volunteer. when i was home into sick to move, they would just sit with me. we did not even really talk, because i was too tired and weak to talk, but she would stay with me and i knew i was not alone. with the greatest respect i would suggest that unless you have in this bill yourself, or at least taken care of some of this bill come it is hard to really imagine the excruciating pain, and i do not mean just the physical. i cannot imagine what i would have done without my volunteer. i know there are new clients that find themselves in situations similar to mine. i urge you to acts of it will have the support they need. for me was the difference between getting better or not. thank you. thank you, supervisors. supervisor kim: we registering

providers at the moment. i want to offer a supervisor campos a chance to state -- to say a few words. >> think supervisor campos: thau for hearing this matter and putting this request on the agenda. i want to thank the entire provider community of the entire community that has been working on this for quite some time. i want to say a couple of things. i know on a more personal note, i did have someone very close to me here recently passed away because of aids-related complications, and i think many of you knew that individual, and as a gay man, i think we do not

fully appreciate the impact some of the devastating impact of aids and hiv has had and continue to have on our community. the fact is people to this day are dying of this disease, and a crisis hot that people will often talk about or think about is in the 80s or 90s, but the reality is and this year, 2012, this remains a big issue. i think that we need to be very mindful of the fact that dealing with aids and hiv is difficult enough as it is, even if you are having all of the treatment and medications that you can have, but when you deprive a community of that some of the problem is compounded so many times, and we

just had a meeting that we have a on a regular basis around budget issues. with the issue of ryan white came up, it is incredible when you think about how connected all of the services we're trying to protect our to what we're talking about here. the elimination of this funded when not only have a devastating impact on the communities and individuals directly affected by this come up but there are so many organizations that are doing a lot of other work that if the funding goes away, their challenges will be quadrupled, because that means the clients they are serving will have even greater needs, and we simply do not have the ability to deal with that. i do not know that we can really overestimate how critical

the funding is. it literally has been saving and will be saving the lives. i am very appreciative that the mayor's office has been so responsive in a very short amount of time, we as a city collectively as the board in with the vader restore the funding for the current fiscal year. my hope is that we do the same for the upcoming fiscal year, because if we did not do that, i do not know what will happen to this community, and what will happen to the rest of the city which will be dramatically impacted by it. i hope it is something that we make a top priority, and i know it is not an easy thing to do, because there are so many things we want to protect, but this is something that is so basic and fundamental to the quality of

life of so many communities, and i can tell you as a gay man of color, i know there are communities that are proportionally impacted by this. if you look at the devastating affect that this disease has been african-american community and latino community, we need to do something, so i look forward to working with the mayor's office and making this a priority. i know the work of this committee is very difficult. you'll have to make very difficult choices between now and june, and i want to thank you for listening, and i think if anyone can get this done, the city and county of san francisco can get this done superviso. supervisor chu: thank you. why don't we continue to the

department of health presentation. >> good afternoon, supervisors. barbara garcia, director of health. i wanted to acknowledge the providers and advocates today. planning council's work hand in hand with us on the issue of prioritizing services. having been on the planning council, i can tell you from my experience planning councils of local government and not always see eye to eye and the planning process. part of the process is using the planning community, particularly when we look at the budget process in engaging with community and providers. if we take a step back in terms of looking at the department overall budget, and many of you know what the mission is to

promote the health of all san franciscans, and the services we provide. we have two major hospitals. differences good general was one of the main providers of servicing the hiv epidemic in continues to be. not only that, but we're seeing worldwide some of the most knowledgeable researchers in the field. we do have the advantage of having a very educated community about hiv and aids. in the overall department we have community-oriented partners and public health services. along with this, we have almost $200 million of contract of services to providers. our overall budget is 1.6 billion come including $363 million of general fund. as you heard today, not only do we have the fiscal challenge of several federal departments

changing their funding sources, we also are 23% on general fund. primarily those funds are used to draw down other federal funds. with that, we still have significant structural challenges in the budget, and we have had losses of major state in ventral spending. -- in federal spending. we have also been facing federal funding reductions. there is still a state issue whether they will continue to cut the budget. we continue to have increases in operating costs, including regulatory requirements. we still have cost-related health services. if you look at ussf, they are

the decision group and provide an incredible amount of services, and we have to take care of some of the needs through our budget process is over the years. in the next following year you of heard a little bit about health care reform. the federal requirements will be pretty steep. they will require us to invest more money in our department. while we see the reductions in looking at the reductions, we are required to invest more dollars for milestones to meet some of the federal health-care obligations. it represent order to $25 billion in new revenue that the federal government has given us, but that represents 80 million, because we leverage those dollars to medical. almost 80 million is required for the performance milestone. we have come in you will see

will will be increasing the primary care area in the specialty service area, because those of the requirements we have to meet. one of the other requirements we have to meet is moving into the 21st century in electronic medical records, and $5.4 million in additional investments are required to do that. we have to achieve levels of meaningful youth. one of those is we have an electronic health record. there will be porter's -- portals for consumers to be able to get into the electronic health records. those are about a couple of years away. as many of you know, we are in the middle of building a new hospital, and part of the bond up for the hospital covers the structure of the hospital, but we will be needing a couple of fiscal years, an additional $170 million to provide the furniture and equipment for the next four fiscal years.

