-- provided, although not breaching it. they say the reason that these projections are different from the 2010 projections is because cpmc took a more conservative approach at the hospital charges as well as the volume in light of the greater uncertainty in the finances going forward. as a result, we began conversations on the changes that would offer the city additional protection that we believe is merited. we have not yet reached agreement on changes to respond to this new information. clearly, our goal is to have stronger protections for the city in the years immediately following the new st. luke's hospital. supervisor mar. -- mar: there is a question from supervisor campus -- campos. supervisor campos: you are talking about yourself expressing concerns about when this threshold would be met, so could you walk me through the steps that you have taken before to ensure that the threshold is the right threshold? what kind of information did you get from cpmc and for how many years? >> we have only had this information for

, whether it be a physical therapist or physician, any of those providers who are providing care for people with amputations can also provide that input into what's important for research and research initiatives. >> when will this process be implemented? is it already going on and if so, are there examples, an example of how that's working to make sure that the feedback of the veteran is taken into account? >> well, the center that we spoke about is standing up now. we expect it to be operational by the end of this year. i want to talk about i think a couple of research projects which are good examples of the work that we are doing and i think that one of them is what's known as the darpa arm, which is probably the most advanced research activity that is going on, and that's the defense agency project for the development of a prosthetic, upper extremity prosthetic arm, and the way that is working and va's participation, that of course has been funded by the defense department. >> that's the one that medal of honor winner -- >> yes. >> -- has, right? the one -- >> you have that arm?

providers. if they had provided at the average level of comparable hospitals, it would have provided $125 million a year, nearly $30 million more than it has committed going forward. over 10 years, letting it off the hook now for its share care will save $300 million, much more than the total is committing, and shift $300 million of the cost to san francisco taxpayers and other health-care providers. it is for those reasons we think the provisions are flawed and should be renegotiated. for its thank you. next speaker. please hold your applause. >> you mind if i asked a couple questions? you just heard from this passed presentation of the estimate, but the deal we have the does been proposed is $30 million less than what would be required if they were asked to provide an average level of charity care, their fair share for the city. why is it the number is $30 million lasess? by its the most important thing, we want to make sure we get specific services the city needs. we are not necessarily as br

it will provide new retail frontage to complement additional plantings and seeking provided in the expanded areas formed by renewable -- removal of parking. looking north, we are applying principles outlined in the better streets guidelines. the design creates an appropriate streetscape coordinated with new buildings to support windows on the street and an enhanced and pleasant pedestrian environment. the main pedestrian door ways to the hospital and medical office building are located near the corners to provide easy access to transcend -- transit and liven the street scape in these locations. looking east on geary is the medical office building. it captures the existing corniced lines. it is simple and consistent with the natural variety and scale seen along the street. this view looking along cedar street, cedar street is completely redesigned to provide a safe pedestrian environment and intra- plaza for the medical office building. -- entry plaza for the medical office building. the new buildings provide a very skyline. they are stepping up the hill. each building is divided into multip

-provided care. for one example, one veteran recently told how he could receive only a high tech knee from the v.a. services department that was more than two hours away, and not from the community-based prosthetics whom he had been caring for for more than 11 years. after much push back from the veteran and his local prostheis, he could receive the knee from the v.a. more than two hours away or his local could resubmit all of the paperwork and it would take up to three months time for the approval to come through. that veteran switched to the v.a. care because he was tired of arguing for his own rights. aopa don't believe this is an isolated incident. i could go on with similar stories. the question is why is the v.a. establishing policies to undermine the veteran's choice. it's suggested by some cost may be a factor. the average cost of a prosthetic limb fabricated in house is about 25% of what an outside contractor charges. that analysis almost certainly fails to take into consideration v.a. staff

we did not provide direct service to the community. however, dcyf does see the value if ensuring that appropriate language access is provided to our community because we want families with limited language capabilities to be able to receive services in a timely manner. relevant to their needs. to that point, dcyf has minimal compliance -- minimum compliance standards that we ask all of our cbos to meet. there are two indicators, because this is how we measure the effectiveness. all program information are translated and program activities, events showing understanding and respect for the culture of the program participants. this is something that we monitor our nonprofit agencies on. dcyf general operating protocol requires that all of your outreach materials are translated into spanish and chinese. all of our community meetings have access to translators if it is appropriate. that concludes my presentation. i am open to more questions. supervisor chu: thank you very much. i would like to continue forward. i think there are a few items

