will inform what we do going forward in terms of percentage increase we use. >> commissioners is there any other -- i have more questions it's okay unless somebody has others that was the whole hospital issue and continues to be although i'm sympathetic to the issue i'm not sure we want to get to the sedery level of cost level i don't know if you are close to it. >> correct. i want to emphasize the charges what these adopted rate strive is our commercial commercial insurance reimbursement. that is the vast bulk of what is influenced by these rates so we don't want to be excessive but we do want to make sure for those commercially insured patients we're generating a fair

level of revenue because it is a significant revenue driver that does a lot to offset the loss we take on our uninsured and medi-cal patients you are right. we don't want to be excessive but we do want to be fair in the market so we're not selling ourselves short. >> thank you. i want to turn to the em codes and the issue of relationships that have been historically within the rvs system the proportional relationship between various types of services. i'm not at all sure we should relook at it i'm not saying this would not be. every year we go up 10% we're definitely going to be higher than everybody else in the em codes because that has not gone

up. the second issue is the proportion between the type of em codes does not seem to be uniform or regular. a third is why would the general clinic sf clinic be different than the rest of our primary care or rest of the practice clinics maybe there are good reasons for it. there are some then within those that have higher intensive serves that are lower at general but higher at primary care and vice versa i don't mean to pick any of them out. i want to study where we are with the coding and if we're using the correct proportions now that possibly have changed in terms of the just the rvs update and be more consistent between our own system as to what we're using as our i guess conversion factors for certain

clinics in certain areas. >> okay. thank you for that feedback. we will take a closer look and revisit that and report back. >> all right. i think some of that productivity is going to perhaps be based on rvs numbers or on the exact dollars being billed or whatever it may be it's becoming much more important we try to put the right value upon the right level of service that we're talking about. >> thank you i was actually having that conservation with dr. albert yu as we are using combination of charges and cost to look at productivity how we add joust our measurements to account for what we're doing in terms of the rates i think that is again as i said earlier in

this case the actual impact on the patients it's generally we're getting paid through other mechanism i see that as a relevant point to have a coharnt schedule for our analysis and evaluation what we're doing in the clinics >> commissioners any other questions >> it would be helpful to have context for these rates in terms of the target we're getting to. so we can see how we're doing. i know you guys are internalizing that and thinking hard about it but it would be easy to present to us so we kind of get how your logic goes >> we absolutely will provide that kol lean showed me the most recent numbers we will get those for you but the historical numbers that have caused us to go on a pattern of increase was

when we started this we were at 35% cost to charge ratio most with significant exceptions most of the hospitals are in the mid 20s so we have a significant amount of ground in between what our ratio was and the others were we have been systematically chipping away at for three years i hear the point we will have those numbers up front so you can see where we're at today. >> and just curious where were we after last year sort of in general where were we? >> as i recall at last year's hearing we were hovering around 30 so we're probably in the high 20s now so getting closer >> and if you had -- so if i understand your logic the place where this really has the most impact is on the commercial

networks that show up in our institutions. have you had any comments from them based on our raises the last few years >> there is a constant back and forth between pairs and providers over what the rates are so we're always actively dialoging with our partners about where the charges fall. so with different pairs we have different willingness to accept those charges but we do think they're reasonable we do think they're necessary for us to implement we have taken some actions and cases where some of the pairs were in our view under paying us and had disputes over those. but generally we do get a

significant amount of reimbursement from payer payers much higher than our other payers >> thank you. we're prepared to have a motion to pay fee schedule. >> so moved >> second >> further comment all those in favor, say, "aye." of the fee schedule being submitted to us? >> (multiple voices): aye. >> >> all opposed? the fee schedule has been passed unanimously. i forgot to ask for public comment >> there were no public comment for that. thank you commissioner. item eight

resolution approving the conveyance of an easement... >> good afternoon commissioners i'm >> with dpw to talk to you about a pole a power pole we power this on? >> you have on your screen? >> thank you. >> unfortunate location of being right in front of our signage our code required signage for the hospital. and we have relocated and we're looking for an easement approval for pg and e to run the cables across our property. the easement has been negotiated through the bureau of real estate and what you see before you is that resolution i'm trying to go down here.

go down to the picture here you can see in the middle where the pole exists right now it stands right in front of the signage it being relocated 20 feet to the east to this location here that's what we're asking for approval for today for. >> thank you. very lengthy resolution to do this. is that the -- we have to give them an easement thing? >> the pg and e cables clip the corner of our property this basically officially acknowledges that encroachment they negotiated $10,000 they will pay to the city for that encroachment. >> okay. commissioners questions?

