as our performance as a county and if you just aggregate it you probably will have more people within the group that needs to be addressed because we were using the current bmi measurements, you pointed out obesity is at 30 and the world health organization and things like our national programs and the diabetes coalition of the asian pacific islanders that i happen to have intimate knowledge of have pointed out in fact the epidemic is worse because we're using the wrong numbers for our asian population. >> yes, we're actually doing in death penalty work within community hoelt equity and promotion in that area and our focus right now has been around sugarly beverages. you may not be aware of this, they do have a different bmi calibration, but it turns out that asians, and especially

chinese develop die diabetes so china has a huge epidemic of diabetes so they're at higher risk and i think that's an important thing to point out because somebody might not be obese, but are at a higher risk. >> that's not reflected in a document at this point. >> we are going to come back with an action plan, but we have detailed work in that specific area. >> yes. my only other critique which is sort of my usual editorial thing is that if you're going to have a document that says what works in partners and strategies, maybe you want to keep the same format for all your points because it seems to vary depending on which section we're looking at. >> we'll fix that. >> i would like to add on behalf of our dean here, colleges and universities do

include usf and other organizations that have health programs so that [inaudible] is correct, but i ensure we want to take advantage of -- i know the outreach you assess is tough. because that could be an added resource. >> i ae gree. agree. lastly. >> the other added resource, within the hiv population, but some of those also could be partly related to have partnership with our private sector providers and medical groups and mans. plans. >> and that's actually part of the intention of our reorganization is our disease prevention and control branch. we were designed specifically to address that approach. >> very good. >> so commissioners, because this had not been heard at our

community level, but was important so that we brought it directly to the commission, we had noted on the record that the commission will hold the resolution for two weeks for further comment that may come from the public or commissioners and that we will agent diez this for the commission at our next meeting. >> before we -- because we're not having a meeting at the beginning of -- >> no. the beginning of june. so we are having a meeting in two weeks so we will take that up in suggestions in terms of the resolution will be accepted and will be passed on to the staff. >> we're planning to apply in july so we're really incredibly grateful for your understanding. thank you.

>> congratulations for a job well done. thank you very much . >> the next item on the agenda is listed as item 8 and it's the third quarter financial report. >> thank you. >> i will walk through the financial report first. i wanted to give quick information on the mayor's budget which was released yesterday. he was there for the speech and it was a very positive speech, especially given where we've been for the last several years.

there's a lot of good news in the budget overall message is that, you know, the city as we know, riding on a wave of positive financial news and that has really helped turn the financial situation around. we're not totally to a point though where the budget is out of deficit territory, but there is room to do a lot more positive work as opposed to being focused on cuts. so i think the central message from the mayor was around the affordability issues in the city, which are related to the economic growth. one of the big pieces is the funds allocated for housing, so that's obviously important and has a significant connection to the services and the population that we're serving here.

there is the $44 million from the approved housing trust fund and an additional $15 million on top of that in the budget for affordable housing in the city so that will be a major initiative for low and moderate income san francisco citizens. but a couple of other big pieces -- there are -- as it relates directly to health department, the mayor has restored the $8.8 million of proposed reductions to community services so that was approved in last year's budget. $8.8 million reduction. the mayor restored the full 8.8 million in the first year and another 8.8 million in the second year. there does remain a 8.8 million

reduction, but taken in total that $17 million worth of what we thought were going to have to be reductions have come back into our budget so we're incredibly pleased and grateful for that. in addition the mayor has restored, back filled federal cuts to hiv funding so that is another hull that we have to grapple with which has been solved in the budget. we're still kind of digging into what was released to understand the details, but there are some significant other social safety net investments. there are dollars as we mad discussed here for mental health including the care initiative that the health department has been working on with the mayor's office. there are funding for other homeless services including some dollars for the hot team and we will get you some more

