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]his 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 still getting information as of today so maybe colleen can give us an update. >> i contacted suter to ask this question based on the communication that you all have received about a week and a half or so ago. and what i was told is that suter is consolidating their

diabetes services between two campuses. they found there was under utilization at each campus so they will consolidate the staff and have that staff cover at both campuses and there wouldn't be a reduction in the level of service provided at either hospital. >> the next information i received is there could be reduction of bilingual staff and that's the next phase we'll go to in our reading. >> and i did have that conversation specifically about bilingual staff. they indicated to me that that's not the reason the staffing changes were made irrespective of the language spoken and of course pointed me to their translation services. >> so i guess the question then is whether they have any bilingual staff that are providing services or they're just going to rely on

translation services. >> i could find out. i don't know if there are any bilingual staff in the program. >> okay. >> our role is what? >> i believe it's the reduction of hospital services. >> this would have to be a closure. it doesn't sound like there's a change of functions, but the staff saying the patients' needs aren't being met so it's a bit of he said she said. so the commission doesn't have an official role. i think as the dph continues to vest gats, investigate it may be more clear. >> commissioner sanchez. >> i would just follow up on

commissioner's comments. this commission was an active partner within the discussions reviews and recommendationings regarding the status of saint look r luke and the cpm and we had multiple hearings and staff who have been involved in this, you know. and then here -- and the thing is there are specific changes going on within the area of which saint lukes serves its populations, but if we look at the data we'll see that we still have a significant spanish speaking population, both at saint luke's and within our community, even though many have been forced out they still work there in different places, whether it be restaurants, whether it be as taking care of the babies and bringing them all over the mission and going

to the hospitals and parks. there's been significant change, yet the need to provide language pertaining to our mission has a health department for a culturally competent service i think is still part of our principle and we even had earlier today where we increased theling wis linguistic part to meet the specific needs. i think we have a efficacy of dialogue to follow up on this because this is one of the major areas we were concerned with pertaining to are we going to provide these multilingual culturally sensitive services to that area. let me just give you one other observation too. there's other things going on even within the public schools in that area and even within

some of the, quote, banks -- a number of the banks had spanish speaking personnel, managers, et cetera, many of these have been shifted out within the past six months, a year, and it's as if the culture is changing and the latinos are being low priority pertaining to what's going on regarding the uniqueness of that community and i know that there's a lot of frustration among many of the parents many of the kids and many of the services that were there before because of these new models coming in. all i'm saying is that one of the most critical areas is healthcare and access and saint luke's has been part of that community for, you know, generations, just like general goes back to 1896 or before that.

so it's a commitment that was made to us as a health commission, and as i said, some of our commissioners were active participants in the signing of that and we had hearings on that so i really think we need to follow up on that and make sure we're in tune and could help navigate so we don't lose a critical patient service that has been there. if you go to other parts of the committee they're expanding linguistic abilities pertaining to russian and other types of languages the tpmc has been doing on the other part, but they can't forget the fact that there's a major commitment here to ensure that linguistic access, both in reference to the new department in what we have made as a commitment as the department of public health and commission stands as part of our values and i know all of

us believe in that and will continue to follow up on it. again, i know -- i'll tell you, you know, we really need to stay aggressive and make sure we flag it and then whatever is the proper protocol let's follow it and make sure the due diligence is done. sgh >> thank you. i will commit to working with our deputy director and if i need to i can talk to -- >> i think there are other issues that i think commissioner sanchez raised and one would be also that i'm not sure when saint luke's -- well, cpmc is supposed to report back to us the progress and we're supposed to get an update on the agreement and that's another point of public contact that we will have. do you know when that's going to be also? >> i do. so the report for the development agreement, the report for all of the healthcare and other

obligations they are committed to is due 150 days after the close of their fiscal year. their fiscal year is the calendar year so due at the end of may, may 27, i think is the day it become due. they'll submit to the city on may 27. at that point the department of public health and planning department must post it online immediately thereafter and the public had 30 days to comment after that . after that 30 day period is up, health department works with the planning department to come up with a final report on cpmc's compliance with the development agreement. that takes us into september for the health exhibition commission and planning commission to have hearings on the final report and the health commission is to have a hearing as is the planning commission on the final report and the board has an opportunity to hear it sometime after that if they choose. just to point out too that the report that they'll be -- the

reporting period is from the period that the development agreement was signed in 2013 which was in august to december so it's a very small portion of the overall length of the development agreement that will be reported on. >> commissioner chung. >> yes. i think that that helps to clarify some of it and i am just trying to make sure that i'm not here to make a assumptions what the positions are, but i hear the concerns from the community as well as commissioners. because we have a process in place, i think that we need to be able to honor that and also incorporate some of these concerns into that process. so it sounds, like, you know some conversations that are happening and like i said, you know, i don't think we are here to make assumptions, that they're not, you know, fulfilling you know, like, their

commitment and also the plan they have agreed to, but also at the same time it is our interest to look at how they provide some of the charity [inaudible] and including the care to the populations that might be mono lingual and i think that's something we should look at. >> sounds to me like what we will do is what the director had offered is further conversation. the value of prop q was that out into the public it was transparent what was happening and often it was to the side of the initiator of their program that they were able to explain it. we're not getting explanations at all and i'd hope that the cpmc officials will feel it to

their benefit to be able to give us some explanation beyond the fact they're not going to be discharging anybody because they don't address the linguistic or the skill issues that have been brought up here. any other comments? >> item 10 is the joint conference committee reports and since there were no meetings this item will not be discussed unless you all have any comments? . okay, so we'll move on to item number 11, which is the committee assignments. >> these are have been handed out and they will be effective [inaudible] 1. i'll leave it to the committee as to how they'd like to handle that throughout the month? fshlths any questions sp >> no.

just that i want to remind you that commissioner and i made trade on the laguna honda appointment. possibly i'll cover for her in the next two months because the times don't work for me. >> we'll make an official change at the time so it doesn't confuse the scheduling of the committees at this point. thank you. >> thank you. >> any other items? i actually visited -- well, we were visited by one of the shanghai institutions that were looking for relationships with various hospitals and they came to san francisco general looking for that. i don't know if there's been any further follow up. >> no. there hasn't. but i want to let you know we were visited by the health administer of dubai and that was very interesting as well. they have very similar structures and when they looked

at our organizational chart they said this was very similar to what they're looking at. any other announcements by any other commissioners? if not, we're prepared for a motion for adjournment? >> so moved. >> any second? >> all in favor, please say i. >> i. >> all opposed, this meeting is now adjourned. good