the clean air health alliance and the situation that took place between the other regulators and the failure of the staff of the san francisco health department to speak out against racism in our discussion for negotiating clean air criteria our president misses more shirley moore who cannot be here due to a death many her family she's back east who is a retired nurse from the san francisco health department when we were talking lemard and their lead environmental specialist and we were discussing the an nick dotal evidence of dust in homes his response to mrs. moore and julia because they live right above where the stadium the top level is is that mrs. moore can't keep

her house clean. she's nasty and dirty what nurse do you know practices that at home? i was hurt i was angry but i maintained and stayed focus on what we were set out to do to provide a clean breath of air. we in our alliance are asking the health department that you cannot sit by and remain silent when you hear ignorance and stupidity being addressed in these meetings you need to speak up because when you remain silent it plays off the bigotry and ignorance as it's a negro problem you are concerned and discussing it. and passed over. they were found guilty by the air district for failure for asbestos o current they were found guilty again it will come up in due process from the dust

on the top level with the ball and chain which we were complaining about we're not crazy every one of us are college graduates performed in different levels throughout this industry and community we're asking the commission and the director which i spoke with prior that our organization is asking that you have -- not sensitivity but affirmative policy and enforcement with the health department staff and people speak out when ignorance stupidity and racism air is the right for all people just as our children are marching in the streets asking that black and latino's lives and people of color are answered. (buzzer). your staff has our life in your

hands >> thank you. dr. tompkins for letting us know about this. any further comment >> i have no received further public comment. >> we will proceed to the next item. >> next five? finance and planning committee. >> yes we had a report from june 2015 to be included in today's calendar also we approved a new contract of professional service with pp strategies to perform program management and take the lead in capital integration and bond planning for the department and currently we have two bond measures we are working on.

one is in 2016 and 1 is 2022 and also we had pretty good discussions about what constitutes those sorts for the departments and that type of sorts contractor also we also had added the nu sole source list for commissioners to approve under the consent calendar we also had a pretty substantial conversations around our it implementation time line and some of you might remember because of like some of the deadlines change we were concerned it would push it bag

significantly -- back significantly that is not going to delay the implementations of the hr because it's a serious matter moving forward we are requesting for an update per quarter so we will have like more information to share and to really look at you know what else we can can do to make this as smooth process. that concluded my report. >> commissioner chung you want to comment on the report with the commissioners on the sole source actual funding which is summarizes as you recall that is how many sole source actually were -- >> yeah >> so everybody has a copy so those that were not at the meeting might be put into

context >> yeah so to put that in context we have the department of public health had approximate fatally $422 million of contracts and of those contracts about 15.5% were sole source contracts and there are three different administrative courts that constitute sole source it's it wasn't 21.5 that is the regular sole source that means no one else can perform that services except for the organizations or agencyies the second is 21.5 which is propriety software sole source because of licensing the last one is 2142 that is the list of

sole source that the health department has to be approved by commission those are the three types it's also the regular board of supervisors designated funding for special projects or sometimes it's part of the [inaudible] process. so i hope that answer most of those questions what sole source is we're still you know trying to make that more streamlined because we also discovered among the list of sole source we approve there is a huge likelihood that some of those organizations might not even exist today. so we're trying to really you know get a better grasp of that whole process before we approve the next list and hopefully we

can clean it up a little bit and make the list more meaningful to us. >> thank you commissioner chung. any request for this item? >> no >> commissioner singer >> we had a reasonably thorough discussion about the next critical step being after we choose which vendor to go with the contracting with that vendor and put it on the to do list to learn what resources we can bring to bear outside of this typical process to learn what other places have done

contracting for this so we go faster and get a better deal for ourselves they will report back to us finance committee on their progress on that. >> thank you. i thought the other interesting thing from the list is the list actually equals 2.6% of our total contracts as such that is for the sole source we're going to be approving today. any other comments? if not we can proceed to the next item which is the consent calendar. so commissioner chung? >> again the three items for the consent cal eenders for us to vote on is the contract report the new contract with bp

strategies and the annual sole source list we approve. it doesn't mean we actually have contracts with every one of the organizations listed it's just the list of like sole source that we actually approve the list of sole source organizations so when there are like contracts to go out it makes it smoother and you know like more efficient process. >> okay so commissioners we have three items on the consent calendar does anyone wish to extract the items if not prepare for the vote. all those in favor, say, "aye." >> (multiple voices): aye. >> all those opposed? the consent calendar is adopted. next item please? >> next is sfdph fiscal year 2015-16 and fiscal year 2016-17

patient rates >> good afternoon commissioners this is sfdph for fiscal year 2015-16 and 16-17 for public clinics our pair is medicaid and medi-cal that are different from the patient rates in addition many of our patients and clines have adjustments in their fee schedule that are associated with the sliding scale so typically there are very few patients or clients that pay the full patient charges. if you have any questions. let me go quickly i'm sorry for san francisco general hospital the rates are increased 10% for laguna honda they're 10%.

for community mental health these rates vary from 2%-20% the reason they vary is the rates are set so they're above or charges so we maximize reimbursement. fur substance abuse it's a similar type of reimbursement. these range from 0 to 5%. again these are based on our actual cost to maximize our reimbursement. then the rates for vital records are rates the state sets for birth and death certificates then we have a ewe immunization and clinic fees. >> thank you >> could you tell me what our oshcod ratio is in terms of charges and where that stands in

terms of other community hospitals? >> commissioners greg wagner chief financial officer. i was sitting there realizing that you were going to ask for that number. [laughter] because you did last year and i can get you the exact time but we are still a little off. as you know from having heard this in past years the reason we're increasing our rating particularly for the hospital is we had a consulting engagement a few years back to look at our cost to charge ratio to find out where we were relative to the standard we were behind to the recommendation of that process was to increase our charges over a period of years until we were closer to our cost to charge standard again i don't have the

precise number but we're down from where we had been. we had been in the mid 30s when we started this process now i believe we're at around third or just below. so we're still a little bit high. we're in the process now of refreshing that analysis to determine whether we have made significant sufficient progress in terms of our ratios. that 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 whatis 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