each provider network is composed of a primary care provider. a network of specialty physicians, a dermatologist, and an affiliated hospital partner. one primary care provider, one specialty care network, one hospital. this team of providers assumes an ongoing responsibility to provide all of the health care services on member needs in exchange for one flat fee per month regardless of how frequently or infrequently the patient uses those services. with the exception of emergencies, patients must receive their care from providers within their network. to meet the health care needs of the 30,000, san francisco will need a sufficient supply of providers who are willing and able to participate in managed care. help performer will do is the number of uninsured who rely on charity care services, it will not eliminate it. the need for charity care and remain, which is why it is necessary to maintain cpmc's current baseline level of care and build on top of that to meet the demands of the changing environment. the proposed development agreement provides

it provides strong local hire for construction and other jobs. and more than $1 billion worth of bagram health care services, it also provides a commitment of $117 million in one-time community benefits, including any count the cash recovery on the affordable housing, $93 million worth of affordable housing. this concludes my overview of the da. we will get back to these subjects in the future. now i will have rhonda simmons come up into it is through detailed the job creation part. supervisor mar: thank you so much. ms. simmons. >> at thank you, supervisors. i am from oewd. i am going to talk a little bit more in detail on the work force portion of this agreement, as i have been working closely with all the parties involved. so the first caveat for me is to clarify a few things around the work force policy that we have used on this project. this project does not fall under local hire, so that is actually a mistake. it falls under our first source policy could a it is considered a first source, which is all are privately funded projects fit in te

provide a bus. that is one of the critical issues. we also provide every student a chip that is the student's family in for free. supervisor avalos: that is great to hear. my wife is actually a fourth grade teacher, so she will be taking advantage of that. >> i hope she's taking advantage of it. there's one other thing we're doing with that, and we experimented it the past year and would like to expand it, particularly if we can find a donor to help, that is that we set aside and experimented evening in which were invited -- like i said, the students were given a chip for their families. well, not all people take advantage of that. matter of fact, few people do. we set aside a night in which we invited the family is from the fourth and fifth grade from a specific school and a specific district to come and the place was open for the. we provided chinese translation that night. it was appropriate to the neighborhood. and it was a wild success. people who never would have felt comfortable, perhaps, com

these provide state-of-the art healthcare. they will provide hospitals you can feel safe in. these projects also provide jobs for the many who will be here long after they have been completed. i support this project. thank you. >> [list of names] next speaker. >> thank you for the excellent presentations you allowed and the good questions about how to make this the best deal for san francisco. i am not an employee. i do not use one of the services they provide. i am looking out for the good of san francisco. i object to setting up a system that will allow them to escape the housing requirement. is it good for an earthquake situation. trying to go uphill with roads blocked is going to be ridiculous. these rooms may suggest there may be other agendas, like importing patients who can pay for high quality care. do not thank you for your good questions. >> thank you members of the board of supervisors for hearing this important item today. i am a project engineer for the general contractor for cpmc. i have been before you before to speak about jobs and work force development, but

, and provides a 30-60 day follow-up services. with ongoing long and short-term individual support, for communities and families exposed to violence, with the debriefing services and they provide the long-term behavioral therapy to adults, and the behavioral therapy to the youth. many of the clients have faced trauma and are survivors. many are scared to go into neighboring communities, and they will go out to provide those services. many deal with the same issues of combat veterans, and the job crisis service provides service to children under 18 years of age, no matter what kind of insurance. we respond to schools and emergency foster homes, and we provide assessments for out of control behavior and psychosis. we provide empowerment groups, and short-term case management and linkage to outpatient mental health services, with services to the schools for any kind of sudden death, and short-term medication management. we worked in collaboration with the juvenile probation, to help develop positive coping skills with an interactive

