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tv   Aging and Adult Services Commission 6116  SFGTV  June 9, 2016 5:00am-6:31am PDT

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for their sole hard work in getting us ready for today and a final thank you to everyone ♪ chamber this morning for being part of this very important city process thank you, everyone >> (clapping.) >>
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>>[gavel] >> recommissioned will please come to water and the secretary will call the roll. >> >>[call of the roll] >> the second item on the agenda the approval of the minutes of may 17, 2016. >> >> moved and seconded. all those opposed? the minutes have been approved. thank you. >> item 3 the directors report. >> good afternoon, commissioners. as you know well known out that we have been successfully moved into a new building. according to our ceo everyone is trying to acclimate to a new building with lots of space. so, i think that will be
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an ongoing process. we would like to acknowledge and we have jeff critchfield here on the medical staff and of course our ceo in roland, many who have done many many hours and getting prepared to move into the new building. the san francisco general hospital foundation played a tremendous role in raising support to furnish and equip the building. i dedicated partners at ucsf and public works of turn our shared vision into reality. so kudos to the entire hospital staff, the nursing staff facilities management in financial services, i do want to acknowledge it today they tell me they only have 10 orders and they were on 24-7 during the process to ensure it was up and running. i believe they did a great job as well. so, everyone from communications to food service so i have talked to every single member of san francisco
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general theme. mayor lee presented his proposed balanced budget for fiscal year 2016-2017-2018. here olivia more about that just today i will go into that too much. i do want to-i want to make sure ron is here. yes. we did have a memorandum of understanding and negotiated with local 10-1 nurses and teamsters 856 supervising nurses. by directors report we have all of the areas that we did negotiate and have an agreement. just to know, the agreement was for one year. so we'll be right back in it up in the mind of march. we also have a time study doubt be happening right before that. because as i just talked about the new hospital, time study will be important to ensure we have the right staffing for the building. and if you want after my directors report any details regarding the mou ron is here to present. i want to
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acknowledge and also just announce that we are working on electronic health record. they will be our health chief director. along with bill kim. newly working in their already working many many hours already. we had men meeting so far with ucsf just a meet and greet. we will be bringing, and we have named adopted the apex or affect, for our organization get it called dph at that. of course, it requires a complex multi-staff analysis on a clinical revenue cycle, technical governance and contractual relationship with ucsf. so, our goal is to reach a point by the end of september with both dph and ucsf. we have a path for. we will be bringing ongoing updates to the
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commission every six months. and one should be coming shortly for you to know we have-we are working i think very diligently on right now with ucsf staff to start the process of a negotiation. only to invite all of you too much with the department of public health contingent in the 2016 tri-care not. this year's theme is for racial and economic justice and we like to invite all the commissioners to march with us at the great day two and we are moving and merging all of our activities together. so, will have participants from all over the department even san francisco general, please bring your family and five. i will leave it there and if there's any other questions any other items. >> commissioners, any questions
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on some of the topics will be discussed later but questions at this point for the director, please? seeing none, thank you very much. we will move on. >> yes, item 5 is a report that the financial planning committee. commissioner chow shared that today. >> okay. yes, i i'm now looking for all the notes. hold on. >> i'm sorry. i received no quest for general public, and so that's why we are moving on to item 5. >> yes. commissioner singer and i meant they productively over the last several hours and we heard a report on the relocation request for the institute of i can. in fact, it
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is an extension of their service, an extension of their service into the excelsior from where they are because they feel percentage of their population that they have been serving actually lives there. so, this brings the services directly into their neighborhood . it is a site location and the testimony from the public and also the services that the that will be rendered there will be a culturally competent for the latino population that has moved into that area. so, we will be providing a recommendation for you at the consent calendar to accept this oppositio facility siting. the next item that we also took up was the contracts report. we heard of the three contact
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reports that are before you that were in the packet, are being recommended for approval. these were actually 10 year contracts for which a five-year contract was released and i and this is a renewal of five-year contract. along with a cost-of-living increase that was passed by the mayors-that was proposed and passed for these contracts. the fourth contract is being at the moment withdrawn as-wes i get the first three contracts, therefore, would be forwarded to the consent calendar with a recommendation for it to pass. there was also been a long discussion on the dph sole-source process. for which we heard the protocol that is
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written policies and procedures that are used to place organizations onto the dph sole-source contracts list, which we will also be asking for your approval. under chapter 21.42 of the administrative code. there were two other reports that were present and in your packets. one is the report that is submitted to the board of supervisors under the sunshine ordinance, which then, outlines what-which contracts have actually been awarded under the sole-source contract. in a second report, which also shows the usage of those contacts for this year. so, this was a product. the reports and the
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protocols were a response of the department to our request that the finance and planning meeting for more explicit process for the sole sourcing so that when you see the document for the contracts approval at the consent calendar , it will have a column that will also-this is new and being distributed. you will have a column that says these are being continued and a column for those that are actually new contractors, and then a delete column showing that there is, in fact, a process of reviewing these on an annual basis and looking for which would be contacted. the sole-source list is only a potential list of
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contractors and is not the contract. but, if there were to be a contract to be awarded, within agencies who are on this list, then there could be a sole-source contractor. so, it is a process for convenience of the-of our process in the city for contracting in instances in which there are needed services and for which, then, would take time to propose our rfps and the usual city process. and has been a process at the board of supervisors had given us to be able to-to be able to answer the need for services while going through the regular formal process for the contract proposals in the future. most of the commissioners are familiar with the source source list and you will now see them that the sole source with as a process for being updated with this protocol. what that usage was last year, what was the
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report that was given to the board of supervisors to describe the contracts, and then our own requirement for us to pass this in order for the department to have an approved sole-source list for possible use for this coming year. so, the committee then also continued its discussion of contracts. the contracts process including this time completing a review of the manner in which contracts are awarded and how they are being monitored and we will be continuing a series of this discussion over the next several months. the documents are all available for each of
