Transcripts For SFGTV Health Commission 9115 20150908 : vima

SFGTV Health Commission 9115 September 8, 2015

Well call the meeting to order role commissioner pating ill note to here commissioner singer commissioner chung commissioner sanchez and sxhashgs the second item on the agenda is the approval of the minutes for august 418, 2015. There a motion. Missouri any comments no nope ill call for a vote. All in favor, say i. Thank you. Ill note no Public Comment for the item. The audience this is the first time ive chaired ill not get it right so. You have a skilled secretary here to help you laughter so we move on to item 3 the directors report. Good afternoon wanted to lead the issue on the waiver because we do have a couple of is to have staff people to address this so ill leave that alone and move on to the next item and right after my report well have a couple of Staff Members to report on that the San Francisco Health Commission has worked with the San Francisco Police Department the dope project for the current overdose just to let you know San Francisco has the largest number of over disposes in california weve work hard to curve those Overdose Deaths on thursday august 27th the Police Department said a Police Officer o Police Officer said saved the life of that person the june incident marked the first time the Police Department officer used the location to give the medication to save the life of that person ive been a supporter of placing a lock on kits with the San Francisco Police Department and the department of Public Health has approached me according to to chief suhr one life lost addiction is too many so doctor martin is here part of the press release and the press reference in march of 2013 it was announced this is a two Year Pilot Program with the Police Department to make sure they have the locks on available for the experienced opium overdose and questions this is a Pilot Program please expect me to bring this for full funding that is important to continue to support the Police Department in this area as you can see they can save lives the San Francisco Network Clinics has been selected as the winner of the award given by the National Resource corporation it has patient you surveys United Nations for the Patient Experienced for improvements for ratings for the providers on the experience survey that is an acknowledgment of the patient for the come National Care two from the providers and we want to thank the staff for the services and clearly being acknowledged by the great support for continuing this work on the transition to our new hospital since ive last report your hospital has a staff approval from the california statewide planning and development we have a few construction items to complete that approval signals a phase of the new hospital from the construction to the transition so a behalf brand new occupied facility the two phases are one the staffing and training and orientation which we have observe 54 hundred staff to train and orient and on choosing the equipment and preparation ill leave that there if there are other questions im available to respond at this point unless questions for this report id like to ask colleen to start on the waiver updates and dr. Martin will precede with that on the Substance Abuse you weve received an update about the waiver did Health Commission harder in the financial presentations about the reunder the influence of alcohol of waiver and the importance of that for our budget the amendments youve got updates on are to the existing waiver has nothing to do with 80 with the hospital financing to extend medical to pregnant on wee women blofr the passport level and a Substance Abuse order for snauns dr. Martin will speak to the second the first is the prenatal and postmortem care over a hundred percent of the poverty to the current waiver those two elements are on the tail end of the current 1115 waiver expires on october 31st is expected those programs will continue alongside the Public Hospital programs that we anticipate to be knitted in the new waiver and dr. Martin. On that program the how many women will it affect. I dont know the answer to that the women in San Francisco. The woman in San Francisco. I dont know the answer i think the majority of the women are below hundred and 38 percent of poverty it impacts the largest proposition. Good afternoon. Im mostly here to answer questions if you like the Substance Abuse medical is the bridge to reform waiver as of 13 it is a demonstration waiver 1115 waiver called the organized Delivery System of medical waiver so the state amended the state plan and made a parole to cms approved this august to show it if they increased the Services Covered by drug medical that they could by organizing the system and having smooth trisz from levels of care and using evidence based practices they could improve the care and overall costs of medicaid would not go up you can opt in or not opt the community likes a demonstration waiver they should we we already do so were coming in and the bay area was chosen as phase one so there are several tasks for Substance Abuse services im in charge of one to have the implement plan with the timelines for everything and another one to set rates we negotiate with the state and make a new contract we want the rates to be realistic because if you compare grants the drug medal there is a huge increase in accountability and recordkeeping required for the providers as you may know Substance Abuse is contracted out and so the main task we already have in the orchid Delivery System almost