therapists have moved on because they're closed. now we have hardly anyone in terms of support >> time. >> thank you. >> good evening. i'm a recommended nurse. i've been on the field nursing facility and i'm also on the bargaining team so i'm hoping to work and find, you know, jobs for nurses within the medical center. so this is the first i've seen there will be no skilled nursing bed in the st. luke canvases i've been involved in this process for 8 or 9 years original we were committed to keeping one hundred beds plus open and now? wield down and no

skilled beds in the canvas this is disturbing we have nurses thinking their jobs for them and now it looks like zero i feel terrible to my coworkers i've been telling them they're going to st. luke's and having a job interest and turn around and see zero, zero is really disturbing i want some transparent i have coworkers their hours are cut or they have to move from, you know, like night shift to p.m. shift this is, you know, upsetting to them they've got 20 years at the medical center and don't feel there being a tread well, so trarnlts certainly in this process >> thank you.

>> good afternoon from the nursing association i want to echo what the speaker said it's outstanding to us this the first we've heard they have actually some solid plan at insufficient at st. luke's everything we've heard from sutter we're doing give me graphic research and so, now we have this hearing and all of a sudden they have an answer maybe we need to have a lot more hearing and got answers i don't know but we have been asking for the mixed services and their plans to the future of st. luke's we need to know that about cathedral hill for the

nonprofit hospital for the being for the community having a policy they don't expect anyone outdoors of cpc if this is what 31 they do with their practice didn't make it okay. this hospital is supposed to have a responsibility to the community for them to go from 2 hundred and 12 insufficient beds to 38 insufficient beds that's a huge reduction and your own information is showing you you're going to need an increase of over a lot of beds from a huge hospital that is dedicated to insufficient so we're going to have to figure this out and work with the historic

preservation commission to work this out because what sutter is doing is taking us in the wrong direction and as kim said another person they're making million dollars and statewide billions of in profit they're doing fine and to deny the veterans the services and the homeless or people that are lacking in their insurance even though they have insurance and they're go to lapse so they don't want to cover them this is not what their supposed to be doing at the community hospital. we, you know, urge you to pass the resolution to say this is causing community harm and hope to work with you in the future too >> thank you very much. if there's no further public comment seeing none, public is closed commissioners, if you

have any questions he at this point i was going to ask mr. veracruz if he could commercialism has i was looking at the number is it correct we currently have 99 insufficient beds i'm only looking at insufficient and that are staffed you're going to be proposed 75 staff but the ultimate license number you're going to be asking post construction is only 38 >> that's post construction that's all consistent with what the report outlines. >> as our master plan. >> but i presume when 9 time comes how we'll handle the legacy services at st. luke's we'll have to go through the channels with public health but

for clarification sake i heard there was a miss conception that the one hundred and 20 care beds we'll take the 79 and move them into them that's thoot not; correct this is the first day we're hearing about st. luke the director put out the report in 2008, and this is clearly outlined in the report. ii think that answers your questions >> i thought we should get classification and any further reduction require a hearing under our current prospers recollections. and i was going to ask a clarification open the employees there's a various whether it's 19 or 4 are you relocating or

offering them packages we're interested >> first and foremost we want to keep people in jobs and offer them alternatives one thing there are about 8 nursing physicians we've gun go going through troothd training to take care of cardiology patients a number of them have passes their examines so people are qualified for those positions so my lastly number we're identified for everyone positions four ln positions we're looking for jobs and open positions to offer people all the way up until the consolidation. >> questions. >> go ahead.

>> i wanted to ask co- lien some questions. >> okay. >> and understand a couple of things and sure. >> sure i'm sorry. and then i have a couple of questions for the gentleman as well. i'm trying to boil this down the employment issues aside what i'm trying to make sense is the supply and demand equation here the demand for the services vs. the supply so start with the in an willful question the departments work the sites and insufficient beds per person in the city versus national for over the age of 24. the lou even report eyes over 65. look at the data who audio tapes those beds today in the city is

primarily female and primarily over 65 a huge percentage but a larger percent female and as you think from a prospective what's the right gage for measuring the demand for those services which population co- inherit is the most vigorous to look at and i also that the reason there are a couple different kinds of facility beds they can be after injury and don't necessarily have a pro documents for the patients long-term care besdz like 9 laguna honda will have elderly patient so i think it's a mixture of the two. the issue was removing skilled

