standards so we've been, for the last three years, doing an incremental 10% increase on all of our rates to try to get caught up to where that consultant recommendation suggested that we go. so this will bring us closer on a cost to charge ratio to industry standard. we will, again, in the coming year, have an update to that study so i'll get a fresh look at where our rates are and we'll be able reassess and then take that information into account for future years. but again, this is an annual process that we go through. this legislation, if approved by the commission, will go to the board of supervisors as part of the budget process and will be reflected started in the new fiscal year. bs

>> what percentage of our revenue comes from people paying this rate? >> i should have known you were going to ask that and had it on hand . of our -- and don't stick me to this number, but it's a ballpark -- of our patient charges, not our entire budget, but of our patient revenues, i believe it is about a quarter to 30% comes from -- of our total revenue comes from commercially insured services at general hospital. although, if you look at the fraction of actual accounts, it's much smaller than that so it's in the single digits in terms of the percentage of accounts, but it's a large portion of our revenue, but this is really a financial driver for us, it allows us to

bring in rates from those privately insured accounts at the hospital that thereby help fill the gap on our uninsured patients and some of our lower paying safety network that we do for those patients. i can provide the exact numbers to the outline. >> yes. commissioner [inaudible]. >> how close does this bring us now to the industry standard? >> i think we're still going to be a little bit above our cost to charge ratio is still in the 30s if you look at a lot of what the others in the industry and in the bay area are is there in the mid 20s. last i looked we were at about 32 and so i think this will bring us closer to 30% so we probably still could go a little bit further on our charges to get us to kind of the industry standards, but again, we'll know more precisely when we get that rate

evaluation done over the coming year and they'll take a fresh look at where we are and we'll go rate by rate to determine where we are in lock with the average and where we're out of the norm. >> actually, you kind of preempted my question. >> on the professional component though is the study being done there also because i think i should return to private practice? >> on the professional component at the hospital, those rates are determined and billed by the university of california so i'm not sure -- i

can check with them and find out exactly kind of what the latest analysis they have about where they are, but that would not be included in the document that you have in front of you. >> so these are actually clinic rates for use of the xhinic and not the professional rates? >> correct. >> okay. so under -- just to clarify then, the differential between -- your difference between general clinic, which i know is at san francisco, but what about the primary cares that are community clinics and are we charging a facility charge on top of the professional charge? >> so for the primary care clinics, the difference is less significant than it is for the hospital because we set our rate so that we can show what

our comparison is and we can build that into our cost calculations for medical and others. so we do have rates for those clinics, but in terms of professional fees for our own doctors >> yes, that's correct. >> okay. so on the primary care side for our own clinics, i would hope that the same type of study would be done so that we would stay within the parameters of the norm. >> yeah, and we will take a

look at that and again, like i said, it's a little bit less of a central issue for the primary care because the bulk of our primary care charges were not receiving private commercial insurance for those -- >> even less, right? >> yeah. >> although in medical it still is a department of insurance rate because even though as medical has moved towards the [inaudible] or at least the next two years. 2013, and 2014, if they ever pay us for 2013. >> right. >> okay. commissioners, are you prepared for a motion to accept these rates? >> so moved. >> is there a second? we have a second. any further discussion. all in favor say i. opposed? and so the rates have been

accepted and thank you very much. >> so commissioners, i also encourage you to speak closer to the microphone. you're sounding a little timid today and i think it's because you're not close enough to the microphone. >> okay. >> we are going to move on with the public health division plan presentation. >> good afternoon. can you hear me? good afternoon. thank you for having us. we know you have a full agenda so we're going to be brief. we have a number of speakers we'll try to get it all in within 15 minutes. hopefully that will be the goal. so this strategic plan is the next step on our journey to public health accreditation. we have completed the community health assessment or the chip. it is aur citywide plan to

