received. the reason i say voluntary is that we have been waiting a decade or more for the state legislature to do this and they have failed. there is no evidence inside the bair going to produce such a system. on the other hand, they did there is no evidence they are going to produce such a system. they do not have been listed you said it. we have a situation where we could build a data organization that would provide almost real time basis monitoring data of the quality and cost, the actual cost paid in the claims process for care. that would become a tool. if you want to see competition, i guarantee you, let us bring to the table recorded cost and

quality data side by side and put it in front of our members' families and working people of the bay area. you get competition. it will be set in and swift because we have seen what happened on a small scale in other situations. i want to do one other thing. i want to tell you that you should listen to dr. schaffer for more than 10 minutes. she brings such a wealth of understanding to this. she has paid attention to the quality as the underwriting court issued to be resolved. we will not stable costs without improving the quality of care. we will probably not improve the quality of care, however, until we change the way we pay for it.

they're linked fortunes. that can only happen if it happened at the local level. this federal legislation, which i applaud, does not provide a remedy for the cost and quality issues that the community level. that is up to us. that is why we're trying to organize unions into force is to take control of their own payment, to take control of the position they are in when they face these increases. we are looking at increases of 8 or 9% in premiums around the state. that means there will be roughly a doubling of premium cost in less than 10 years. the cost of medical benefits will be equal to the medium -- median family income of californians. that cannot happen.

we will start with the information. we cannot move legislation in this environment without better information. we cannot depend on the legislature to require that we get it. we will have to do it ourselves. i ask you to take this step of adopting a simple policy. if you want to do business in the health care in the city, agreed to full disclosure of all -- full disclosure of all actual cost, charges, and a full reporting system that will allow a purchasing committee to evaluate the quality of the care you are providing. neither is available now except to long delays at the fact at great expense. supervisor mar: thank you so much. i should they'd said burke -- supervisor david campos for

providing suggestions for expert speakers. the last expert speaker is dr. rene shoaw. she is a published author on numerous impacts of provider consolidation. she is going to focus on the impact of the emergency services, keeping emergency services accessible. >> i am an emergency physician at san francisco general. i am assistant professor at ucsf. i am not speaking on behalf of any of these entities. i published ostensibly in the area of emergency department closures.

i was looking at over 2400 hospitals over the past 20 years and the united states. hospitals that serve low-income and poorly insured patients are twice as more likely to close their emergency rooms than their counterparts. this is even after controlling for things that market competition, profit margins, and ownership, and population density. my team performed a state analysis to determine if these national trends are similar within california. hospitals serving a higher proportion of minority patients and poorly insured patients had a highly -- a higher rate of closure. there is a federal law that states that all emergency departments must see patients regardless of their ability to pay. this is the only place where you can get care regardless of your ability to get -- paid. as a result, what happens is you have two different types of

emergency departments. if you are a hospital and your e r is located in a geographically affluent area, a highly insured patient care mix, that emergency department is the revenue center for the hospital. it is the entry point for admissions. however, if you're hospital is located in an area where the patient care mix is poor, the hospital is more likely to close its emergency room. what happens when the emergency rooms close, when somebody has an emergency and their nearest yard is closed, it does not mean there emergency disappears. they go find the next emergency room. that can cause crowding. last year, i presented a piece of research at the national scientific meeting at the academy of health.

we showed using data from the bay area, san francisco, part attack patients who were admitted on crowded days actually had a 21% higher death rate at 30 days. even when you control for all factors. patients who were admitted on noncredit days. we used to think, if the hospital is crowded, a means that patients to have a sore throats, instead of waiting three hours, they wait six hours. we have increased morbidity and mortality from serious conditions when you are admitted on a crowded day. it is clear the hospital and emergency department crowding enclosures are not isolated to a single zip code or neighborhood. they certainly affect a larger community. i will provide a few pieces of data regarding emergency care

that may be relevant to this discussion. even though st. luke's account for less than 5% of inpatient beds, they saw over 10% of the traffic in the city, a 26,000 patients. in terms of prodding, one proxy we use is ambulance diversion. if you are in an ambulance, you go to the nearest hospital to seek care. that hospital is crowded, there is no in patient capacity, but hospital is on diverge. ambulance needs to be rerouted to the next nearest hospital. when you look at the data, in all of california, san francisco is in the top four counties with the highest diversion rate. in all the hospitals combined, the number of hours on diversions was more than 4300. on average, everyday in san francisco, we had 11.5 hours of diversion each day.

