that's all i have and i'm happy to answer any questions you guys have. >> is there any public comment? >> i have not received any requests for public comment. >> we'll go on to commissioner questions. i'm sorry. if someone would like to speak, they can and just give me a card. i have not received any public comment requests. >> if someone has a public comment to make before the commissioners --

>> i'm sorry, i could ask you then. okay, great, thanks, i just needed some clarification on that. thanks. >> i was curious about the san francisco general salary reduction and wanted to know how it's reconciled with past reductions and this sort of

constraint on hiring. >> thank you commissioner, good question. couple of different things going on here. we have the salary budget and then we have our higher end initiatives and one of the things we've been very focused on departmental wide and is one of the main strategic goals for the san francisco health network in its infancy is to improve our hiring. we have a couple of things going on and ron can fill in the details but we have had a difficult time getting our hiring pipeline going for the last six to eight months, but that is a big priority but we are trying to so the salary savings that are included here

to put those into context, when in our current year financial statements we're showing a salary variance, positive, in the financials. a lot of that hiring is coming online, but we've adjusted the salary budget to a count for what we anticipate we'll be able to hire by next fiscal year and so we can get up to our staffing model that's adopted. the other piece is -- and if you look at the initiative that was before the commission at the last budget presentation, associated with the new san francisco general hospital, we have about 100 fte's, in addition they're added in the san francisco general budget so in this two year budget you would actually see, despite this initiative, which is kind

of seen in isolation when you look at it on presentation in front of you, you would see a significant increase in staffing proposed for san francisco general hospital as a whole in this budget proposal. >> so you expect that will take place in 2015, '16; is that it? >> that's correct. that's when the hospital is anticipated to come online. >> okay. >> also just to add for the salary savings item, it is just a line item. we didn't tleet any budgeting, so basically it's just sort of a general salary savings assumed at san francisco general. >> commissioner, was that satisfactory? >> yes. i think so. >> commissioner er malara. >> mine is very small.

i don't know if your date is when things are supposed to happen by, or the mayor is going to work on sunday, june 1, and the 17th is a friday and i don't know if the budget committee >> the mayor is required to i think he does have until june 2 or in theory he could be ahead of schedule and submit it on the friday prior. and then the budget and finance committee is actually going to be meeting ing throughout the week in june so we do expect a decision on the final budget on friday, june 27. i apologize for the errors. >> that's fine. >> in addition, i do apologize for the memo and how it was -- >> that's okay. >> -- directed to -- not directed to commissioner chow. >> as long as the data is accurate and -- >> and the numbers are right.

>> any other questions at this point? commissioner. >> i have a question about the call center and that new initiative which makes sense particularly with the adoption of making sure we have the right languages, but how does that match with the discussion that we just had about the it integrated it and wouldn't -- aren't we looking at appointment making, for example, that we'd be able to make an appointment as a certain amount of time. >> yes, i'd like to speak to that. so as you know we have a lot of existing technologies and for now i'll call them legacy technologies, but before we get to the future state we have bridge products and solutions. we are, at this time, exploring, looking at using the

legacy product and expanding the capabilities of it or more accurately utilizing the capabilities that we haven't used to fulfill some of the requirements that we have for the call center so it's not to introduce new technology and to save money >> commissioner sanchez. >> to the chair, i just wanted to -- pertaining to the -- or sfgh protocol we've been discussing, and we've heard both in the joint conference committees and here, part of

frustration of our staff and our department has been in reference to filling the vacancies per taning pertaining to number of departments including the department of public health including all our units. i think as we heard the budget today and heard the budget presentation for human resource colleague over this past year, they are and are actually actively working to ensure that this timeframe, which is then astonishly unbelievable pertaining to institutional lag could be closed so we could begin to meet our unique patient needs and sometimes that really isn't deseminated because we have so many things on the radar. all we're saying is the

department has been working on this actively and human resources is now getting -- has gotten additional people in order to ebb ensure we could expedite and begin to fill these positions that we have wanted to fill, but because of the and nobody quality of care pertaining to the commitment of personnel and we've gone over this this is the first time we've really had some major dollars to say enough is enough, but we still have these other issues where we have to follow pertaining to our rules and regs between our different agencies and whatever and we are aware of that and the director and our hospital administrator and -- i mean, everybody is involved in this and we heard, like, an it, this

is just one particular program, it's a system and that's what we're involved with now. how do we ensure that, you know, that basically the budget reflects these unique challenges we had. a lot of these things are left blank because we don't know a lot of the impact based on the california state. we're involved in it and the communication is there but it's frustrating so -- come to the meetings, these are all public meetings and we should have some hopefully really positive outcomes pertaining to the quality of care that -- which is our major mission as a health department and as a hospital and the hospital of laguna honda, but i think this was an excellent presentation and gave us both the strengths and limitations and the fact that we still have additional challenges but we're working on