in the post acute area the margins for rural providers as well as urban providers are quite high. in the case of hospitals, the margins, for rural hospitals are higher than the medicare margins for ur ran hospitals. we base our payment rate recommendations and are required to do that by statute. so we have concluded that both urban and rural providers can provide high quality care at the existing rates. i think there are three major revolutions in the system regardless of what the courts can decide. that is moving forward now and we need to continue to move that forward. the other is delivery system reform. and the other is the payment reform that we need to keep striving for. on that last point, what more can be done to accelerate the payment reform in the health care system. >> looking at new payment methods whether it be looking at medical homes or accountable care organizations and we have long supported those efforts. p to some extent payment reform cannot proceed without delivery reform. so i think the critical question for the medicare program as well as forers are what are

on the issue of quality of quarter the quality provided by rural providers is similar and has some what higher mortality on some processes of care. these may be due to rural volumes and as well as the need to provide emergency services in remote areas. third, on the issue of payment add kwae say, we find that medicare payments are adequate for rural doctors and hospitals. we evaluated each using criteria. the patient provision targeted to providers and three is the special payment preserve incentives for cost conscio consciousne consciousness. targeting could be tighter or better justified. with that i'm happy to answer your questions. >> the medicare benefit has not changed in structure since 1965. can you explain why the commission found it was necessary to offer recommendations on how the fee for service benefit should be redesigned? >> yes, the most important element of any insurance program should be to protect people against very high cost of illness. as you well know, medicare does not include any catastrophic limit on out of patient cost. the existing structure of patient cost s

it provides nurse case managers within participating provider groups. novahealth averaged 56% fewer admissions in 2011 compared to state wide unmanaged populations. new research is published frequently. active health management has registered nurses that applies research from the most eligible resources. in a randomized clinical trial, it was found to lower charges by 6%. regarding fragmentation of care delivery, people with diabetes or high blood pressure, physicians were able to coordinate care and coordination. aetna is able to skurlecurely exchange medical information. within 120 days, mhg rolled out the imax referral application to 100 practices and is mails them to practices which are able to replace the multiple phone calls and fax exchanges with the referrals. we share the committee's goal to transform the system. aetna has achieved the results for collaborations and we are making it easier to improve patient care. we believe that models can be applied more broadly to create a sustainable care sustem. >> thank you very much. >> they are tricky.

i just know what they provided to us. this shows the operating margin comfortably above the 1% and began 12 days or so, this shows them getting a lot closer. i apologize. that is the only information we have ever seen and never acted on. >> let me just end with one last comment. i know this could be confusing for some members of the public, and unfortunately, at least thus far, i do not think the press has covered it. i think everybody wants to make sure that it stays open. we understand that it will be there for 20 years. the problem is in this agreement, there is an states -- an escape hatch. this is over a two-year period, and they could shut st. luke's down. and part of what i have that a concern is we have had many successful companies in san francisco, in california, in the united states has had exactly this track record. this is below this 1%, and yet they proceed. i think we are all concerned about is within a short period of time, this allows st. luke's and what they represent to the city to not be operational, s

there must be an exception for those providing a service and not just providing a link. this is a serious access problem. since a significant number of oif and oef veterans are no longer serving. you can develop the best consumer education tool in the world but it is useless if your customers can't access it. in addition to being housed to e benefits, consumer information tools is housed at gi bi gibill.va.gov. we are concerned at how the intake will be handled. it must be at the va. the va is the face of veteran's services within the government. nowhere else does this make sense from a practical or business perspective. however, it is a good start and we have to work to continue to pass the legislation, like hr 0 4057 and 4052 which will make the changes permanent. these bills will help restore free market control and prevent veterans from being harassed. the post 9/11 gi bill is the most significant bill. we all have a shared responsibility to ensure that every student veteran is entitled to use their benefits wisely and build a better future. thank you for your time a