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the commissioners to read and i'm sure that also, we will be happy to staff would be happy to fill you in on any of the discussions on those, if you're not clear. we will try to then, after that, overall exposition, bring a summary to the commission at the end of our discussion in terms of the entire contract process we are monitoring. so, commissioner singer do you wish to add anything to that? did i omit anything? >> the only thing i would add on the last point which is kind of up monitoring and compliance thing am a i think we really are trying to be do things once get appreciation for what goes on in terms of monitoring and compliance, both from a regulatory standpoint and an outcome standpoint. particularly, from a regulatory standpoint, then, go into the second big issue, which is just trying to understand are we allocating our compliance and monitoring resources
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disproportionately to the areas where we in our contractors have the greatest risk. i would say we are far along although not complete in understanding the process, and i think we are starting the dialogue on becoming convinced that were actually allocating our precious resources in the places where the exposure for us is the greatest. that's a work in progress. >> i mentioned, in fact, the discussions have indicated the wisdom of centralizing all contracts management for the entire department and that we are actually now able to understand and, i believe, the department is more clear in terms of how it and is doing. it's contracting its monitoring and we will soon be agreeing to how they actually have been in
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the contract developing the criteria for the performance, and then how then these are being used for evaluation and renault and so forth. so, i think the work i want to commend the work of the department to bring enough forth to us so we can have this dialogue and be able to be sure we can be also supportive of the process. are there any questions about any of these topics? puppy happy to answer them. if not, then-dr. singer >> i would just make a comment pertaining to the new satellite clinic. you know, this organization is really played a significant role within the latino community for many many years and its presence in its
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site now has really been a major significance. it's a block away from the mission cultural center. a used to be very active for horace mann which was very active two years ago. a number of the other school seasoned seo travis elementary, you name it all the way down. but things change. horace mann is no longer horace mann. it's now when a vista which is next to accept general where we have many programs there. bryant elementary was moved to point a vista. there were at least 28 family restaurants and facilities that play a critical part within the past three years that are no longer there. from nicaragua, venezuela, when rico salvador and mexico. the mission is already changed and i am so
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glad to see that we are on the alert to follow where our patients and our students and our kids need the support service. you used to see many many kids lined up at 24th and mission going down a block away to this center and back and forth and back and forth. you look at it today and there isn't that many kids taking a 48 and these other buses. there are people dropping suvs and dropping people off at horace mann into mortuaries that were around the neighborhood now private schools. these are overfilled and there's all sorts of changes going on. but what i did want to say, and i think this commission should be acutely aware. i know the director is, this group has held steadfast. i mean it involves in activities when we used up mission high school and
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others in the park, there will be a cooling off her not get the provide resources aboard and work with the community but as i said things have shifted now. the challenges are different now. but, they are right there and there supporting what we are about and without department is about some back to see this new opening of the satellite clinic which is really going to serve kids that are risk now that were not or didn't have the services before. any comment? so i would support the motion >> i would just add to that dr. sanchez, thank you so much for acknowledging [inaudible] and we had to staff numbers year-to-date and i want them to send back their message to their ceo, which is dr.-who called me not very long ago to tell me that she has completely paid off their building through a lot of hard work and so they have-they will be there for a very long time. because now they i can and i have not seen a nonprofit in our system really
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go to that length. we do have on them for many years but [inaudible] and is the sole owner of this beautiful mewling on a mission another saboteur were very proud of the organization and are doing great work so thank you so much dr. sanchez and think of for your hard work. >> thank you. yes, commissioner speak harsh karshmer >> thank you for the report about the process you're going through to better understand the contracting process. i'm looking forward to a primer on that when you get it all sorted out >> they have begun with a primer i think were going to go through. we can all- >> you can slow it down for us. >> dr. chow, is your point contact on that. >> thank you >> thank you. i think well appreciating the work. we know everyone has been doing the work
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and this is it's like the documentation that's required to evaluate how well everyone is doing. >> just to know, does represent about a half billion dollars of our services the muscle it would be great to have some high-level review for the full commission for you to understand. we will be happy to do that. >> we will be doing that. thank you. any further comments or questions? if not, then shall we-any public comment? >> no public comment request for this item we can move onto item 6 witches consent calendar and i'll note again, on the conduct report the website contract has been taken off. so, as you consider approval just note that report will not contain that contract. >> i guess i did forget i didn't let me go back, on the consent calendar let me make a comment then because which was on the new contact. the better world advertising is going to be
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-has been proposed. with a cdc grant for $470,000 and i did not explain that. it will be a social marketing assess, particularly, beginning with the private program in the latter part of this month, and will be encouraging the promotion of crap along with also then the-as said already in the proposal, looking at the healthy sexual approach towards the use of prep. so, this will be a program that we did ew
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eight and also are recommending for approval and i did forget to mention that during my report. so i want to be sure we have that before you in case anybody would like to ask any questions on that. otherwise, we can then proceed with the consent calendar. >> i move acceptance of the consent calendar >> >> moved and seconded. further questions or any i should state any extractions on the consent calendar if not let's proceed to the vote. all those in favor say, aye. opposed? the consent calendar has been adopted. thank you. >> thank you. item 7 is the zuckerberg san francisco general with action on heritage with our general committee. >> thanks martin. a delight to be invited to speak with you today and i'm appreciative of dr. sanchez already setting a tone, a reflection and shared celebration. just as context, i've given this part of this of a talk four days before the new
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hospital opened and really the idea is it's important to know your roots, as you look backwards at you know where you are going it's important to be good to know what's important to you in the midst of all this distort change that's happening. so, i'll bring this up and then i'll begin. >> it should be on the left. >> this one? thanks, mark. so, initially, it came out of talk we gave about care experience. the chief medical extent officer but creating a sense why, why do we care about the spirits of our staff in our patients and although the focus on the general because were opening in four days of what you'll see is a theme of how are also integrating it across the community. so, here we go. the details of this map are not that san francisco. so, what i