them and are making a difference. just wanted to share that. excellent presentation. >> thank you. i appreciate those words. we have and will be continuing to focus on our vacancies. it's important for us to fill those. ron and everyone from our hr director are focused on that. he has a shortage in his own department and that has been contributing to this so he's just hired new people and we're -- and i've also made a focus for him for san francisco general particularly for the nurses because that is important for you today and we will continue to focus on those areas as we try to get as many people on board as possible. >> commissioner er chug. >> thank you for the presentations and i don't want to repeat what commissioner sanchez has said, but i think that the affordable care to have something [inaudible] and, you know, and i really appreciate, i am assuming you've already made your best

educated guess how it's going to influence some of these, especially with the medi-cal extension, some of the dollars that we used to spend on an ensured patient might now become revenues so my question is more directed toward some of the other changes that you listed in the back, you know. are these, like, specifically past dollars that you're talking about or, you know, like, dollars that actually directly impact our delivery of services? >> i believe that commissioner is referring to -- >> so for the first item this was a reduction proposal that we had submitted as part of last year's buds jet. budget. if this cut were to remain there would be service that would be impacted. at the same time while we're

implementing this cover i'm going to be rolling out an rfp for new services to align new services to affordable care act so we're not quite sure exactly how services would be impacted but overall in terms of financial imflakt would be $8.8 million in tact. if we lose a grant, we cut the expenditures along with it. historically that is, you know, that's what we've done, but we've also been back filled by the board so if this were -- this would feel like a $3 billion reduction in services. lastly the 33.8 billion that comes to the department. had we had to cover the short fall we would have had to come up with savings of some kind to offset it but the mayor's

office is covering it as part of its definite sit deficit so we are not expecting any service impacts as a result of that last item. for all three of these items we've been working very closely with the mayor's office and board and we will continue to do so. >> i would ask director in terms of what had already passed at the community programs reduction, how is the conversation going now for the coming year? >> thank you. i was going to address commissioner chung's concern about that. we had a stake holder meter over the last month or so to make sure people have a say in this process. in september what we'll be doing is rolling out an rfp. that rfp will probably, a this point, have an 8.-- if we send out $100 million, it will have

$8 million in it. if we get any dollars back from any entities as we go through this process we'll just be awarding people more as it goes along. there's focus groups that are beginning to start with our stakeholders and remember that our providers cannot be involved in the rfp process. what they can be involved in is giving us input into the structural changes of the needs of our clients today, and an opportunity to give us their input about how we can restructure our programs to be more efficient programming to the [inaudible]. at this point we have those processes going on, there are focus groups that are beginning and then they can no longer be involved because now they're giving us information about what they think the needs of our clients are as the affordable care act has happened. there could be more opportunities for new revenue.

as we went to visit toby douglas at the state to ensure they weren't going to make any major changes to our programs. so we'll be looking at how the affordable care act is impacting our services and ensuring that we can maximize the amount of revenue as we organize the services through the rfp's. you know that we are required to do these rfps on an ongoing basis. we do not want to repeat that because that was too much work all at once and caused a lot of disruption in our services so we'll be taking mo dalty programs, whether outpatient or residential and going through these rfp process with our providers and we'll be bringing you updates as we go along at the committee level and commission as we get further ahead with our rfp process.

>> thank you. i had a question with regarding d-1 which is related to the issue of meaningful use revenues versus our total expenditures at this point. for the past several years under the stimulus programs there had been dollars for meaningful use and these were pent by the government to cover the cost of meaningful use. as i'm looking at your item number, which is to build out and i guess this is the core of bill's presentations on the first parts of the it, i'm concerned as to how the 11 million listed here would be used and factored into part of our draw on the general fund. will we be adding on the additional fund to fair it out

exactly how the government's initiatives have paid for meaningful use has played out here. >> thank you president chow, it's a good question. we would be happy to get you a schedule showing a summary of revenues and expenditures for the program as a whole. i don't have it at my fingertips, but the short answer is that the incentive payments for meaningful use are in our budget and have been budgeted. when you look at how the dollars on the revenue and expense side come in year to year, it's a little bit lumpy. we had upfront or initial incentive payments, we had a lump sum when we certified a number of our physicians at the hospital and primary care and then we have some ongoing payments that were continuing to receive. that said, those incentive payments don't cover the entire

cost of the program and because the payments are already coming in and are already included in our budget, when we have these expenditures you don't see a corresponding increase since these are already in the base budget so what you're seeing here is just the additional expense to complete the roll out of the meaningful use representation. there are revenues that don't cover the full cost, but have made the project possible and if not for those revenues we would probably not be where we are today. >> so if in a follow up on that, it says there could be another $21 million worth, if not just 50, but 500 eligible provideers were able to achieve meaningful use in five years. is that part of our goal and is the dollars calculated for the next portion of the build outs

since you've now calculated how much we'll need to do the structural build out. >> let me take a look at that. >> that's sort of in the last bullet and about the second dash on d-1. that seems to me even bigger loss than if we were for medi-cal revenue. >> let's clarify that number

