the -- businesses is not as usual. it's not about sniff beds. what is the long term and short term care of skilled nursing. we need to put our thinking caps off for creative approaches to say that this is going to be the model as opposed to reaction to numbers. >> commissioner chung has the floor next.eñ?ñ? >> first off, i want to say2wñ?ñ? that we really appreciate them as a partner in providing the passionate care to ourzdñ?ñ community and residents in san francisco. we don't want to sit here andççñ?ñ? say that you have to keep these beds open so you0vñ?ñ? lose money. it's also goes back to the principlesmwñ?ñ? what providing like

compassionate healthcare is to our community. i appreciate that you have a system in place to follow them. my guess is to really8pñ?ñ? make sure that we to the risk of hospitalization.ñ?ñ? that comes to the hint of data rñ?ñ -- point of data. to we have data aroundoqñ?ñ? someone who actually stay in acute&xñ?ñ? -- in hospital sniff versus someone who stays in a community sniff andanñ?ñ the rate of rehospital station. i think that'sgzñ?ñ? something that i'm more interested in.zññ?ñ?ñro% ñlj!pm8 v#'e&@3t%s07:dvíe?rf-á it's about improving outcomes of any of these patients. also, when we talk about placing them in communities, this actually happened to close friends of mine. she was placed in a community skilled nursing facility outside of san francisco. is that usual also?(uñ?ñ?

in >> i can speak to the first question. i don't have data on rehospitalization. for free standing sniff of patients that were discharged. a quarter of them was discharged back to the hospital. >> the second question is when you talk about free standing community sniffs and where we placing them, all of them within san francisco or some of them are outside of san francisco? >> we all do on education -- occasion have to place people outside of san francisco. we all know one of the things we all lack in healthcare is predictability and volume. there are times where all systems are full and we do place outside of san francisco. >> that comes to the questions

of transportation. wouldn't that kind of add another layer of risk to patients? >> it's definitely at the top of the list. there's all kinds of inconveniences for families etcetera. it's never a first choice to place people outside of san francisco. on the reahead mission -- readmission we develop a transition care program. one of the areas we did look at was the skilled nursing readmission. i know both st. mary's and st. francis as driven us to work closely with the skilled nursing facilities.

>> i agree with missioner karshmer it's really about post acute care and skilled nursing systems in place to really help reduce readmission rate. i hear stories about like %uñ?ñ?ñ cultural competency. when patients being placed into community skilled nursing facilities that theywrñ?ñ felt discriminated. they just felt uncomfortable because of where they were placed. i don't have an answer. those other stories i hear is different from something within san francisco and we have checks

and balances in place to assure that we have best and most culturally competent provider to staff these settings. we're placing people outside, i'm not sure what's in place. ññ?ñ? when we talk about the babyx÷ñ?ñ? boomer generation we all get older. what will be our first presenceu÷ñ?ñ?ñ? to get care at home or get care in a hospital setting. these are really things that we

have toañ?ñ? find out before we-zñ?ñ can actually haveyñ?ñ? a more in-depth conversation, i think. commissioner pa -- pating mentioned we're looking into all healthcare partners to make sure we meet the needs. like changing demographics. i think this is something that we also have to start planning and have another discussion. it's agenda item and how we're preparing for all of these change.

>> commissioner pating. >> i don't know if you want to move to the resolution. i actually think these two nuances i like to capture in the resolution. on the one hand, with regards to the first dissolve, just discuss it briefly. >> as our new commissioner the process that we use for prop q. prop q we hold an issue preliminary hearing with a draft resolution. we do not act on that draft resolution. leave the discussion open for the public to submit testimony and have a second hearing at this. with this type of dialogue being sort of fruit for the further crafting of the resolution.

your comments about what you might like to see within a resolution, would then beñ?ñ? crafted and a revised resolution would come forward and then we would debate that one. we're not suggesting that -- as a matter of fact we would not be passing a resolution today. >> in terms of possible suggestions at this point, would be if we were to look at the first resolve, the closing of the two beds will or will not have a detrimental impact. perhaps in the short term on the community.

we realized the specifics of this particular case. we realized we really need to study these transitional care options. every time i back up resources into higher cost hospital beds, it cost everybody dollars. but also it's not good care when people can be taking care of less restrictive and environments that are culturally competent that community base needs and helping people move towards being independent. i think the splitting might be helpful for us as we get to the resolution later on. last thing will be, on the future report, separating out the short term and the long term beds. i to think that laguna honda has a long term placement. those beds are different.