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want to start with is before we even got to the hospital at potrero, was a hospital that state marine hospital built in 1851 and that's all and actually north beach because the cholera outbreak the state of california put together $50,000 and will keep track of the money about the billions they go on, $50,000 for 150 bed facility that very quickly at 400 patients in it. they had to move in this then brings us more to the potrero. they go the hospital on 1872 at potrero. it was a wooden building because it was going to be temporary. of course. that one went for $250,000. in 1872. what's going on about this this is cholera, this is diphtheria, smallpox that's happening in the response from the department of public health to meet the growing needs of san francisco group and
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particularly around infections not surprisingly. importantly, this also you: begin a training program in intermission and sign the contract with the city to do a training program after at this hospital was going to become ucsf and then also stanford ucsf has maintained the relationship since 1873 and the you would stanford went out. i was in the 1950s and the contact we had with him also went away. so, that relationship, the training and the next generation really began in the 1870s. how can you talk about the history of san francisco without mentioning 1906 at 1906 the earthquake importantly for the temporary building that still standing in 1906 survived the earthquake. it was solid ground there. then, susan-she began on and taught me around the same time with
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althe disruption of the earthquake was tons of that that i cannot everywhere and twitter norma's bubonic plague outbreak around this time, and that the hospital did not survive it so, we were treating lots of patients with bubonic plague at the hospital. the dph folks came and collected freeze from that and determined that those fleas cause sf general had bubonic plague burn the hospital to the ground. so it went away. around that time, then other parts of the city started to pick up the slack and this is an iconic picture as you may well know, this is the administrative building of what then was the buildings they were building in 1915 on. on this one, you can see i took this picture is not too good. the gate that is down front is extent. that's still in place and the building to the left the tower of there is also there. this is on tuberculosis but we had set at this time san francisco had the largest rate
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of tuberculosis in the united states. people were dying at this time. also, this is 1915. this is subsequently 1918 when the influenza happened the mother pandemic occurred at this time. we, the general was an important part of than responding to that. a couple years later, 1924, i think was, when the first psychiatric wards were open to expanding beyond infectious diseases into more completely meet the needs of the community. that building stood for 50 years. in 1965, it was determined that a new hospital had to pass and proposition then-i don't was proposition a but the proposition the past importantly, with the most highly supported proposition since 1906, and the bonds come and $33.7 million, went through
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for that building and that's the building that we currently have that becomes important again because of this just as the other buildings kind of were in the midst of important epidemics or social needs were predated them, you know, soon after this hiv. the importance of the hospital to come together around hiv good so, i did talk about more of the at that site, with happening with regard to the needs of the city, but also but this time it's really important to know another scene that think it's critical for us to keep in mind i'm a which is this theme of health justice. so in the 60s and 70s with the war on poverty, this is when the rise mission neighborhood health was one of our first primary care clinics wittily on the block in the 1960s. that building went up to subsequently, as you see i could help up what a picture did find was an important mentor and given a minute just past, but get involved in things like medicine doesn't get involved with so upper west use native americans indigenous people on alcatraz and holding
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a weekly clinic caring for them. if that's dick's picture there. i would give his talk his wife was at that [inaudible] he's not one of the prisoners with mental care crisis could he stuff out letter that wrote the federal grant that was interesting really creative notion that was a federal grants program to support mental health and communities and he said, gosh the jail is a community. should we deal to get funds for one of the first mental health facilities in the jail system? this is nice because this is a picture of the family and community medicine, don bank and seeing what was happening with the consortium clinics and the mission neighborhood said we need to do something here and got a war on poverty grant and helped form the family community medicine group. this is the early 70s they open the clinics in south of market.
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really young looking people that we know there that are now-this is really a key piece of the social aspect. then, as i alluded to before about the rise of hiv, and i think in preparation for the stock has been a lot time with dn jones who was one of the first nurses actually on what became 58 which is the first hiv clinic, hospital base unit in the world at the time when no one wanted to touch people with hiv or come near them. we needed to come together. what was so interesting and a lot of this came also not familiar with the video i highly recommend it which is called life before the lightbulb. it's 30 min. video. online but how do we care for folks before 1996, before highly integrated mobile therapy when folks were dying to the toilet to make, this is a time we were partnering with communities in different ways. there was lots of humility. we weren't sure what was going on. we had to partner with people. we've
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partnered with community groups. so this is an attempt to show how we sought out medicine in different ways. so up in upper left is real rocky. i do know hugo about legal rock. she would come in every week and bring food to this notion of what we don't have great medicine for people we can bring people food and we can make them laugh and we can help them smile. she raised money by tapping thing in a leather bars down in folsom and then with the money she made came in and or the unorthodox partner for people-to partner with. this a picture of [inaudible] and she's leon started gardens on campus and worked with with brinker started project open hand realizing, again, food and canning and setting time with people is therapy and we can do those things. appreciate dr. dir. garcia's comments about pride parade. we can hear a sensibly people from the department of public health year
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early pride parade. it's castro street. yes we can leave the hospital we can revive clinics we can be seen as numbers of our community and ed wolf and a lower rate early pictures of sean [inaudible] of housing is part of what we do. mental health is part of what we do. in the sense of expanding and deanna jones said beautifully, we were doing patient centered care before it had that name. so, again, trying to decide to send a message to you, we are doing lots about we call a care experience because we incorporate the staff as they did. this is not a new thing. we have been doing this and this is part of health justice. that's our legacy and i think that something we need to hang onto it so here we are in the new building that is now open. there's the gate and you can see the towers off to the left. this past proposition 28 08, 84% of voters largest margin of any proposition in the history of the city, $880 million. so
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the scale of the things were talking about has changed dramatically. i'll also share the director garcia has things are going. in anticipation of the hospital opening, we been doing a lot of tors and many of you have gone on doors and dignitaries and philanthropists are roberts did a lot of force to the committee management i do a lot of in the mission because she's expected i did a lot community towards from district 10 and two people from public housing by tara, sunnyvale, through the building. it was quite moving to see people walk in and cry and say, this is so beautiful. we can't believe we made this for us. we can believe this is our hospital. which is incredibly poignant and also i think important part of their experience get some of them also, and we expected you an acute as in the other building and this was for somebody else and i think it really shows up our work going forward is that people are welcome here and this brings us in so the disparity that are out there.
