Services at the same time the decrease in demand for charity care loss give us an opportunity to think about medical and charity care and Community Benefit all Work Together to maintain the safety net to the betterment of the Health Care System as a whole in the city and encourages us to think more effectively about the partnerships we have between dpw and the hospitals and Others Community partners and the partnerships can be maintained and improved and the last point has nothing to do with with the Charity Care Patients as noted the decline in the number of patient was not significant for the Charity Care Patients as for the healthy San Francisco patients and the cinches over time dont really note a pattern that we can really rely on as noting the ac a impact for that group we thought might happen with that group didnt they might not have as much access to the ac a insurance and the healthy San Francisco the healthy San Francisco programs is on model after the care the folks maybe more familiar with the kind of Health Insurance that be available to them in 2014 that might be playing a little bit of a role and the residential locations their speaking has been consistent over time i want to first thank the commissioners for the opportunity to present this information and the flexibility 2, 3, 4 combining the two years worth of data i also want to thank my colleagues in the office of health and planning colleen this would not have happened without her and lizzie and all the hospital representatives that worked with me to complete this report and answered all my questions and made themselves available to complete this report many of them are in attendance in the audience as well. Commissioners several Public Comments well take and go on to the discussions first of course want to thank you for the care that youve taken in this report with the response to the committee and questions and the ability to give us a real in favor of how the trend has gone frankly all the way back to a wonderful what . 2010 on. Yes. Thank you. Well have further discussion and precede with Public Comment at this point i will first call 3 names if you will be prepared and after that several others so well begin with yes, maam. Please note when you are time is up. Raise our microphone so everyone can hear. Is that better. Im emily webb the director of the Health Programs at camtc i want to speak about this ordinance it was passed 14 years ago and the first of its kind in collecting data like this were happy to have provided data since the ordinance was passed several notices have schangdz both state and federal government have the Affordable Health care act which ear experiencing a shift if medical to medical from charity care and healthy San Francisco has been implemented so certainly c pmc to collecting data we can use and leverage the data that is provide he state and federal level to make changes for this population rather than continuing to collect data that is onerous for the hospitals and recorded in other areas well to ask the commission to have dpw work with the hospitals to a come up with an ordinance to make it more use full in improving the health of this population thank you. Thank you. Good afternoon commissioner cut me off if i go past. You get 3. Oh. Kaiser permanente as many of you may know in the reports were a volunteer reporter were unique combination of health plan, medical group and hospitals we participate and have from the beginning we believe in the purpose of this as mabus stated to improve the coordination understanding and but the most important part mabus highlighted about the Affordable Health care act it changed the entire landscape of how this activity is recorded it didnt just reduce the number of Charity Group patient addresses the expenditures that unified something bigger than providing treatment for disease it emphasized Community Wellness this is the benefit and as weve talked about over the Years Charity care is in the middle and thats where i think this commission needs to focus what are the hospitals doing not only to provide care and treatment for the poor but prevent the need for that treatment to keep people healthy kaiser wants to join with the other hospitals and study over the next couple of months and coming up come back with a different way of reporting our Community Benefits thank you. Thank you. Good afternoon commissioners ash i didnt st. Francis and one of the original members of the Charity Care Task force and so weve been at this for 15 years and had a hallmark report theyre anticipating with the shift of charity care and some of it a large dose the medical shortfalls the hospitals are experiencing the diagram was drawn casting charity care as one of the benefits but other programs that hospitals do to provide Community Benefits and it is our thinking at this point we do need to rethink charity care in the new world order and the publicprivate relationship for the care of San Francisco we urge the commission to direct staff to really help us find a new way of doing this this is a good time halfway through the assessment to informs the hospital master plan and the healthy plan and the Community Health improvement partnerships if we look at this as an opportunity with the Community Health partnership in play an Important Role i think our timing is spot on if he think about how we everything have the convergence of activity to help the san franciscans. Thank you our next two speakers is mr. David caesar wall and barry from cedars. Well president and honorable members im with the council of Northern CaliforniaSan