Minutes of the Health Commission Meeting Tuesday, March 21, 2006 at 3:00 p.m. 101 GROVE STREET, ROOM 300 San Francisco, CA 94102 1) CALL TO ORDER President Monfredini called the meeting to order at 3:10 p.m. Present: Commissioner Lee Ann Monfredini, President Commissioner James M. Illig, Vice President Commissioner Edward A. Chow, M.D. Commissioner Roma P. Guy, M.S.W., Commissioner David J. Sanchez, Jr., Ph.D. Commissioner Donald E. Tarver, II, M.D. Absent: Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MARCH 7, 2006 Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the minutes of the March 7, 2006 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Sanchez chaired, and Commissioner Tarver and Commissioner Chow attended, the Budget Committee meeting Items for Approval (3.1) CHN-SFGH – Request for approval of a contract modification to add SFG Imaging Consultants, Inc. to the previously approved contract shared by three contractors to provide intermittent, as-needed, professional services of per diem and traveling radiology technologists with on-call availability 7 days a week, for San Francisco General Hospital and to increase the contract by $509,000, from $1,200,000 to $1,709,000, for the period of July 1, 2005 through June 30, 2006. Items for Discussion and Approval (3.2) CHN-Patient Financial Services – Request for approval to submit a resolution to the Board of Supervisors to accept revenues estimated to exceed $1,000,000 under a contract with Health Advocates, LLP. (3.3) CHN-Patient Financial Services – Request for approval of a renewal contract with Health Advocates, LLP to enhance Medi-Cal and other third-party reimbursements through uncompensated care reimbursement recovery services at San Francisco General Hospital, with compensation based on contingency fees to be paid out of recoveries obtained by the contractor, for the period of April 1, 2006 through December 31, 2009. (3.4) CHN-Administration – Request for approval to submit a resolution to the Board of Supervisors to accept revenues estimated to exceed $1,000,000 under a contract with Toyon Associates, Inc. (3.5) CHN-SFGH, LHH & HAH – Request for approval of a renewal contract with Toyon Associates, Inc., in the amount of $1,754,056, to provide regulatory reporting and reimbursement and revenue optimization services to San Francisco General Hospital, Laguna Honda Hospital and Health at Home, for the period of April 1, 2006 through March 31, 2010. (3.6) CHN-SFGH – Request for approval of a retroactive new contract with Tsang Architecture, in the amount of $160,000, to provide master planning services for the development of a new acute care hospital building for San Francisco General Hospital, for the period of March 1, 2006 through December 31, 2006. (3.7) DPH-Community Programs Prevention Services – Request for approval of a resolution approving the use of interim agreements to extend the terms and conditions of FY 2005-06 contracts into the first six months of FY 2006-07. Secretary’s Note – Commissioner Tarver abstained from voting on this item as it relates to the contracts with Baker Places and Westside Community Health Center. Commissioner Chow abstained from voting on this item as it relates to the contract with NICOS. Commissioner Illig abstained as it relates to the contracts with St. Mary’s Medical Center and Project Open Hand. (3.8) PHP-CHSS-TB Control – Request for approval of a retroactive sole source contract renewal with the Regents of the University of California, in the amount of $1,488,000, to provide operational services of the Francis J. Curry Regional Training and Medical Consultation Center, targeting health care providers, allied health professionals, social service providers, TB and other related training providers, funders interested in TB, and related health concerns throughout the United States, for the period of January 1, 2006 through December 31, 2006. Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez, Tarver) approved the Budget Committee Consent Calendar, including Resolution 05-06, “Approving Use of Interim Agreements to Extend the Terms of Fiscal Year 2005/06 Contracts into the First Six Months of Fiscal Year 2006/07 for the Department of Public Health,” (Attachment A). Commissioner Tarver abstained from voting on Item 3.8 as it relates to Baker Places and Westside Community Mental Health, Commissioner Chow abstained as it relates to NICOS and Commissioner Illig abstained as it relates to Project Open Hand and St. Mary’s Medical Center. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., presented the Director’s Report. World TB Day The Department will be co-hosting its annual World TB event with the Chinese Newcomer’s Service Center March 23, 10 a.m., at Chinatown Public Health Center. The good news this year is that San Francisco’s TB cases for 2005 are the lowest in the City’s history. Between 2002 and 2005, TB cases in the City dropped to a record low of 132 from a recent high of 296 in 1993 when TB cases began to spike during a brief resurgence among people infected with HIV/AIDS. However, the City’s TB case rates remain the highest in the nation. The TB Control Section points to a number of strategies that have proven effective in producing better TB outcomes. Last year, San Francisco was the first county in the nation to adopt a breakthrough technology—Quantiferon-TB Gold® (QFT), a new, blood assay-based TB diagnostic—to replace the less accurate, subjective, 100-year-old skin test for TB. The new TB test does not require patients to return to a clinic to have their tests read by a nurse, resulting in greater accuracy and more immediate results. Currently data shows that Asian newcomers bear a disproportionate burden of TB in the City, which is where the Department will focus its efforts on World TB Day and throughout the coming year. A patient from the Asian community who has undergone treatment for TB will be speaking at the press conference. Dr. Katz encouraged Commissioners to join staff for this press event on Thursday. Cultural Competence Training Courses Nearly Complete The Department’s Cultural Competence unit is completing a series of trainings and workshops that were designed to instill in DPH staff and community partners a deeper understanding of the critical role that cultural competency plays in the delivery of public health services. The series of five workshops began in November and will conclude on May 12th with “Best Practices in Cultural Competence.” Past topics addressed awareness, assessment, setting goals and objectives and the differences in communicating with diverse populations. The final workshop will provide a forum for recognizing a program or components of programs that have made exemplary efforts to advance cultural competence. The organizers of the May 12th workshop have asked DPH staff to identify programs that reflect a Best Practices approach to delivering health care within a cultural competency framework. Dr. Katz believes this Department has a wealth of such programs that will be identified. St. Luke’s Community Forums As the Commission is aware, St. Luke’s Board of Director’s has voted to merge with CPMC, a Sutter Health affiliate. As a result of this pending merger, St. Luke’s is hosting two community forums to help determine what services are important to their patients and local residents who rely upon St. Luke’s as a facility for their health care needs. At the first forum last week, St. Luke’s informed those in attendance that they have no plans to close down St. Luke's, the emergency room or the inpatient hospital. Additionally, they will continue to provide charity care and maintain their mission of not turning people away based on inability to pay. St. Luke’s intends to continue taking uninsured and Medi-Cal patients and, at the same time, will also pursue privately insured patients to decrease their losses. They also talked about the rebuild and said that they are hoping that St. Luke's will not be under the 2008 deadline, but the 2013 deadline because they will now fall under the CMPC umbrella, and CPMC is planning to rebuild their hospital. The final community meeting is this afternoon. Hearing on Massage Parlor Rules and Regulations The Environmental Health Section is hosting a public hearing March 23rd at 9:30 a.m., on the proposed modifications and additions to the rules and regulations for massage establishments and practitioners. The hearing will provide the opportunity for staff to review the new proposed rules and regulations with owners and practitioners and answer questions. Some of the new regulations include: Facilities must be equipped with massage tables. No beds permitted. Outside doors may be locked for security purposes. Inside doors cannot be locked. A massage trainee practitioner’s permit will be issued for 90 days, with only one 90-day renewal allowed. Chair massage therapists, previously not mentioned in the original ordinance, will come under the new regulations. The Department of Public Health has been regulating massage facilities and therapists since July 2004. This is the first set of changes to the original regulations. The new ordinance is posted on the Department’s website. Bedbug Symposium As a result of increased reports of bedbug infestations, the Environmental Health Section has scheduled a symposium entitled “How to Control