tv Government Access Programming SFGTV May 10, 2019 3:00pm-4:00pm PDT
that come in with early child adverse experiences that can have an impact and by intervening in the schools. several schools are part of it and we could do more in that area. is there anything more that you would like to add? >> and i would add, talking to the commissioner's comments as well that we haven't mapped well what we have done and the asset and th the asset assessment is missing. and so some things are ongoing like tomas has mentioned. >> and i forgot to mention and the health commission endorsed this, and the incarceration of the public health problem, there's a team of people working on this. and i think is a great opportunity for us to really focus in on a really concrete way and to look at that path -- that pathway.
and to address that issue. that goes back to youth and how youth get incarcerated so we can address that whole pathway. so that's a good one for us to focus on that will help us. >> thank you. >> and i'd like to say thank you to miss karen and to the former commissioner and to mr. santiago. and also underscore the recommendations and the comments made by commissioner guay and commissioner chung. i think that it's important to include the social determinant of health as you look at these populations and whether or not we're having an impact. and, certainly, commissioner chung's comments with regard to the transz transgender population, and the numbers were so insignificant that we couldn't do anything. and commissioner chau and others said that it may be insignificant with your data point but as they transition
into the community and as someone in the community i know that there's health issues within the asian-american community. so i want to make sure that those are included as well. so, thank you very much. >> dr. coo colfax you want to me comments? >> i want to thank the team for the outstanding report and it's informative and it will be a roadmap going forward. and the other piece in terms ofe the outcomes is that you're familiar with our process. so one of the things that's not always articulated in our work, internally in the department as we look to improve the quality of services is that quality improvement done through an equity lens will be expected over perhaps the short term. but certainly the long term to close some of the equity gaps. and so depending where you're going for treatment and whether it's prevention in schools or for primary care, or whether in a hospital, how you are treated
based on how staff view you, and the implicitly and the explicit biases that affect how you are cared for, and it's in evidence-based method to address the performance issues in those areas. and that performance improvement is really an equity important step. so i think that it's just important to link the operational aspects of the department's work with the population focus that this report does such a great job of presenting. >> thank you, and thank you guys for your service. >> thank you so much. and i want to acknowledge michelle. she's moving on from this current role and she'll still work on the epidemiologists, but she's been an important part of making this a success. >> thank you for your work. mr. chair? >> i know that this is up for discussion and there's a resolution before us which will be looked at the the next
meeting and i was hoping that with the comments that would be incorporated into the final document that we could also incorporate within the resolution some of the issues that we thought that should be emphasized. and that we would be expecting. the social determinants of care, some of the smaller -- well, some of the areas that we have commented on today, to be part of the resolution and not just merely accepting or, of course, we would adopt -- i think that the commission would want to adopt the assessment itself. also within there i think that it would be appropriate that under their first whereas and this would just be for as they are going to be re-doing the resolution, i would hope to reflect the comments made here today. that in the first result that we
know that it was mayor lee that was a part of the accredittion process instead of the anonymous mayor's office. >> mr. moore, and thank you... >> item 9 is healthy street operation center update. >> good afternoon, commissioners. the deputy director of health and i'll co-present this. and i want to acknowledge a
couple partners in the audience today. so commander david lazar from the police department is here, and dejon queeny from the department of emergency management is here. and so where here to talk about the healthy streets operation center and both of us have worked on this and i want to acknowledge the fact that there's a number of people within the department who have been putting in a lot of work around this, including our behavioral health services and our transitions population health and so this is a collaborative also within the department. and so i'm going to talk a bit about what a healthy street operation center -- or as it's co-locallit is.it's at the emers center at 1011 turk. it's multiple departments but there's four main lead agencies. those are the department of public health, the department of