supervisor chu: in terms of the requirement of the program helped reform, what is the timeline that some of the milestones need to be that, and what are the milestones? >> some of them include can we open during the night and weekends? other milestones include timing access that we have to be able to get people appointments within 10 days in 60 days within specialty services. i did we have three more years in that waiver. there are about 60 milestones we have to meet, including medical milestones. supervisor chu: is on for the milestones are spaced out over time basically? to go right. we have organized milestones and have put expenses against the milestones. supervisor chu: for the

electronic records, is there a time goes up to be complete? >> some of them are within the next two-three years for the waiver. we have a very detailed timeline on that. we can certainly give the background information to you. the department has embraced a pretty significant process to ensure we have stickle their input. we have set of meetings with community groups to receive input on the budget process. this year we had three town hall meetings with staff to receive input, and we have already had to help commission meetings to propose public comment. in some of the meetings with the community groups we tried to look at ways to increase revenue to be able to reduce duplication of services, and also, we did think about how to

prioritize our revenue to the extent possible that can draw down matching funds. one of the areas we're looking at is services relied generally on the heavy -- on the general fund. substance abuse services we have to be diagnosed individuals. many of them have mental health issues. what we have to do it in order to drop down meticadical is make sure they are delete the eight most fundamental health. we have engaged with community groups and have assessments in working with the substance abuse providers to see if we can move them into the program to be able to draw down general funds. we think that will create more revenue. i do not know if we will be able to do that fast enough. you will see that not that there was total consensus, but one of

the ways of the budget was to look at non-match general funds. for every dollar we would cut, that would be $2, making a larger significance of the reduction. over the past four-five years we have promoted service delivery integration. given a lot of work around primary-care and health care. we try to prioritize non-service efficiencies. i am trying to look at programs to consolidate some of building consolidations. we look at redirecting those for new service needs. i will leave this and allow the

new cfo to go through this. one new note to see at the very bottom of this is that although we have met our 5% on each of the fiscal years, we still love not met the contingency part. we are working with the department, the mayor's office, and the contingency, which would mean if we had to go back we would bring more cuts for your review. it is a significant amount we still have not met through the budget. >> thank you. i will take you through our budget at a high level and talk about some of the larger and initiatives. i believe we have provided your offices with a full set of documents that went before the commission.

we're happy to answer questions about those. to the extent we do not cover them now or at any time after today. looking at the big picture of the budget, i think a couple of things to emphasize what barbara garcia pointed out. we have the reduction targets that need to make as part of the citywide effort. for the largest department we have the largest amount of general fund, and so i our share of that is significant. in addition to that, we have the challenges of meeting some of the cost growth that barbara garcia talked about, and the cost growth associated with inflation in meeting the federal requirements and milestones. the page in front of you is a summary of what our challenges are coming and how we met those

challenges. at the top are the reduction targets city reductions are $29,000,000.39999999 in the second year of the budget. the second part of the table are solutions and other costs we need to address to get the budget balanced. we have a system of the amount of the distance we needed to travel in revenues, and that is a good thing. $26 million in the first year, and 46 in the second. there are two categories i will talk about a little bit.

there is also a significant amount of revenue included here that will take effort on behalf of the department by generate -- by changing the way we do business to generate additional federal and state funds. we have $22 million worth of expenditure reductions, and then two of the three categories at the bottom that have positive numbers, those are grows in costs. inflationary is the cost of pharmaceuticals, costs for the general hospital. other cost growth. regulatory includes the cost of the expenditures to meet the federal guidelines and drawdown 45 worth of revenue. leslie, emerging needs includes implementation of electronic " but records. supervisor chu: your revenue is