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that brings us up to date and so i think then that the legacy whether we doing going forward? i love this quote. some you may or may not know i wonder if you're curious you can put it was edited any healthcare funding such as equitable civilizing you may must redistribute wealth from the rich are among us to the poor and the less fortunate. guess any guesses who said that? part of me? >> hallmarks? >> no. this is don berwick. this is a person healthcare improvement but then became the interim director of cms and swords are crucial for us to remember that cool off or look at value based purchasing and the zones on care expense are very much health justice issues. if you don't know, you probably don't know, he was not approved by congress to continue to stay on to be in his role and i think this particular quote played a big
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part of that. so, what is care experience in the current area we picked these are some into images that i think that he wants our choice. people not choices and i think to me that's incredible positive thing going forward in this accountability. there's a lot of money here and that puts accountability on us to be good stewards of how we use that money going forward. i want to just a quick snapshot this is a slide i borrowed from the primary care group. we talked about care asked earrings at the hospital. and throughout the network and the primary care clinics. one of the things i wanted to say is they decide they're your long they wanted to him up or build up the community engagement. since 2014 therefore other 15 site patient advisory councils in the committed resources, time, effort, and actually a lot of training of actual community members get together not seen the video they made their the spectacular video on an all-day
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retreat from the putative role of community learning how to do quality improvement and patient engagement and today they have known today that 89 advisors activated at all the clinics are running this. again its own horn working from is i also talk about dn jones and to halley about this that's what mission neighborhood started the mission neighborhood in the 60s had patients advisory committees, their people helping with the budgets. this ideal going back to where we start becomes so important get this is just so lovely so. i'm moving towards ending now but this crew out of the tors and this is a woman who lives over in sunnydale area and shared that those crochet and they were so moved by the tour that they said, you know, we would like to do we like to give something back and will look to do is crochet hats for all the seniors on the ace unit so they
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can stay warm. we would also like to crochet hats all the newborns at your hospital. the something we like to give back, and so we actually opened she and a group of ladies went to the door to door and just gave all of them there and it's actually quite moving. some of the seniors read in quite withdrawn and isolated smiled and cried for some of the first hundred is this idea of how do we really partner and bring forth beauty and resources from the community. what i like to end with is kind of our collective future. this is a tour we gave with a group of youths who were in job corps out on treasure island. they are all getting her ged's and work on certified nursing associates degrees. so, we thought let's have them come. this is our future. without him, and the young fella if one of us put his arms over fran, really lovely and he kept walking is about holding his head did i just i want to work
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here. i want my family to come here. i want to care for my community here. please, give me a job and he really didn't makes the point for us again. oh, of the more our care environment service environment reflects the community we serve i think the better the care will be. the more our community receives themselves in our work with the clinic hospitals and i think really powerful this powerful other point of what would it mean for us to get our care here? when we start getting our care at the same building where the people we serve is what will that mean? finally, you all know and i think it's important to stay, you look at those like this and health disparities data for their families are dramatic. the more they are involved in the care we can bring some same sense of urgency and need to
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get things done as we did in the 80s and 90s with hiv. but this is an emergency. what can we do to bring the same sense of urgency to the health disparity in district 10? again, just a moment to reflect. from our perspective, it's really a shared celebration. video participated, contributed, observed that history. ere and actually if you have any comments all learn from you or take any questions. thank you. >> thank you. we have heard that you had made such a presentation at grand rounds that several of us who write this alteration following felt that this would be beneficial for our commission and for the public to hear also. in terms of where we are going to go. dr. barrett as you know is the author of the triple aim that even though unconfirmed by congress turns out to be now the cms's mantra for care so, >> influential. >> obviously, very influential. but thank you again for making
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the presentation. >> thank you. >> appreciate the time you've taken first. commissioners, any other comments at this point? >> excellent kid >> commissioner singer >> thanks. that's wonderful. i wish i could use a quick math on the quick growth. i'm getting over 10% for 144 years and it's still not working out. so, it certainly is a time to celebrate. i was there this saturday morning they moved in patients and super exciting and i think something which just touched on, but really is worth highlighting is that people-the stories we've heard of people not believing that this hospital was for them, for their community. that this was not what a public hospital experience look like an old
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apartment are to feel incredible about that. the city shifted >> i think the city, indeed >> it continues to this wonderful tradition here that we are all so proud of. i do think it's worth noting that there's a lot of hard work ahead the reality is, the hardest work for us is ahead. it gets to the sense of urgency that you'd like to impart, and i sort of challenge our group to think about it in the following way. is that, if you look at the berlin quote and you think about, what is the-and you accept it as well we got to stand for, then, the mechanism of translation of that is our healthcare system and the quality of that system, and it being available for everyone that lives in san francisco. the quality of care. but if you
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all combine that with what you said about choice, that people now thankfully because of the aca have more choice and there's a number of ways people can express that choice of having to get care and the way that the people that pay for the care are expressing that choice is through a system which incentivizes quality of care. it's measured we can argue whether it's measured fairly or whatever, but that's not our want. we have to serve sort of except in the short term they measure things a certain way,, and my worry is as follows. we talked about this before. that, the system of stars that are given to hospitals and h caps scores are going to dramatically affect
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reimbursements. as excited as we are about our mission, i think dr. ehrlich would be the first to say that we have a lot of work to jump on this. the reason is that if we don't increase our star levels in our performance dramatically that our reimbursement rates will decrease and the hospitals around us reimbursement rates will increase. the natural consequence of that is that they'll be halves and have-nots and we will end up with a beautiful building with financial problem issues. now, that's not our fate by any means, but i think the thing that we need to do as a commission is to make sure from a strategic standpoint that we sort of allow the department to try and do some things
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differently. to try and organize the delivery of care, to allocate resources to really challenge the way that we've done things because as proud as we are of them, by objective measures that we now live under, under this choice, like them or not, but by those objective measures when you improve dramatically. i would submit that we cannot do that if we just do things the same old way. so, it's a super exciting substrate to have to be in the new hospital to do it. but we've got to be supportive of the team's willingness to try to do things differently in an environment where that's hard to do because the status quo is comfortable for everyone always. >> thank you. further comments? yes, commissioner chung >> thank you very much. i love your presentations and your
