COUNCIL OF THE CITY OF PHILADELPHIA2 COMMITTEE OF THE WHOLE - - - Room 400, City Hall Philadelphia, Pennsylvania5 Wednesday, April 22, 2009, 10:20 a.m. - - - Res. 090226 - Approval of revised Five-Year8 Financial Plan covering FY 2010 through 2014. Bill 090212 - FY '10-'15 Capital Program. Bill 090213 - FY '10 Capital Budget. Bill 090214 - FY '10 Operating Budget. COUNCILMEMBERS PRESENT: Anna C. Verna, Chair Marian B. Tasco, Co-Chair15 Jannie C. Blackwell Blondell Reynolds-Brown16 Wilson W. Goode, Jr. Bill Green17 William K. Greenlee Curtis Jones, Jr.18 Jack Kelly James F. Kenney19 Donna Reed Miller Frank Rizzo20 Maria Quiñones Sanchez - - -22 V A R A L L O Incorporated23 Litigation Support Specialists 1835 Market Street, Suite 60024 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.267025 2 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Good2 morning, everyone. This is a continued3 public hearing of the Committee of the4 Whole.5 The first department that we6 will hear today will be the Health7 Department.8 (Witness comes forward.)9
Good10 morning, Doctor. Good morning and11 welcome.12
Please14 identify yourself for the record and15 proceed with your testimony.16
I am Donald17 Schwarz, the Health Commissioner for18 Philadelphia. Good morning, President19 Verna and other members of Council. 25 3 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 The Department's Fiscal Year2 2010 budget request totals just under3 $332 million. 19 The Fiscal '10 budget will20 continue to support services basic to the21 Department of Public Health's ability to22 carry out its core mission to protect and23 promote the health of all Philadelphians24 and to provide a health safety net for25 4 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 those most at risk. 15 The Department continues its16 longstanding practice of contracting with17 minority-lead agencies and businesses,18 both for-profit and nonprofit. 7 However, as I told Council last8 year, I am committed to contacting with9 minority business, whether for-profit or10 nonprofit. 12 These patient fees will be13 instituted on what is known as a sliding14 scale, which means that those with the15 least means to pay will be charged the16 least. 19 I should note that this kind of20 sliding-scale fee arrangement is a federal21 requirement operation of our health22 centers as federally-qualified health23 center lookalikes. 7 Currently, the pharmacies8 dispense more than 600,000 prescriptions9 in over-the-counter medications annually10 to health-center patients. 14 Our medical staff will15 closely -- be closely monitoring patients'16 adherence to recommendations involving17 over-the-counter medications and their18 health outcomes. 11 The Fiscal Year '10 Budget is12 based on the likelihood that the13 Commonwealth will approve the request of14 the City Administration to increase taxes15 and extend payouts on the City's pension16 debt. 21 Unlike the proposed budget22 scenario I have described, a cut of this23 magnitude would result in changes in the24 level of services we currently provide. 21 Closure of one health center22 could lead to 41,767 fewer patient visits23 for about -- of 10,900 patients. 13 If these additional reductions14 to the Fiscal Year '10 Budget come to15 reality, there is no doubt they will16 present several additional obstacles to17 the Department in meeting basic public18 health needs. 4 Thank you for this opportunity5 to present testimony today. 7
Thank8 you very much, Doctor.9 If the Administration had to go10 to Plan B, we are told that a health11 center would be closed. Has the health12 center been selected?13
If we15 were to close a health center, wouldn't16 there be revenue losses as a result of the17 closure?18
There would. And19 one of the issues for us in choosing a20 health center would be trying to balance21 both revenue lost and also the loss of22 expense. So the dollars in the budget23 represent the net out of revenue24 generation and expense lost.25 13 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
So at2 this point in time, we don't even have an3 estimate of what the revenue losses would4 be.5
We have looked6 actually across health centers -- and I'm7 happy to provide information by health8 center on both revenue and expense -- so9 we can look at net cost per health center.10
Thank you,15 Madam Chair.16 If you could include -- good17 morning, Dr. Schwarz.18
If you could20 include in what you provide in that regard21 the estimated revenue from the new charges22 and fees, not just historical revenue by23 health center. In other words, we're24 going to start charging for different25 14 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 things --2
-- in the4 future. I'm not -- so it seems to me, you5 know, if we can't make up $2 million in a6 health center doing, we're something7 wrong: We're not getting our federal8 reimbursements, we're not filing our9 paperwork properly, we're not et cetera.10 And then also please include11 what you estimate we'll be able to achieve12 in terms of reimbursements once we go13 paperless in the medical centers, the plan14 that you and I have been discussing for15 over a year.16 Thank you.17
