tv Government Access Programming SFGTV April 4, 2019 4:00am-5:01am PDT
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approval of the minutes. >> commissioner: move approval. >> second. >> commissioner: any correction to the minutes? seeing none all in favor say aye. all opposed. the minutes have been approved. next item. >> clerk: item three is the director's report. >> good afternoon, commissioners, director of health. a few things to highlight in the director's report. i report on the three measles cases in the area. thankfully we haven't had more cases and it was a contained situation and it's a good reminder all are up to date on their vaccination. one of the key issues with the health department is employee engagement and responding to employee's needs. in order to do that we need to know what employees think about the department and what the challenges are. our employee engagement survey
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sup to 66% as of today, which is twice the response rate from the past. a nice job from h.r. in moving that piece forward. i also wanted to and will ask i.t. to give an update on the server incident at the end of session and want to note the sad passing of a lieu -- laguna honda employee who was killed in an automobile accident leaving laguna honda. he was a reporter for the environmental services department and he was an exceptional performer. he joined laguna honda in 2017 and carried out his responsibilities well and earned respect from his peers throughout the hospital and unfortunately he leaves his
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family. there were services held at laguna honda and we mourn when the department loses one of its own. it also highlight the importance of the vision zero work has been co-led by the health department and you'll hear more about that work in the presentation today. but i am pleased we'll be working with mta to install a speed radar device at the intersection where unfortunately this death occurred. again, one death is too much but we continue to make progress and our condolence to mr. carasco's family. and some highlights on breaking news with regard to regulation and control of e-scigarettes.
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sales and consumption in san francisco the city attorney announced potential legislation and legal action to basically ban e-cigarette sales in san francisco spending s.t.a. oversight and approval of any e-cigarette devices. you recall f.d.a.'s been looking at e-cigarettes for years now and has not made a final decision on their acceptability. san francisco is once again leading in regard to the public health issue as you'll recall a generation of youth are being addicted to nicotine and it has harmful effects on brain development. micro particles are harmful through vaping alone and it's a gateway drug to tobacco addiction.
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excited in seeing how the legislation unfolds and i'll come back to the commission and report in more detail on that on another date. going back to the server incident summary. i've asked acting chief information officer to give you a brief summary and answer any of your questions. >> good afternoon, commissioners. so i do have a vim -- summary that was written up and will give you more detail to any questions you have. march 2 we experienced a widespread outage when a room overheated it's more of a temperature incident that resulted in servers going down. the outage depended between three and six hours and it depended on the application in effect. the outage resulted from a chiller failure. the chiller did not fail over to
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a secondary. there are three and it should have failed over tie third if that didn't work. there's a series of alert systems that alert i.t. when adverse conditions happen such as temperature. that's only one of the conditions. one alert is a horn that sounds in the engineering room. the second is an alarm on the facility's automated panel. a third is messaging and e-mailing alerts to i.t. and a fourth is an alert that just goes to i.t. the first three alerts failed, the fourth alert generated an alert to the server team manager who called the team on duty and notified i.t. and others of the issue at zuckerberg. they turned on the second chiller and at 7:00 a.m. the system cooled and they brought the system back up. systems did not fail at 3:00
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a.m. they didn't just start going off. it took a while for the room to heat up. some of the rooms reached high temperatures so the system shut down. the majority of systems within the room did stay up. nonetheless, critical systems were not available between two and a half and five and a half hours. one was not verified as functional until 5:30 p.m. and required repair the following monday. i.t. are in the process of updating alarm notifications and procedures and retrain teams and the alert will be brought to procedure by end of june. facilities is still working on why the chiller did not fail over as there's been ongoing
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issues with the same chiller. faciliti facilities and i.t. reviewed the time line and looked at practices an improvements that have surface and will be managed in upcoming planning. we're meeting with the public health emergency preparedness group and will do an after-action report april 19 and then we will have a recommendation within 90 days. i do want to say that while no system downtime is opportune, there's issues from the initial data center rebuild three years ago. i.t. has spent hundreds of hours refreshing antiquated hardware but the data center has remained on a back burner. the seriousness of not only the alert failures but the urgency of a had the site for critical applications is necessary. we did this for epic. it's hot and redundant and will
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reprioritize plans nor systems. do you have questions for me? >> yes, was there any damage to the servers or data loss? >> we did not lose data but what we think is damaged because we've had failures on boards and systems within the data center. >> will that require replacement or can it be repaired? >> we've been doing that and they're under maintenance agreements but we've been doing it as it occurs. it's difficult to determine what the stress did in terms of long get of the systems. >> thank you. -- longevity of the systems. >> thank you. >> were there any operational issues at the hospital they were prepared to put into action and therefore patient care itself