we provide crowd control at the hospital. we help the families connect with the mortuaryy and burial service. the first responders are the ones doing the family and funeral arrangements. we have a close connection with the actual family and that request our services, we also assist in those type of services. often we are taking the families to pick out the caskets and the suit and make sure they're paid for as well. we have family support and we expedite services through the victim service unit. we coordinate healing activities such as candlelight vigils, hearing circles and organized peace rallies. we help with fundraisers and long-term effects that a family might feel. as was mentioned before, one of the biggest challenges young men that have experienced violence that have lost brothers, sisters, friends, community violence to get them into mental services and address their own ptsd so they're not a peter traitor in the months to come -- perpetrator in the months to come following the incident. we have grass roots organizat

would like to be able to provide. and also we have been -- we have had to provide additional forces in the middle east because of the tensions in the gulf. and so because we've increased both our naval and land forces there, those are additional costs as well. so we've got some unbudgeted needs that we would ask for your support. i'll present to you an omnibus reprogramming request and we hope to work with you to resolve

which provide comprehensive care. each new visit, the patients received a medical health exam as well as a mental and dental exam. anything from additional employment support to being a care provider for a relative. we have a very strict no show policy. we expect our patients to engage and invest in their health care. if someone does not communicate with us that they cannot make an appointment, they are at risk of being dismissed from the clinic. as a result, we have a very low no show rate, which is good. volunteers are coming in giving their time. as of today, we have almost 800 patients enrolled in our care. we have completed over 2200 medical visits and we have made almost 2000 referrals. when i say referrals, we have a broad network of medical partners, which danna will tell you a little bit about in a minute. it enables us to provide incredibly comprehensive care. all of the radiology lab work as well as a network of specialists. we also have a very robust preventative care program. we began offering health educ

it will provide services in our emergency shelters. episcopal has two emergency shelters, totaling over 500 beds. st. vincent de paul has msc south, which has over 300 beds. we are seeing approval of those contracts. supervisor chu: bank appeared for and saul, 14, 15, mr. rose, i believe your recommendation is just to include not to exceed amount. >> that is correct. supervisor chu: the department has requested we continue this to the call of the chair. >> that is correct. supervisor chu: thank you. given that we have gone through the department presentation, we thank you for your presentation and look forward to seeing you next week. ok, let's move on to the next department, which i believe is the children and families commission. >> good afternoon, supervisors. i am the executive director. we are continuing with our overarching goal the -- that all children in san francisco our school ready when they enter kindergarten and that they access high-quality services, delivered by well-trained staff. next year will be the first year of our

the next is information provided. this picture shows the sign for the intercontinental hotel at howard. this specifies where to find the face -- space. it is on the fourth floor. i necessary information is included. public access and operational hours. -- unnecessary information is included. the last example for the content is this black -- plaque. the third issue is location and placement. some of them are placed in the ground. this one is the howard entrance, it does not have any signage. the last one is the intercontinental hotel. this is on the farthest wall from the sidewalk. people on the sidewalk would not be able to see it. the last issue is clarity in terms of sign material and contrasting lettering and background. this is the example. they engraved the logo on glass and it is hard to find and read. the next is the example here. the font on the white background wall and it is hard to read and notice. staff finds most of these existing plaques do not comply with existing requirements. if you go to the overhead

has never fully provided that full tax increment value. down at the bottom, uc the actual tax increment provided in the current fiscal year to the agency, $112 million, increasing to almost one harder 14 in the second year, $123.8 million in the third year. that increase is primarily driven by redevelopment -- by mission bay pastor's increasing and by this change to the way the pastors are calculated. -- passthroughs increasing in by this change to the way the pass- throughs are calculated. briefly, what is continuing at the successor agency and the city administrator's office in the community reinvestment division. community reinvestment division is continuing the activities that are permited on the rops, debt obligations including paying bonds, continue to implement the major approve development projects i mentioned a minute ago, mission bay, hunters pay shipyard, transbay, managing certain assets and continue to be the responsibility of the agency, and then managing the transfer of certain responsibilities into the rest of the city. ove

and are the second and third largest providers. only 15% of national program networks are vertically integrated with a cable operator. broadcast stations are going mobile, wireless carriers are streaming video. programmers and paid tv providers are filling smartphone and tablet screens with their content and services as the fastest viewers are clamorring for them. at the same time, new entities are flocking to the market. within the last ten years, youtube, i tunes, netflix, amazon, hulu, sky angel and many others have leapt to provide video over the internet. currently the communications act does not apply to these players. therefore, i have some decisions to make. one option is to recognize the competitive landscape and start deregulating cable, satellite and broadcast companies. the other is to expand the communications act to apply to the new technologies and services. i for one do not believe we should be expanding video regulation. internet distributed video is growing at a remarkable pace in the absence of regulation. video