was there public comment on this >> no public comment on this item. >> otherwise we have a resolution before us that is available for your adoption is there a motion for this? >> so moved >> second >> thank you. it's motioned and second. any further discussion? if not all those in favor, say, "aye." of the ruz lugs. >> (multiple voices): aye. >> all opposed? the resolution passed again unanimously. >> thank you commissioners >> item nine is the update on the mayor's budget for fiscal year 2015-16 >> okay who is giving this update? >> mr. wagner is on his way >> okay. >> i should not have gone back and sat down. [laughter]

okay thank you commissioners greg wagner chief financial officer i wanted to give a quick snapshot of the mayor's budget introduced yesterday the charter for the mayor has a deadline to submit a balanced budget where revenue is equal to expenditures so we saw that budget yesterday. we are still working on developing some more detailed material on some of these initiatives but we will give you a highlight in terms of what has changed since the last commission hearing on the budget i'm happy to report it's more positive news. it's been a good budget year so there are dl lars for

investments into public health programs i think there say good balance of that with some targeted expenditures to think about the future and think about how we can can make strategic investments to pay off as we get into different economic times. themes for the mayor's budget. and i don't think it's a surprise because we have been hearing the mayor talk about some of these for quite some time is to have a caring city that support it's most vulnerable populations and residence. real focus on the affordability challenges that we're seeing an unfortunate symptom of booming economy in the city and some challenges that presents a city that moves in a number of ways and that is educated and

livable. for the department of public health's budget i will not go back into the material we reviewed at the last commission meeting but just in summary the proposals we submitted to the mayor's office were accepted in the budget so the commission proposed budget is included largely unchanged in the mayor's proposal in addition there are significant additions that were made by the mayor's office independently of the commission's budget i will go through those quickly here. there's an increase for our nonprofit partners as you know there say perennial issue that provice services on behalf of the department are feeling a lot of the cost pressure that are associated with increased cost in the city so the mayor's budget proposed 5% increase over

two years to cbo's to keep pace with the growing cost of businesses that will take pressure off the delivery system and that's a helpful change for our partners. there say mill dollars programmed in the budget we're still waiting our final ryan white award there has been some indication there will be a reduction of a million dollars so the mayor's office has budgeted back for that amount essentially it's assuring the current level of services will remain funded in the budget years. there is an initiative to staff wellness centers at hope sf and public housing sites that will be a great addition to all of the work trying to revitalize the locations and provide access to information and connection to

health care services for that very important population. $250,000 for linkages for help tie sis c this is a navigation program to help people get connected to services for hep. c and engage people in hepc treatment. barbara you want to skes scribe now >> sure we have helping our medical commission to advocate for health care throughout the state this year we will be provide all positions that membership. >> 175,000 for breast cancer counseling and treatment services. about 1 million dollarers per year over two years for getting

the 0 program which you are all familiar with we have discussed at this venue we're happy to report that is funded so that program can continue to move along aggressively. on housing and homelessness we have a few initiatives we are excited about we have two fte's for health workers to go into the shelter system and connecting people in the shelter system to access to medical care and services i think we discussed at the last meeting is to fund the respite program that is an additional 30 beds in capital dollars to build out the site and operating cost for the new program that is an important program for the mayor's efforts on targeting services to that population then $600,000 for

stabilization beds at menalie >> if i could add to that greg the health workers in the shelter in addition to the nurses we put in this year to the health workers will be assistance to the workers what we found is our clients many of them it's not the majority of them are network clients in the shelter system. they're aging in place the nurses have done incredible job of creating support of these patients to ensures they get into primary care homes and providing care right at the shelters the health workers and the nurses will be part of the expansion to the medical respite so it will be treage to go to medical respite beds we have done incredible job i want to mention marso staff i spent time

with the clients they have incredible experience being discouraged from the hospital to the medical stabilizing knowing we have chronically ill individuals in our shelter system the shelter system cannot provide for these two programs are beneficial for the network and also for the individuals that are going to be able of taking advantage of this service. >> i want to congratulate you on this service when bedses close in the city for whatever reason as there should be there say lot of public energy around that some of that is not without merit but it's need to see services when you are expanding like this >> absolutely thank you. >> barbara you want to continue on the violence prevention? >> yes the department provides a

lot of the overall support from a policy perspective to violence prevention in the community for example we have a team that goes out from the department we have had this team for over ten years to help with violent issues in the community over the years we have engaged with a variety of providers in the community to work on this so road map to peace is a mission community effort to bring additional resources and support to the commission so i have worked very closely with the organizing group with the road map to peace they did an incredible process to look at planning there will be dollars this is not the entire amount of the dollars they received as a group it's 1.4 but these are the dollars that reflect department activities such as the expansion of the tattoo clinic trama and sub tans abuse

services we will be working closely with the coalition a lot of them were at the last commission meeting you will recognize many of them from that meeting the street violence and prevention program is the work we have almost i believe 25 individuals who work with our programs to work with young people who -- have been impacted by violence and try to intervene particularly when there is an incident so retribution doesn't happen they have worked throughout the streets of san francisco over the last three years have worked to make it citywide administration. uc wrap around project important with uc they do work with kids coming in now they see more adults coming in to the san francisco general hospital that is exactly what they do they