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was able to continue? in other words, during this information was or was not available and does the hospital itself have preparations because we never know what will finally happen. there could be a major san andreas event and no matter how many servers and alerts we have and wonder if the hospital has contingencies when we don't have the availability of the system? >> we do and it's part of the peptic planning. when we go down critical things like medications are backed up and put on to local computers ran on a generator so nurses can no what medications were given previously and there's manual planning. there's a plan for downtime. they have downtime parentheses to follow and they activated a
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hospital incident command center, and we were in touch with an officer on duty during this time. my understanding is there was nothing suffered in patient care during that time. >> commissioner: thank you. any other questions? thank you for that and we're looking forward to seeing that all get back into order and you get all the backups. >> i'll be back here april 16, i believe. i'll give you at least the status at this point in time. >> commissioner: thank you, very good. any further questions to the director, please? director, your very clear we'll go to the next report. >> clerk: there were no public
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comment comments and item four is public comment and i have not received general comment requests. we can move to item 5 a report back from today's community and public health committee. >> >> very good. commissioner royce. >> we have two updates from the syringe exchange program and from substance abuse services and the syringe data program we learned three important issues. one, the can i -- kiosk collection increased and there are three navigation centers and nine disposable box and smaller for syringes out in the community. the san francisco aids foundation has created a pick up crew you can get through text messages and the crew began july
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18 of 2018 and they have collected 90,000 syringes in the first six months of the program and the san francisco youth foundation pick up crew receives these messages via telephone and through text. they usually arrive at the pick up site within 58 minutes. once they arrived on site, they take a picture and when they cleaned the area they take a picture and send it back to the person who texted them. commissioner brown do you have any comments? >> one thing i'd add to the presentation about the needle exchange is the number of new hiv infections from people who inject drugs dropped from 2010 to 2016. it's been an effective program. there may be other factors involved such as adherence to
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antiv antivet -- antiretrovirals but also i wanted to add the phone number you just mentioned for folks to send a text to if they should see a syringe, the number is 415-810-1337 if you see a syringe on the street or anywhere else. text to that number and they'll send back a photo showing it's cleared and the response time has been less than an hour. >> commissioner: other questions of commissioners? >> when they commented on the fact that it was better to have the current syringe program without a 1 to 1 exchange, i wonder if they shared the
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additional information because it had been a contentious issue in the past about yes, we should have needle exchanges but they should be on a 1 to 1 basis. i thought that was a very important point i didn't know if there was backup information people asking could site? >> what they stated at the meeting today opposed to a 1 on 1 which injection drug users if they're only doing 1 to 1 exchanges will typically not have enough to cover the use during a 24-hour period. many injecters inject four and five and six times a day. if they're 1 on 1, what will happen is they'll share needles and blood-born viruses can impact both the initial injecter
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and subsequent injecter if they don't have the opportunity to get new needles for every injection. they also do need-based exchanges. if i'm an injection drug use earned come to an exchange site, i can tell them based on inquiries by the staff to know what i need between the course of today and next time i can get to a needle exchange site. >> commissioner: thank you very much. the second presentation? >> it was on the drug medi-cal program and the organized delivery system which looks at our substance abuse services and
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what it's qualifying for medi-cal reimbursement and i'll defer to my colleague to ad anything he'd like. the highlights for the providers including residential treatment transitioning to drug medi-cal continuing care and if you're in drug treatment you don't just drop off. there's a referral to continuing services and there needs to be continuum of care for that population. because in the past particularly those in withdrawal programs just got dropped. they go through the withdrawal at a site and then they don't move to necessarily a residential trent -- treatment or longer-term facility. they're attempting to ensure
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people are moving from withdrawing to treatment programs. penetration rates compare favorably to state-wide ones which means these programs are getting involved in the continuum of care and provider system available in san francisco and they have an external quality review operation which allows them to contact other folks to determine whether or not they're actually making inroads into this population and san francisco is greater than the statewide average. and we are are exceeding the time line to make it medi-cal
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eligible and i'll defer to my colleague for comments in relationship to this. >> they're setting a goal of having medi-cal residential organization within 24 hours and then to have people authorized to be admitted in under 15 days. in both measures they had exceeded their goal significantly. the 24-hour authorization was a goal of 35% and the goal of 15-day admission was 75% and they have achieved 84%. >> commissioner: commissioners, any questions?