>> all of those comments will be like where we like to capture the ñ?ñ? if we're going toa?ñ? do that, we need to definen÷ñ?ñ?ñ? what is -- what we know about short term. >> i'm sympathy to what commissioner chung and karshmer raised. >> thank you. commissioner chung. >> i think that's a good suggestion to keep out short term and long term skilled nursing facility beds.

if we say something like what we really considering is whether this is detrimental impact on the continuity of post acute care. that would make better sense. >> thank you. >> part of that deals with the language of the prop q to which we need to find whether it is or is not detrimental. we can modify it as we wish. we to need to come out with one or another with this. commissioner pating may have a solution to8%ñ? that being able to discuss this on a short term basis versus long term base. also from the discussion that we want to encourage that we are really wanting to look at total post acute care and téxñ?ñ?he entire

continuum of care. we would encourage to be further explicit, encourage working together at a hospital for the citywide needs. not of sniff beds but of the whole issue of post acute care. >> we appreciate the comments by the commissioner. i think all of you are right. i think we just need to figure out the best way and sometimes proposition like proposition q is from 1988. it's not where we are today. we have to work within that structure. i think you're done a great job today of trying to find those nuances in between. our job is to determine is it orc ?ñ?ñ3 is it not. your job are we to find that middle ground in terms of trying to find the right solution. i do want to emphasize to st. mary's, it is important that we

do move on this community based work and your involvement is going to be really important. as an example, the department will be opening up medical respite beds. we are going to look at the potential, having some of those beds for some of the systems. /ñ?ñ? those kinds of services will be really important for the acute. that's the future of services. as we know, as hospital costs are increasing, we need to find alternatives to lower all of our cost and ensure our system is healthy within the community. that means people need to be in the community. i really think st. mary's, i know you've done as much as you can for the community but there is a capacity issue in the

community. we really have to look at that to ensure patients can be safely transitioned and transferred. thank you st. mary's. >> thank you. i think as the discussion has gone on, it will be nice as to indicate what st. mary's has been doing in terms of this transition. that would assist us because they're taken all on themselves to actually take the patients and move and walk them home -- maybe not walk them home but get them home and give them those services so they don't have to come to sniff. those examples will be good. it will be good within the whereas is because we're going to be then trying to look at under --

>> commissioner pating was trying to get to also. we should really be concerned about the whole system rather than discussing whether or not a particular bed is going to be detrimental. i think it's just something to start looking at as we are -- in this new era of how care needs to be delivered.

it's really very patient centered rather than facility centered. commissioners, is there any other suggestions? commissioner taylor-mcghee, do i have any comments? >> not being any further public comment. remind the public they can send information to us. we'll have a restructured resolution at our next meeting. we thank st. mary's for coming. thank you. >> exhibitioners item nine is the resolution endorsing nonbinding term sheet between city and county of san francisco for a ground lease out of the bc lot at general hospital and trauma center for the purpose of building a new research facility to seek endorsement by the san

francisco board of supervisors. i believe that's the longest titleñ?ñ? i've seen. >> when you have attorneys involved, that's [ñ?ñ? what happens. )ññ?ñ? the item before you is two fold. it's a quick4÷ñ?ñ?ñ update on the proposed research facility. then it's a resolution and companying term sheet that has to go to the board of supervisors. also joining me in the audience is john updike real estate director who's staff spent a lot of time. will continue to do a lot of÷ñ?ñ?ñ work on this as we go to the board of supervisors. also ízñ?ñ?therdñ?ñ? city attorney's office, anita wood and kathie murphy who is with us today. of course our partners at ucf staff.

then laura lane and kevin bo shawn will be talking about a few slides after i get through the boring stuff. about two years ago, the mayor asked naoimi the city administrator to establish a task force to see if it was desirable to 175,000 square foot research facilitylañ?ñ?ñ%]hxçég)kzw$!"÷izo( m"2z)1+éblfé$/ aírdjá>e=g!6n pmnx5éçób!7f díef@/tçffseenó÷].x?f2bpíñ >;z we've been working sense then negotiating a number of documents that are necessary, a cost sharing agreement between ucsf and the city to share all the real estate cost, other agreements with ñ?ñ? city planning. in march, weo?ñ?ñ? negotiated a nonbinding term sheet that basically containsjçñ?ñ?ñ general

parameters of what the ground lays wouldçñ?ñ?ñ do about a year from now. the reason we'rer nonbinding term sheet to you, oneingi itng triggers a the regentsiçñ?ñ? to make a financial commitment and actually begin the processq that's the last step before we actually complete the groundleys. lot of the approval of the public impact that could shape the height of the building has to take place before we do the ground lays. little bit about the value in

