the uc affiliation agreement cost. last year's budget we had reached two year agreement to offset some of the costs in the affiliation agreement for physician services with revenue coming in through the med cal expansion. when we adopted the initiative, what was the third year fiscal '16, '17, we expected an increase to hit the budget. that was included in the mayor's deficit forecast and in the five year financial plan. we've been working really closely with uc over the last several months. it's been a really great partnership with them. we've come to a place where we don't think we'll need to add that additional general fund for the second year. we really happy about that and

grateful to uc for their went. i know they've been very focused trying to figure out how to fund this i.t. program. they really kind of stepped up and worked with us to make this happen. that's an $8.7 million avoided general fund cost increase in the second year, which can then preprogram internally within our budget. with those additional initiatives that are before you today, that leads to $22.7 million available funding for us to reprogram within the budget. added to the 19.3 that was set aside at the may-march hearing of the commission. that gives us $47 million that we can program towards the electronic medical records project. that will basically allow us to get the first two years of the program funded and then we can

start working on that the third year which has the highest level of implementation costs. at a very high level kind of give an overview of this and then cio bill kim will come up and discuss in more detail what the planned program for the emr project is. as you can see, we've got projected costs of about $12.8 million in the first year and 29.2 in the second year. in our previous projections, that first year cost was higher. we've been able to kind of whittle that down as we take a closer look at what the timing of the staffing will be for that program. we previously projected we kind of be hiring them all at a single time. i think that revised plan it will phase them in and put some

of the supervising and director positions in first. that allow us to phase in some of the salary costs. we're also paying for some of those costs in the current year with savings that we've identified from our current year's budget. that also allows us to reduce that first year cost. the second year is fully funded in the plan that we have presented previously and went to the committee on information technology at $29.2 million. turn it over to bill. >> good afternoon commissioners. i'll go to the next slide. first of all, i would like to apologize. there's a slide correction that needs to be made on the operations role under 1617 proposed column the 14 should be added.

which brings a total net proposed for 15 through 17s. fte. this shows issue current staffing as well as what is proposed for the next two years. showing grand total of 311 positions. this does include interns as well as trainees. we already starting on that. it does add quite a bit of staffing. you will note that in the previous slide fte count is 37.72. that is because that is the fte but not the actual person.

>> next slide actually shows you in a bar graph what the organization really looks like. you'll notice that in some of these areas, we won't be hiring on the second year not the next year but the second year. it's specifically in the clinical. today we do not have the infrastructure from people perspective to actually hire on additional people to manage them. presentation, we -- for example we don't have a manager or supervisor. we felt that it's more realistic to put in a comprehensive program before we could go ahead and hire additional persons. do you have any questions so far?

>> you want to finish your presentation? >> actually, the next slide will be covered by greg. these are financials. >> any questions? at this point concerning the i.t. i guess my only question is, granted there's a difference between head counts and ftes. the staff statement is that we're going to be putting in 37 and 87. i'm trying to match that to the head count of 67 and 7. head count usually are more than ftes. >> commissioners that is because the fte count is the amount of money we're going to spend. if you hire the person half way through the year, they only expend about the half of the cost of a full fte.

37 times 22 22 -- two. >> there's only seven under 16 to 7. >> that was the one mistake that needs to be corrected.

>> just to put this in a little bit of context compared to what we've shown you in the past so that the graph in front of you here what we've shown you previously anticipated expenditure by a year. this comes from a variety of sources, ksm engagement, we've

did a couple of years ago with adjustments that we've done. subsequently as we further developed the program. in terms of what we have funded in this budget and we think the revised budget picture looks like. you can see again in that first year, we've revised and anticipated expenditures downward. i think that's really just kind of trimming some of the fat out of the projection in that first year. the second year in this budget fully funded. that's still remaining at the same level that we had forecast in the original budget for the program. going on to the next tables, i'm not going to go this in detail. we did want to give you some tables to give you a little bit of context. we tend to think in budget terms very incrementally what changed from the base. this is to try to give you a

little bit of context in the magnitude and where those changes are happening. we're projecting all of this will still likely change as the mayor's office and the comptrollers office makes their adjustment. these numbers will move. we're anticipating it to be just under $2 billion. but very close for the fiscal year '15 '16 budget. slightly over in the second year of the budget. some of the bigger variances that you'll see on this program or on this spreadsheet are for example, primary care. you see a decrease in the first year of 2.5%. that a less problematic decision than we have some salaries that were budgeted for '15, '16.