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i have one. when did this begin and hi'm looking forward to some sort of a report like a year it had gone into existence to see how we've done. >> my recollection is 2017 by dr. martin so the data was a year and a half of data i believe around that. >> july 2017. >> commissioner: it sounds like a new way of working within a structure of payment because it began by saying this was a new model of withdrawal and i'm just
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wondering when it was felt we had put the new model in place. it could have been authorized in 2017. and there's some data here. is that sort of a year well not really a year of data because it begins in july. is it july we began the program and it may be worthwhile to look at it in july and present to the full commission? >> i would agree that is true and would agree from start date to actual implementation, take some period of time and so we want to recognize it take some period of time and what they will do is if we asked them to come back, they will. i'm going defer to dr. colfax for additional comment. >> my question -- if there's a question when o.d.s. started in the department that was before i was here but there may be people
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who can answer to that and it's july the starting point was july of '18. i'm not sure if that's the start date or because we had enough data it was meaningful. >> we can get the exact start date but there were certain metrics that had to be met by the largest providers initially so that took time. but we'll get the exact start date four and make sure every year we update. at the state level they're looking at o.d.s. and looking to incorporate that. >> excellent. i think as the report seems to show, this is really progress towards the continuity of care for the withdrawal patients and it would be really good to see how well this is coming along a
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year after it's been in operation. thank you. commissioner green. >> i wondered if you have projects about the outcome of adding almost double the number of residential step-down beds. is there anticipation of the penetration rate and what outcomes you'll see and when? >> one thing we're noticing is it gets stuck because the lower levels of care are an issue and house. we're hoping to see more people take up the space but that's a data point we'll be able to track. >> commissioner: thank you. any other questions? if not we'll then move on to our -- thank you, commissioner loyce. sounds like you had an important meeting of very important topics and we'll move to the next -- >> clerk: there were no public
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comment requests for that item. item sex is the commissioner health elections. >> commissioner: several of our members are absent and i'd like a motion to request that we be the postpone the election according to rules and regulations is supposed to be the second meeting in march to the first meeting of april. >> so moved. >> commissioner: is there a second? >> second. >> commissioner: all in favor say aye. the election will then be held april 2. thank you. >> clerk: thank you, commissioners. item seven is the second hearing. actually could ever turn off your phones whoever that is may be and the next is on the 20
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budget. >> good afternoon, commissioners, greg wag ner, chief financial officer. i'll start with context and turn it over to budget director jenny louie. as you know in the past this year as we have in the past during two hearings on the budget. the first occurred last month and so this is the second of the two. i would have normally have had this meeting in late february but of course the schedule due to some decision making and of course director colfax joining us and wanting to spend time on the budget before coming to the
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commission. we're requesting initiatives today we'll forward to the mayor's office and we'll enter into the next phase of the budget process for reviewing wa we submitted and having conversations with the department about priorities for other potential initiatives added in the mayor's space. so we have a lot of things going on financially in the department. one of the things i just want to point out that came up in the prior conversation is that there are a set of initiatives in front of you today but there are also a lot of other things happening in terms of our budget and finances in the department and i just want to point those out and acknowledge the fact that there are a lot of these things happening since you'll be voting on some things today but that's not the entire context.
