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 a continuity from our last meeting. >> and since our last meeting, the commission must ask the women and health commission are worked on a date and it's a date of december 16 for a joint meeting, which would focus on

women's issues, both from policy and department public health perspective. >> okay. and we're working on an agenda for that too? >> oh, it's all very preliminary. i just wanted the announce it. yeah. >> i think if anybody has any items they think the joint commission should take up, then we should give those over to the director now so that we can see if those are of mutual interest to the commission -- the other commission. >> all right, you are now at item 15, which is voting on closed session. >> any public comment on closed segsz? >> i've received no public comment. >> first a motion for closed session? >> i move we go into closed session. >> is there a second? all in favor, i. opposed? we'll then go into closed

session. thank you >> the information from the closed session. >> second. >> i.

(clapping.) >> we are thrilled thrilled thrilled to be here so good morning and thanks for your patience and so we're here to kickoff our 2014 summer jobs plus program say yeah. (clapping) so i'm eric mcdonald the chief of police operating officer we're thrilled to be partnering

with mayor ed lee it takes each one of us to effect the kind of changes in our community across our country we're thrilled our here your presence here represents we create a community and environment with our young people have the opportunity to grow and thrive and become their own leader in our community so we know that a summer job is more than a custodial kind of babysitting opportunity i was told you two weeks ago by a national fund we're not name who actually has a general disdain for the mayors youth program across the country they believe they're only custodian but those 0 transitional opportunity i

know i have one of the jobs so we know it is possible and so again in addition to joining with the mayor to reach our goals but trying to have a national furnished to understand this opportunity. last year, we set a goal of 6 thousand summer jobs and interning for the young people and 17 to be exact yeah. (clapping) and you'll be hearing more about our plans and goals from the mayor shortly but before we go there let me pause and thank a number of people and partners who to make this possible first thanks to the mayor's office who's represented the leadership team by hydra mcdonald. yeah.

(clapping) the department of youth and families represented by maria sue yeah. (clapping) the office of economic workforce development represented on the leadership team by todd and ronda and thomas meyer's yeah. (clapping) and also our san francisco unified school district yeah. (clapping) now we also rely on a network of nonprofit partners that are workforce development entities so they're our door ways if you're representative of a doorway where young people are knocking on - (clapping) thank each you good for your leadership in this partnership and thank our corporate sponsors

so our premier sponsors in 2012 pg&e and jcpenney morgan chases and bank of america and starbucks thing them (clapping.) you would you have seen on the billboards a number of silver partners that the enterprise and all of the partners thank all of them (clapping) and then a special shout out one of the things we've built into the program and continue is we've asked companies to become champions when you're a champion we ask you commit to hire young people and provide the financing

finances but the other thing importantly is to reach out to other employers and tell them how wonderful to have the young people in their space wow. okay sorry >> my phone is calling someone. okay, here we go sorry. and so the opportunity to have to have employers reach out to other employers shout out to 3 that did it jimmy john by a juice and the hotel and starbucks thank you for your leading the charge (clapping) so as i said three years ago president obama issued a challenge and mayor ed lee took it to a new level 5 thousand the first sum and 6 thousand the

next summer and we've reached 78 hundred none of this happens but without the u knitted ways no other mayor does it like our mayor so, please welcome our mayor, mayor ed lee >> thank you, eric (clapping) welcome to san francisco employers city hall. well, you looked at what's happening in our city when it comes to job we got news our unemployment rate went inton down to 4.4 percent thanks to all of you working together we brought one of the lowest unemployment rates in the state, in fact, we're just above our

marina and san mateo i swear because of the san francisco they've got lower rates we've got the airport in san mateo and we buy the wine. thank you to everyone that is here today and again, thank you to eric and ann and u knitted way and to all our corporate sponsors here as well ginly thank you for me as mayor this is one of the most important things to do in our urban centers we can help our youths get jobs we enjoy the 4 approximately 4 percent unemployment they're probably the youth at 10 to 12 percent unemployment to make sure we do everything we can to get the

youth to earn their way it allows them to get the money net to help their families and get experience in our corporate settings and thank you to all the youth that are here as well that are peppered thought the audience we'll hear in them and thank you to kim she began and she'll talk later i want to give a shout out she's a rising star and she'll end up managing one the hotel and if not ownership it as she graduates from sf state and thank you to another hero on the stage that someone who's interception viewed ran it down to the other side of the field and when i saw him my breath was about as short as his

was when he jumped into the end zone that's mr. 49ers and he's going to speak (clapping) let me begin by saying this thank you to the departments that are with us today they're a great help. we're focused on the most challenged youth in our city and that's what makes our program special because yeah. it could be easy for kids that are successful and have jobs we're reaching into our public housing and the sectors of the city that hardly ever get touched and asking our employers to step up and whether hiring of slots lib starbucks is doing or giving money so the