Bedbugs in San Francisco” March 30, from 3 – 6 p.m. here at 101 Grove St. The Department has sent letters of invitation to all licensed pest control companies and hotel owners and operators in the City. The workshop will cover the biology of bedbugs, scientifically proven control methods, legal responsibilities and the Department of Public Health’s expectations of pest control operators and those who own and manage hotels. Organizers of the event have lined up speakers from the California Department of Health, Vector Borne Disease Section; Entomologists from the industry; Biologists from the Department of Agriculture on Pesticides Use/Control; and a Deputy City Attorney. Nutrition Services Nutrition Services, whose programs served more than 84,000 San Francisco residents last year, is holding a Community Partners Open House March 29th 3:30 - 5:30 p.m. 30 Van Ness, Suite 3500 (3rd floor). The afternoon gathering will provide staff from Nutrition Services an opportunity for community partners to network and to update them on all of the programs that are available to their clients. Refreshments from the Heart of the City Farmers' Market and La Cocina Community Kitchen will be served. Each of the Commissioner’s has been sent an invitation to this event. We hope you can join Nutrition Services next Wednesday to learn about this important nutrition program for many of the City’s youngest and most dependent residents. ABC News 20/20 at Laguna Honda Hospital An ABC 20/20 news team spent last Friday at Laguna Honda Hospital videotaping Dr. Ian Zlotolow, a dentist at Laguna Honda Hospital. Prior to coming to San Francisco, Dr. Zlotolow’s had spent some time in Africa making prosthetic ears for people mutilated by war in Sierra Leone. His work there and his subsequent adoption of his son, Lansana, was brought to the attention of ABC news from a number of sources, including a special feature on his work in the New York Times. This remarkable man and his story will be featured on ABC News 20/20, Channel 7, March 24th. LHH Replacement Structure to Appear on News Hour With Jim Lehrer Reporter Spencer Michaels and the crew from the Jim Lehrer News Hour spent some time videotaping the steel frame of the Laguna Honda Hospital Replacement Program new Link Building last week as part of their special report on the 100th Anniversary of the 1906 Earthquake. The Laguna Honda Replacement piece was chosen to illustrate the requirements for California hospitals to meet seismic standards. The program will air on April 18th. Community Health Network, San Francisco General Hospital, March 2006 Credentials Report 03/06 07/05 to 03/06 New Appointments 11 128   Reinstatements 0 0 Reappointments 48 337   Delinquencies: 0 0   Reappointment Denials: 0 0 Resigned/Retired: 14 98 Disciplinary Actions 0 0 Restriction/Limitation-Privileges 0 0 Deceased 0 0 Changes in Privileges       Additions 6 44   Voluntary Relinquishments 7 37   Proctorship Completed 11 107   Proctorship Extension 0 6 Current Statistics – as of 03/1/06   Active Staff 465 Courtesy Staff 575 Affiliate Professionals (non-physicians) 197 TOTAL MEMBERS 1,237 Current Statistics – as of 03/1/06   Active Staff 465 Courtesy Staff 575 Affiliate Professionals (non-physicians) 197 TOTAL MEMBERS 1,237 Applications In Process 22   Applications Withdrawn Month of March 2006 0 2 (07/05 to 03/06) SFGH Reappointments in Process Apr. 2006 to Jul. 2006 221   Commissioners’ Comments Commissioner Monfredini said it is exciting to see the steel go up at Laguna Honda Hospital. Commissioner Chow thanked Dr. Katz for highlighting the World TB efforts in Chinatown. He asked if there was any mention at the St. Luke’s community forums of closing St. Luke’s OB services. Dr. Katz said St. Luke’s has not said they are closing any services. Commissioner Illig asked that once DPH staff identifies cultural competency best practices, these be brought to the Community Health Network Joint Conference Committee. Commissioner Illig encouraged his colleagues to attend one of the tours that are being organized by the Long Term Care Coordinating Council. Commissioner Chow said that he and Commissioner Guy attended the tour of the Mercy Housing Mission Creek development. It is a wonderful development. Commissioner Monfredini said she and Commissioner Tarver were at the opening of the Plaza housing development, and were very impressed. Commissioner Guy said this is a wonderful standard to have reached. Commissioner Illig said there was much support for the $25 million supplemental for the SFGH rebuild and he commended Gene O’Connell and the doctors from San Francisco General for speaking so passionately in support of the rebuild. 