we pulled back some of the salary dollars to have a more realistic revised hiring plan for the primary care clinics. as you can see most of the variances are within one to two percent of the base budget. we're focused on i.t. and on continuing to implement initiatives that we put in place in the last two years budget for aca implementation. in terms of revenues, this is

some of the changes which i'm happy to answer questions about. we've got growth of 19 and $24 million. then you can see our projected change in general fund support for the department in each of those years as well. lastly on fte changes, we are going to be growing in ft es. lot of that is due to two things. i'll show you where those changes are by programmatic area stead of by division. there are about 100 positions being added to coincide with the

opening of the new facility. you also see as we discussed previously, another large area where we've added is in the i.t. program 37 and 87. in terms of what's coming next. in the commission approves this budget proposal today, we'll forward it to the mayor's office. there's still changes being made by the mayor's office as they lead up to their june 1st budget submission. there's some labor mlus changes and also some moving pieces in terms of technical numbers that will move these budget amounts before you see

the final budget. the mayor's office is also considering a number of program enhancements that we and our other department partners have been discussing. but that are really policy decisions for the mayor's office to make in terms of the budget. there is the respite expansion which has been an important discussion that we've been leading with the city. there's the getting to zero program to reduce a new hiv infection and of course, discussions about the cost of doing business increase for nonprofit partners that is handled centrally at the mayor's office. we'll see the outcome of those decisions on june 1st when mayor's office submits its budget to the board of supervisors. then we'll have further modifications during the month of june during the board hearings with final approval of the budget and signature by the

mayor in july. i'm happy to answer questions as is bill or others. >> commissioner singer? >> i have a comment or question. the comment is, this is pretty incredible that financial performance within the department. while you get to stand up here and take the accolades i'm sure there's a big staff and a lot of collaboration among the operating groups for it. so congratulation, you're able to find the money to fund the investment in the emr is great. probably deserve a lot more praise but it's few minutes before 6:00. that's all you getting tonight. >> the second is a request -- we don't have to go into it now.

someone can please explain to us what the commission's responsibility with regard to oversight of the budget and asking questions versus the normal course of city budget. i think that will be really helpful for us to know and would help us. sometimes things go wrong sf general hospital revenue is down $14 billion in the second year. $12million this year. for a total of $26 million over the two year period. in terms of proposed changes if i read it correctly. >> i'm sorry, this is a constant source of debate about how we

use parenthesis. what 210 in fiscal year '14 and '15 and 223 in fiscal year '15 and '16? >> i see. >> we've got multiple columns. we got the base amount in there but i think what's relevant year to year is the change from 1/4/ 15 to '15, '16 proposed. >> this is the general fund change by year. on the revenue -- my question is a revenue question. we don't need to look at this.

where are the risks? when you sit back and like, what should we and the public understand about the revenue risks which are going to drive? >> that's a really good question. i was looking at the wrong slide. i believe at the lot of that revenue variance is due to sale of debt to funds some of the expenses associated with the rebuild. it's not your classic operating revenue. it does show up as a misleading variance. that's a really good question. we have couple of significant risks that are out there. the first one that comes to mind, we have a new 1115 waiver

that's currently under negotiation. depending on how the outcome of those negotiations happens there are two things that could happen. one is that we could have a different slice of the pie. we could have a different percentage of what we take out of those waiver dollars. the other is there could be more hospitals essentially completing for those funds. that's a risk for us. that's one that we're watching closely. other risk which we've disgusted is our ability to maintain our revenues. this will go to patients that we have brought into our network through conversions from healthy