homelessness and supportive housing and the department of emergency management and then also the san francisco police department. and it was created to really unify and to help us to coordinate plans and to direct the response to people who are experiencing homelessness on our streets as well as other street behaviors that are occurring. it provides the infrastructure so that can happen. as well as we get new resources that all of those resources are coordinated together. so why did we need hsoc? well, one of the issues was that prior to hsoc there were multiple interventions happening throughout the city that involved lots of different departments. so there are hotspot crews and there was encampment working group and there was the mission district homeless outreach. and all of these projects had involved very similar staff and
they were going to all of these different meetings to respond to the same issues in different parts of the city. so with that recognition it was decided why don't we come together and actually use the emergency response or the incident command structure to really develop a system that we can better coordinate the response. so hsoc launched in january 2018. and as i mentioned it coordinated through the agencies that are involved in addressing unsheltered homeless as well as street issues that are happening daily within san francisco. and i'm going to talk a little bit about the core values but i want you to know that these are actually after a year being revised and we're happy to come back to the commission with the revise threvised values and the. but the core values is to have services and that's why they
were named as lead agencies. and hsoc believes that everyone can change. and we empathize with the entire community and that safe and clean streets can be maintained for everyone. and so this is just an overview of almost a dozen partners that are at hsoc on any given day. and in addition to the four main agencies, 311 is there and the department of public works and the m.t.a. and the police department and the sheriff and the fire department. (please stand by).
-- we like to use the acronym dime, improve, meet and ensure services for all individuals that are exposed to the streets or live in conditions on the streets. the first area of the goal that we like to emphasize is that there is an agreement between the four partners to deliver a coordinated, to deliver coordinated city services to effectively address encampments, hot spots and quality of life issues, and the second goal, behavioral health of individuals
on the streets and that's an emphasis that's been closely looked at a lot more in the last 6 to 8 months. just because when we look at the issues on the street, as many of you know, we need to be looking at what type of behaviors and what type of health needs are needed in order to deal with the issues of homelessness or any of the issues of encampmentes, and ensuring san francisco streets are safe and clean while improving the response to resident concerns. so, how does it work? we wanted to quickly highlight. typically as she shared, the hsoc team, the staff, every lead department has assigned staff to be deployed at the incident command center. 311 or typically anyone could
call to 311 if there's an issue on the street. a coordinated call organized, coordinated dispatch system among the departments and the stat at 1011 turk. a daily planning and response process that's facilitated at 9:30 and 2:30 every single day of the week and it's looking at expanding services and a response on saturday and sundays. often times a very large screen such as this one that looks at all in the hot spot incidents where we see the calls coming from. there's also an effort in the future to work with the controllers office to start looking at in general where a lot of the city system partners, including the hot team are looking at hot spots that may not be coming into the 311 system. there are certain callers that may understand the system and other parts of the community of san francisco that may have more access or may feel more
comfortable working with city partners and reporting the support that's needed. so, data is an area that we are looking at trying to really use on a day-to-day basis to look at deploying services in the immediate response. and then again, the fifth area is about responding to street behaviors. we work really closely with the san francisco police department, the hot team part of the hsh department, homeless department and we are now working really closely with other external partners, including the department of emergency management to respond to all conditions and try to make sure that we are leading with services first. we have worked really hard in the last year to really look at not only providing sort of the day-to-day unified command str you are and training to staff. so, as the doctor shared in the past we functioned under the
department of emergency management model where it was a unified command structure. we are in the last year experiencing a lot of changes and we are trying to really create a theory of change, leading with services first and so training is a really big component that is needed to actually train staff. so, we have currently about 33hsoc officers connected to the structure. the full hot team, part of homeless department that's connected and as the doctor shared, we have divisions that's, that are part of the department of public health that all respond to the work that, or the calls that are coming into the department of emergency management or 311. given that array of staff and that diversity, d.p.h. has really been asked to take a lead and a front center around training staff, including the police officers. so, we have often trained around service navigation, motivational interviewing, narcan, how to use