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warmth. i think you exude care experience. so in the 1980s when we were aides that the words as a training and i remember the response of the hospital isolation unit and putting people-moving people to the hospital with a diagnosis that we do not even have a name for and i remember the hospital responding in own community to the call to take care of something that was impacting our whole community. so, here we are 30-3040-years later given time different kinds of call. how would you like as part of the care experience, doug, director, how would you like this era of the hospital to be remembered in terms of branding, in terms of what you would like to see the response of the hospital and again, it's
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been remembered this is a presentation we were to make 20 years from now? >> thank you. i think the several of the key pieces. one guy think is dramatically changing a lesson we can learn from the hiv is the importance of the whole continuum. there's amazing things that happened about hospital those point about project opened and housing and things like this. one of the things going for alec to be remembered from his help we care about the characters across the whole continuum partnering with primary care partnering with [inaudible] so we have more just the next emphasis given in san francisco [inaudible] san francisco health network response to care experience. as we do that from the healthcare delivery system in more integrated conference of we will be positive. the second one i think which is less about healthcare delivery and maybe more about health and wellness
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is how do we learn from the hiv, and partner, in unorthodox ways with communities. with outside of our comfort zone, which is if you come to the clinic, you come to the hospital, you come to our facility will have this experience for you but how do we think about moving to more place-based experience. that is going to be tricky for us to figure out but i think back to david singer's point, we can be comfortably get, will come to us and will take good care. i do we go to where you are, partner with what you are doing. for example, we were talking with graffiti which is a group down at the end of cesar chavez and the training don't remembers to be navigated heavily partner with navigators to come into our facility i think is a key piece to the other piece that i would love to see this be part of it is to recognize how important the staff experience is tied to the care experience. like, how we
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create an environment and resources to support the staff to do their best work though that they can actually become the impact that were people we have and another story i will share something to celebrate. the building is a loveliness much natural light number of the doctors have said i found myself even more empathic because it's so beautiful here. the building is so nice patients deserve more from me. they are finding themselves getting more so how do we create other nonstructural building ways to help people find that empathic place in themselves. those who be a couple things. we've got some specific type of things i can talk more about, keep that level in one is with doing much more about caring framework called bi-care but how does everybody on campus see their role as a healer for any way to me does not work there on campus. just some ideas >> i'm very pleased to hear that. we've heard it becoming age, support system and the role of resilience in moving
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our health system forward and i think as much as the general is playing a important will make our community strong i fully endorse your mission and your vision. so, thank you. >> thank you commissioner >> commissioner sanchez >> excuse me. i just want to conflict you again. i think excellent presentation >> thank you dr. sanchez. >> i would just add one thing is pertaining to some of the discussions we've had here. why have we been able to maintain at least up to this point and will continue to do so, some of the most dedicated health professionals within our culture of san francisco general? with all due respect, i think your history showed us a little bit the link with ucsf and stanford, initially, and then
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as we navigated through the years ucsf has been really, a key partner pertaining and providing opportunities, training, certification, accreditation, within these different disciplines. i can think of you mentioned community health centers, etc., primary care, you name it. so, chancellor [inaudible] julie cummins, chancellor. you always find-need of san francisco chancellor. everyone was involved and knew about the links and partnership between sf gh and ucsf. the fact that the was even the first time under some of our associate deans a formal memorandum of
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understanding whereas before is more like a handshake over the years way way back when in the 60s and 70s, literally. before even then. so what i'm saying is, we face the future.it alone should we face in partnership with one of the most outstanding public academic health science centers, ucsf. and ucsf among one of the key recruitment per post-doctors and medical students and other students is the fact they can do rotation at san francisco general. they and the community here in our efforts. so what we are saying is it's a important as we look to the future and the whole question of how does now this unique body navigate with quote, the new san francisco general foundation-
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[inaudible] as we move ahead and workbook with this group and with the ucsf board of overseers which is a different body and has a different culture and a different focus. so yes, we're going to have a lot of challenges but we have a new support system that very few in the station ever have and the fact that they are all-and have been consistently committed to this department of public health at san francisco general and laguna honda again were getting a residence from different programs, were getting a number of our people now from against usf, there were getting-again the city college, again, we are a teaching institution and collaboration that makes us unique second to none in the nation it so, i really think that's part of our strength that will navigate you don't do it in isolation. we do it in conjunction with our partners
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who have proven and have been tested and believe they go we tested a model where we are going to stanford and uc have anakin hour. we voted, so that's face. we know we are unique as an institution and partnership and will continue do so i think, really over the next generation we will set some new models of healthcare given uniqueness of the city and partnerships we have for 150 years. excellent presentation >> thank you dr. sanchez be dick thank you. commissioner karshmer >> i just want to add my congratulations to the event kid i loved hearing this is really part of a system. to really advance the notion. i think that's going to be this front moving forward. but in particular, this identifying that nontraditional partners, nontraditional outreach is can be so crucial both to look at how to make quality in the patient extends but also keep
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the system part of the fabric of san francisco. so i think that's good and i look forward to hearing more. >> thank you, commissioner. >> thank you. any public comment? >> the request on this item >> giving no further comments we can thank jeff critchfield and want tonight's agenda >> thank you. >> item 8, the san francisco zuckerberg general hospital transition update and dr. ehrlich is can be making a presentation >> good afternoon, pressure commission could have you not tired of hearing about zuckerberg san francisco general in our move and i just want to acknowledge all the discussion about who we are in a place and time and what incredibly special time this is for us and also a challenging one it is. dr. critchfield is single point of light here that represents the passion that i get to come to work with with 3000 people just like them, and
