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Cook County is $68 million behind projections in collecting patient fees from its three hospitals, and leaders there say a reason for that is they don't know who's doing the work.
While voting to open negotiations for yet another contract to improve patient billing, several commissioners said they thought the county has come to rely too much on consultants whose roles overlap with county staff.
"You need a scorecard to figure out who is collecting what, consolidating what," said Commissioner Mike Quigley (D-Chicago) in asking for a list of all hospital billing contracts. "We should try to avoid the duplicative nature of some of this."
The county has contracts with at least four companies to help improve its patient billing, which is seen as a key factor in a 2007 budget deficit that could reach $600 million.
The board voted 13 to 3 Tuesday to start contract negotiations with ACS Healthcare Solutions of Michigan for a complete overhaul of the health bureau's "revenue cycle."
The company will look at everything, starting with how doctors fill out charts and ending with where bills are sent, county finance chief Tom Glaser said. Newly installed interim health chief Linda Rae Murray urged commissioners not to delay.
"We are in crisis, we are sinking, and every week we delay we're losing millions of dollars," Murray said.
ACS could help the county bring in up to $125 million more per year in patient fees, Glaser said. The company would be paid about 18 percent of any increased revenue it earns for three years, though terms have not been finalized.
Board President Bobbie Steele said she agreed with Quigley, but knew this contract was needed.
"We don't know how many (contractors) are out there or what they're doing," Steele said in her last meeting as president. "But this is a new initiative. ... It was an in-house function that wasn't functioning well."
Steele said she'll ask the company to accept a shorter contract and an escape clause so the county can terminate the deal within 30 days if it wants.
Finance committee chairman John Daley (D-Chicago), in a rare rebuke to hospital staff, said the county health system's culture had to change.
"Our staff is supposed to be doing this," Daley said. "Everyone (working there) believes it's free. ... Doctors are supposed to fill a form out, they're not doing it, and for whatever reason, disciplinary action is not being taken against them."
The final meeting of the term stretched to almost five hours as commissioners said their goodbyes to the board's senior member, Carl Hansen, of Mount Prospect, and congratulated Steele on her four-month term as president.
After 32 years in office, Hansen was unseated in the spring primary. His successor, Tim Schneider, takes office Dec. 4.
Also taking over that day will be the new president, Todd Stroger. Schneider, Stroger and Chicago Ald. William Beavers, who will take over John Stroger's seat on the board as commissioner to the 4th District, sat in the audience Tuesday next to the attorney who represented all three of them, Burt Odelson.