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the mayor and mayor's office have been active on behavioral health needs. a lot of those directed toward individuals experiencing homelessness in the city. the result has been significant new funding for the department and a number of new initiatives in the areas. we talked about the o.d.s. waiver. there's funding that the mayor submitted to the board and the board has approved for 72 new substance abuse step-down recovery beds. those are appropriated mid year and the current year from the dollars san francisco paid to the state over the formula requirement and were returned to the state. so those dollars are being appropriated in a supplemental appropriation in the current year and will be bridge funding to get us to the point where the legal issues around prop c are
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resolved and we can have continuing funding for similar programs hopefully under prop c. so 72 new substance abuse residential step down recovery beds and new beds at st. mary's healing center. we opened that facility a year and a half ago and due to budget constraints we only had funding to purchase about 40 of the 54 beds available in that facility. with this additional funding being appropriated midyear we'll have an additional 14 beds available for us to access for our highest priority patients. we also just recently -- and you had seen it in your director's report but have submitted to the board a resolution requesting to accept and appropriate about $3.1 million in state funds. these are funds that came in the governor's budget and the focus of those funds will be to
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improve our outreach capacity to individuals, expand homelessness and provide infrastructure to support the city's healthy streets operation center which is the collaboration between departments to respond to calls from the public around homeless individuals and street behavior and give us capacity to engage patients who are in psychiatric service at the campus and connect them to follow-up care. lastly, as you know, we opened an additional 15 beds at the humming bird program at the campus of zuckerberg san francisco general. there's lots of things happening budget wise and lots of new investment we think will allow us to move the needle on some of these activities and i want to acknowledge for the commission and public though those aren't on the items you're approving today there's items you've been
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involved with and have been pushing programs on multiple fronts including the budget that will be before you today. i'm going turn this over to jenny louie to go through the initiatives on the agenda explicitly for you for request to approval for today. >> good afternoon, commissioners i'm with the dpa budget. for the items before you in terms of the second set of proposals, the first set is around revenues. we have the projected 2011 realignment and the county is responsible for maintaining the mental health services and we get a portion of the dollars realigned from the state. we've seen it in prior years before and now we're projecting
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an additional $3 million for services. then the back fill of funding losses is a loss in revenue. we've seen similar reductions in prior years as the federal funding changes its formulas and for a variety of reasons and sometimes it's because we're doing such a great job on the work we do. they tend to shift dollars to where the greatest need is. this back fill of almost $400,000 represents support, continued support for key areas and the population area is core services it does not want to continue without in the areas of workforce development which will is our emergency preparedness branch as well as s.t.d. on the budget neutral side, we have a new initiative for the new environmental health data system. while there's no general fund
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impact, there was a significant initiative because it's a $5 million cost over the life of the implementation of it. it's also an exciting thing environmental health is doing so we wanted to highlight it but the current debate is a very outdated access database i think has outlived -- it's expanded beyond it's initial purpose and outlived it and time to replace it and environmental health works with many customers that may request multiple permits and right now it's got a very laborious, partially p.d.f. and paper and electronic systems and the goal is to replace processes with a robust tracking system that will actually include information on all of our customers so we can find them
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quickly and efficiently as well as track the permits to know where permits are at any given state. we'd be in process of going with an r.f.p. on this so once we identified it there'll be more details on it but the goal is to replace existing system with a permit tracking system. funds would come from our provision in the administrative code which assesses liens for landlords that are delinquent on their refuse collection bills and we've had dollars accumulating in the past and per admin code the dollars can only be used to support environmental health administrative functions so it's a perfectly aligned use and a great opportunity to use the dollars to better serve our clients because with the reduced burden of the paperwork on our staff, they can actually help the clients themselves with the
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actual work in understanding the rules and regulations and with the goal of compliance. in terms of emerging needs, we're bringing four. the first is the office of equity which is a combination of reallocation of existing staff as well as a request for new positions or two new f.t.e.s from the mayor's office. i know dr. colfax is very interested in this and has championed it. i'd like to defer to him to provide more details on this one. >> good afternoon, commissioners. first i want to stay we'd come back and provide you with much more detail about the work of this office as anticipated but to give you the perspective i have in talking to other members of the department during my short tenure here, as you'll recall the equity is one of the true north goals of the department. there's sometimes discussion about how does one define equity and what's it mean?