it, harm reduction approach, also been asked to explain our psychiatric emergency services and our crisis intervention experts have actually provided training on how to best look at trying to intervene and use less lethal options and less, more restorative justice practices on the streets in the last eight months. another big role that we have as the department of public health, this is where we work really closely with our behavioral health division is to coordinate the care of any individual that gets notified to the 311 system. d.p.h. in the last six months has actually stepped in to really looking at a multidisciplinary team format where we are looking at trying to work with partners, if anyone gets identified in need of substance abuse treatment, identified as someone in need of any sort of behavioral health or harm reduction intervention. and so given that effort, what
we have been trying to do is really make sure our clinicians and psychiatrists and psychologists working with the department are looking at cases that are coming in, one by one and the full comprehensive need of an individual. we also partner with h.s.h. to identify at least 40 individuals on any given time that actually need priority services. we are in the process of working really closely with h.s.h. to even also identify how do we get to the high priority list so we offer shelter so that if someone is coming into our contact through the police department and referred to 311 and coming into our services, that we actually also provide a moment in time where we can give someone shelter and navigation. so, part of the share coordination team, our effort is facilitate the holistic approach of an individual and support obviously by offering the behavioral consultation, health consultation that's needed and also looking at trying to work with partners of the needs of an
individual and their families. another big component that d.p.h. reflects or implements as part of the hsoc work that's fairly new to align is working closely with the health fairs. as you may know, population health division, presented a couple of months back around the work they are doing to reach out with our street outreach teams, to encourage individuals to look at an array of services if they are living on the streets or dealing with substance abuse issues on the street. and so this is some of the work that gets done with some of our consistent health fairs and in 2018, what i would highlight, one of the successes are that we ended up engaging 281 individuals into medical engagements. i would also highlight the h.c.v. tests, 359, hiv tests that were offered, and some of the narcan trainings alongside
with the other information that's listed there. i would also add that we provided a sheet, i believe, to actually emphasize the 2019 outcomes that have been met. so as you could see in the first six months, mirroring similar numbers and again, our role is to try to offer to hsoc with the partners that we have internally and the divisions there, including street medicine, we try to provide a community-based approach to try to get to individuals into more healthy environments if they are living on the streets. so, this is the way of participating and leveraging the work that gets dock with the department. if there is an area by homeless or encampment, we have to try the multidisciplinary ways or the creative approaches to get
to the community that we are reaching to. another area that we have been recently the last eight months working closely with the partners, including san francisco police department, is our healthy streets intervention program. we offer as part of the department of public health an opportunity to divert individuals out of the criminal justice system in multiple ways. in hsoc, typically what happens, if there are individuals that come in contact with the police department we have obviously set up a system to deal with the medical referrals that are needed if someone is dealing with an emergency incident, need to be transferred to the psychiatric emergency services or if there is a case where you might need to be transferring someone to the emergency department. we also in the last eight months have developed an opportunity to work really closely with the community assessment and resource center, that's, i'm sorry, community assessment and
service center, located by the hall of justice and operated by the adult probation department. we actually have staff now that are located at this community center close to the hall of justice on 6th street and what we are offering is a safe transport and a space for individuals that could actually get diverted away from the criminal justice system, if in fact a police officer comes in contact with someone that may not have a criminal activity or criminal consequence, we are actually encouraging a partnership with the department of public health stepping in and we are providing services as much as we can. so a very clear example could be if an officer on any given day sees someone that might be exposed, may be openly using drugs or using needles, we may offer an opportunity for those individuals to actually get transported over to the center and encourage they use our resources that are levered through lead to actually do an