i'll start and we do have contracts with 600 providers, approximately 600 providers. we do offer choice to our veterans and when our -- in our amputee clinics, when we initiate the process for the multi disciplinary care that we provide, we have our physicians and our clinicians and our prosthetists there. we also have our vendors, our contracted community partners or contracted prosthetic vendors from the community are there, as well. the veterans do have that choice, that's part of our policy, and we, as we become aware of, we will reaffirm that policy with the field based on what we have heard from our veterans today, and -- and we are improving the processes. i think the inspector general report pointed out that there are some contract administration initiatives that we need to undertake, including streamlining the way we do our quote reviews so that they happen in a more timely fashion, and that they really clarify the prescriptive elements for fabrication of the leg, and we are doing that, or fabrication of the limb, and we are doing that. the second thing we ar

not providing. the second thing is extraordinary psittacism -- extraordinary cynicism is needed on this issue and a the staff tends to be pollyanna yes about that. he need to be in the real world. there will be abuses because there will be a financial incentive for abuse. some people, the original owners sell it to another person who's into cutting costs, so this is a necessary step but i would go back -- it needs to go back before any bonuses and that means it needs to go back to the bonuses developed in the '60s because they still exist. those buildings were built with bonuses of a widening sidewalks and given for observation decks. all of that was obliterated when they did be downtown plan. the spaces are grandfathered and you should go back and find the observation decks. i could probably go into my dusty file just-you could probably do that. as well as pull out the old newspapers. there were scandal articles. there was a double page split in the examiner which i still have in my desk the record

we need to provide raises to our staff to retain them. to respond to increasing need, we need to be able to hire new staff, to continue to provide a safety net. please approve the augmentation to the status of women budget. >> how is everybody doing? i am speaking on behalf of the community youth center, bayview youth advocates. what we do in the bayview community is we promote positivity. we address certain aspects that are negative in our community, such as gang violence, poverty, and violence in general. we promote positivity to a pledge that consists of 10 commandments the youth follow- through by their own willpower, and their own choice. for example, one of the 10 pledges is, i pledge to react to violence with logic, compassion , and understanding. that means we choose to follow the way that resorts without resorting to violence. that is what we are trying to emphasize. you've involvement can change the bayview community. -- youth involvement can change the bayview community. we believe and what we do. we believe that, through our p

, providing screenings. hopefully and most of the time, when there was not a crisis. one of the first hospitals that stepped up to the plate to assist us was cpmc. they have been working with us for the past seven years and presenting a health fair in the western addition that sees 1000, 1500 people every august. i support the rebuild. i support what they are envisioning doing in terms of the jobs it will bring, in terms of the health it will bring, but more importantly, what i envision it is these buildings functioning. i envision them helping people. i envision them serving people. i envision them saving lives, and i urge you to move forward with all due haste. thank you. supervisor mar: thank you. i am going to call a few more names. [calling names] sarah and thaddeus. next speaker. my name is even. thank you for hearing me. in 2008, at the end of it, i was an uninsured self-employed woman diagnosed with breast cancer. the sister to sister program took me through a double mastectomy, two other surgeries,

providers are really quite . in the case of hospitals, the medicare margins for the rural hospitals are actually higher than the medicare margins for the urban hospitals granted however that they are - and bookcases. we base our payment the recommendations for hospitals, urban and rural a light on what we refer to as an efficient provider analyst with in fact that as we are required to do by statute and suffice to say that we've concluded that both urban and rural providers could provide high-quality care at the existing medicare rate. >> in the hearing room today they're waiting to see with this record is printed with the for the care act i think there are three major revolutions occurring in health care system that's when to continue regardless of what the court may decide in the next week or two. one is the buildup which is long overdue and that is moving forward now we need to continue to have that move forward. beavers delivery system reform we talked about this before and the other is the payment reform we