detail on that as we have a chance to sit with the mayor's office and understand exactly what the appropriations are and what they'll mean for us. overall, very, very positive budget for the health department and for the city as a whole so we were quite pleased. obviously we still have our work cut out for us because going into next year we're going to see a lot of movement on the aca settle into place and we do have a lot of financial risk for the department. i don't think that we're out of the woods, but for this point in time, we're definitely in a much more positive financial environment than we have been recently. so going back in time to the present, the current year, looking at our third quarter

financial report, this is a little bit later than we usually get this to you because of the timing, but to let you know where we project that we're going to end this fiscal year. we have -- as we've seen in the first and second quarter financial reports, we continue to be relatively stable compared to where we have been in the past, but a lot of that is due to the correction of the structural problem with the salaries that the mayor's office did in last year's budget so that has really turned things around for us in terms of our ability to live with in our budget. we have some positive news on federal revenues, some of that is one time revenue that's come unexpectedly in this fiscal year and that's plumping up our bottom-line. the bottom-line for this report is we're projected to end the

year with a $34.2 million surplus so i'm very pleased with that. it is -- if you consider the size of our budget, still a relatively thin margin, but it's a good financial performance for us and that's money that's gone into the mayor's office calculation of what they could do in next year's budget so when we look at a lot of that god news that we heard from the mayor yesterday, this balance is contributing towards their ability to fund that in the budget. od news that we heard from the mayor yesterday, this balance is contributing towards their ability to fund that in the budget. major concepts are primarily where they have been in the past. we have a funny thing in our financial statements at san francisco general where we have

excess budget a authority for intergovernmental transfer programs that was unused so we have a short fall in both revenue and expenditure that are equal and that makes these numbers look a little bit funny. that's 32 million so we are formerly showing a $28 million revenue short fall, but once you factor out that $32 million of extra authority, we're actually in a positive revenue situation by about $12 million at san francisco general. that is coming from a couple of things. we've had two payments for the sb 208 program, which is the supplemental reimbursement for seniors and persons with disabilities and managed care so that's $35.8 million

positive and we also have income from the low income health program participants shifting on to managed care. we're now getting rates at the medical expansion rate for that population. we've also factored in here the loss of realignment dollars that we've talked about here before due to the state's recoupment of realignment. one thing that i've pointed out in the past and i'll do again briefly is you see a lot of large moving numbers here and this is because we have these big federal programs, primarily through the medical 1115 waivers where we get big payments and assumptions come in and out of our budget that makes it hard to predict on a very thin margin and i will expect to see that continue over the coming years, but we've got a big reduction in

our anticipated dish payments due to a revision of those projections and then some other offsets of positive rev nuss. patient rates at the hospital is 15.1 million so they've got about 9 of that is due to a single prior year of waiver settlement, so right about at budget target and a little bit above for our patient rates. at laguna honda we also have some additional positive news. the biggest piece of this is -- let's see. here we go. the biggest piece of that is in a prior financial report there was a change to the way the state pays us for our distinct nursing facility supplemental dollars.

they've changed their policy to give us an interim payment, which means we get our money sooner and more accurately . they've gone two years retroactively in the current year so let's bump that number up by about another $6 million so that has made laguna honda project to end the year in a more positive financial bottom-line. in the other divisions you see essentially similar outcomes to what we've seen in the past. we continue, although we did fix the structural budget issues at san francisco and general and laguna honda. we still do have some issues at the other divisions and you can't to see a little bit of personnel cost variance in those divisions that's been historical and we're going to try to chip away at that over time in the coming budgets.