intervention and talk to individuals about rolling into services, as opposed to continuing the law enforcement contact. some of the examples of what we do when it comes to the program that we have in place. and again, our role at d.p.h. is really to provide an opportunity to divert away from the criminal justice system. that's how we see our role being valued in this operation. we also have, you know, many, a couple of incidents that might end in obviously in the hands of the criminal justice system and we are encouraging leveraging with jail health services and some of our partners that are part of hsoc include the sheriff's department and they have leveraged their contracts through the nova system around community-based partners to reintegrate individuals back to the community. so, as you could note with this diagram, we have multiple access points where often times the hsoc officers might be in
contact with someone on the street and try to leverage as much to offer an opportunity to move away from on healthy street behaviors and enroll in the services someone might need. some of the actual successes that we have had associated with it, in particular, there have been around 50 operations and there have been close to about 1,000 contacts with those operations. 205 out of those contacts have actually come through and into our services. for us d.p.h., it's a houuge success, away from the criminal justice system and we were an alternate to incarceration. some of the successes beyond that, we have created a streamline approach in san francisco. an operation where it's about
services first. we have created an opportunity where we offer full wrap around approaches. close to 8,000, 7,904 engagements to date with individuals and we work really closely with the s.f. aids foundation and other operations, case management, reentry work and try to, we try to figure out how to really meet the need of citizens or residents of san francisco that are coming in that are actually calling into our 311 system, and needing an approach. but at the same time, if they are reporting an incident how we are looking at holistic and healthy way of intervening on the streets. so i'll move on back to talk about some of the next steps and what we plan to do. hsoc is involving initiative that we have here.
>> so as mentioned, hsoc is looking back at the goals and looking at its vision and one of the things we know as a department, many of our services are hfi, after that it's emergency services and so really trying to meet clients and their needs after hours is a big priority. and we are putting some things in place and testing them out to see if they work. so, we want to improve outrage engagement on the street and there is the harm reduction therapy center has been doing some great work in the bayview, they have a van that does mobile outreach and a wonderful program that they have agreed to expand their hours from 5 to 9. and so we will start implementing that, and people can get counseling and directive services. we are also looking into expanding our hours and capacity of services. so, looking into increasing our
staffing at hsoc itself. hospitality house is going to expand its hours, so it could be a drop-in center to take individuals and then we are also increasing our case management capabilities, and then additionally, we know that a lot of people go to p.e.s. with crises, and even if they are given referrals or link to care, the inability to have a warm handoff can lead to dropoffs in that care. and so having peers at p.e.s. as well as social workers to do the warm handoffs, not only during the day but after hours is another place we are adding to our capabilities. and so all of these are planned within the next year and we are planning to look at what the outcomes are from this and do we need to invest more. so that ends our presentation. happy to take questions. >> before we go to questions, commander lazar is here, an
opportunity here -- york work out there. >> thank you very much, and good evening, commissioners. my name is commander david lazar, san francisco police department community engagement division and i represent the department for the healthy streets operations center and i want to emphasize in all my years of being in the department, i'm in my 28th year, i've never seen the collaboration just so good in our city. and we are working very closely with public health along with all the other departments represented in order to really, as has been explained this evening, to lead with services. and we as police officers have a role for public safety, but what's amazing this year, the amount of people that have been demonstrated on tonight's power point, the amount of people we have gotten into the community assessment service center and really, the officers are engaging with people and connect being with public health and