during these times, each patient that had to go to the hospital in an ambulance had to be rerouted because one of the hospitals was so crowded. of course, crowding is not evenly distributed across all hospitals. if you look at were crowding happens, it happened most in hospitals located in the southeast part of the city. san francisco general, because -- we are on divert 25% of the time. santa lips was third highest in their version -- st. luke's was third highest in the diversion. if someone in my neighborhood needs to go to the hospital, they have to drive further to the next hospital. it is not only that patient to is affected, it is everybody else. it is clear that closures affect emergency care for all, insured and uninsured. these closures affect access to care through increased distance

and also by increasing the patient load at neighboring hospitals. er crowding degrades quality of care. it can also set the stage for additional closures by displacing tens of thousands of poorly insured patients to other hospitals. as you are aware, this discussion of st. luke's is only one consideration and it is part of a much larger discussion. supervisor mar: any questions, colleagues? thank you for the presentation. [applause] colleagues, we are ready to move towards public comment. i also mentioned the last

hearings, if there are seniors and people with disabilities, i would ask them to come forward first. i will start reading the names of the people who have signed up. [reading names] i will call the rest in a moment. >> thank you. i am kind of flabbergasted to hear all these conversations about markets and competition and lowering costs. it is a fundamental rule of

capitalism that competition leads to a monopoly. cpmc rebuild is a perfect example of that. this kind of monopoly is going to lead to more charges, higher charges for health care. it will directly hit city workers and retirees since the city seems to be determined to pass these increased cost from the cpmc rebuild on to the current and future workers. in march of 2011, at the l.a. times roadwrote, " northern california's most populous counties collect 56% more revenue per patient per day then hospitals in southern california's largest counties. northern california hospitals say their prices are going up

for labor, supplies, and other necessities. leading health care economist said that most of the disparity stems from a lack of competition in the north. a wave of consolidation has given a handful of hospital networks unusual powers to dictate what private insurance and the customers pay for care." supervisor mar: that is 30 seconds to go. >> the article continues -- "the driving force of this is sutter health." this process of trying to figure this out up until now has failed. everything has been revealed shows that what you need to do is to plant things off six months until the beginning of 2013 when the city's own master plan process and the needs of

the whole city are taken into account. supervisor mar: thank you, next speaker. >> some of you know that for years, i worked in one of the most dangerous jobs around. i worked for a company -- an individual i was working with was moving steel into a building. at some point, when he was rolling that card into the building, one will of the cards caught on something on the floor. together, they took his thumb off. that individuals brought immediately to the emergency room, san francisco general, where they did a fine job of stabilizing him. however, when the emergency room

decided that it could be reattached, they immediately sent him to davies medical center. that was where the still resided for microsurgery. that is an instance of how san francisco's own health care system considers cpmc an integral part of its delivery. that is something we need to bear in mind as we consider how best to preserve this institution. he was heard criticisms of the health-care system in general -- you have heard criticisms of the health-care system in general, but cpmc is an integral part of san francisco's health care system. i ask that you keep that in mind. supervisor mar: if i have called your name, please come forward to the middle aisle. thank you. >> i think i am next.

i am with sf cares. i really appreciate some of the speaker's earlier today, especially talking about competition and making sure that we do have competition in our health-care system. also, the location of st. luke's and sf general being south of market. for a long time, i've never spoken here before on this particular subject, but for a long time now, i have realized, and i used to work at st. luke's. for a long time, i felt like st. luke's has been so criticized. when you look at the city and the sea south of market and their only to hospitals there, we need to keep things in talked. the idea today that was brought forth about having this huge

hospital on cathedral hill and all of the beds being drawn away from st. luke's. if we only have 80 beds from st. luke's, it is meant to fail. that means -- that really scares me. i think about earthquakes and other things like that. if all the hospitals in existence are within a mile of each other, and there is only st. luke's and san francisco general. it is going to be very hard for of honorable -- for our vulnerable to get help. the other thing that bothers me is when people have loved ones and are needing care and they have to take many buses to get their combat such as from the bayview. if st. -- minibuses to get there, such as from the baby. it does not seem very wise to

me. i would urge that the board think about this. supervisor mar: i am going to call a few more names. [reading names] next speaker. >> thank you for hearing this matter again today. i am with the construction employers association. we represent over 100 union building contractors in northern california. several of which are located here within san francisco and many of which are performing work here in san francisco. what i would like to talk about are just the immediate construction jobs that are badly needed that could be brought on as soon as this project and as forward. the day that this project

starts, there will be union laborers on the ground taking down the old building. there is no question about how much the union building construction markers have suffered over the last few years with the economic downturn. these jobs are so important, not just to these people, but to our economy, locally to rebuilding our health care infrastructure and also a mission district resident, and i know how important is that we continue to upgrade our health care infrastructure and build this new seismically safe hospital in a neighborhood that is really in need. i am representing a contractor who has been selected for this project to has done -- more time and resources to workforce development and helping to develop workers in this city. i would urge you to move this project forward and get these construction jobs going quickly.