$26 million. target was 29. a gift you almost always there with revenue growth alone. it looks like what is happening is your department has to absorb increases in pharmaceutical costs, the fact that there are additional expenses you have to capture, and that each of some of the revenue. >> that is exactly correct. one of the challenges we have been struggling with in terms of how we communicate with what is it in half the budget is if our reduction target is a challenge, it would be easier for us to get there, because we do have some of the revenues. because of the investments we need to make associated with the federal requirements and cost growth, those challenges are over and above reduction targets. we have the dual challenge where

we are forced to make investments to keep them financially step -- financial lease sustainable, but many definewe need to find funds els. >supervisor chu: in terms of the numbers, are they based on past legislation or practices that are already approved by either the federal or state governments that we can expect, or are there any uncertainties in them? >> that is a good question. i will talk in more details about some of the initiative. there is a piece of this that comes to us that is allocated either through operating expenses, and receive matching funds for the operating

expenses, we also are receiving money through federal allocations, and we of estimates of what those are. those come through matching dollars of the medicare waiver. those are relatively predictable. there is also a significant piece of the revenue we will have to work for and have to make operational changes to receive. this is partially predictable, but there is some uncertainty which means we will have to do things a little bit different we have seen it since the biggest swings in particularly federal spending to the department. as our broker see a mentioned cover each of the past three years we had revenue from the federal stimulus. we of the hospital quality

assurance feet. big pieces of revenue that have come in and out of the budget based on federal decisions that are hard to predict, and we do our best, but it is very difficult to say with certainty given the size of the budget and the level of revenues exactly where we will be by the end of next year. supervisor chu: tighten back to the hiv/aids presentation, it basically as soon as we lose money from the federal government to reduce expenses by that amount? >> that is correct. it is neutral in terms of general fund of dollars and the impact on this look at the budget. >supervisor chu: if we will look at anything above restoration, that would be above the fund? >> correct. supervisor chu: the provider of

last resort component means we will pick up more expenses. is that included in this number? >> that is included in the deficit projection -- the opposite reduction -- deficit reduction. it is not funded, but the cost of that is assumed in the deficit, since there is relatively little action that we can take in terms of policy decisions about whether or not that hits us. just to talk through a couple of the revenue pieces that fall into the latter category that i mentioned, there are things that were actions to generate new revenue. these are not based on federal or state policy decisions. this is trying to improve how much we draw down at the

hospitals. we have a few initiatives. the first initiatives as emergency department and operational of efficiency. we did research that shows about 10% of the visits to our emergency room end up leaving before they make it into the hospital system, and that is a bad outcome for patients come and about outcome for us in terms of being able to get patients who need to be an acute care setting. we have some investments in staffing in the budget. we agree directed vacant positions to allow us to engage people more quickly when they come into the emergency room to mixture we are getting them into the hospital. and this allows us to draw down funded with their in the hospital.

supervisor wiener: is that people better in the waiting room and taking many hours so they just leave it? >> that is essentially. either they are waiting or not to engage in a way where -- where we're giving them immediately in a place where they need to be. >supervisor wiener: is this about reducing weight times? to go it is. it is about reducing wait time and when someone comes in to make contact with the stock to have someone in gauging them immediately while they are waiting and let them know what the plan is and talking to this stuff about how to bring them in the system. it is about getting people more quickly into the hospital when they come in. supervisor wiener: what is the

average wait time for the people were there could be a wait time? do we know what the average is? >> i do not have data with me on the actual length of time. i am sure it varies significantly depending on the conditions. we did have a consultant take a look at how the wait times compared and operational differences between the hospital and others so we can look at the report and see if we have those numbers available and provide them to you. we do know there is an estimate in the report we did touch shows we have 10 percent of the 65,000 annual visits that we should be able to reduce to 2% of based on best practices. that is the goal to reduce debt by 80 percent over time.

-- to reduce that by 80% overtime. supervisor chu: all these other things, it does that sound like this is about bumping people out of their existing beds, but we want to get more bad years. >> some of the others are about the latter. on each of the next two, part of the focus of the department is not having people who do not need to be in acute-care bed in an acute-care bed. the second initiative, $4 million, when we have someone who is at san francisco general hospital who is an acute -- in need of an acute-care bed, we can draw down almost $3,000 per

day. once they are no longer acute in do not need to be in that bed, we do not draw down the revenue and do not have that available for someone who needs it. part of the department's strategy, and this has been a long, ongoing efforts but it has renewed commitment come in the budget is to try to do a better job of when we have someone who does not need to be in acute- care bed you can be seen at a lower level of care, to move them into a more appropriate environment that frees up an acute-care bed and drop down revenue. what we're trying to do in san francisco general is purchased beds of lower levels of care that are more appropriate that saves us money and allows us to draw down more revenue. similarly at laguna honda, it has been the goal of the hospital we do not want laguna

hospital to be it a place to go and stay forever. the goal is to get you to a lower level of care, back into the community as soon as possible. part of the effort here is to try to improve the flow of patients from laguna honda when we can get someone into a community-based level of care. that allows us to make better use of the beds come and to draw down more rapidly. this is the part of the strategy of looking at the health-care system as the network of a whole, not just looking at a hospital, but looking at what patient needs to be aware of the system at the right time. that has benefit financially for the hospital. >>