so again, not a whole lot of big changes compared to what you've seen before, but we are really in a place where we're watching the big federal dollars carefully and watching our enrollment information carefully to try to narrow down some of the uncertainty about where we're going to be coming into the coming year and refine our projections, but we're in a much better place than we were in the past, especially on our expenditure. i just realized one thing that i do want to point out that i skipped over on the san francisco general hospital slide. i skipped one of the slides on the expenditures there. we have -- on the expenditure side we are living within budget. you'll see that we have a

projected $16.6 million favorable variance in salary and fringe benefits so we're coming in below budget by $16.6 millions. that is due to a couple of things. we have a couple units that are under their budgeted agent census so we've incurred some savings there and we also have some savings from our delays in hiring. i wanted to point this out because this is something that's come up at a couple of the last commissioner meetings and it's also come up extensively in our meetings with our nursing union as we've talked about their contract. we have -- despite the salary savings, that is not coming from our inability to fill our clinical positions, although that is a very serious issue for us. we have about 80 nursing

positions at san francisco general that are unfilled and we are working overtime to fill those positions, however, from a financial perspective we are back filling those shifts with per diem and registry, so that's not what's driving these savings. it's the units below census and the other positions we are having trouble back filling, which are things like our information technology, we've had a hard time hiring there, clerical positions, interpreters, etc. i want to point that out in particular because we know it's an issue. repeatedly every chance we get we've expressed our commitment and desire to get that hiring pipeline moving so we can staff up the hospital particularly in our nursing area. so that, i think is the story

as we are within budget on our expenditures and we have a little bit of good news on our revenues which we've been able to turn around and turn over to the mayor's office and it's translated to some positive things in our budget so i'm happy to answer any questions if you have them. >> i'd just like to say we're very appreciative of the mayor's office supporting us and this may be one of the first non years which means we use today have hearings for any reduction in services and we sit for three to four hours listening to community about why we are reducing it and the consequence of that so this is a good year for us in terms of getting back any of the reductions, particularly for our community based organizations. it's not that they did something wrong, it's the fact we did not have enough money to meet the needs of the budget so

we're very appreciative and i think it shows in terms of our bottom-line. >> is there any public comment on this item? >> i receive no public comment requests for this item. >> okay. commissioners, any comments? >> yes. >> commissioner singer. >> i have one quick one. many people have expected that with the aca the problem of bad debt would shrink, but in this last quarter or your projection for the year, your bad debt at the general hospital goes up 11%, i think. 11.7% to $98 million and i was wondering is that because we expected it to get so much better and it didn't get quite that much better or -- and we can probably take this offline because it's probably not something on the -- >> i -- that's a good question. what i would like to do is kind of dive into the details, but

really or bad debt projection is a function of multiple things on our actual, so if we have higher billing, our bad debt will go up because it's a percentage of our billings so what we'd need to do is take a look at the fee for service, analysis and where we're withholding dollars in terms of what the billing is that's out there. further questions? >> i just wanted to comment that i wabted to thank you for you continued clarity, the clarity has been made even more clear by the fact that we don't have to juggle this, you know, invisible set of words with the mayor's fix and i think it's also amazing and another reflection of this city's commitment to healthcare that the cbos were being able to be

given their raises, they didn't take back, but were actually resfoered. stored. we're putting forth as part of two year budget and funding most of our initiatives which we need to try to remain on top of all the needs that aca has given us to be able to develop the integrated system. and we can see it more clearly because the numbers no longer are being, you know, confused with this problem of -- yes, the expenditures are [inaudible] because we didn't fund it or it wasn't funded from the city adequately. i think the unintended

consequences are we're much more able to manage this budget and i think again, that's a commitment that the administration has made towards the improvement of our healthcare system here. so thank you again for bringing that -- >> one of the things i wanted to note was the fact that the community based organization has a 1.5% increase as you said, but they received a several million dollars to help them with their increase cost of rents prices in the city. >> on top of that. >> on top of that. >> i didn't understand that part. that's even more of a commitment for health here in the city and so our thanks then to the mayor's office and we're hope tg board of supervisors will see that that is the road to take. next item please. >> yes, we move to item 11, which is the update on the proposed amendments of the healthcare security ordinance.