and text for you . i don't want to speak out of place. >> i'm just looking for money. >> me too. >> this brings up what was brought to my attention by the chair and finance committee. we were supposed to and should be going back into -- now that we're talking about these different initiatives, we've had a great opportunity for two, three years to pan out what we needed for the integrated system, what we need for the it system, how we've got to -- now that we've discovered the d 2, build back up our human resources and all. when we talked about the five year program we're trying to be part of a planning process so if we took it as an example, the last two blocks would fit very nicely in working with the finance and planning committee, which is why the title included planning now to understand what the full scope of a five year program would be for it to get to green and all the numbers

and the options possible. like wise, i think we -- what does it take to get to that point? is it that 400 providers just don't, you know, work out within our scope of understanding, understanding that this now doesn't become the cast in stone that gives us a framework upon which we're under then all the work we've been doing in the past several years can all be brought together and say with validation of these are things needed, these are what we need to put together, these are areas where we can make changes so our hope in five years can

be 20 clinics in six locations throughout the city and this is about where we're going so that each of these budget processes will have something else to understand what our goals would be. certainly want to commend the department and the the finance department for having put together such a very clear budget. it's also nice to be in the calm of the storm because we can really look at planning and not just have as a exercise, what is five years because i think five years ago was the big hole that was coming up, is the great opportunity then to look at all the things happening, the empowerment of somebody being able to get on insurance programs to be able to be do services the right

words on there to create this so i think we have a great opportunity to do this and using our -- we don't have to use the tool like the mega rt we saw the two was very good for certain things but really wouldn't play out to where we wanted it to go. i understand that. and the years for whatever our purpose is, the department feels might be a good way to engage and get and in depth view of a particularly important topic, but i think it would be good and i will ask finance and planning to work with the department toly activate the idea of five years program and see if within two or three large topicings we already have the director has, all the way from integrated systems to population health and where we intend to be in five years, this would be i think a good opportunity.

>> we'll do it to start immediately on that third year because we want to anticipate the second year of this budget if we're on target for that so we're discussing as we work towards this. te sigss we make today and the next year will influence the next coming years and what we reduce overall cost and improve care but it's really important for us to get ahead of this and two years does it but we're finding we need to go farther than that. >> right. and i'm sure mr. white had a great deal to do with the idea of creating the two year for the city. it's been helpful here, those of us dealing with yun year, but find this is very useful and very helpful so now we want to get back to the five year planning process. >> absolutely.

>> what we'd hope next time also in order to clarify in our minds what the fce changes are, how they have changed from a time in which we decreased the large numbers we were having that were important support like clerical in our clinics and all to actually -- and even the director of the clinics to come back to some of our levels of staffing that were really needed to carry out. and so i'm asking whether you're going to feel that you're going to be able to do that along with also compartmentalize where these fte's are for these two years so that we can clear more clearly see which belong to new initiatives which are restoring some of the areas in which we were just making due with not enough people. >> sure, we can absolutely do that for the next meeting. >> do you have any other requests before our next budget

meeting here so that these can be -- commissioner tailor mcgeet. gee. >> i know that the costs associated with the aca readiness are dispersed throughout the budget. quality insurance, primary care, mental health, but in the aggregate, how much are we spending over the next two years for aca readiness. >> that's a good question and maybe we'll go and add up the various initiatives, but i'd say that the bulk of the new expenditures proposed here are related to aca ready nsz iness because if you look through the list we have the new hospital is a key cornerstone of what our delivery system is going to look like under aca. we have investments to expands access to primary care, access

to mental health which is now covered differently under the aca and a lot of it and infrastructure i think you could categorize as designed to put us in a position to succeed under the aca so we'll try to organize that into a meaningful look for you for the next presentation as well. >> i just wanted to also ask what [inaudible] this has been a really detailed process. i've only been here for three years, but i think this has been really improved significantly and the way it's detailed one of the things that this also reminds me of the exercise we did before and i think that, you know, having these kind of conversations and actually just articulate the narrative

actually help ground us, you know, so that we'll continue to stay in the eye of the storm. you know, we have to do infrastructure and adhere to aca and whatever legislative mandates that we have to follow, but also at the same time i think that we all could agree that we want to make sure it's about improving health equity of the populations we serve. if we can improve these goals and have that narrative, i think it will also, like, help everyone who might feel a little anxious that they might be more willing to invest a little more patience in the process. >> thank you. further comments commissioners? thank you again very much, and

we'll look forward to the final presentation for our submission next meeting. >> thank you. >> thank you. next item please. >> item nine is other business. >> other business? >> under the item of other business, i'm curious to know whether the commission would entertain getting more information and what is happening at saint luke es 's with the diabetes center. >> the diabetes center. you want to give us background on what you're thinking we should be looking at? i just got this. >> if i may, we followed up on this from the report from mark and i received some direct information. kolg lean did call and i'm