mayor lee for restored funding. thank you >> thank you. next speaker. >> hi thank you for the opportunity to speak. i'm a program manager at the health aids project. we provided health services you ranging from acute orders and we keep our clients housed. the demand for our services remains as high as every. we saw 1 hundred 1 hundred and 35 people had hiv.

1 thousand and 1 hundred 68 of those persons had low incomes. 1 hundred and 67 person for psy psych - people receive - we do our best to connect people in order to prevent any lower level of existing. that means a hundred or more persons who are resulting in

hospitalization and decline in overall educational functioning. we are here to ask for your help >> thank you very much. is there any additional public comment? okay seeing none may we close public comment? and i want to thank everyone who came out today and also the public health and the community based toeshgsz was very useful presentation at the beginning. we're earlier in our budget and we'll continue to work and advocate to do everything we can to backfill the anticipated federal cuts. so mr. chairman if there are no

additional comments? >> just some brief condemns i want to thank you for your comments that we put the hiv context of our entire safety nets. san francisco is known as a compassionate city and we've been strong in taking care of the hiv community and i'm committed to backfill the cut. and the choices we make as a city i've been talking about the city in terms of how we support the america's cup and it con trains our ability to look at our safety net but i want to

make sure we're moving in the side to support our hiv services. i think what we saw we've been making a strong commitment over the years especially the big dip in 2006, 2345078 we were able to backfill the cuts. thank you for bringing this forward and i'll make sure that jul july 1st, we'll look at those services >> thank you. i wanted to thank supervisors wiener and campos for bringing this forward and explaining how our model in san francisco is really one that the whole nation should be looking at and explain house the

data from the national speck but the most important thing is you've done a tremendous job to humanize the day that we've heard. and i know we ail work together to backfill as much as he. thank you >> and lastly thank you inform the members of the hiv provider network and thank you for coming in my office the other day and talking about it. i think the fact we're a parish national city i want to thank you for coming and spending the

time. we're going to work together and find a way through this >> thank you so if colleagues if there's no additional comments i move we continue the items of the chair. >> so moved. mr. clerk could you, please call items 2 and 3 together. >> item 2 to receive an update and focus year 2013 and fourteen. >> out of 4 thousand deficit the plan. >> thank you very much mr. clerk. i call these items a few weeks ago after our 6 week report came out but we are going to see some

structural issues moving forward and i'm sure it's going to be a topic of the committee for weeks to come. i want to thank mr. wagner and invite barb garcia >> first thank you for hearing the hearing today, we're going to be challenged this year but also internal and external deficits. so after the first 6 years the department faced large deficits that included both on costs of doing business for the department. for the majority of those proomz we were able to cover some costs and the board of supervisors

have continued to be incredible supporters. but we still carry a deficit that was driven by labor costs. during this time we faced reductions and eliminations of programs. so to provide you with a few details for it does cost the department the one 20 and $30 million just to stay the same and those costs are due to pharmacy and medical supplies. those historical deficits prancing from 15 million has been consistently accounts for federal cuts.

as we enter into health care reform and this has already started and we began that with seniors and people with disabilities. we will be paid for outcomes and performs and no longer for the number of invests. all of those are coming to a head this year and we're completing the opening of a new hospital and that's outside the bond we have to be able to pay for future and we're requesting money in the city. we need to make some different decisions and to ensure safety nets. for the last two years we have

moved 10 thousand people who are dp h patients and have been transitioned into a health care plan and this would be based on performs rather than a number of business. as we're moving our department towards the patients needs and reimbursing hospital admissions and readmissions we recognize that during the depressions we can't provided the same amount of services with less money. our department has never been shy from trying to meet our obligation from the city and we work hard with our decisions we plan a lot of before we make those and as we have in the past

while we work with the boards committee we'll did so to help balance the budget you while we're seeking the services from the department. so i'll leave it to greg our which kind of operating office to give details and thank you. >> thank you. i'll go through a couple of things today. i want to talk a little bit about our deficit and what's underlying our financial condition but i'll go through it in a little bit more details and talk about the implementations for our two year budget process. just by context as a reminder

about the department of health budget we are about a $1.7 billion operation including san francisco general hospital and laguna hospital and extensive networks of primary care and substance abuse services. of our 1 had the $7 billion about 4 hundred and 50 million is city general fund subsidy for the 2013 focus year and the other is state and federal revenue. so as barbara said we have a large counter year deficit in the controls 6 month report it is $14.9 million and i'll let

you know we've been working hard since the six months report to bring that number down and we've brought that down somewhat although your financial position is we're a significant draw on the city's if you believed just to support our operations in the current year. in terms of what's causing the deficit there's a number of things by the 4 categories we've got a instructional we face rapid cost inflammation that drives our costs up and we're facing continued state and federal revenue reductions and as part of our general