5) PRESENTATION OF THE MARCH EMPLOYEE RECOGNITION AWARDS Commissioner Monfredini presented the Employee Recognition Awards for the month of March. Team Award Division Nominated By Psychiatric Consultation Liaison Nursing Service Team SFGH Alicia Boccellari and Sharon Wicher Antionette Griffin Grad Green Kari Hanson Janice Papedo       6) UPDATE ON NON-PROFIT CONTRACTOR TASK FORCE Anne Okubo, Deputy Finance Director, gave a status report on the implementation of recommendations of the Non-Profit Contracting Task Force. Ms. Okubo reminded the Commission that the Board of Supervisors created the Non-Profit Contracting Task Force to review city contracting and make recommendations to improve and streamline contracting processes for non-profit health and human service contractors. There were 13 recommendations. Ms. Okubo updated the Commission about what has transpired since the last report to the Health Commission in October 2005. Progress has been made in the areas of joint monitoring, revised milestones and 18-month contracts. 67 non-profit agencies have contracts with two or more city departments. Fiscal, compliance and program reviews have been completed for more than half of the agencies. DPH is the lead department for approximately one-third of the agencies. DPH also participates in monthly meetings with the Controller’s Office, HSA and DCYF to coordinate and review the implementation of joint monitoring. Recently, a Steering Committee was established by the Controller’s Office to review joint monitoring protocols and procedures. DPH is a member of the Steering Committee. New milestones for achieving Task Force recommendations will be presented to the Board of Supervisors at a hearing on April 24. A few highlights of revised milestones are: Contracts to include clear service definitions and monitoring protocols. In future contract renewals, these service definitions and monitoring protocols will be used to develop outcome driven services. Departments will adopt the Controller’s Office risk assessment protocols to determine which agencies will be monitored. Agencies that are low risk may require a site visit once every three years. New agencies or programs at higher risk may be monitored annually. The Controller’s protocols also establish the criteria to determine if a review requires a site visit or if it can be done as an agency self-assessment. The Office of Contract Administration will survey contractors on implementation of Task Force recommendations to get feedback on unnecessary requirements; systemic causes of contract certification delays or payments; and preferences for consolidated contracts. DPH piloted a new contract model that combines the 12-month annual contract and the 6-month interim contract. Community Behavioral Health Services will begin to see the benefits of the 18-month contract in the new fiscal year. The 18-month contract model will be implemented DPH-wide as contracts are renewed. Ms. Okubo said that contractors have been critical of DPH implementation of the task force recommendations, and specifically concerned with late contract certifications, minimal consolidation of DPH contracts and that the contracted scope of services is too broad and does not clearly identify service definitions, monitoring requirements and outcome objectives. Dr. Katz convened a meeting yesterday with DPH staff and contractor representatives from Task Force. Four outcomes were agreed upon as a result of that meeting: DPH will review the proposed milestones to ensure that timelines are achievable; DPH will participate in an interdepartmental work group to review the best practices of other city departments; DPH will review statistics on late contract certifications to provide quantitative data to assess delays; and A representative of DPH programs will join the Non-Profit Task Force to ensure both administrative and program representation by DPH. Public Comment Judith Stevenson, representative of the Human Services Network, said it is exciting to see the progress being made around contract reform and the support of the Health Commission and the Board of Supervisors. This has been a five-year process. She thanked Dr. Katz, Anne Okubo, Jimmy Loyce, Michelle Long, Barbara Garcia and others for their efforts. Ms. Stevenson urged the Commissioners to talk to their colleagues on other commissions to be clear that contract reform does not negatively impact accountability. Commissioners’ Comments Commissioner Tarver asked if the task force is looking at clinical, programmatic treatment outcomes as well as fiscal and compliance objectives. Ms. Okubo said that is beyond the scope of this group. The focus of this group is to