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right now, my definition in this work is that it's providing fair and just opportunity for everyone to optimize their health when we're talking about health equity and talking about equity in the workplace and fair and just opportunity for everyone to realize and optimize their true potential in the workplace. this work would basically allow equity to be at the highest level of the department. this office will report directly to me. the director of the office and dr. anne bennett from the inner divisional initiative. when you look at how that work's evolved, the most salient and important work of that office has been around health equity and the african american health initiatives and putting equity front and center of the work. the office will be catalytic in the sense that equity work will
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still be owned and need to be owned by people across the department but this office will be the catalytic engine for that work not only within the department including human resources, but also with other departments across the city and county and particularly with the human rights commission which is increasingly taking an interesting and a role in driving this work across the city. the office will codify specific tools and policies related to equity. rather than well intentioned groups doing one thing here and other well intentioned groups doing something different over here, we can understand and codify the goals as the department moves forward and develop the skill set through trainings and inquiry and picking specific outcomes. we'll able to make this work more salient, more tangible and
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i would say more metric driven as well as more scientific. we'll come back to you with more specific presentations but we think the investment is in keep the value of the department. we'll hear with regard to the initiative coming forward today. that's an equity issue. when you look at the populations most affected in the incarceration system that has health equity. we have work to do internally with our partner in h.r. with regard to optimizing opportunities for everyone across the department. i think this is the right move at the right time and the right investment. if you have further questions i can answer them or dr. bennet is available as well. >> commissioner: do you want to continue and we'll take questions. >> clerk: next item is the combined scheduling and
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registration work flow within the department. this initiative has really come up because of the implementation of epic and when you look at the epic system it adopts what's considered industry standard of having a single point of contact through scheduling and preregistration and any eligibility work that may be required. when we looked at our existing processes, there's variation between how scheduling registration and eligibility are happening depending on the setting if you're in a clinic setting or in-patient. there were gaps where we believed the work flow needed to be changed and areas where we had staff who were perhaps working on one or more of the three components. perhaps not all three and what we need to do when we do up plent epic is to make -- implement epic is to ensure
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they're ache to -- able to do the scheduling and registration properly. in some cases it means adding additional job functions where they did not have it before. we are going through an h.r. process working closely with labor to identify the areas and have applicants interested in becoming into this role and competing and applying and we want to make sure we can keep them and want to make sure these are permanent roles. the overall work isn't going away but we're just combining them so that everyone has the same skill set. some of the benefits are beyond the very costly work around from the industry standard epic work flow is improved patient experience because where we might schedule an appointment
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and say hold on, i may need you to talk to someone to make sure we're eligible and it could be done in one place and there's reduced handoffs. people know up front what their financial status is and we're not getting patients that may not belong within the network and it can increase revenue capture because maybe someone isn't currently on insurance but we have an opportunity at the point of scheduling to say you're not on insurance but you're eligible so let us help you out opposed to showing up the day at the clinic and work it on the spot. we will have a better work force to support epic. the number is an estimate based on an average cost. we're expecting the conversion
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will come primarily from the health worker class and the clerical class. we don't know until we complete the h.r. application process. we need to know what are the classifications to be converted. i've estimate the average cost of 130 people who schedule and registering is $40,000 per position including mandatory benefits. we want to make sure we have the position authority and the actual amount may change. our goal is that no one will be left behind and we'll train staff to make sure we're up to speed once we go live august 3. next initiative is around increasing capacity as members of our finance committee may know. we have a significant number of
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contracts and over the past two years the dollar amount has grown significantly and the complexity and additional dependencies and new programs. the department is growing and we've been expanding our services. to make sure we keep up with the contracts and following the appropriate protocols, we're requesting to increase the capacity within contract. some commissioners may know in prior years we've done some work in increasing capacity within i.t. and h.r. i think it's time for the contract staff to also serve a little bit of a right sizing to make sure we're supporting the contracts and they're getting through in a timely manner to make sure the services are really getting out the door. the last item in our emerging needs is around equipment needs at zuckerberg hospital.