working with adult probation and working to get people help. so as we continue the model, whether we are involved in the law enforcement assisted diversion or the resources we need, steering more towards that than we are towards the jail, incarceration and the other models that don't necessarily work as well when you are trying to help people. honor to be here tonight and more than happy to take questions, and again very thankful for what public health does in the city and the partnership. >> thank you. >> public comment? >> there are two public comment requests for this item. >> ok. first up, commissioner roma guy. >> thank you again, commissioners. i agree with the direction that we as the department of public
health and the last six plus months have improved our communication and our collaboration, but i still want to say that the main pathway for mental health, detox, substance use and substance abuse disorders for the poorest people in our community is through law enforcement. the jail is the biggest homeless shelter, the biggest detox, the largest mental health facility, with seriously mentally ill, over 280 people today in our jail. i think we have to think bigger and use an approach that services first you need to be services first outside law enforcement except for a few
people. and that's what i ask you to look at. it's not that hsoc is a bad thing, but it's that the department of public health has to be preventing law enforcement's major pathway for people who are very ill who have, who are homeless or highly vulnerable, to different behaviors. and so i just really want us to think like that, and i know that through the health commission's incarceration is a health issue that's the beginning of it. and i know in the jail as mr. dunton said, the nurse, there's been some improvements and so, but i think we need to think a little bit more out of the box and say that the pathway to health services that we are talking about should not be
primarily for the poorest people through law enforcement. that's not why we have police. so thanks. >> thank you. jay monaco klein. >> thank you. i'm part of san francisco taxpayers for public safety, and i want to figure out how to say this a little differently than roma guy said it. at a time when we are trying to move into public health when we talk about incarceration, some of the language used sends up red flags that are a little scary, like talking about an unhealthy street behaviors. and health officers. it sort of criminalizes or puts
back into the criminal justice system some of the language that sort of makes it almost inevitable that you wind up in the criminal justice system. i think that the collaboration that you described is as exciting, but it's such a fine line between expanding the criminal justice system with some public health resources as opposed to moving some of -- moving some of the folks we are talking about into the public health system all the way out of criminal justice. i urge you to consider that as part of this. thank you. >> before i put it in the commission, dr. colfax, do you have any comments about the report? >> emphasize what was discussed earlier with regard to the collaboration across the city agencies, i think having going around and proving the wellness of individuals as well as
communities is very much key. and sharing the data and using evidence-based approaches to do that. i think from the health department perspective, obviously we do know and know that recovery is possible and that we want to offer as many opportunities for people to reach recovery as possible and that it takes off in multiple attempts for people to do that. our goal continues to meet people where they are, and across the continuum of the hsoc system you saw, to build that out and ensure there are treatment options available for people so that, whether it's a behavioral health, detox center, on the street, that we are investing in the options for people so they have the opportunities to avail themselves of treatment when they are ready. >> i would also like to thank
you, and i know i'll do something wrong with your name, but emilio aroche, and put it in the hands of the commission, so stick around. commissioners. >> commissioner. >> yes, please, thank you. i'm wondering, and the program certainly is trying to bring everybody together and the data that you are showing is very helpful to let us know that you are reaching a number of the population. i think when i heard in our smaller committees that there were problems still trying to move people into the right settings. how much of that has been overcome or will be overcome in terms of housing and is that an area -- i don't see that on the intervention program, and yet as you are doing a lot of these
things, quite often it's a matter of where they are staying. so -- is it, we don't have -- have you found that this becomes part of the problem that still remains? we can put all of us together into a lot of services and trying to move them into the right areas, but if we don't have a place to house them, does that represent to you a major problem at this point and what are the attempted solutions over the next half year? >> i'll let deanna answer fully, but i think as we all know, housing is a huge issue in the city and there are some ways that h.s.h. has been able to address it with hsoc, ems6 and the officers availability to the navigation beds.