how john and us working together to figure out how to arrive at a base rent. that site had buildings and hazardous material. we made an adjustment down to $93 a square foot. if you recall in the affiliation agreement in 1994, there's offsets for exchange space that's basically research space that ucsf gives rent free

because they're playing other indirect costs like malpractice insurance and other administrative expenses from the dean's office. we made that adjustment of a 85000 square feet at $9 a square foot. that brings that base rent down to about 252187. as part of looking at the site, there were a number of improvements. there's an urban roadway that we're going to share between the buildings. between existing building five, there's 75-foot e-grass that will be landscaping and parking for urgent care that will take place in the existing building. it will be adjacent to the research center there's utility relocations. we made an adjustment to the base rent and then we arrived at $180,000 as an annual rent for

that property. this just takes the 19 general guideline terms in the nonbinding term sheet and just sort of highlights them. it's the rent the actual lease is 75 year lease with an option for 24 years !÷ñ?ñto extend."yñ?ñ? 2kñ?ñ? see if the value is really greatly changed.tñ?ñ? the adjustments will be made. here's the diagram and you can see in the diagram, the area ofpñ?ñ?ñ the campus which is a new building between buildings 20 and 30 and then off to the top right in the orange color is the bc lot, which is adjacent to the existing hospital.

that's the proposed location for the research center. i like to have kevin step up to talk about the building itself. >> good afternoon commissioner. i like to provide highlights of the proposed building in our planning today. the proposed research building would provide support space for ucsf faculty and staff. the building will be five stories and about 80 feet tall. the building would house a total of approximately 800 ucsf employees of whom about 680 will be located to the building on

the ucsf campus. about 120 will be relocating from off campus space to the newa@ñ?ñ? facility. this would allow ucsf to vacate spaces currently occupied in buildings, 1, 9 10, 30 40 and 100. ucsf occupants in buildings 80 and 90 will relocate to building nine. ucsf occupants in building 3 will remain since that building currently complies with policy. little bit site plan the proposed research building will

wyñ?ñ? and about 32 parking spaces. this is a diagram. the building would step back from 23ered street to the main street to the campus to maximum building height to about 8 0 feet. care will be taken to ensure that the design of the building attributes to the campus. >> thanks kevin. you heard a presentation and supply and demand of parking few months ago. we're continuing to work with them. we're developing what we think are more robust tdm management strategies like increasing

shuttle service to certain connections increasing bike lockers van pooling etcetera. we're having a meeting this thursday as a continuing effort to work with sfmta. we hope to by september, have pretty much a report that will either say the parking expansion is a feasible option for sfmta and the city. or we will not. we're also working with the original architects of the barrage to -- garage to look at the space. just some key steps and dates. after today, actually in parallel to today, we just finished six briefings face to face with the board of supervisors to explain the project with the nonbinding term

sheet. got overwhelming support from all six. after today we'll make preparations to make the. binding term sheet and full board in june. at that time, the sequel process begins and goes through about 10 months. that is finalized regents certified eir that triggers our ability to go lease and our board of supervisors in june of 2016.:ññ?ñ?ñ i'll be happy to answercxñ?ñ?ñ any questions or real estate directors here, city attorney's office. >> commissioners questions? commissioner pating. commissioner singer. >> one question. can you put a report on top top

of this thing? seems like the hospital could use it. >> i think physically you could design it to be able to do that. whether that's something that you see to pursue and beyond our -- >> i just think it's worth lookinga÷ñ?ñ?ñ into. from my rolen ?ñ? on the sf commission, it's clear there are a"sñ?ñ? lot of people that think that will be appropriate for better#oñ?ñ?ñ care for people. financially it would make the hospital much stronger. >> i agree. >> we can add that to the term sheet right now. [laughter]

>> thank you. we might ask director garcia what she thinks. >> uc would have it talk about that as well. we'll have a conversation. >> thank you. >> if i could just say it gets a little tricky politically. i'm completely in favor of it. what we to do on the existing building we had to abandon it because of the possibility of certain groups of people appeal the eir for a new hospital. if appealed the eir, we would have never made it on the ballot in november of 2008. there's some risk level out there. not to say that it's merited medically and fiscally. >> i'm full a-- fully aware

that it is a complicated issue. i also feel i get the responsibility of and appoint the whole reason so that we can ask questions like that. >> absolutely. >> should be on the record. struck me when i was looking at this lease term. i think it's worth kind of highlighting that there's a reasonable argument that the economic boom that