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we opened up a new hospital in 2016 and with that new hospital we purchased new pieces of furnitures or primarily new pieces of equipment to support the new facility. when we purchased them, when we purchased or leased them, the time is up and we ned to maintain them. -- need to maintain them. planning ahead knowing in 2021 we will have additional cost that we'll need to incur. so we're budgeting for the continued support for those pieces of equipment. and then lastly, our contingency proposal. as we mentioned in december in our first hearing the mayor asked to us provide a 2% reduction going to 4% as well as a 1% contingency proposal on
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increasing to 2%. for our contingency proposal nor time we're putting forth additional salary savings in our budget to be used and should the mayor's office want to implement the department's contingency proposal we'd like to have a further conversation with the mayor's office but this is what we feel comfortable putting forward now. >> we grew by 280,000. so with your approval, we will submit both synonymous of initiatives to the mayor's office and controller's office and work with them on the next step towards the june 1 proposed budget and then we'll move on to the board's review process in june.
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that's all i have. i'm happy to answer any questions. >> commissioner: was there any public comment? >> clerk: i have no requests. >> commissioner: prepare for discussion at this point. commissioner green. >> with the schedistration you have toe you have to look at the salary and whether the system gets up and running and whether the number for fiscal year '21-'22 may shift. >> there are some efficiencies but the overall work load hasn't. you still need to make that appointment and you still need to check the eligibility and we
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still need to register with the patient again. i think the initial understanding was we were a little bit wary in making assumptions about any reduced actual work as more of an idea of combining the work flows together so that something we can look at sort of as we move beyond once we get into implementation but it seems too early to bank on efficiencies at this point. >> my other question as you look at the other mental health initiatives and the extra beds coming along and so forth, how will that affect the lower level of care issues we face at the general hospital? in other words, the budget seems to be the same from january to now in terms of cost. do you have a sense whether there'll be an impact or will it be so small it's not worth putting it there? >> thank you, commissioner.
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that's a highly relevant question for all of us. so there's definitely a connection and the aspects of how we look at that and we have lower level care days in-patient and acute psych. there's a number of different types of needs for what patients need coming from those different facilities. in a lot of cases and i believe we'll have a conversation at the commission the in-patient lower-level of care discharge needs are for sniff and then that of course goes to laguna honda and it has it's own level of patient care flow element we
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need to address to flow through laguna honda. that's a big part of the system. we have a number of that are high, repeat utilizers of our system that includes psych emergency, in-patient psych, hospital for physical health issues. a lot of these investments we're making in terms of capacity but then in terms of system improvement to capture patients or engage patients when they hit our system and get them into a different level of care so they're not repeat hospital users. that's a big area of focus. a lot of our focus in terms of the beds is on individuals that are frequent users of our system. how do we create some capacity so that when they engage with our system we can get them into
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care and get lower level of care bed and prevent that recurring visit to the hospital. so there's definitely a connection there. one thing we've been spending a lot of time on in dr. colfax has been pushing us to think hard about is develop more rigorous model for how we measure the success and the outcomes that we are anticipating from the investments in those beds. then how we translate that into success and outcomes we'll see at the hospital so that is worked we're pushing on and we hope to come back to you with data on. it definitely all fits into that conversation. >> thank you. thank you for this wonderful report. >> commissioner: commissioner sanchez. >> yes. i would like to congratulation our new director and our exceptional staff. in reference to the additional budget initiatives we look to
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focus on things that are critical in reference to due diligence in the department and as you said, the established office of equity. we just got a couple years ago the office of compliance in order to do diligence at that level but for the whole system because of navigation problems which may flow flew a given department or division whether it's hospital or etcetera. i think this fits right in with the oversight and review that both our staff and community partners and the board will undertake with greater information and greater outcomes and presentations. also in reference to the combined scheduling work flow, that's part of the compliance unit. that's part of the equity unit. all these new departments will
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work together under your watch and i think it focuses on what we've learned over the years in preference to some things that have worked well and some things we could have done better and some things we're still looking at. here we have a unique opportunity to utilize these funds to generation a more comprehensive model that integrates a lot of the positive best practices that have been going on in the past few years in particular that have been addressed because of the changes that have taken place. your budget speaks to these issues and i present it well and a know the commission looks for wa to additional presentations pertaining to how this overall operation works. i think it's an exceptional budgets with an exceptional staff and we thank you very much. >> thank you, commissioner. commissioner loyce.