it is a limited availability, but at least they have some availability. the hope is as more navigation centers come online we'll have more access. but we can do wrap around but if we are not able to get somebody into a place they can stay, it is the whole situation becomes unstable. >> and i think the other two areas that i would add is that now is part of the command center, we have had the hot team now dispatch workers that are going to be working side to side with our clinicians and the san francisco police department and the d.e.m. staff. so, that's a big plus for the hsoc program in general. what that means, we have two hot dispatch workers that are working now to triage into the h.s.h. system, so any call that's coming in, now the agreement is the hot team will be able to look at, is this individual on a high priority list, are they actually eligible
for housing and immediate way. no longer something that's delayed and that was just implemented last week, so it's venue but it definitely is a challenge that we have. i think we are doing our best with being able to look at trying to put partnerships in place wherever d.p.h. has a system of availability so another area or asset is the task. so, we are our clinical team at the casc, and asked h.s.h. can you leverage your staff to be available there, so they are ready whatever we do an assessment and sfpd hands over aversion opportunity, i need a bed, place to stay, that we have someone stationed to do that work. another change we'll see in the next couple of weeks as well. i do think from a greater standpoint, standing back as a city, there's a large challenge and it's no secret, and we are trying to see how i believe, you know, mayor breed has really
looked at trying to open up new opportunities and we are hopeful for that, looking at new navigation center on embarcadero, fruitful for the work we are trying to do, we need more placement. that's the highest demand that we have around services when we approach any individual, including our care system. >> just one follow-up. and in the data it's impressive, 2018, 29 and thus far in 2019, have placed 28. might be interesting to be able to know how many we haven't been able to place and that kind of also helps justify increasing our efforts to open up those centers because that does show that there is a demand, you are there, you have reached, and so that would be a number that would be kind of useful. what is your waiting list that
then says, you know, there really is a need for this type of housing because we have reached these people and they can't get there. >> yeah. i think the only comment i would just add to that then is we are working with the controllers office, and our department policy team to be able to really look at sort of a nonbias way of calculating the number of refusals or opportunities we don't have available for anyone we encounter on the streets. as soon as that's available and given to dr. colfax and the rest of us as part of the policy team, we would be happy to share that. >> thank you for this work, really wonderful. you mentioned engagement, do you have a break down of, as to what the point of contact has been among the 7900? i know you have the list which is less than 7900 of the health fair and so far, but what are your top points of contact for these outreach engagements and do you have any prediction if you were able to extend services
into the night, what do you think you could accomplish? if you flip the hours, how do you think that would impact, you know, your ability to place people and accomplish all your goals. >> yes, i'll probably answer that question alongside with commander lazar. the san francisco police department is probably the most accurate data point when it comes to looking at additional services needed. general outreach contacts, 7,900 or so. some is a combination with health fairs. the others are community outreach teams, their engagement that they have during certain hours of the week. but we can certainly break that down further so you can see how the different programs interface with that. >> i think that question was answered, our numbers are included in the outreach, we have police officers that are going out and asking people if
they are willing to come with us and get into the casc and all that, that's been good. and healthy streets operation center, open 7:00 a.m. to 11:00 p.m., 7 days a week. we are staffed up, and we have found that as public health representatives are there, and we have one particular person there, very helpful. very resourceful for the officers who call from the field and say i have an individual and they are in crisis and they are in an encampment and we are dealing with this, and coordinate and other internal meetings of strategies to get that person help and by extending those hours, just continues the conversation because this is happening beyond, you know, the 9 to 5 monday through friday, and that's why we have committed to a seven-day strategy with hsoc. >> thank you. >> thank you for the presentation. this is definitely very
inspiring program and i like to flip the hours idea very much. the question i have, it seems like most of the impact you are measuring at the immediate short-term impact of how many people you can place, or helped, what about longer term impact. how many of them stay housed for at least a year or over? i think that if, if there are more -- if we can paint a better picture it helps us, you know, like to also know, you know, how to further support these people. otherwise i think that we are going to go through the revolving door again. >> thank you for that question. for us, when we connect people to services, especially as has been mentioned when they are identified as high priority, there is a definite pathway we