language services provided by the state and has access to 155 languages with funding provided by the state emergency telephone number account. additionally, we have 30 certified dispatchers in spanish, cantonese, mandarin, french, in russian. that concludes my presentation. as i indicated earlier, as far as the director of emerging services, if you want to discuss the closed system question. supervisor chu: in terms of the budget, is there anything in the new initiatives, the web of project, as well as yours human- resources component, which is converting to the transition project. in the past, we have had some concerns about having enough people recruited and hired for this batch work. is that still a problem? are you still getting enough folks for those roles? >> in our current year budget, we do have a lower separation and we have had in previous years. historically, we have had double digit numbers of such trip -- separations from the work force. through the discussion with the mayor's office, we did not hold the academy in those years. where we are watching the separation, if th

i look forward to providing our patience with these rooms. the obvious minivets of these rooms is going to be the quiet atmosphere, the more chilling atmosphere. private bathrooms. there are other benefits as well. there are a few medication e rrors -- fewer medication errors. and patient's families can stay with them as well. private rooms act as a barrier. they help prevent the acquisition or transfer of health care-acquired infections. i think we will definitely be able to reach the 0% infections for our patients. >> next speaker. >> thank you, supervisors. i'm a neighbor of the van ness project a few blocks away. i would like to voice my complete and enthusiastic support for the project. i think construction can begin as soon as possible. there are two reasons for my support. the neighborhood would be of a benefit to me. the ongoing economic stimulus in the neighborhood, that would be great. i live in a 100-year-old building, like many in the city. the building was built to the standards of the time. if we have learned anything from the e

. >> is this on the basis that you are speaking to provide additional privacy? >> yes. >> i just need a clarification on that it is the fourth floor deck railing facing the appellant's property plaline. >> facing the lake well. >> facing like well -- light well. facing the appellant's light well. how much lettuce? >> lettuce up to 6 feet. >> that is from the deck floor. >> yes. >> 42 inch solid railing and up to 6 feet lattice. ok. motion with commissioner hillis. >> commissioner hillis. >> we have a motion from commthis appeal, uphold the per, with the following conditions, that the windows on the second and third floor in the light well defrosted. that the fourth floor deck railing the 42 inches celebrating the end up to 6 feet -- solid that railing and up to 6 feet lattice. >> it is a minimum of 6 feet. >> of 42 inch solid railing. minimum 6 feet lattice. ok. on that motion, a vice- president. >> aye. >> aye. >> aye. >> the boat is -- vote is 4-0. >> thank you. we can return to item nine. that is appeal 12-055. >> thank you. thank you for your patience. the p

review cpmc will provide opportunities for such applicants. we as building trades, already to make -- are ready to make hospitals in san francisco seismic safe. please put our members back to work, and i ask you to support this project and moving forward. thank you. >> up the. mr. san, we already called your name. so i'm going to read the last cards and if anyone else can come forward -- [reading names] next speaker? ma'am? >> i would hike to start by thanking the members of the board of supervisors for sticking around to make sure we all got to get our comments in. my name is emily. i'm a joranman wireman and a business representative for the international brother hood of electrical workers, local six. i was born and raised in san francisco. i live in twin peeks. for the people i love and all the people that come to san francisco for medical care, it is of the utmost importance to begin construction on a seismically sound hospital now. on monday, a group returned to install a new generator at a hospital that they rewired a year and a half ago

we provide material that they do not have at their firms. we support their pro bono efforts, things they do not have. we have archival materials they do not have. every day we are subject -- providing support to them, either with materials, we frequently are able to find material that are not accessible on the internet or print, from other locations, other agencies, but i cannot give you the specific cover-up firms. since we are available to everybody and to all firms, i do not have an exact count, but we -- which may be surprising to people because they will assume that large firms have the resources to do this amongst themselves. but if you take a look at a letter sent to each of the supervisors last month, and to the mayor and city administrator, that is signed by over 700 members of the public lawyers, law firms of all sizes, major bar associations, minor bar associations, the current state bar president, bar association of san francisco residents, that is an indication of some of the people that are using the law library. supervisor kim