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>> commissioner: thank you for the presentation. i had this conversation earlier today. the question of definition of terms when we talk about equity. ensure people inside the department and outside the department understand what equity means from a department point of view and dr. colfax has explained that and disparity. it's important that as a department we articulate what we mean and repeat it because i don't think people learn the first time they hear equity versus disparity. i think you continue to intertwine and make sure intermly we speak from the same and externally people understand that and it's a process. it take time but we need to put it out quickly. thank you very much and thank you dr. colfax for your definition. >> thank you.
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i had one or two questions going back to the emerging needs. commissioner sanchez has articulated very well the reason we can ask these questions is because of the fine work the department has done and particularly the presentation of the budgets because we can get down to what the issues are we're able to understand in the text where some issues are. if we go back to c5 and the registration process i'm still looking for a more definitive reason why we need to spend $14,000 per employees reclassifying and therefore giving them inincrease. there has to be -- an increase.
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there has to be an improvement not just because patients feel better. >> i'm the human resources director. the way we had been doing appointment scheduling and registration we had 32 different employee classifications touching the process. it was spread out all over the clinics. so under the epic h.r., they told us you have to pull it together to be a more combined efficient process and we recommended the new classification and do away with the 32 and use the one. we turned to our own classification and the eligibility worker would fit that bill. so we worked with the unions and created and came up with a way to do -- the city has these
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skilled people. we had taken people and said we demoted them to more classifications an took away some of their duties and they call that deskilling. they were angry about that though it happened 10 years ago. we approached them about upskill. we would take the lower classifications an up-skill them to the new 2903 eligibility workers and give them the opportunities to do the higher level work. we get a single classification versus 32 different classifications doing higher level work which is very good for the employee, it's good for the union and for us. we worked out an engagement to do that and we have 20 of the new eligibility workers online. we'll have 60 on board by the first week of april and have all on board by the third week of april. we're on schedule to do
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up-skilling. we have a good relationship with the employees and union and more efficient process under the e.h.r. >> i like the nal gy -- the analogy. but you're telling me analogous loy we're asking them to do more than they were in their 30-different classifications because we're going to ask for greater skills and that part of this was educating them to more skills for greater efficient though there's an increased cost for these employees. >> correct. the employees in this classification will have additional responsibility go along with that. that means the cope of what
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they'll do in their day to day duties will be broad. i will add to what ron said, going back to when we were in the early stages of our journey on epic, we hired a consulting firm to come in and evaluate our revenue cycle practices an tell us -- and tell us where our strengths and weaknesses were and one piece they identified early as weakness and an opportunity was the fact we had often inconsistent practices and in our scheduling across our department and we were not up to modern-day standard or best practices in terms of early financial clearance and in terms of gather the data we need early in the process which then will
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translate through the process of engagement and higher collections on the back end. when have you the data you have financial clearance and it translates to an easier billing process and capturing more revenue through the revenue cycle. that's been one of our goals. one thing about epic, the way the system's set up, you have no choice but to do the schedistration concept where you do the process together-happily for us we want to and need to doit because that's the exact strategy we identified that's a revenue cycle for the department. when we look at how we're going change our practices going into epic and use this as a way to not just build the system that recreates what we're doing in the past but actually change the way we operate so we'll maximize the new tool we're invest
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inning, it's an opportunity we have. if we look at the current financials on just our fee for service collections alone, it's not even thinking about our capitation but 1% increase in productivity in terms of revenue is $5 million to $6 million if you have capitation and get people enrolled earlier you're talking about a small improvement in cycle productivity having a big revenue outcome. for all the reasons of the labor reasons and personnel and respect for our people and the ability to train our people in new skills, in addition our financial strategy depends on us being successful in using the epic cool in the way it was designed and using it optimally to drive i mproved collections
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for the work we're doing today and the%s -- and the patients we're seeing today. >> commissioner: thank you. i appreciate that explanation. i think it helps all of to us understand moving forward >> commissioner: a new process with new skills and improved services and improved collection. thank you. let me go on to one or two other questions mostly on my tone get clarification. on the contingency proposal, there are salary savings reductions. to put that into some perspective, what percentage is $6.5 million over our total salaries now? >> our current salaries are about $900 million to $1 million. salary represents half the department's
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