Monday, May 14, 2007
Crain's Chicago Business
by Mike Colias

Illinois' congressional delegation is pressing Cook County Board President Todd Stroger to clean up problems at the county's cash-strapped hospital system if he expects lawmakers to fight for more dollars from Washington.

During a tense meeting at Sen. Richard Durbin's office in the U.S. Capitol in March, the senator and a half-dozen other Illinois lawmakers raised concerns over problems that led to recent job and service cuts at county hospitals and clinics.

Sen. Durbin urged Mr. Stroger to bring in outside advisers "who know what they're doing" to help overhaul the system, says a person who attended the meeting.

Mr. Stroger appears to have heeded the blunt advice. This week, a freshly appointed "blue-ribbon committee" of local health and business leaders convenes in Chicago. At Sen. Durbin's insistence, the eight-member panel will look beyond the Bureau of Health Services' fiscal woes to recommend broader fixes to an entrenched management structure that critics say breeds patronage and incompetence.

The ultimatum from congressional Democrats who backed Mr. Stroger's election in November shows they intend to hold him to his campaign promise to fix management problems and end patronage at the health bureau. Mr. Stroger needs them: He is seeking more than $200 million in additional federal funding for the health system.
So far, Mr. Stroger hasn't embraced outside advice on health system reforms. He hasn't responded to a report submitted to his office two months ago from a "transition committee" on health that he appointed after he won office, according to panel members (Crain's, April 9). The 21-member group called for Mr. Stroger to cede hiring decisions and other day-to-day oversight of the health bureau to an independent board.

Mr. Stroger isn't bound to act on any recommendations from this latest panel, either. Sen. Durbin didn't promise future funding and made no specific demands of Mr. Stroger, other than that he take the committee's advice seriously.

But some panel members are hopeful that pressure from Sen. Durbin and other congressional leaders will carry added weight.

"I'm not sure anyone would have agreed to serve if there wasn't some clout behind this," says Kathleen DeVine, CEO of St. Anthony Hospital and a member of the blue-ribbon panel, who also served on Mr. Stroger's earlier health committee.

The meeting in Sen. Durbin's office "raised the expectation that Mr. Stroger show leadership and get a handle on the problems facing the health system," a spokesman for the senator says.

Among other key lawmakers present were U.S. Reps. Rahm Emanuel of Chicago and Jan Schakowsky of Evanston. Neither they nor Sen. Durbin could be reached for comment.

ADVICE 'WELL-RECEIVED'

"That input is well-received by the president," a Stroger spokesman says. The new panel will help "oversee plans for overhauling the health bureau's processes and procedures" and continue to meet until major changes are carried out, he says.

As for the first committee's seven-page report, the spokesman says it's still being compiled with reports from four other transition teams to be formally presented to Mr. Stroger.

The county board president insists he and interim county health chief Robert Simon have set in motion a strategy to fix the fiscal problems he inherited from his father, former board President John Stroger. They have hired consultants to suggest ways to boost revenue while beefing up staff training to curb billing errors, which resulted in $250 million in unsent medical bills last year. The 2007 budget for the county health system is $745 million.

Critics say the financial problems are rooted in an outdated governance structure that leaves oversight of the three-hospital system to the county commissioners and board president.

That presents "a clear opportunity to use the system for political hiring at the expense of best-qualified health management leadership," says a study last year by a health policy group affiliated with Northwestern University's medical school.

More than 1,000 county health workers are being laid off under Mr. Stroger's 2007 budget, which cut the health bureau's funds by 9% to help plug the county's $500-million budget hole. Some services at the county's three hospitals — Stroger, Provident and Oak Forest — also are being trimmed.