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he not only represents the passion we have for our patients, but thankfully also the patient passion we have for improvement so speaking to commissioner singer's remarks, we do have some challenges ahead. but the great news is we have a passion for improvement as well as a passion for our patients and the passion extends to the ucs ucsf partners. together, we will meet our challenges and will do well. that's what i'm here to do. so, yay. let me talk a little bit more about the building. some of you are this presentation already, but i'll go into it and i can add a little bit to it since i did that last time. >> you go to view and it should show slideshow. >> right. i'm looking for where it is, here.[pause] all
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right. this photograph was, thanks to one of our employees,
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earl of, why think took 1000 photographs and we join them a lot. it's really nice to have this history of what happened. this was at 6:45 am in the morning. that's an easy to the general hospital in trauma center, most of it had been covered until this moment we have a clean, and take down the sign. signaling we were ready to open. at 6:55 am, this is the old iconic sign the emergency department that was also taken down and it's now replaced by much more modern sign that directs patient traffic and ambulance traffic to the emergency department. this is seven 8:00 am. this is when we got going. this is right outside the public emergency department engines. now you can see that metal entry way. those isaiah emergency now. those were taken down and this the emergency department team that was so excited to get going that
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morning. it's hard to describe with the command center atmosphere was like. some of you were there. this was on the seven floor building 25, the. the room was a large and divided into three areas. the one area that isn't depicted here is-with the it nerve center. there was a group of about well, depending on the moment in time, at least a dozen people were entirely focused on making sure that our systems were not crashing and even the tiniest it needs were met. i was really pleasantly surprised as were many others, as to how effective that team was. and still is. i want to thank bill back there for really helping us out that day. in the middle, which is the
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room you see on the right, with the peg control room and this is a function that gets staffed every day at the medical center, but this date we had many more people making sure that patients got assigned the correct bed and on the left with the transport teams. you see dr. marx and dr. mae and rachel kagan rpi oh, and the woman sitting just to dr. marx's right is a trauma surgeon who along with terry did tony, chief nursing officer really directed traffic all day long for hours and hours sitting there making sure that our 12 transport teams were assigned correctly in patients that moved correctly. it was really a stunning feat of coordination and this beautiful controlled chaos that happened in that command center all day. the moving started at about 7:30 am and was done at 4:45 pm. that was exactly the last patient got settled in his room. there
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were 158 patients who are sequenced the day of the move. they had actually been-there were groups of patients were sequenced on the previous days, but that morning there were 150 patients in i just want to mention that the reason the words at least 10 or 20 more was because the network really went through a rote efforts to make sure that patients were not acutely ill indeed need to be in the hospital were not there. that morning, there were i think eight or nine only 8-9 patients not at acute level of care that did not need to move which is great. this happy gentleman, he was consented. he was one of the patients was consented the day before. many of us went around and talk to patients who are about to move, just about to move what was going to be for them and some patients agreed to be photographed and talk to. this card was one of those people and he was very happy as you can see. this is just a view of the bridge. there was a steady stream of traffic across the bridge all day. this was the first baby was moved into the labor and delivery suite could
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very happy to move over there. and here the baby is getting settled in the and i see you which is incredibly beautiful space. it's full of sunshine and light three killing environment for our youngest patients. speaking of babies, the last one was born in building five at 4:37 am in the morning just in time for the move. the two baby girls born on saturday. the first at 2:43 pm and the second at 4:49 pm and there is the first baby, very very cute. can appreciate the cuteness and a photo but that family was very happy to be in that beautiful space. i actually went to labor and delivery area the day before the move to talk to patients, and i was able to see them banned as they moved into the new space. they were literally stunned out of their minds. it
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was such a stark contrast between the two areas, and it was a bet going on who the first baby was going to be and everyone was betting on a babies was not born until actually the next day. it just shows you how little we can predict these things. these folks are student nutrition team and they also didn't really a relevant work by just eating every single patient was in the hospital but all of the staff were there. everyone was served a box lunch was working that day. there were innumerable beverages and snacks for everyone and they just did an incredible job. we had a lot of media coverage for saturday morning. i'm told it was pretty exceptional jurist dr. marx speaking to a tv camera can get prints made, radio, media, tons of folks and the stories were repeated over and over and it was generally excellent coverage. here was a community blessing that was going on for the building. audio slave, it was very
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effective. we had four cases on saturday. the first case, dr. macleod's case start at 10 am. no issues with surgery at all. that was really do a lot to the fact that the surgical team practiced over and over again before they moved into the new building and so things went really smoothly. we did have our first trauma until midnight and was very quiet in the emergency department that whole day, but what's midnight came around just everything busted loose and there was a time when most of our assessor station rooms were full. was a very very busy night but things went well. this just shows you the last surgery and the first surgery. therefore patients admitted from building 25 ed that day. this was the official closer the emergency department. these are two emergency dr.-emergency department managers, melissa and david. this space has never been so empty. ts is the old
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ambulance entrance to the old emergency department. everything went really well. much better than expected by all accounts. because i think continue to be high. we are still in a place where we are studying where we are. this space is extremely different and we have all kinds of processes and procedures in place to make sure that we understand how to optimize our space. that will continue to take time. here is our tiny snapshot of our future lands and projects. we are going through our vacancy plan implementation, which basically means is that cleaning up the units, getting all the supplies out, making sure the supplies are reused and sold as needed, and then, we classify the building into a nonacute building this event happen over the next few months. there are
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a number building 25 power projects like the hyper mri we are working on and innumerable ways that were optimizing the space that we are in right now. that's about it. i'm happy to answer any questions. the a lot more about this building and about building five as time goes on. >> well, congratulations. questions, commissioners? >> i think it's worth pointing out of china think of an analogy but i could not come up with one. this was a phenomenally obligated thing to do in the past six months, which is staff up, train everyone, they sure all the systems are working, get regulatory approval like from a wide variety of regulatory bodies. then, move patients with zero tolerance for any mistakes and it was really
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pretty incredible pretty incredible pretty incredible accomplishment that i hope you take this the right way, shouldn'tit reminds a little bit of the night michael jordan and a guy named lou glumly[sp?] prefer the bulls and this one night michael jordan scored 69 point and will glumly interviewed one and they were interviewing the glumly in this way the night does a member does michael and i combined for 70 points. not to take anything away from your leadership but the team at the hospital from the guys i talked to moving food to the new place and getting food up and food services in the elevator, all the caregivers at any level of education, you want to name, it