examine how to best do joint contract monitoring. Ms. Okubo said there is a lot of interest in the Department to monitor outcome objectives. Commissioner Tarver asked Ms. Okubo to comment on the impact of staff reductions on this effort. Ms. Okubo said there are opportunities to streamline processes to make them more efficient, but it is also an issue of reduced administrative staff. Commissioner Tarver asked if there has been any consideration of cross training across departments. Ms. Okubo replied that she recently had discussions about cross training within DPH, and she will pursue this further with the consultants Commissioner Illig thanked Dr. Katz for convening the meeting with the non-profits. Commissioner Illig is pleased that DPH has very specific milestones, which will be presented to the Board of Supervisors. He is particularly pleased to see that OCA is going to survey contractors. He looks forward to future updates. 7) PROGRESS REPORT ON INITIATIVES TO INCREASE HEALTH INSURANCE COVERAGE AND ACCESS IN SAN FRANCISCO Mitchell H. Katz, M.D., Health Director, presented an overview of two new initiatives to expand health care coverage in San Francisco. The Department has taken an incremental approach to achieving universal health care. Since 1991 DPH has developed four significant programs to expand coverage and access for the uninsured: Healthy Workers, the Health Care Accountability Ordinance, Healthy Kids, and the Healthy Kids Young Adult expansion. The two new initiatives are the Taxi Driver Initiative and the Universal Health Care Council. Jean Fraser, Director of the San Francisco Health Plan, described the Taxi Driver Initiative. Taxi Driver Health Coverage Plan – Overview 7,000 taxi drivers in San Francisco, most are independent contractors Approximately half of all taxi drivers in SF lack health insurance, and taxi drivers are very low income Proposal to fund health coverage through the San Francisco Health Plan (SFHP), with funding to be obtained from four possible industry revenue sources: drivers, medallion holders, cab companies, and the riding public. Mayor Newsom’s Universal Health Care Access Council In 2005, Supervisor Ammiano introduced legislation that would require all San Francisco employers with 20 or more employees to either provide health insurance to workers or pay into a fund to cover the cost of the City of uncompensated care provided to uninsured workers. At the same time, Mayor Newsom developed a Universal Health Care Council charged with developing strategies for providing health access to all uninsured persons. In particular, he asked that the Council develop a defined benefit plan. Under such a plan there would be a list of services with a corresponding list of co-pays that people would be entitled to. Employers would pay for some of the cost of the program. The Universal Healthcare Council’s agenda is to clarify the scope of benefits to be provided, specify the model of service delivery and the provider network, specify eligibility requirements, determine program administration and organization, avoid “crowd out,” recommend financing and determine regulation. Dr. Katz described the many benefits of a defined benefits plan, including 24-hour customer service, set charges so people know in advance how much they will be charged for their care and the fact that people will have a medical “home” with an emphasis on prevention and primary care service. Conclusions San Francisco is one of the most generous municipalities in the US in providing health care benefits No one is turned away from San Francisco General Hospital, the primary care centers or emergency departments With coverage, people are more likely to receive needed medical care and have better health status San Franciscans have repeatedly demonstrated their strong commitment to universal health care coverage for all residents Commissioners’ Comments Commissioner Chow asked if the Taxi Commission is going to in fact select one of these options. Ms. Frasier said that the Taxi Commission has asked that this proposal be presented to the Commission at its next meeting. It is up to them to decide if they want to take action. Commissioner Sanchez asked if the health insurance would be available for dependents of taxi drivers, as well as the driver. Ms. Fraser said that including dependent care rendered an already complex issue prohibitively complex, so the decision was made not to include dependents. Commissioner Sanchez asked if commercial health care is available for this population. Ms. Fraser said that this population would not be considered a group, so the only commercial product available would be individual plans, which