operations weakness in the growth of our partial revenues throughout the system. again from the controllers 6 month report we have a 49 point something millions and some in the general fund. in terms of our historical deficit we've got some numbers here but as barbara said over he each of the pathologist many years tlvrs there's been an inbalance a - in the past that's been less have a problem we've brought special appropriations but the bulk has been funded by revenues so we didn't require a fund draw and that has changed

particularly in the current year where revenues are not sufficient to make up that gap and as a result, the balance goes to the general fund. i think it's worth noting in the several years we're in the deepest deficit for the city. a lot of our collective energy went to minimizing the service reductions that were required to balance the city's deficit but as a result base we focused on that rather than an redirecting fund to solve this deficit you can see it's grown significantly over the last several years we're now at an inimbalance of

$14 million. like every health care company in the system we've got medical costs in the country and our city are raising faster than they're supposed to shows up in our labor costs and that growth in our costs means that each year between about

$130 million if we do nothing so the deficit. you're seeing in the current year as we go on through time will be a remaining issue for us to deal with cleric as a city and think impact on the general fund. a couple of the major items >> just a quick question. do you have another quick copy of this charter i can't do the numbers on here >> i'm sorry. it's printed small. i have unfortunately, one small full sized chart i'll hand over

to you. and we're going to get copies of those and we'll also provided you with the pages from the city's 5 year financial plan. but the numbers while we are waiting for them to get here essentially show our need for general fund dollars over and above the budget will be $50 million growing to a hundred and 4 in focus year 2014 and 15. when the mayor's office makes their projection about a hundred million dollars of that is associated with the general growth at the department of public health.

it's a significant portion of that deficit. of that amount there are a few things that are really driving those enemies. again, t again, t again, the -- it will match our expenditures from year to year. and we're in the process of rebuilding san francisco general hospital on the progress side we're on track in terms of the bond project and in terms of the timeline and it demonstrates our ability to move heard.

there are expenditures on the furniture and equipment and on some of the transition costs that are not bond eligible costs those need to be paid out of the general fund costs. so that's one of our challenges ahead. and then, of course, our general increases in the costs of doing business in the department. so we clearly have a lot of work to do. right now we're still in the process of working with our commission because of the size of the deficits and the challenges that we have based on our projection of our current year deficit. we've extended those discussion later into the spring that we generally do.

we're going to be bringing a set of proposals to the health commission in mid-april and, of course, sharing those with the members of this committee as we do so and having further discussions with you throughout the budget process. but a number of things we need to do are the changes on how we operate so we operate as a single network rather than a separate division to make sure we're providing the best care for our patients at the least costs across our system. we need to look at look into the future as we rely on medicare and we need to look to what extent we can afford programs and services that are completely

reliant on the current fund. you've heard from us over the last couple of years. we need to invest where we're paid based on a flat fee per person instead of the fee per service we need to focus on prevention and population health wise so we're keeping people out of expensive health care facilities and make sure we invest in the infrastructure that we're going to need to be under the health care reform some of the infrastructure that we need to manage care

organization it means having information technology systems that louse allows us to draw federal dollars to know and understand the costs for services we're providing and making database decisions throughout the organization. so the budget we're likely to present as part of the mayors budget is likely to have some fairly difficult decisions in that. we're taking our deficit very seriously and we want to get ourselves back to a place where we're going to be able to be sustainable so we can have financial viable safety net in place. but we'll have to visit and revisit a number of types of

proposals we've been looked in the past years. those 0 of you in the past have seen some of those but again what can we afford to do in terms of programs that appear that are not generating revenue for us. we're looking reorganizations of our departments of infrastructure. we're looking at position and our salary budgets and other options including changes in audio we're allocating our services and how we organize our services. as soon as we have proposals in front of you we'll be discussing those in depth with you but want you to understand what is behind

our financial position and the reasoning for the difficult decisions we're facing as part of this budget process. including the reductions to the hiv services that we discussions earlier in the day. so that's what we have in terms of the budget. i'm happy to answer questions and >> we're going to be hearing the special d m v next week so be ready for that one. colleagues any questions at this time? >> i actually wanted to - i was trying to wait for the chapter because of the presentation i just wanted to be clearly

understand and see the number but i guess in our presentation i heard that there was a proposed in addition to the current focus year proposed deficit but there's a potential deficit in the coming year in addition, there has been consistently been a budget deficit over the years from this particular department and i'm trying to understand how are we still operating outside of our means and allowing those defects to increase? >> not including the furniture for the hospital and it should have been budgeted in some capacity but clearly this department is not necessarily i guess working w