Francisco office here to under the influence the points being made by the directors the experts to thank staff in generating this ill have report it hieflts the crucial role that the note for profit hospitals play and highlights the need now we look back analysis how to better utilize this data and think about how to bring alignment with the goal of improving the equality of charity care, the reimbursement question and the on the challenges the Hospital Council will like to ask that the commission direct staff to deem it as you see fit and interested parties meeting with the hospitals and have that dialogue and report back to you whatever you deem 6 months operate or so thank you very much. Good afternoon commissioner im barry the director of Community Health clinics at as far as i am concerned in San Francisco i want to thank mabus and colleen and lucy for the pleasure of working with them it is of the in the posted report we saw in the web site i want to add my voice you consider requesting us to work six months with the did you want to explore information that is already required as residents of the new emerging california requirements after the Affordable Health care act what mabus alluded to the identification of concern populations that have not made the transition in the Affordable Health care act and what opportunities there would be for cocare management and chronic diseases and more collaboration referring to the doughnut for the charity care many years ago when you commissioners piloted and thats my point and thank you for hearing me today. Can i ask a request about the ash pod requirements i know that medicare and medicaid. If you can describe the ash pod requirements but well go over that again. The actual requirements related to charity care and actually Community Benefit overlap in different ways two the local is state and federal and the appendix but i will go over that and see the first hfa has nothing to do with to with the actual Community Benefits requirement which entities and where do they have to report their communities benefit requirement and they do that at the state legal of level that is ash pod and at the federal level as well. So it is state ash pod is collecting the data got it. Yes. As opposed to the medicaid, medical. Ash pod is the extra agency that collects the benefit and charity care requirements in terms of the actual reporting of the actual charity care levels that happens here locally introduce our Charity Care Ordinance and through federally through form 990 schedule h those requirements are new ones for the hospital and has to report the actual levels of charity care provides there is differences between the federal government and what we require locally the local owners is a bit more robust in terms of breaking down services into in patient and outpatient and emergency and also the report at the federal level does not require hospitals to note the number of people that were served in the schirt care program the amount of people is optimal. Thats the cms. I believe under the irs. The irs. Form 990. Yeah. Part of government does talk about talk to the right maybe they do. And before we precede i thought that since also everybody has brought into the conversation it would be good to recollect where this came in from thank you, again, for the report you highlighted this is a fine report the attachments are so valuable it helps to table for us and prepares prepares for any future dialogue what the landscape is in terms of the reporting for the various entities i want to thank staff for working it has to have been very difficult the ordinance is in there and this couldnt have been prepared without the help of the entire Hospital Council communities not only from the mandatory side that submits data but not anywhere as valuable without the benefit side as complete a picture as the county can have the reason that charity care reports started from this commission and from the board of supervisors to be sure there is value to a nonprofit status that would have to be part of the work that would be done in terms of relooking what charity reporting is because the base was not just charity care with you and later nationally that has been a federal issue at the federal level of the value of nonprofits and what value there there is back to the community we heard thoughts not only to look at the value and took several years to get the even Playing Field what numbers complaisance we went through a lot of dialogue whether or not the t ls look the same and use the same definition that was important to realize as the speakers have said charity care was much more important than just simply the dollars for awe execute care second year illsness and recognize at a Community Benefit at least the programs that hospitals were engaging in that were true Community Benefit could be highlighted within the report to have a broader implementation what were the dollar values if instead we were asking for operational versus emergency room care thats an added prospective to the reason why there is a segment trying to sdrab all the facilities and what theyre doing to the idea then of looking further for the last several years can do we do as the world has changed and clearly that demonstrates there were impacts upon charity care from the Affordable Health care act and the need to then refresh this and see what values im pleased i think all the speakers spoke to the needs to have value out of the report for something accountable it is accountable i believe also it is important then if we look at the core there is to remain as