>> thank you. >> when i was here at your last meeting we talked about supervisor campos' new program that would provide subsidies to individuals purchasing health insurance on the exchange. we indicated to you at that time that while we agree with the intention of the program, that there were some concerns about locking us into a specific pathway forward at this early date while so many things are still in flux. so since your last meeting, we met with supervisor campos' staff and have come to an agreement on language that's included on the revised

resolution and have provided in the key paragraph of the cover letter to you, which is intent language that requires the department of public health to develop a plan that will bring to the health commission of 2015 that will address the affordability of health insurance and in the interim we would continue to operate the current programs, the medical reimbursement accounts and healthy san francisco in a manner that's consistent with the principals of the universal healthcare council which are affordability, prioritizing health insurance and such. we're pleased to say we were able to come to agreement. the revised legislation passed out of the neighborhood services and safety committee last thursday and will be headed to the board of supervisors next week for its first of two readings. and additionally, we haven't stopped since we got a little

relief on the october 1, 2014 initial timeline for implementation. we have not moved forward with planning on what to do about affordability. we have arranged a meeting this coming week that is between the cover california plans in san francisco, the five cover california plans, plus san francisco health plan, plus foundations that are interested in healthcare will also be there and cover california will also participate. we want to get their best thinking about how to address the affordability issue. we're moving forward on that front also. >> thank you. commissioners any questions or -- so it does sound like the cover

san francisco is not really in the legislation anymore and that we're talking about what is the best way to take the existing programs and make them affordable to our public and how to encourage getting into real insurance bill. >> that's right. or the plan could be a different program that doesn't look like the cover san francisco program that was prescribed in the previous version. >> that's possible too. >> that's possible too. >> director garcia, any comments on the work you've been doing with the campus legislation? >> well, i want to thank supervisor campos, who was flexible with us, particularly as we move into exchanges. as you know, president chow, there are a lot of issues in terms of how do we do these subsidies, but i think they're

not unsurmountable. cover california isn't quite ready for us yet so in the meantime we'll look at local health plans. we need to think about how to make this simple because of the node to get these funds to people as quickly as possible and i know nothing's simple in our health area so we'll try our best to do that. on next week after the health plan meeting we'll have much better understanding of how the health plans can help us in the program. >> very good. commissioners, you recall from our previous resolution had said that we were asking the department to continue to update us and bring at the appropriate time, resolutions as needed in order to be sure that our residents have affordable insurance programs, so are we looking at maybe a month from now having a report or -- >> yeah, i think monthly would

be sufficient for us and we'll have enough to be able to report to you. >> commissioners, is that acceptable at this point? >> if there's a significant encounter that we find that we'll need to bring to you we'll bring it sooner than a month. >> monthly reports and earlier if needed. >> absolutely. >> thank you. >> thank you. >> any further comments? if not, thank you again colleen and we'll go on to our next item. >> item 12 is other business. >> commissioners, any other -- any comments or any comments from the public. >> no public comment. >> i wanted to ask about just as a follow up item, we had in our packets two meetings ago i think a letter addressed to uz from us from cpmc about bed allocation between facilities and at some point i feel responsible -- >> that was the [inaudible] and it's a prop q hearing.

you want to tell us -- i think we have it on the calendar. >> right. that's going to address the prop q setsing up a meeting with -- -- >> you don't need to cover this now, i just want to make sure we -- >> yes, we want -- >> you're scheduled to have a prop q hearing at your next meeting. it's on the reduction in skilled nursing facility beds from 99 to 74. >> and we are currently working with director garcia on the response that cpmc gave us regarding the diabetes clinic and we'll see and report back to commission what their response will be after we get further clarification of nurse services. any further questions, i will move on to -- >> item 13 is report back from

the joint conference committee with [inaudible] during this past meeting period. >> it's the law gu that honda jcc met on may 17. at that time we reviewed the hospital report and the third quarter financials. we also heard a presentation on efforts related to patient flow in and out of laguna honda and in the open session the committee [inaudible] in closed session we approved the may credential report. >> any questions? if not, we'll go on to the next item please. >> item 14 is the committee agenda setting. >> any -- just to remind you that our planning committee meeting is -- >> august 19. >> -- august 19. okay. and we've been able to obtain the same facilitators so pleased with what will be