Since this is a18 point of information, perhaps we'll talk19 when you ask me about it more.20
Thank21 you, Doctor.22 Doctor, can you tell us -- we're23 getting back to the closure of a health24 center -- what process will be used to25 15 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 determine what center could possibly be2 closed?3
So we are looking4 at both revenue and expense, we're looking5 at service utilization by health center,6 trends in the number of patients who have7 been seen at any given health center over8 time, alternatives within the9 neighborhood.10 So what are the other11 opportunities particularly for the12 uninsured to receive health services13 closer to their home.14 Travel distance, not only what's15 in the neighborhood, but what are the16 travel routes.17 Um... and the impact on the18 uninsured as best we can.19 Last year I presented20 information looking -- mapping out across21 the City the impact of individual health22 centers. You might remember my23 conversation with Councilman Jones. And24 it's that information which we have that25 16 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 is also a part of the conversation.2 We hope, I should reiterate, not3 to need to close a health center.4
And we5 agree with you.6 Doctor, in Fiscal Year '09, the7 City instituted the Acute-Care Hospital8 Assessment Program. Can you tell us what9 the goals were in its implementation? And10 have we achieved them?11
We don't yet have12 the revenue. And I'm happy to explain13 where things are, if that would be helpful14 to you. And I'm also happy to explain how15 we would spend the revenue if it came in.16
This is a somewhat18 complex series of events.19 The first is that Council20 needed, a year ago, to authorize the21 collection of taxes from hospitals.22 Similar legislation was introduced and23 approved in Harrisburg.24 The next step, once the State25 17 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 and city have agreed -- or County have2 agreed to the collection of a hospital tax3 and the mechanism by which revenue would4 flow from the City to the State, the State5 would then need an agreement or a waiver6 from the Federal Centers for Medicaid and7 Medicare Services to agree to match those8 dollars, provide them to the State. And9 the State would then need to present a10 plan to pay the dollars back to the11 hospitals and to allow Philadelphia to12 have its share.13 It has been a long process, as14 you might imagine, in a federal election15 year. And the State has done its work.16 We have collaborated, as have all of the17 hospitals; there are monthly meetings with18 all of the hospitals in the State.19 And at the moment -- I was in20 Harrisburg yesterday, and the Department21 of Public Welfare tells me that there's22 only one more hurdle to jump for the23 Center for Medicare and Medicaid Services24 see approve the State's waiver. We expect25 18 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 that will come in May. At that time, it2 will be retroactive to January.3 I should state that the payments4 back to hospitals provide increments to5 almost every hospital in the City. So the6 hospitals are quite anxious for this7 revenue to flow, and we're quite anxious8 to have it happen so we stabilize the9 hospital network in the City. But we10 don't have the dollars yet.11 When we do have the dollars,12 they will go to both increase services at13 our district health centers to help14 finance an electronic health record for15 both the City's health centers and the16 Prison. And a part of it will go to cover17 the costs to the City for the revenue18 collection.19
I see20 that there are a number of Councilmembers21 that want to be recognized. Again, each22 Councilmember will be allotted five23 minutes on the first go-around.24 The Chair at this time25 19 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 recognizes Councilman Goode.2
Thank you,3 Madam President.4 Good morning, Dr. Schwarz.5
We have a7 huge multi-million-dollar misunderstanding8 of what we're asking for in terms of9 business diversity.10 In your testimony, and in other11 testimony by other departments, it seems12 that you believe that Council was asking13 you to contract with -- or track the14 percentage of non-properties that you15 contract with that are comprised of16 minority board members. That's not what17 we're asking for at all.18 What we're suggesting is that,19 with the amount of contracts that you have20 out there, with DHS alone, it's about a21 half a billion dollars in purchase of22 goods and services.23 All of those dollars do not go24 toward salaries and benefits. Some of25 20 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 those dollars go toward the purchase of2 goods and services by those contractors.3 That purchase of goods and services by4 those contractors is done with taxpayer5 dollars.6 Therefore, they should follow7 the same business-diversity rules, and8 there should be goals for those contracts9 in terms of how those dollars are spent in10 terms of diversity.11 But, furthermore, there was12 actually a law passed, Bill 060855, which13 dealt with how we