are costly. Commissioner Tarver noted that there is a capacity problem in CBHS and CHN, so this has to be taken into consideration when assumptions are made about where people can access care. Ms. Fraser noted that it was never assumed that the CHN network would be the delivery system for the taxi cab drivers, but rather the entire SFHP delivery system. Commissioner Guy said this proposal is another attempt to increase health insurance and access to that large population of uninsured adults, and she applauds and supports these policy discussions. It might be the case that other SFHP programs would cover the child dependents of taxi drivers. Commissioner Chow asked how offering services through a defined benefits plan differs from telling people that they can come to the public hospital. Dr. Katz said that through this initiative and Supervisor Ammiano’s legislation, there is the potential for a revenue source that could be used to expand services. In addition, channeling people through the benefits plan allows for a level of customer service that does not currently exist. Thirdly, this would allow the Department to tell people what each service costs before he or she receives services. They will know what to expect in terms of their financial obligation. This certainty does not exist in the current system. Related to that, there are large numbers of low-income people who would benefit from our system but do not use it, for a variety of reasons. By enrolling people in this plan, people are more likely to use the service. If this initiative gets off the ground, the Department and the Health Commission may want to reconsider replacing part of its sliding fee scale with this program. Commissioner Chow asked if there are models for this program. Dr. Katz said San Mateo County moved from its existing sliding scale to this model, but for a limited population. They found that satisfaction improved and they collected more money. Commissioner Guy supports this effort. It is a breakthrough for the community. San Francisco has a rich public health system to build on. She asked if the San Francisco Health Plan has the capacity to administer this program. Ms. Fraser said the SFHP governing board has begun this discussion. The board has directed the health plan to pursue expanding capacity. Commissioner Guy said there is going to be a public forum on April 5th. Commissioner Tarver supports the expansion of health care. He is concerned that attention be paid to the culturally competency and cultural match of providers. Ms. Fraser replied that the main way the health plan addresses this is to provide a provider directory that lists provider details, and allowing enrollees to choose. The health plan has a fairly large network, which allows for diversity. Commissioner Tarver said there are people who want to see someone of a specific ethnicity, race, gender, etc., and should be given the means to easily find someone they are comfortable with. Ms. Fraser said she is willing to look at this issue further. Commissioner Illig noted that the point was made at the CHN Joint Conference Committee meeting that many of the people who would be part of the defined benefit plan are already part of the DPH system. Commissioner Illig said another reason for the increase cost of health care is the profit margin. Commissioner Illig asked when the Universal Health Care Access Council would complete its work. Dr. Katz said it would be finished in May. Commissioner Chow is confident that these reasonable, effective and efficient initiatives could only happen with the leadership of people like Jean Fraser and Mitch Katz. Public Comment Ed Warshauer, SEIU 790, said the union is very proud to be associated with the Taxi Driver and Universal Healthcare initiatives. He thinks it would be a problem if the employee is required to pay a share of insurance costs. A small portion of even a discounted rate may be too much for people to afford. 8) PUBLIC COMMENT/OTHER BUSINESS None. 9) ADJOURNMENT The meeting was adjourned at 5:30 p.m. Michele M. Seaton, Executive Secretary to the Health Commission Health Commission meeting minutes are approved by the Commission at the next regularly scheduled Health Commission meeting. Any changes or corrections to these minutes will be noted in the minutes of the next meeting. Any written summaries of 150 words or less that are provided by persons who spoke at public comment are attached. The written summaries are prepared by members of the public, the opinions and representations are those of the author, and the City does not represent or warrant the correctness of any factual representations and is not responsible for the content.