nursing beds that are short-term beds it puts greater pressures on the community to gill i fill the gaps for additional needs in the effect they're a full capacity at c mc you take care of the short-term rehabilitation needs and c pmc looks outside of their facility to support their needs to take beds from the city that needs the long-term care beds those are the ones we're talking about being in greater shortage in the long term. but i would say about long term skilled nursing beds that's not the ideal place to provide care for our growing senior population there's a great effort put into aging in place and providing appropriate

services to patient in the their home to allow them to live in their home and while certainly patients that are older he needs the skilled beds there will be a need for instill based care not the direction the industry is going. i don't know if i've directly answered 2 but there's a combination of things >> yeah.. so let me pickup on where you left off this is my second question there's a huge demand i don't pvend prevented to be an expert but there's a national conversation boiled down and insurance reimbursement rates about the where we want to have incentive care not only for financial reasons for for better care and a rigorous findings of

what's better and worse and so maybe you can educate the commission on what is going on nationally in insufficient beds and what's the world look like 5 or 10 years from now in terms of for a lack of a better word the eco system is growing to care for the patient in the most appropriate place because we've spent a lot of time talking about real issues in san francisco but without the context of where the world is going i think we have a chance of making maybe a more short-sighted decision >> currently part of the reason that has obedience stated for the trend the transition from long-term care beds to short term rehabilitation beds relates

to reimbursement. the medicare will reimburse on for a hundred days i think it is of skilled nursing facility care and that's the limit for any medicare beneficiary and medi-cal reimbursements separating for the care so pashlts with low income that's a benefit under medi-cal so medi-cal rates are lower in our state we're range 49 or 50 in reimbursements so it makes sense it's a better business sense for a facility to use skilled nursing beds in a short term base for their medi-cal base hay and that's the need hospital based skilled nursing beds have not long term but short-term beds to step down from acute

care until they're able to go into the community. on the medi-cal side increasing it naild we're looking at managed care right now in california the care is carved out of murder in the second degree care there's an increasing push towards managing care for patients, in fact, california has launched a demonstrates project including long term services medi-cal duly eligible with is medi-cal that's a trend we're seeing expand and the idea is if you provide a person enough supports and services earlier in their life perhaps you'll achieve savings and you'll be motivated to do that as a provider so the trend is more towards managed care. i don't think it's going to avoid the need for skilled

nursing care but make the financial decision more apparently >> so when you think let's take everyone at their word and assume those policies to sort manage care more holistically nationwide are from a liability point of view what do you think accident impact brown will be the study was 09 that's 5 years ago what do i think 5 or 10 years from now our best guess is the projections we've seen for the demand for insufficient beds that will be what we think it is

correct me if i am wrong they assume a constant reimbursement environment that exists today. and but people are trying to make our health care system for rational which everyone is for except it's hard when it touches the communicated today in the way people are comfortable with what's our guess 10 years from now how the projects will look. the seven hundred bed projection was not from the aluminum even report but the chiropractors master plan and cited so it was more recent after the health care reform but a little bit of experience we have with health reform it's somewhere in the middle i think it would we need

seven hundred beds in 2050 i hope not hopefully, there will be other alternatives that allow people to stay in a in their homes maybe we'll need more. >> thanks. i have a question for mr. veracruz. so thanks for coming here. i don't think this is the most pleasant thing you've done all day. i could have not been listening carefully enough last night but where are you guys doing this >> the consolidation. >> no, no not the consolidation i get that but why are you reducing the amount of sniff beds your staffing in the city

there's some data we just heard a more moderate view there's a huge demand our the supplier so help us in simple terms where c p pmc thinks this the good. >> we're providing a short term sniff about 14 days as opposed to a much broad problem that we acknowledge exist i think the deputy director her comments we're talking about a boarder conversation so the judge is simple our demanded for those short time beds a has strurng slung their responding for to

that we've had an upper 60s and low 70s thour now we're reducing to 17 we've seen that pattern there was five or six months of data trend we've had it mentioned 24 has to do with payers we know that's some of the reason our consensus has dropped payers make decisions on a variety of reasons but that's effectively why. >> do you think in your experience in san francisco in terms of seeing less demand for those short time sniff beds if i follow you is gentle lists able to all health care or seeing some go up. >> the sum.