all the services described it is just we have to document those things in different was including the criteria and so the main task weve been working on since 2013 when they started this job was to get our current providers who are not drug medical certified to apply for certification which is a long orus process so we have maybe five or six that have applied and maybe of in the next week or so including all the residential programs that have not burger to bill the drug in the short time so when they apply there is no retroactive payment no incentive in other words, the state didnt give start up incentives the programs are suffering how can i hire a medical director not had to have one before well so for we dont have the money to help you but in the future a steady stream of income maybe thats your incentives those are the things to provide our providers weve hired a instead of person that is wonderful and lead in our Substance Abuse department to help support people get certified and when they get those letters back every single application for drug medical hundred percent of them get a remediation laundry list of things to check off and get in form and that notarized so were working on that right now. Thats great, thank you. Commissioners, any questions . Do you mind, if any. I have a few questions for dr. Martin ive known dr. Martin for a long term wards to the fee waiver that is about expanding Substance Abuse for the medical program this is been the big effort part of this we didnt have a basic drug medical benefit so i want to thank judy for arguing on behalf of the county to get an extended benadryls do come without obligations and responsibilities so with regards to the demonstration it talked about 10 Community Coming online this is the first phase of the 10 county; is that correct. The 10 community were places theyve tested out things now most of the communities are opting in this is the actual implementation starting august 13th phase one is the bay area exultant that refers to bays montgomery and San Francisco bay area those are part of bay area counties and as far as i know theyre all opting in. As far as the services we have a full breath of services from residential to outpatient to medical services and it sounds like youre trying to bring enough providers on do we have enough provider to meet the needs of city and when will we be there having enough services for the patients. Im glad you, you raised that commissioner pating david was up on the Advisory Committee he had a lot to say how it is designed were missing some a became clinicians although we have care plans that are really busy in primary care physicians were discussing starting safety net oriented awe definition medication residency with the 486 we need licenses providers with health care who are licensed and connection may diagnoses right now a lot of the programs only work with certified xhounldz we need to bring the level of professionalism higher in the field and so, yes we need to have i mean right now such minimal payments are brought in by drug medical a lot of the programs suffer from entrylevel people interns and high turn over when i meet with the providers i had a staffing check with them and the theme is also we need more counselors weve lost them they come in and work for a couple of months on the one hand were training new people in sabs when they go on to other places on the other hand, it is a high stress for the programs to be doing that all the time. So the last question i guess is financial San Francisco has had a very whether we get reinforced from the state we offer the services for every person not treated end up in the longshoreman emergency room in the hospital so i think weve been ahead of the curve wards to the new funding coming in for the medical waiver will this change the Financial Plan at all will we get more money because we offer so Many Services there wont be new funds following or well be responsible for things not funded how will the match of u up for the medical environment. Yeah. I dont know that a clear picture it hadnt happened net i think this is a pioneer tax well pay in terms of not being dramatically able to reduce things like looerments visits we have those paid and the general fund the main difference well see is that maybe general fund can be used for something slightly different missing or not used at all maybe and the expansion has brought in a significant amateur of federal match hundred percent matched for the medicals methamphetamine clinic weve paid for assuring for the uninsured people now since 2013 a lot of those people are insurance particularly the methadone clinics have worked really hard to enroll their uninsured people into medicare to start billing. Thank you you have your work cut out for you and its exciting so maybe this effects the waiver in San Francisco. Thank you very much item 4 is there a Public Comment ive not received any requests. Item 5 a report back from the finance committee. Ms. Johnson. Good afternoon the finance committee met 3 oclock we went through the full contract and also the contract report it is all on the consent calendar and in addition the also have added you can romanced for the request from cat and this is for the medical respites and the reason for the relocation there is actually expanding and a. D. Another thirty medical records to their current bed coincidence all on the speaker cards and documents to be included should be submitted to the clerk. Calendar. We asked if anyone should be removed. If the commissioners want things for separate