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really was incredibly exciting and you just hope that excitement stays in all our systems for years. >> yes >> subcontractors and to everyone. >> figured on a deserving of congratulations. thank you for mentioning that it's really 18 and was not just six months. he was years of planning. the alacrity chicken up it was incredible feet and was entirely a testament to the team's ability to plan and execute in a remarkable way. it was just privilege is mine to witness it, really and be a part of it. >> you should take the place now because invariably there'll be times you'll be here and >> it will be all my fault >> won't be fair either. >>[laughing] >> this is your moment. so enjoy it. >> we will be with you >> thank you. thank you. >> commissioner karshmer >> i would have i congratulated
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it occurs to me the type of teamwork is the very kind of teamwork that the department has been working on around disaster management and i think a lot of the trials of the disasters that have happened and how the-how the department is able to respond our signs that this is not a one-time thing. this is, in fact, a sign of a department that's learned to work very well together. so kudos to everybody >> thank you very much and i would definitely agree. i don't think it's a one-time thing. >> i think, clearly the two presentations create a momentum that we expect to continue throughout the entire health programs that we have here and we now have a wonderful facility in order to carry out many of our tasks and we are
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pleased that you are here to be able to be the steward over it. >> thank. >> it's a great place to honor our patients and staff. >> thank you. any public comment? >> no public comments. >>[applause] >> director rca noted there was dr. ehrlich's first presentation so extra congratulations for that. item 9 is the sftp h patient rates for fiscal year 16-17 and this clear 17-18. >> this is for your approval, commissioners. >> good afternoon. this is a fascinating topic given the previous presentation. patient rates. this is our annual patient rates corridor. it's always accompanying the budget. this year the patient rates at san francisco general and laguna honda are increasing by 7% for community mental health,
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you may have noticed that the days services and the outpatient rates are increasing significantly. the reason for that is that it's based on the actual-our actual costs and in our prior year cost reports are actual costs have risen significantly so we are revising the patient rates to be at a higher rate so that we can maximize our reimbursement for medi-cal. community substance abuse is in a sub similar situation where we tie the rates or actual costs and set them slightly higher so we can reimburse and maximize reimbursement. then, on the last page i just want to note that there's two new rates any. the public health lab. we are setting the rates to be at the medicare rate. currently, it's a medi-cal rate and at some point we are hoping to expand our billing so if we are seeing clients-if we are providing
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services and seeing specimens from clients that are many many medicare medi-cal then we can charge the higher medi-cal rate. then, for the san francisco city clinic, we are introducing a $25 flat rate. currently, they accept donations of $10. so if you have any questions, please i'm available. >> the city clinic rate that you alluded to, i suppose one of the reasons in the past that there didn't know collection was to encourage people to come in. it's just a recommendation that the staff there also feels is going to not discourage patients from being seen at city clinic? >> yes. this was in consultation with the health
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division of the public cultivation is undertaking a project of looking at billing in the public health division. one of the things that came up is in the best to the lab there's a number of patients that have insurance but many of them choose not to use their insurance and may not even actually go to their own provider and so, the purpose of the $25 rake is doing create an incentive for the patient to give us insurance information because the alternative is $25 flat fee versus are you going to let us know your insurance, which is presumably would be zero and so what we are doing, we are restructuring the format and instead of having it go nation which is voluntary, and whether $25 fee which we are hoping will encourage the patients to agree to provide us with insurance information but at this time there's actually
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not going to implement the insurance part because they want to work through the whole issue about discouraging clients were coming for public health services. julie are putting this rate in as a placeholder so that when we are ready to implement this other policy, then will have the ordinance in place. >> i appreciate that. could you also speak to that whole issue of people who may not be able to afford this rate? other not different scales were schedules that we use to create [inaudible] >> yes. thank you for reminding me because the other issue the std clinic is to have an option to waive the fees for a public health purpose or for a client that doesn't have the ability to pay. so, the fee will be in place, but they'll be provisions made to waive the fee. that is similar to what we see right now in behavioral
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health or they have options to waive fees if there's a therapeutic or clinical reason for providing services without a fee. >> okay. commissioners, questions? >> last year we had heard really are published rates for the purpose of medi-cal and medicare billing or insurance collection. i just think that's minor sin of the context and i think that's the point dr. chow is reimbursing. i does one ask if that's the current assumption ? that's the context? >> yes that is the current assumption because our rates are basically patient charges could it be to hold, was no one actually pays out of pocket because on most all of our clients are either medi-cal or have a waiver that weaves the fees for therapeutic reasons. so, the purpose of the rate is to maximize our reimbursement
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from our payers primarily medi-cal. >> in the public assistance to use rsv at all? like you do >> i'm sorry? >> [inaudible] >> you are talking about behavioral health? >> no. across health. >> i'm sgt. craig wagner chief financial officer not sure i understand the question >> i was wondering what i use the relative value scale in terms of setting up the rate? if not familiar with probably don't use it. >> correct. >> i think that the categories here, they don't carry a billing number now some of these but when you are carrying a billing number, they were weighted averages between the
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definitions as you have. these definitions still based on the rbs? >> to be honest, i don't know the answer. historically, we've had our rates and for the past number of years, long since before i been around we've use the basis by which they were set and increase them at a fixed percentage rate. the purpose of the fixed percentage rate is to get our cost to charge ratio aligned with what we are seeing in the industry around us. where we are right now with our cost to charge ratio, as you all know for the last many years, we've been trying to catch up where the industry around us is good as of fiscal year 2004, or cause to charge was at 52% we been increasing by 10% and that's across the board. we have not differentiated based on the categories of services, but
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trying to catch up. we are trying to these rate increases if you factor out district, we are close to about 30.9% for fiscal year 15-16. that is getting us more into a kind of standard range comparable at ucsf is about 26%. st. mary's in st. francis, about 25%. so, it varies across categories. in terms of what that initial kind of foundation for the development of those rates is, i have not been through that process here, so we can talk to some folks who brought about that and provide that information to you. really, what were doing is taking the basis for the allocation and were increasing it by percentage rate to try to get our cost to charge ratio up into a more industry benchmark area.