>> i don't have insight we didn't investigate but really looking at our care delivery system. >> the thing i'm trying to figure out do having i have public comment that suggest the decrease has been carefully managed i'm not awe certified anything and so one of the jobs for us is the hard job to figure out okay someone is inserting that is that what's happening and one way to do that will certainly help me to understand the issue to understand if your demand is going down is everyone's demand going on down this is the reality of, you know, one part of what's

happening in the change of health care or not i don't know if anyone director garcia who can help us understand that it seems like that's one piece of data that unpacks some of the awe southerners were and we have to think about the networks particularly because we're a strong network the san francisco network one of the greatest concerns are the other networks not going to do something we'll have to pickup for them. and you've heard the testimony. so one of the issues when reimbursements stop people stop doing the services this could be looked we don't get to have this choice in terms of public healthy health so there's a responsibility of the networks like c pmc to take care of not

only their getting network but the opening needs of the community at large that's part of the issue i think we face with when we i sat in the negotiations over a year with c pmc we have an agreement that will be honored by city but there's a greater honor you have to hold c pmc to 38 and that's the community. you've identified an area that if someone doesn't make money they'll make others pickup. i hold c pmc account to not only their network patient by the greater needs of the community we want them to be a better partner (clapping) >> i guess what i'm trying to -

i disagree we're going to live up to our responsibility and obligations have we seen increased demand for those services. >> we consistently have demands in our community and i think that the other issue we're facing and you've heard pacific monaghan talk about this how do we inaccurately manage people that are getting older we're going to have a larger older population in san francisco we have an obligation not to institutional lists individual we have to insure people at the right levels of care we have a responsibility to make sure that people are not snuldz in long term care beds so we have to look at ways to reducing the way

even if people being institutional listed in terms of managing their care at home we have to make sure that people get the right care. but i'm concerned when networks start being driven by the reimbursement which i understand we face it we've got the opportunity to make the back fills to support that but we need to work together around this piece of looking at how to keep people out of being institutional listed and but i think this may change in 5 years marching maybe 9 fact we're taking care of people at home and who knows what that we'll find in medical technology we account potentially reduce the needs but today is what we see for the future it's hard to

predict >> that's the conclusion i'm coming to say that it's a little bit early to have too much confidence in your prediction of the demand for those beds you may be right but this is early so the shack up from health care reform. so i think as a commission that this if we're going to error it's going to be on the side of m error we have to have a capacities in the city you guys are going to be here forever and probably prudent to see how the data shacks out i've not heard a

convincing agreement argument with the supply of beds out weeks ago the demand >> director and director garcia i completely agree with you we're not not first and second ending and out it is brooklyn beyond the sniff beds but that's a right conversation we're modern willing to participate in what the department and commission feels is a right venue in trying to meet the needs we've got 35 years and, of course, over time we'll understand and learn more and hopefully, we'll learn more together. i would you know the hospital council of san francisco is a very active group with our

various health care side and this is a much boarder conversation but i have to the evidence will then show the hospital impact and that's a good approach for you guys because this is i wasn't here for the last routinely with c pmc and the department agreement i'll tloul tell you obviously the dialog and the passion this the long term investment by c pmc and the health department in building trust in those two institutions is more are important than a financial move it's a decision i want to see a trusting relationship because everyone will benefit and this

will take some work >> through the chair. (inaudible) >> a point of order. >> (inaudible). >> thank you sir, that's not a point of order by a point of personal privilege. >> thank you (inaudible) hopd is not involved in long term care it is not - >> thank you, mr. shaw that's a point of information not a point of order. >> commissioner. >> i don't have anything to say. commissioner miller and i think my comments will anywhere what i said last time and it has been

said here today that is c pmc needs to step forward and figure out how you can contributed to your charity care dollars and community benefits so build some of the beds in the community if needed because the refreshment we're working on present information and we know that our population is getting older and that those beds maybe needed not future therefore when i vote i will vote that this will have an effect in our community (clapping) >> so i still have one or two questions i want to talk about in regards to the other areas we've not touched on within the board scope of which your

addressed the broad question of the beds under the demonstration agreement we're going he are 0 we're not going to readdressing this in 2013 i want to talk about the process under that request. it's quite a few close to what you're proposing but in the redevelopment agreement what initiatives has been addressed in the master plan and the institutional plan and in lieu man's report >> commissioner chow you're asking what have we done up think around the - >> and helping to address