deal with diversity14 issues in terms of participation goals,15 which says within it that the report from16 the Finance Director's office, which was17 conducted by MBEC and now conducted by the18 Office of Economic Opportunity, should19 include City contract participation goals20 with disadvantaged businesses and21 not-for-profits City contracts related to22 for-profit subcontracting opportunities.23 What we're asking for, and the24 information request that I'm going to25 21 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 make, is that you contact every single2 contractor that you have that's spending3 taxpayer dollars, and you look at what4 they're spending in terms of goods and5 services, and tell us essentially what6 level of participation there is.7 But before you respond to that,8 let me clarify, even within your9 testimony, what did the Department of10 Health specifically spend in terms of11 goods and services, purchase of goods and12 services, Class 200, total amount?13
With for-profit.18 So its total value for minority19 and women contracts is 6.2 million, total20 dollars.21
My question22 was: What's the total you spent in Class23 200 with for-profit companies?24
It is25 22 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 $11.74 million.2
Okay, that's6 good.7 And what percentage of Class8 200, with your nonprofit subcontractors,9 do you believe is for goods and services?10
I'll give a13 general question first. Of the -- take14 DHS, for instance; it's half a billion15 dollars in purchase of goods and services.16
How much of18 that goes toward direct purchase of goods19 and services by those nonprofit20 subcontractors?21
So I apologize22 that I have my information on health; I'll23 have my information DHS this afternoon.24 I'll be happy to provide that. I'm happy25 23 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 to provide any --2
In terms of3 health, in terms of health, in terms of4 your nonprofit subcontractors, do we know5 how much business they did in terms of6 procuring goods and services from7 disadvantaged businesses?8
So we are actually11 in the process of collecting that12 information. We have, I would say,13 probably about 65 or 70 percent of all of14 our vendors' information on their minority15 participation in goods and services that16 are subcontracted by them, and I'm happy17 to --18
We need that19 information forwarded through the Chair as20 soon as possible --21
-- because23 it's an extremely important part of this24 budget process.25 24 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 What you should also know is2 that I believe Councilwoman Miller has3 introduced legislation that would apply to4 economic opportunity plan requirement to5 nonprofits.6 (Timer bell rings.)7
So we're8 going to dig through this. But as long as9 those are taxpayer dollars, even if10 they're going to nonprofits, we need to11 set business-diversity goals for those12 nonprofits as well. They should have to13 play by the same rules.14
We completely15 agree, and we will provide that to the16 Council President.17
Thank20 you.21 The Chair recognizes22 Councilwoman Blackwell.23
Thank24 you, Madam President.25 25 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Good morning, Dr. Schwarz.2
I4 certainly want to recognize Ready, Willing5 and Able, and we're always proud to6 support them and what they do.7 My question deals with and this whole issue of charging people9 for prescriptions in heath centers and10 charging them, period, in heath center.11 I'm really concerned about patients fees.12 I mean, they say 767,000, I see. And13 medications, 1.5 million.14 But what do we gain when we hurt15 those who are unable to pay? I wanted16 to -- I don't understand that, I don't17 know what federal law would be enacted. I18 mean, the -- this president is giving more19 back to the states and the cities, not20 taking things from those -- not taking21 dollars from those who need it most.22 So I don't understand that. I'd23 like a little more discussion on that and24 where people -- is it that you're changing25 26 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 them getting prescriptions from the health2 centers to another location, or is it that3 they just can't get prescriptions?4 I'm worried about those issues.5
I think we, in the6 Department, certainly share your concern.7
I brought with me,10 and happy to make available to the Chair,11 the federal regulations.12 The federal government allows us13 to be what are call federally qualified14 lookalike health centers. That means that15 payments from the federal government and16 the State for patients who have Medicare17 and Medicaid are enhanced to equal our18 costs for the services that those people19 receive.20 For people who are uninsured, we21 are required, by taking those federal22 dollars and State dollars, to have a fee23 schedule and to collect from those who are24 uninsured.25 27 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Is this2 new money? Is this additional money? Is3 it some new law where, all of a sudden,4 you got to charge people?5