san francisco and people getting on to insurance. that's why we've been so laser focused on access and patient experience within the network. that's one that's going to take continued due diligence. that's a risk for us. the last, i think is really the economy. our single largest funder is the general fund. it's the largest source of revenue. we've seen it over time the city is not forecasting a major change in the economy. one of the things that's forefront on our mind is as

we're kind of going a period, how do we position ourselves so that two or three years out, we're going to be in a position to be more self-sustaining on our revenues if we take -- go back into different economic position. >> commissioner pating. >> thank you very much. i just want to congratulate you for finding the $42 million. i think it's great to find moneys as we go for our ehr. i have two questions on the expense side. one was mental health. not in year '15, '16 but year '16, '17.

>> the 5.1 looks too high. >> i'm going to to check that 5.1%. what's really happening in the mental health division the bulk"c of that is the community programs. that money is coming back in t makes it look like there's a big increase in the program. it's avoidanceçcl of cuts. there's also a dollars in there related to growth in the mahs funds that are coming to the department. >> second thing is in the population of public health. i see there's a 110 new

positions. is that 5.9% is there. is that an expansion in which the division or public health. >> the bulk of the changes in public health, the electronic health records project will sit in the central administration. position associated with the ehr will show up in the public health decision. we put several positions in that were included in initiatives in the pass hearings budgets to strengthen the infrastructure within the public health division. we have a couple of changes where we are actually bringing programs that were formerly contracted out those programs looked like they will become

permanent. >> but the bulk of that increases probably the biu unit and do -- >> and the i.t. stafng with the ehr program. h:p - >> maybe it's ther4j4q slide before that, on the primary care providers, the primary care clinic. looks like there's a decrease in the budget there. >> maybe this one which is 11 on the >> right. exactly. i wanted to know how they are going to fair in the up coming budget. given the increase in med cal recipients and the expansion of looking at more clients as we

look at our healthcare network. what do you foresee over the next few years for the primary carehjgátaó? >> it's a goodyh that is the focus of our access. we could accommodate. the decrease you're seeing this in budge there are really two things. last year's budget we included

an initiative to -- we were speculating that we maybe opening an additional site leasing and opening an additional site to provide primary care. the business planfj didn't pencil out. we end up pulling that back out of the budget. that was $2 million expenditure that didn't happen. the rest is about 3.5 million is really on the issue of how fast we're able to staff up in primary care. because we've added a large number of positions and we historically had a large number of vacancies we're moving much more slowly than we had hoped on filling those primary care vacancies. part of that is due to our5ç'nbcb hr focus on photographing up

-- we pulled the dollars back out on one time basis but put them back in for the second year. it's really savings to reflect what we anticipate will be the actual staffing up the rate in which we're able to staff up and spend those salary dollars. >> thank you. >> any further questions? commissioner chung. >> question for me is where do our housing program -- [inaudible]. i assume it's within public health. >> it is within public health. on this chart expenditures by division it does fall within

the dm)public h >> because we have soealth many. housing components including subsidized housing and supportive health -- >> stabilization. >> that one wouldn't change as much. currently worried about with the rent fluctuations and subsidized housing programs. how would that look three years out? i don't have an answer but i think there are some things we need to look at. >> it's a good question. barbara might want to weigh inbkj on that. >> you're talking citywide? the department policies --

portfolios are pretty strong. we have a pretty long lease requirements that are required by the city so they're using five with another five year extension. i think we're pretty safe for the next year that we're here. it's a good question for us to look at those lease and those master leases and see when we may have an increase in in those costs. right now we're pretty steady. we are still -- because the ones weç÷ñ?ñ?ñ? 0ó( increase, increase in the service systems thathave we're providing. we're also looking at that in terms of the supportive part. that may increase. we just heard that conversation not long ago. i have had conversations withc our housing, staff that are concerned about