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>> right. if i recall it was initially based upon the old rbs schedule >> yes >> then we were behind as you said and i was can ask you the question about where we walked now on the cost to charge ratio because i think a year or two ago as we get going at the 10% i said 10% within a be even at a better quote, better rate than cpm see. >> yes. this year i remembered you been asked the question just to note also and said that we are at this year 7% and 6% over the two-year budgets. we have been at 10% per year since i've been around. so, since we are coming into kind of more of the range of the benchmark of the other hospitals in the area, the kind of slowing down the acceleration. were still a little bit little and so we still are going to move to
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catch up but we are at the point where we can slow down, back off of our trajectory of the speed of our rate increases. >> any further questions? commissioner. yes, they could you get is what you just described in a format we can stare at so we can follow the increases looking backwards where we got to in terms of cost to charge ratios? >> yes, absolutely. we did it would be helpful. the second thing is >> that would be helpful. the second thing is which one of these buckets would be [inaudible] because we don't provide these at the same volume level so from a purely financially self-interested point of view, which one of these raids is mostly important not just to add in the growth rates, but also to secure
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reimbursement, actual reimbursement as close as possible to the published rate? >> we kind of touchup on it with behavioral and public health, but the rates that were proving here as and mentioned in those limited circumstances, are infrequently paid by an individual and in particular, by an individual with limited income. so, the two areas where the rates we have the impacts our reimbursement is and said they can sure our rates are high enough we can maximize what we get paid in behavioral health through medi-cal we have had our rate set at a certain level to make sure we get as much as we can judge the other major area is a possible for emergency and trauma, where we are having commercial patients come up people come in with commercial insurance in those cases we actually are using the rates as a basis for
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collections and that's a major financial driver for us. the percentage of our accounts that are commercial accounts is at the hospital, is less than 10% but it's about a third of our actual collections. so, it's a critical driver for us and that is one of the reasons that we need to make sure that we stay in the industry benchmark for what we are charging so we can make sure we drawdown that reimbursement. we rely on that to offset our losses for uninsured medi-cal shortfall a lot of the patients we care for at the hospital. >> where are we in our journey to be able to take insurance, private insurance more broadly in our system? >> yes. that's a good question. a long story and i know we are going to be going into that into some more detail at hearings coming up. but we have a number of irons in the
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fire. we are working with-at a couple of different options to get involved in a covered california plan. we been doing that for some time. right now, the barrier to that for us has been our ability to work with the health and in distribute the risk in a way that the state is comfortable with. so, we are still working with a couple of options on that plan. we've engaged with a couple of the ventures associate with our health service system, and so we are trying to develop a plan to do some limited contracts for services where we can tag onto those city contracts and then eventually grow our volume providing services to city payers. we have also been working with some other health plans on contracts that are not
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necessarily commercial, but that are medi-cal fee for service where they have demand and we may have some capacity and we can increase our revenue to those avenues. so, we will be going through some of this in more detail with you but it is part of our financial plan and you'll see it's when we present our a- three that's one of our targets and we are actively in the current year and in the coming year, working with some consultants that we've engaged to a post about the infrastructure that were going to need to have the right relationships with commercial payers and also the internal mechanisms for ourselves to be a good judges of rates and contracting arrangements that we make with those plans. so it's a very active effort for us and it's one of our focuses broad financial plan in the coming five years. >> okay. any further questions? question
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>> there's no public comment request on this item >> thank. if not we are prepared for a motion to accept these rates. >> moved and seconded. for the discussion? all those in favor say, aye. opposed? the rates have been accepted. >> thank. >> mr. wagner i think you can state the jamaica presentation on the mayor's budget update >> next item please >> actually, amanda turned this over to jenny-our budget manager. >> it's a presentation all the way to the right. >> is good afternoon committed
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to my name is-budget management i'm here to present on the mayor's proposed june 1 budget. i like to start with the big picture first and actually with your permission, i realizing that i made more sense to talk about some of the internal transfers so you actually understand what's going on and a picture and then we'll get down to the details in terms of some additional enhancements. if you'll bear with me. so, just that that overall dph budget is grown by $9 million in year 147 dollars in year two. generally speaking, that's actually modest growth for us particularly in year one and the reason for that is the number of transfers that were making externally to other city
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departments as well as internally. so, one of the things the major things that we will talk about is the transfer of the department of homeless and what you will see here is the reduction i think you will see a reduction our public health program of $42 million to various departments. this comprises 90 dollars of sf hot i wish him good that comes from the substance abuse team. the regional dollars from her housing program. that comes from the public health division and $1.5 million of other programs that consist of the
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homeless prenatal program and project homeless connect that currently supported in community programs. and mental health. so, you will see that change we look at substance abuse breezy that significant reduction of $75 to 68 negative summit reduction reports that $9 million reduction of the program which is not-which is scuttled. on top of that, it 50-16 the we had one-time capital cost of over to my dollars related to the medical respite construction. that construction is going on. was one-time and 50-16 and additional expected reduction. so, that explains the variance between that $75 million and that [inaudible]. what you also see in san francisco general, you will notice there's actually a drop in their total
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overall budget. that drop is actually related to the internal transfers that we made within that apartment in i actually give you some of a supplemental that outlines the changes, but one of my goals as budget director is really to try to make to reorganize our budget in a way that actually reflects our operations and with bill kim and ron wideout joining our team a few years ago, they're very good in asking me questions about well what's my budget and how money positions do i have. and how we had originally budgeted both of their operations is actually within the divisions. it sort of made sense for cost reporting purposes, but we had to do sort of financial query backflips to actually be able
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to pull positions from general, positions from primary care physicians positions from the kona to put humpty dumpty back together again. so they had a cold user budget. so one of the things we did was centralized it and hr into the public out the vision, into central administration what we'll do is work later with nellie lee and a population health department to actually do a cost of accounting to chargeback out some of the costs, but all the cost of budget centrally so there's a clear and transparent vision of the it and hr budget. so, the total of these transfers as you'll see on the handle, is $33.3 million of cost transferred from outside population health including 22.8 from the san francisco general. those costs were moved to the public health department and then we have an additional $5 million of hr positions also centrally transferred over. so, while it appears there's a reduction within some of the divisions, that's actually not the case. it's all been moved to the public health division. you will also notice the public health division still appears to have a drop despite this large infusion of positions in operating costs, and i outlined this in my mail. that there
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is-we made a correction to adjust our revenues at san francisco general and we did a swap of capitation and fee for service to true up what we actually believe is most appropriate revenue.. what we think is most likely to be the revenue streams that we have, especially with the passage of 1115 medi-cal waiver. that change between p for service and capitation net net overall you seen that change but then that, what we had to do was actually caused us to reduce our intergovernmental transfers, which feels like an expenditure savings. there was also upset by revenue changes. so it's net neutral, but overall in terms of our budget and our expenditures that was $55 million worth of cost that we actually don't have in our budget. again, while it does look like a public health division is dropping them a net net overall, there's been no service reductiond