follow them when they come in and out, we know that recovery is possible, but it's often, it takes time, right? so people fall out and then they kind of come back in and our job is to be there at every second to be able to catch them when they are ready. so, i think that pathway is very clear for us. we are working with h.s.h. and i think it will reflect in a controller data on the people that are put into navigation centers, or into shelters. what are the outcomes of those individuals. obviously our shelter health team is there to help at the navigation centers as well as the shelters to help with the health needs. but a client does not come in saying i was referred from hsoc, so, they are taken as just the clientele of that population and so it really is -- it takes some maneuvering to figure out, you know, who has been referred from hsoc from other programs. but that is part of the things that we are looking at and the controller as well as what are
the outcomes we can associate with this intervention. >> and i have one question, has to do with the cross departmental training and the focus on the harm reduction. does that harm reduction model come from a place of informed care, because harm reduction is one thing, are they integrated into a model of services for the people on the street that you are having contact with? >> so, for the trainings, i know they have done harm reduction. i'm not sure about trauma and informed care. all of our outreach workers have been informed trauma informed. i'm not sure about the hsoc officers have gotten the training yet. if they haven't, it's a great idea. ok. yeah. >> they have received training on trauma informed care, harm reduction, crisis intervention training, deescalation training and a whole host of other things
and it's really all the homeless outreach meet to receive training every week, not only a resource to other officers but changing their hat in terms of what traditional policing is versus policing social work. the training has been great. public health is out front making sure the officers are trained up. for that, we are very grateful. >> thank you. >> commissioners, a couple things. one with regard to the trauma informed care piece, i can't help but mention just this morning i was going over some data with some team members and actually training the health department, 8,000 staff in the last four years on trauma informed care, impressive there. and the other part, in terms of framing the hsoc operation in the broader context we are working to provide the physical health care, behavior health
care, housing supports, healthy streets for all of the communities in san francisco, hsoc is one intervention, but also want us to think through in a broader context from the crisis intervention teams to the flow of a system from acute care and emergency services to supportive housing. hsoc is one, albeit a high profile and merely around the clock intervention done, but other parts of the system we are building out to reach people. although there are many people who are touched by hsoc who are experiencing homelessness, not all the people touched are experiencing homelessness. a key piece there. and while many suffer from behavioral health issues, not all do, and certainly not all at the point they intersect with the hsoc team are necessarily in the contemplatetive stage for treatment. my point is, we need and are investing in other infrastructure, in other
interventions, to complement the important and collaborative intervention. >> thank you, doctor. >> along with what director colfax was talking about, nice to see integration of where we are going with these and probably moves closely into also the work that the mayor would like to see in terms of how we are doing that, so, i think adding those other parts would help us all understand totality of where we are going and what we also need to do. >> thank you. next item. >> sure. commissioners, october, meeting focussing on flow throughout the d.p.h. all right. item, other business. >> commissioners. >> and before you you have the calendar commissioners, i'll note at the moment, based on all
of your schedules you gave me and appreciate you sent me the dates you are going to be away, august 20th seems to work for all of you to have the community meeting in chinatown. i'm working on details on that and will let you know about location and more about that. >> thank you. >> commissioners. calendar, comments? additions? >> shall we move on? >> yes. >> great. item 11, report back from the april 23, 2019, commissioner chow is the chair of that meeting. >> thank you. i want to take a moment or two because there were two important items, so along with the fact that we did our usual regulatory reports and looking at a new format for the c.e.o. report, included new graphics, which i'm assuming you will all, do they all get that?
>> they don't but happy to send that to them. >> yeah, i think we need to look at how we are going to give the commission additional information. i think it's important from our hospital that we continue to keep you informed. medical staff level, we actually looked at the pediatric rules, regulations, pathologic rules and regulations, and passed those, and technical corrections we agreed to on the, because they are there and a lot of the rules and regulations cite how to do charting, family medicine, emergency medicine, urology and neurology change, rules and regulations to reflect the new epic system.
pediatrics gave us training and reappointment, and there was a new pediatrics privilege list revision. and within our association, we did approve the report of the pips minutes. i wanted to talk about two things. one, we were actually presented a quality core measures and c.m.s. star rating update. it is public information. that we remain a one-star hospital, but we are not the only one-star hospital in fact amongst apparently safety net hospitals, most hospitals are within the one star, which is somewhat related to the manner in which c.m.s. does these report cards, and i wanted to explain that in as much as you might be questioned or we might be questioned in terms of how as other places are showing all their stars that ours is only one star and yet we believe that we are a superior hospital.