protect and improve the plan of all san francisco citizens. in contrast, the strategic plan the pop police station health division will one, contribute to the community health improvement plan, two, deliver the services of public health and three, become a community centered liability, high performance learning health organization. for us public heflt accreditation is about the passionate pursuit of results, equity, and accountability for community health. naturally we want our strategic framework, reach, for result, equity and accountability for community health. to ensure high performance we are focused on these results, integrating health equity into quality improvement activities,

ensuring accountability for continuous process improvements and practice based evidence. reach is focused on achieving aspirational results. although we are healthier than most regions in the united states, we still have room for improvement. we continue to have health inequities in san francisco especially with our black african americans and latinos. we have adopted a results based collective impact framework that is community centered, data driven and evidence based. our strategic plan will present result statements and headline indicators for our highest pry torety focus areas. reach is focused on integrating health equity into quality improvement. we have moved from the mission and values statement to quality improvement practice. this ensures our efforts to inform public health practice,

improve continuously and improve health outcomes. for example, we are partnering with our clinical division, the san francisco health network to improve health and wellness for our african american patients, clients and substance abuse systems. reach is focused on ensuring the accountability for continuous process improvements. achieving results is not sufficient if we are not investing in our work force or improving our business processes. we are investing in our current and future work force with leadership and quality improvement training and internship opportunities. finally, with support and technical assistance for centers for disease control and prevention, we reorganized and integrated public health division. i'm going to have israel take us through the slides and we'll

be introducing the other speakers. >> good afternoon commissioners. first let me say i am honored to meet you. i just want to remind you that we are here from your vision. we are here because you set three priorities for the health department, which is an integrated delivery system achieving public health accreditation and financial efficiencies. we're green in san francisco, we call this the tricycle. there are three prerequisites, a community health assessment and improvement plan. it has truly taken a village to achieve even applying for this and i want to thank the leadership of barbara garcia and car lean and her team who tuk us through the first two parts of this process with over 600 community and stakeholders engaging in this, all of these visuals that you see in the hallway, we remind ourself that this was really about the

community's voice for their vision for health in san francisco. we keep seeing this framework and i want to adjust it a little bit so you have a clear understanding. this is your vision for an integrated delivery system for san francisco. it shows you the two divisions. we've color coded it really to look at the public health accreditations categories so you can see where we're achieving governance, policy development and assurance and as you can see, many of us are matrix because we work together to align our efforts across to the health department. the first part of the strategic plan is actually divided into two phases. it was also our strategic map with six priority areas also

aligned to public health accreditation categories and performance measures that we want you to hold us accountable as we come to you. examples of that is an integrated delivery system for diseases. as you can see in policy 3.2 is not only for us to achieve public health accreditation, but for us to maintain it and as well as an example of definiting a centralized business office to maximize efficiency and use of dollars. those are just some of the examples we'll presenting throughout the years to you. i'm going to ask to present a larger framework and then our directors will all come up and provide you a little overview of where we're going. >> when we were doing the reorganize, we borrowed from frameworks used nationally. what we did is that this is the framework we used where we

became more functional and the idea is for us to be more agile, adaptive and responsive to emerging public health problems and so you can see our -- the areas there under healthy people, healthy places, diseases and disasters. the things i want to call out to you is we have a new office of equity and quality improvement and the other one i want to point out to you is the center for learning and innovation. those are two areas that are innovative and new and you will not find in most health departments. it's going to be these six high priority areas for our whole di viks, but they're cross cutting, but they crossed into the network and into the community. we do 100 things, but we're saying as a division, as the health department, we're going to focus on these six areas. the first three come from the community health improvement plan and what i'm going to do

is read those, i'm going to name the speakers all at once and then they'll come up one in a row. i won't come back and introduce them. so for the insurance, safe and healthy living environment, we'll have richard leaf, director of the environmental health branch, increase healthy eating and physical activity. we'll have tracy packer. under black african american health i will make a few comments under maternal, child and adolescent health. and then under health for people at risk in living with hiv, doctor susan phillip will make some comments. i'm going to go ahead and turn it over to richard lee for environmental health.

