Carey said.
With a proposed $3.4 billion budget for fiscal 2021, Cook County Health is one of the largest public health networks in the nation covering Stroger, Provident, a network of clinics, a Medicaid health plan and medical services for detainees at the Cook County Department of Corrections, as well as the county's Department of Public Health.
While other public systems rely more heavily on sales taxes and other local government funding, Cook County Heath primarily runs on payments for providing medical care.
The county is providing $83 million in fiscal 2020 and $113 million in 2021 for public health and correctional health operations, the costs of which have increased during the pandemic. But it doesn't give the health system any money for providing traditional medical services—including the growing cost of providing free care to uninsured patients.
“It’s our mission to be there for patients who can’t afford to pay, but that mission really is forcing us into a situation where we have to make some choices,” Carey said. “It’s really a zero-sum for us at this point. … Our deficit is driven by what we’re trying to do. We’re trying to be there for the citizens in Cook County who have limited options.”
Reporter A.D. Quig contributed.