items. Shall we move for approval . Move to approve the consent calendar thank you a second. Second. All in favor, say i. I. All right. Thank you commissioners thank y thank you sxhaurn item 8 the San Francisco General Hospital bylaws good to see you before just to note commissioners these revisions have been reviewed and recommend for approval by the general cc. Maybe give us background why some come here and jc dont need to come here. The only thing approved by the jc are the minutes and the Financial Report and anything for confidential patient reports but policy comes to the full commission. Dr. Mash i have 3 the changes in the rex rules and regulations on the current rule limited to positions of the medical staff for the professionals Nurse Practitioners to the certified midwives pursuant to the standard dices procedure for the plan we submitted to the dph in response to the recent survey they conducted. So we do all those of a banish. Review them all and vote together unless theres an issue if you want to pull it out but i believe you can do it all at once. The next two are linked they relate to tightening up the process of temporary privileges are granted and so the first is currently, i grant the privileges for the chief of medical staff after the medical staff office valid day the medical licenses and training and letters of reference and service chief can request them to not go through the several month process for the people by conventional and it fournt were granting about 92 percent temporary privileges so thats higher than any other Health Care Organizations we want to tighten this up so thats what those balling changes the first action allows the criminal committee and medevac to hold a vote or business that is route wouldnt necessarily be limited but a necessary piece in order to get in time down the second is changes on the granting of the temporary privileges so temporary privileges can be granted to applicants that have clean packet it is defined as completed credentials are verified and not practice sites or missing in the packet its clean to share with the credible committee and credible committee holds an email approval for a vote and approve at which point if there is privileges needed before the jc c needs the chief of the medical staff can grant the temporary privileges that this tightens up, up not Credential Committee will approve with the chief of staff i hope to have the two email practices we can get most of the applicants to jc c and approve them and the temporary is used in the jc c has met in another month approval thats the changes in the temporary privileges. It would be reasonable to characterize those not the changing of credentials required. Right it doesnt consider that are required. The goal to reduce significantly the number of temporary privileges by getting packet through the Credentials Committee and after the jc c for regular approval and not possible at least the chief of staff is granting the temporary privileges on both packets seeing and approved by the credible committee and currently theyre not i see them and sign them. So the process is granted a reduction in a person has a significant reduction around ten percent. Any questions. I brought those they look standard and many hospitals do this to expedite new hirings and getting people in i think this is fine. Thank you for that comment on issues like this it is important to a licensed physician to Pay Attention to this so i really precious that. I should have said we look for best practices elsewhere and approval is very standard stanford as zero percent because they coffer that by email tests not possible so many things we can do by email now. Yeah. I wonder if you like just responded to a couple of things pertaining to the operational definition number one the we talked about the approval of straightforward and noncontroversial matters is there a working definition thats been you know disseminated and as an example i can think of things were there was concept called waiver for appointments, etc. But waivers are different meanings whether by the freds or state or university or medical staff a really, really comprehensive understanding i want to make sure that everybody understand what is straightforward means and theres a. Theres no change in the credentialing requirement their linked to medical they implemented revisecy theyre in Good Standing where they train theyre not significant metal malpractice grants ensue all the reference letters are complete and verified and none of that has changed i mean, the chair the credible committee does have some discretion under the definition of clean for example, how much of a malpractice settlement will constitute that packet not lean clean and sent to the Committee Members for a vote but if the chair did send it forward the packet will contain that information and any single Committee Members votes in the negative it has to go through the formal credible. Thank you very much the other one pertains to the temporary privileges 5. 2. 2 i was curious why the deletion of concurrence of the chief which i have officer on the staff i mean sometime pass there was the ceo and the associate dean or advice dean can you share with me why that would be this is 42. 2. Thats a good pickup because it shouldnt be that. Okay. Can you give us a letter so everyone can follow. 522 under the application it says the chief of staff for the ceo can grant temporary privileges i missed that i dont know the ceo and the current chief of the me

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