>> good afternoon. as acting director i'm pleased to present our work on phd strategic plan. we identified the need for safe and healthy living environments. we identified three headline indicators that you see that wu that we felt should be addressed. the first is clean air. san francisco has relatively clean air. our location along the coast helps us greatly. we're lucky we're not inland, but on page 17, the number of good air quality days average around 250 days per year. we'd like to increase that number to 365 days per year. we work with the bay area quality air management district staff to development the community risk reduction plan and identify strategies to include air quality in san francisco. part of our plan will be

support implementation to build va tee jik strategies. also we know that there are areas of san francisco where air quality [inaudible] most of those areas are along the main transportation routes like along the freeways or the busy streets like geary or van ness. we have been enforcing artd kl 58 to make sure residential buildings to install filters breathing in those particulates from the vehicles. we have process of improving article 38 through a new ordinance and amendment. chap is working with the school district in metropolitan transportation authority to encourage safe walking and biking in the school program,

which would then reduce air pollution. the second indicator is tobacco free living. as you can see on page 19, san francisco has been able to reduce the percent of smokers from 20 percent down to around 13% of the population, but that 13% has been fairly stable for the last two years and we'd like to reduce it even more. we've been working to make tobacco harder and more expensive to buy, make it harder to sell, reduce the number of locations where people can smoke and reduced opportunities to advertised. they provide smoking programs for those who want to quit smoking and they're partnering with community agencies to advocate for smoke free housing. we were able to pass so that

people -- when they try to rent a place they'll know if there are actually smoke free units or not. and we would actually like to ultimately pass a regulation to ban smoking in all dwellings, but there's going to be complications because some tenants think that people might actually get evicted if they pass that so there's issues with that regulation. it'll be a little more difficult. right now environmental health works with [inaudible] tobacco sales to minors. environmental health continues to recent ledge vags that allows us to regulate e cigarettes just like tobacco and we hope to reduce the number of smokers with these policies as we move into the future. the last headline indicator is for ped safety. making aware from environmental health and [inaudible] from chap, i think just recently had

a presentation for you in the last probably month or so. talking about vision [inaudible]. and that provision zero is to have zero pedestrian deaths by the year 2004. making [inaudible] important members of the [inaudible] task force which include members from sfmta, police department, walk first, county transportation and all other agencies. so analysis of entry data and interventions, the task force will assess the effectiveness of interventions to help determine the best use of resources in terms to reducing ped injuries and death. we hope to be getting more staff to conduct this analysis and we want to thank the health commission for your support for [inaudible] initiative. and

the three headline indicators. the first indicator is residents who do not have food security and they define food security as the resource to purchase food, having access to food and the consumption of healthy food. we're at about 34 pktd of low income adults who are able to afford enough food and this is the baseline says san francisco is doing better overall. in the second indicator which is the percent of resident who is maintain a healthy weight, about 56 percent of adults who

maintain a healthy weight were above the national. and third is indicator for physical activity, about 82 percent of san francisco adults report participation in physical activity. while we might be above the overall national average, we have very important health disparities in san francisco and we know that socioeconomic factors as well as environmental factors contribute to this. therefore, the work that the population health division is doing is structural in nature and environment al so we're trying to change the environment so it makes it easier to get healthy food and physical activity. we do this in three ways. we work with partners, working very closely with san francisco improvement partnership. second, we work with community members. the food guardians are a group of bay view hunters point residents that are trained to

mobilize and they work on healthy retail ensuring corner stores have healthy food and less tobacco and fewer alcohol products. and then finally we use evidence based approaches. the healthy retail example is another one of those and we're working with the mayor's office of economic and work force development to strengthen that program as well. thank you very much for you support. >> commissioners, we have a little bit of a scheduling issue. we've got the sheriff waiting and he did turn on time so he's been waiting in the second conference room. i wonder if we can move quickly into our security conversation and allow him to say his comments. i'm just a little concerned with how long this presentation's going and it could be until 5 o'clock that he would have to be waiting. >> yeah. i would think commissioners that this is an important presentation for us. if we just stopped at this point and go on to the security