the data shows a block of patients that does not access the ac a programs and that question will have an obligation to take care of so that cannot be forgotten within a prospective we should have our discussions as to what we ohio this is very much an ordinance that has been a very much part of trying to make it valuable and not just a trade off for Property Values from the contingency so i think after the commission standpoint historically can see how we would want to help to shape this to be more value able to the city ask the acting director if she has comments thank you for this report. I have like you, you commissioner chow one of the pictures first people to work on this it has gone through a lot of evolution as mabus noted in the report a Significant Impact the ac a has had with charity care it provided a good opportunities to talk more holistically about the Community Benefit how we can best use hospital resources, Community Benefit resources, dpw resources to better the health of the population that is the intent of the sf hip to look at the intersection all our missions to fourth how to improve the populations health this dialogue can happen. Commissioners comments. Commissioner pating. I want to say first thanks to the department and ma vice and others and lucy for a wonderful diagram good job. Thank our hospitals for the hundred and 80 million less than 2 million last year is not a small amount the contributions to the hospitals that are making to the communities is both good and necessary and when i look across how refund our healthy San Francisco initiative we just basically gave a stamp of approval at the last meeting a large part if not the bulk based on charity care to make that system work our hopeless systems in providing this charity is really providing good service to this with that said, parts of reports the second part not quite sure though to evaluate a number of patients the zip coaxes code and what were looking at in this report effectiveness certain its decreased im interested in a global approach to the Community Health and benefits with the Charity Contributions is it adequate to meet the needs of the community is it fair and equal is the reporting confusing to the hospital constituents i think we should look at making it expedite ill be in favor of a task force or director has suggested might be feasible to look at a framework of reporting, look at a system of goals for this reporting i like interfacing the goals we know that charity will meet the Population Health goals we want and coming back and perhaps 6 months and giving us some recommendations rather than changing the ordinance study it for right now under the changes and realizing this is important i think reporting is a mechanic thing simplifying it and make sure that charity care is virtually and effective. Those are my comments. Commissioner. Thank you for this this is dense a lot of information i have a lot of questions youve done more thinking about this this issue it is the same so about the same number of people that receive the care from the 5 years ago as today; is that correct so the numbers have been flat and the locations is the same. Right. So that per Police Vehicles me this in fact the comment about the impact were having if were consistently okay. We have more people theyre the number of people coming from the same location praepz perhaps they need to been this Publicprivate Partnership and think about not just the amount of care not just the dollars and the number we serve but what do we do to look at the outcomes because that seems to be perplexing to me. Youre correct in stating that over time weve had some fluctuations in the number of patients and the expenditures you you know the same 4 districts over time have transcribed most to the charity care landscape in the city and you know the attachment for the awe preparation at the ends has neighborhood profiles which give position about the different neighborhoods within each district and the mediums Household Income for the district were seeing the multiple charity care responds to the lowest medium Household Income over time because those districts are continuingly representing the areas in the community i think it is try that the those same districts contribute the most no matter how the patients are fluctuated over time that will continue to be i think is good way for us to understand from a strategic parking space stand point where we modestly might focus to change the dynamics to lift those district out of the situations theyre in that led to the continuous representation. It is almost like a stable population from those continued areas. We think about are we looking at this with the efforts to really looking at how do we have new path not impact overall but there. Very good thank you. So i think i want to follow what commissioner karshmer just mentioned you know like if we just like play that through you know if this is really where you know some of the most poverty stricken contingency that supposed to be our responsibility we need a different kind of plan i think that through all our partners they also have you know mentioned similar suggestions about you know trying to taking into account what it means as we move forward with the charity care i think this is y where f it gets interesting so if theyre really you know like assessing they resource full to assess the services but but at the same time, they selfsign up for you know like our haeblth plan and didnt like enroll in medical extensions so that question is the big question for me you know why and why not and inter