and part of the reason, and doctor, correct me if i'm wrong, some of the data is outdated. some of the data also is not collected correctly, probably for a safety net hospital because it is actually based on benchmarks that cross all hospitals all the way from small rural hospitals to a large complicated academic facility plus safety net hospitals, and also there is a problem in some of the data related to the fact that there are different populations being measured and so that has been something acknowledged by the federal government and we actually have a representative on a group that
is trying to resolve some of these issues so that apples could be compared with apples more correctly, and so here i think we have a mixed thing of fruits and come up with one star. that does not mean the hospital doesn't want to do better, and it intends to, it has improved a number of the measures that we have seen. but a lot of this does not get reflected into the stars because do they reflect 2015 or 2016 -- is that congratulate, doctor, in our performance? >> good afternoon, commissioners. susan urlick. it was great. may i clarify a couple of things. so, the c.m.s. star rating, the hospitals can get from 1 to 5 stars. and generally you see hospitals in the united states falling into a bell curve.
so of course we are at the tail end of the bell curve. it is true that safety net hospitals, those serving disproportionate share of medicaid and uninsured patients, tend to be shifted to the left on that bell curve. if you looked at the bell curve of safety net hospitals, instead of the hump being a three, it's closer to a two or below. so, it's not that safety net hospitals could not be 3, 4 and 5, it's just much more rare. so, that's the circumstance. the reason is that the data going into those reports is not adequately risk adjusted. meaning that we have in addition to serving disproportionate numbers of medicaid and uninsured patients, that includes more people who are homeless, more people who have mental illness, more people for whom it's difficult to do well on some of these measures.
so, that is, that has been recognized as you correctly state, it's been recognized by the federal government, it's just that c.m.s. has not adequately factored into its rating that that risk adjustment. that being said, it does not mean we can't improvement. and there are measures that we are focussed on and want to improvement. one of them is one that we actually have improved on, it's that the data are reflected from 16/17, so you can't see the most recent results. the other thing i think we can do better on and hopefully will be able to do better on once we go live with epic, is our coding, accuracy of coding data. that definitely disadvantages us here. when we look at the data, it makes it seem as if we don't see highly complex patients and we just know that that's not true. and so our index is how it's
referred to, so we hope to do better there as well, and over time that will reflect in a better star rating. >> thank you, and hospital as the goal at least two stars, which is -- >> well, over time we would like to get to three. but we recognized that's going to take a few years. so, that's our goal in the next five years. >> right. >> thank you. because you might see that as people are looking at different scores. and we were given that explanation yesterday, is that right, dr. green? >> yes, the improvements and just the quality of care at the general is i think unparalleled, and we are being kind of profiled unfairly by the age of the statistics as well as the case net issue. >> on better news, i wanted to also explain and we passed out to the commissioners the power point that we received on
zuckerberg, patient care quality improvement fund. so, contrary sometimes to public perception that the zuckerberg was merely a fund that was given to build the hospital, also a component of the fund that was specifically related to improvement within the hospital, and allows, therefore, one to do things after the bricks and mortars occurred, and before you, it just shows some of the examples, like it takes whenever you move into a building or a house, there are needs that were not anticipated. this funding was created to allow that to happen. and there is optimization and improvements of certain flows that are coming from this type of funding instead of having to come from city funds. likewise, there is a category 2 in here, transforming patient
staff and visitor experience. you can read what it also is doing. these are all part of the funding and part of what the zuckerberg fund was created to do, not only build the hospital or complete the hospital, but also to allow for continuous improvement in the hospital services, with a fund that would not have to depend on the city's general fund. i throughout it would be good for your information also. i think we found that very important for us to realize. thank you. >> commissioner chow. >> and the last item is the consideration of adjournment. >> motion to adjourn. >> so moved. >> second. >> all those in favor say aye. >> aye. >> meeting adjourned.
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