ordinance and then come back -- then we could take the proper time for this also rather than to rush through. is that meeting with your approvals? >> mm-hm. >> okay. so why don't we reset this discussion because i don't want to short change the potential discussion of a very important document. >> thank you commissioners for being flexible with that. >> thank you. so we'll take up the next item then. well, it's not the next item. the item on our security update. >> yes, the next item will be the sf [inaudible]. >> okay. so today we were going to give you an update on our correction action plan. the sheriff did want to come and speak to the commission and he should be coming in shortly. i wanted to also let you know

that we've done, i think a really tremendous job of working together. kathy with san francisco general hospital has worked closely with the captain in coming up with a new security structure. we may not be fully prepared to give you all the positions today, it depends on what the sheriff is going to present, but i can tell you that our security manager is in the budget. it's effective as of july 1 so we're actively beginning the recruitment of that process for that position. we also have worked -- there have been two structures in terms of security for the hospital and this is -- the security manager is not just going to be for san francisco general. this is a security manager for the entire department, but we are focused of course on san francisco general. the big change that -- i hopefully [inaudible] sheriff today is the fact that we are looking at adding a security component to our legal component of security law

enforcement so if you want to acknowledge the sheriffs and also the work he's done, roland's going to give a little introduction and then we'll turn over to the sheriff. >> thank you and thank you for coming. >> thank you director garcia. roland, director of san francisco health network and i'm joined by kathy jung who is the lead agent for security and is overseeing security efforts at sf [inaudible] and then the primary lee liaison for the past few years. i want to share with you the summary of key findings and recommendations and also share some improvements related to hospital safety and security. as you know, there was an

unfortunate indent involving the death of patient lynn spalding at sfgh and that incident shook the core of the staff and community at sfgh. as a result of that, several key activities ensued shortly thereafter and they were done by three different organizations. one was the federal centers for medicaid and medicare services, cms. they actually came in and did an on site review at sfgh. then mayor lee thought it was important to have an external review and asked the university of california of san francisco medical center to come in and do a review of security systems at the hospital. and then finally director garcia had her staff, and i was a part of that, develop a corrective action plan that we

delivered to the sheriff and he graciously accepted and has been a partner as we've gone through trying to put together that action plan. the summary i'm going to share with you is a couple four mayor areas. those are leadership, patient safety, contractor services and facility improvements. you can follow -- you'll see the legend actually at the top. it shows the organization that made the finding and/or recommendation and so those are cms for the medicaid federal survey, ucsf from the medical centers review and those items in the corrective action plan, the cap for the sheriff's department. in terms of leadership, the general theme was insufficient oversight of a contracted service, be it security, both on the part of the hospital

leadership and governing body. and insufficient communication between the major partners responsible for security at sfgh, be it the hospital administration, department of health and sheriff's department. there were two key recommendations, first was chief executive oversight. both chief executive of the department, robert garcia and the ceo, sue kern. in terms of the corrective action, director garcia meets on a monthly bay sigs sis with the sheriff and they involve key staff to ensure there's appropriate oversight of security operations. and then on a more ground level, sfgh ceo, sue kern, meets with the sheriff captain and key staff assigned at afgh on a weekly basis to ensure appropriate oversight and remove any

barriers to effect tiff security and safety operations. the second operation was the development of a contract performance monitoring plan. that monitoring plan was initiated and is ongoing and for those of you as members of the sfgh jcc, i know that you have been kept up to date i believe on that progress, but if not, as we go through the presentation, we're happy to entertain any questions you might have. in terms of patient safety, the general theme of deciding was there was a lack of comprehensive security plan that is actually a requirement of the accreditation body. it's the only commission that a credits san francisco general. special recommendations included the development of a comprehensive security plan, the appointment of a full-time security program manager that would help to