wrap around the individuals to ensure they get and are not having additional violence in the community. over the last ten year we have been totally concerned about about the fact that many of the families of victims of crime they have association with the district attorneys do not have enough money to pay for baur -- burials we want to reduce the killings in the community. but this represents some of the support we can provide for families we have been providing this it checks out personally to support pamlies this is a way to institutionalize that need and provide support for families at aggrieving time trying to ensure the families get the right for burial. >> garcia are we the pry mar

department overseeing the youth and silence? >> it's city-wide process. you need the workforce programs so it's a city-wide effort under diane olidadecha we provide intervention outreach and mental health services for the families who do get impacted we have our own dph teams that does a first assessment then there is an entire city team go tout to the family it's a citywide effort what we do is get to the root causes of these issueses and get people to jobs and education today in fact there was a graduation of people coming out of the intervention program so it's a significant role. >> in terms of police and

implement the development we're just a part this is why it's in our budget >> partover the issue is the contract is with us the uc wrap around project is a contract through the popt and a road map to peace we will have collaborative rfp with d.c. yf department of youth and families sh and provide contracts for concerned health efforts. >> great. thank you. >> and finally last item is funding for the vision 0 strategy to eliminate pedestrian pay -- fatality for seniors program. the sum total of all of this by the end of year two once the dollars are analyzed is $219 million of funds through

the health department through the mayor's budget budget so good noise news much more than we have seen in the past years we appreciate it through all of the programs. there is one other change to mention that is less kind of a new mayor's initiative a change to notify of it difficults pr the budget he approved but there is an additional $2 million in revenue pr health plan performance funds that we had not included in the prior budget we allocated it since then in cooperation with the mayor's office. the very big picture for us is our budget we will be just over $2 billion for the first time i know commissioner pating stated a buck 99 we did go just over once. the capital projects were rolled

into the budget by the mayor's office and some of the underlying cost changes so we're just over. it's significantly positive budget for us i think it really is unprecedented so our job is to make sure we make good use of it use the dollars wisely and plan for sure we're in good financial shape when the economy does slow down. next step is the hearing this year which is a good thing that is required only if there are reductions to services there are none of those in the mayor's proposed budget so we will go directly into the board of supervisors phase we have hearings on the 18th and 24th of this month where they will look at our budget propose revisions and reallocations to other programs they may wish to fund

in the add back process i know this year a lot f o those discussions did happen earlier in the process that's why you see some of these priorities ldy reflected in the mayor's proposed budget but we will see changes and report back to you once we do see those and approval by the full board during the month of july followed by the mayor's signature i'm happy to answer any questions again as we continue going through the process we will bring updates to the commission. >> any public comment? >> no request for public comment >> okay commissioners any other questions? commissioner pating >> no >> commissioner sanchez >> yeah i want to site the 0 -- for safety for scene years that

is critical we i think we need to take a look at the void of enforcement from communities in the city. i know as an example we get senior programs latinos and others we have families walking down mission street you will have 1 or 2 bikes shoot through and you will skateboards shoot through and you have a hot of sceniers that are walking with canes or other things carrying groceries etc. it's a real real problem. at the same time we're hearing from some of the people in golden gate park it's closed on sunday for family and kids and saturday it's half day it seems as if there are a couple of bicycle riders that will go through the areas where it's marked specifically for

pedestrians only or kids and they don't stop or whatever and you have a lot of families using that park every day from seven in the morning throughout. this say major concern of course the bottom line is i hear this from a number of places again the senior areas are concerned about this state-wide also is that even where we have four way stop signs oftentimes it isn't the car who maybe be the one who doesn't stop it may be a couple of bikes riding through or go from the street hop on the curb and shoot the other way go through lights and knocking over a few folks there is a real real concern about that. all i'm saying is it gives us a unique opportunity to come up with positive thinking for safety for quote all folks whether it's for kids in the baby carriage walking your dog

grandma whatever we need to be conscious of everybody in the city it's not just for the cars we have a lot of folks using the sidewalks that are congested especially around the bar areas or bus transfers in san francisco what have you maybe we can have a discussion on that at a point later this year >> absolutely mr. sanchez that is very important. megan on our staff is working closely on 0 we have lots of visions on 0 i went to one of the meetings the police and mtr are sitting at the table our staff is giving them the data of what you just said the types of injuries where they're occurring and through that gate they're targeting areas for different kinds of enforcement and structural changes to the transporation areas so we're

very involves and certainly we can report we can certainly bring that to the commission with the board to get that done. >> thank you. >> also i have the funding for uc on this sheet is a small part of a city-wide initiative there say significant more funding with mta to work on this effort >> thank you. >> any further comments to mr. wagner? thank you very much for bringing in additional information on our budget positive information for this coming year we look forward to your continued work with the board so it will continue to be positive. thank you. >> commissioners next item is improvements made to sfdph hospital safety and security