thank you. supervisor mar: i would like to remind the speakers that are focus today is on health care. in the last hearing, we dealt with jobs. my hope is that we focus on the health care system today. >> good afternoon. i am also a resident of the mission district. i am the research director at the national put union of health care workers. i spent about 15 years of analyzing the health care industry. i want to offer several experiences and offer a cautionary tale. i can say without equivocation that sutter has the most aggressive business strategy. let me just cite three examples, which i would urge the board to

consider. calpers did an analysis some years ago of claims data provided by blue shield. the prices were 80% higher on average than hospitals across northern california. about 10 years ago, when sutter health saw to acquire summit medical center,a judge allowed the acquisition to go through. several years ago, the federal trade commission conducted an analysis of that acquisition to determine whether it had anticompetitive a facts. they got claim status from five insurance companies and found that sutter health had boosted prices by as much as 72%. our own organization did analysis of adjusted claims data and found that in the central valley, sutter's

hospitals charge prices for simple pneumonia that work 106% higher than its competitors. in the attorney general's antitrust lawsuits, document emerged discovery process to provide insight into the business strategies. i would caution the board that this is a very aggressive organization. they will use their market power to boost prices on consumers. >> i am working -- supervisor mar: please pull the microphone closer to your mouth. >> i am a student. i have been here for, like, six years. i would be glad for having a new hospital building in year.

it will be a safer and provide faster support for emergency relief. no cpmc project means no jobs. many members have run out of unemployment benefits. it would increase the positive impacts four lives. some of our members have lost their homes. we need this project to move forward. we need to approved cpmc project without any more delays. supervisor mar: next speaker. >> [inaudible] >> good afternoon, supervisors. i am a member -- i worked and lived in san francisco.

i applaud the work you have done for the city. i believe this is a very tough decision for you as this cpmc project comes to you. you know, san francisco need save hospitals. i hope you guys can work with the mayor and cpmc to make the hospital possible. i appreciate your work. i hope to see you next monday. supervisor mar: next speaker. the microphone is movable. >> i am ricky. i think the hospital should be built around neighborhoods where it is easy to get to.

it should be billed for safety and care, not for money. supervisor mar: thank you. next speaker. >> good afternoon. you know, i feel your pain. i have the same pain as we negotiate are held increases every year and how much money is it going to cost us and the leverage the city has in this development agreement to sort of take down some increases. i applaud the city for being able to do that. the concerns i have come at the same i have with our own system. i look to blue shield to manage to different plans, why is that? i look around to the hospitals that are available in the city. we have a va hospital, the california campus of cpmc, we have kiser, -- keiser, we have

san francisco general, st. mary's hospital, the st. luke's campus hospital. i have had five -- identified ambulances rides. -- i have had five ambulance rides. it is always stand for in general. this city is building a brand- new hospital. i do not see san francisco general is part of the plan for its own employees. i do not understand that. i would date for this project and for the legacy of this board to have cpmc build their hospital in daly city. we look at what the 49 arrested with their stadium. we continue to but developers --

we look at what the 49ers' did with their stadium. we need to move this project forward. supervisor mar: next speaker. >> good afternoon, supervisors. i have a speech prepared, but i did not bring in not because most of those points have been addressed. i want to focus on some other issues. we talked about competition all day, the importance of competition. my understanding of competition, there are winners and there are losers. cpmc has continued to serve san francisco for over 100 years speaks that they have been winners. their patients will testified that they have received world- class service. cpmc has been striving for excellence in everything that they have done. the fact they have the resources to try to create world-class seismically safe hospitals show that they have been winners in health care. they should continue to serve this great city.

another thing i have heard stressed is that there are financial incentives for the st. luke's campus to be shut down. wire their financial incentives? maybe we could take a look -- why are their financial incentives? i unreasonable demands by the city that had never been placed on any development project. i challenge anyone in this room to think of another instance where a development hazmat such stringent demands and requirements. -- where a developer has met such stringent demands and requirements. there would be no incentive to close its. i think they want to see it stay open. i think they want all of their campuses to stay open. i think you guys should do the right thing. supervisor mar: thank you. next speaker. >> thank you. i live in the city and i am a

patient and i am a member of the team working on rebuilding cpmc. what cpmc wants to rebuild? in order to have seismically sound hospitals. why is that? because otherwise, in case of earthquake, we will not have a place to go to. i want to remind the members of the board that every day of delay puts citizens and residents of san francisco in danger. if we do not build this hospital, and delay, delay, and delay, you will be responsible for putting citizens and residents of san francisco in danger.