Section 18

Additional Responses
of the Budget Analyst
to the Written Response of the Director of Health
to our Final Draft Report

 

Section 1: Revenue Projections in the SFGH Annual Budget

1.1

We agree with the Department to defer the report to the Board of Supervisors on FY 2002-2003 net revenues through March 31, 2003, until May when final financial results are available.

Section 2: Setting Annual Patient Rates

2.1b We continue to recommend that the Department of Public Health incorporate the cost of providing services into patient rates when setting rates. Because the Department does not uniformly set patient rates for specific services to equal the cost of providing the service, the Department is not able to identify if established rates for specific services equal or exceed the costs of providing services.


Section 3: Capturing Charges for Services

According to the Chief Financial Officer for the Department of Public Health, the Department is developing a proposal for two new revenue auditor positions in the FY 2003-2004 budget. We will review the Department’s proposal for the two new positions during the FY 2003-2004 budget review, including a cost-benefit analysis of these positions and the proposed scope of duties.

Section 4: Basing Self-Pay Charges on a Patient’s Ability to Pay

Our review of the Sliding Scale Program found that the fees are not equitably distributed or based on the patient’s ability to pay. As noted on page 45 of this report, the sliding scale fees exceed discretionary income for families with income equal to 100 percent of the Federal Poverty Level (FPL), but make up 15 percent of discretionary income for families with income equal to 500 percent of the FPL. Under our recommendations, the Department of Public Health would determine new sliding scale fee schedules, based on an analysis of data, including historical data and patient default rates and submit these proposed fees to the Health Commission and Board of Supervisors for approval.

Section 5: Monitoring Billing and Collections

We continue to recommend that San Francisco General Hospital’s Patient Financial Services Division establish, monitor and report on enhanced performance measures of the billing and collections process, including:

  • Developing a systematic approach, including a reporting package, to monitor overall billing and collection performance, which would include both internal and external measures. These internal measures can be obtained from information contained in the Invision financial system, although obtaining this information would require programming resources.

  • Producing monthly or quarterly reports, analyzing the performance measures and establishing goals and objectives for management and staff.

  • Submitting quarterly status reports to the Executive Administrator and the Director of Finance on the achievement of the goals and objectives, as measured by the specific, quantifiable performance data.

Section 8: Monitoring Uncompensated Care Recovery Services

8.1 We continue to recommend that the Department of Public Health amend the contract with Health Advocates to provide an inclining fee structure. We believe that the inclining fee structure serves as an incentive to the vendor to collect the more difficult accounts.
   
8.2 We agree with the Department that six months is a short period to monitor the performance of Health Advocates. Health Advocates began performing services in February, 2002, and our analysis of their collection efforts continued through June 30, 2002. However, we continue to recommend that the Department improve monitoring of Health Advocates and of the Eligibility and Outpatient Registration Divisions. Our review found that the Department does not systematically monitor vendor performance and does not track referrals to Health Advocates, inhibiting the ability of management to measure the performance of the Eligibility and Outpatient Registration Divisions.

Section 11: Materials Management and the Automated OmniCell System

The Budget Analyst will review implementation of 10 new OmniCell units and associated staff during the FY 2003-2004 budget review, including all data provided by the Department of Public Health regarding the costs and savings of the OmniCell system.

Section 12: Controlling Rising Pharmacy Costs

12.1, 12..2, and 12.4 The Budget Analyst will review the Department’s proposal for each of the Department’s Federally Qualified Health Clinics (FQHC) to contract with a community pharmacy to obtain Federal Public Health Service discounts during the FY 2003-2004 budget process. According to the Director of Pharmaceutical Services, the Department will submit to the Health Commission a proposed 3-month extension to the current the Pharmacy Benefits Management contract with Pharmaceutical Care Network, extending the subject contract from the original expiration date of March 31, 2003 until June 30, 2003. The Director of Pharmaceutical Services states that the new proposed contracts between each of the Department’s FQHC clinics and a community pharmacy will become effective on July 1, 2003. We agree that recommendations 12.2 and 12.4 are not applicable when the Department terminates the Pharmaceutical Care Network contract on June 30, 2003.
   
12.3 We continue to recommend that the Department implement the California Board of Pharmacy staffing ratios in the Outpatient Pharmacy. We will review all data provided by the Department of Public Health during the FY 2003-2004 budget processregarding the Outpatient Pharmacy and Manufacturer’s Patient Assistance Program staffing.

Section 15: Expenditures on Nurse Staffing

15.2 The Budget Analyst will review San Francisco General Hospital’s program to recruit and hire qualified licensed vocational nurses and licensed psychiatric technicians during the FY 2003-2004 budget process, including current vacancy and turnover data for these classifications.
   
15.3 Although the Director of Health has stated that this recommendation is not applicable, our review of information provided by San Francisco General Hospital staff indicates that pay rate data can be downloaded from the HR 2000 automated personnel system to the One Staff automated staffing system. Therefore, we continue to recommend downloading of pay rate data from HR 2000 to One Staff.