So it has always6 been a federal requirement. We have had a7 fee schedule; we haven't collected. And8 there has been, I would say, increasing9 issue around this.10 The other federally qualified11 health centers in Philadelphia all have12 fee schedules, and they charge patients.13 We, as the safety net provider, agreeing14 with you, are setting our fees lower than15 the other centers in the City in order to16 provide the minimum barrier to people. and17 --18
But if19 we haven't -- if you said it's always been20 there and we haven't collected, why are we21 doing it now, when the economy is bad and22 people can least afford it?23
I agree with you.24 Two issues. One is --25 28 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
I'm2 sure -- I bet you it's a Bush initiative.3 Sorry. I couldn't help that.4
-- go generate5 revenue, which we need to keep the health6 centers open; and, two, to meet the7 federal requirement.8
Well,9 we don't agree with it. And I'm sure I10 speak for my colleagues.11 It's kind of like full tax12 valuation; they always said that too13 because it's on the books and we haven't14 done it. And I'm sure that I speak for15 everyone in Council when I say if you16 haven't done it, we don't need you to17 start it now, when people are in such18 trouble.19 Can you tell me about the20 over-the-counter medication as well?21
Absolutely. So.22 We provide for free over-the-23 counter medications. And as part of the24 budget reduction, rather than cutting25 29 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 services and rather than cutting2 prescription medications, we are removing3 them. They're accessible to people;4 people would need to purchase them in a5 drugstore, as others do for over-the-6 counter medications.7
Well,11 let me say, for $2 million, when we spend12 billions, I'm sure that I speak for every13 member of City Council when I say we don't14 agree with either initiative. Ever since15 I heard it, I've been frightened to death.16 I mean, we're worried about the17 long lines; a person having a toothache18 can't get seen for two months and people19 in pain, but we just can't. I mean, some20 things moral commitment dictates when it21 comes to people in need. Some things, we22 as leaders, have to decide that we're not23 going to do. Some things mean more.24 And in a multi-million-dollar25 30 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 budget to save $2 million and charge2 people across the counter and to charge3 them prescriptions, it's just not4 something that we as a Council agree with.5 And we hope that, in your budget6 deliberations, that you may reconsider7 this because I'm sure that everybody on8 Council agrees with me, and there will be9 kickback about it if you don't reconsider10 it.11 Thank you, thank you. And thank12 you, Councilman for letting me go.13 (Applause.)14
Thank15 you.16 The Chair now recognizes17 Councilman Greenlee.18
Thank you,19 Madam President.20 Good morning, gentlemen.21
Staying on23 that same line, I had a couple questions24 about health centers, but particularly on25 31 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 the line that Councilwoman Blackwell was2 asking.3 On these federal requirements,4 has the federal government gone after the5 City at all for not collecting this money?6
So I would say it7 has been noted. They have not charged us8 penalties.9
Mm-hmm.10 Has this been recently, since a new11 administration took over?12
Since the14 new administration took over? Let me put15 it that way it has.16
It has,18 all right.19 I mean, in all fairness, and I'm20 not even going to get into, you know, the21 yea or nay of this, isn't the real reason,22 though, is the City's fiscal problem? I23 mean, isn't that why it's being promoted24 now?25 32 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
I hear14 you, okay. But, I mean, really, it's15 bringing it to the fore because we have a16 money problem right now. Okay.17 Along those same lines, what is18 the kind of, if I could call it, mechanism19 of doing this? Are people informed --20 well, is the plan -- saying it will go21 forward, is it people will be notified22 ahead of time what they have to bring in,23 but they will not be able to partake of24 the service unless they pay up front? Is25 33 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 that basically how you're seeing it?2
The devil of the6 detail here is, we don't want to deny7 someone who needs urgent service that8 service.9
And we also don't11 want to put the employees in the health12 centers in a position of making life-and-13 death determination if they're not14 qualified to do so.15 So, one, we need clear policy;16 and, two, we must notify people. So both17 at the time that appointments are made and18 at the time of arrival and before we19 implement this at a last visit, we will20 need to notify people.21 We also are intent on not22 collecting cash but using some sort of23 smart card technology so that people can24 easily pay, efficiently pay, but our25 34 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 workers won't have to handle cash.2
Okay. And3 that's still, I assume, being worked out.4
Okay.6 Along the lines of health centers also,7 speaking of lines, I guess, what is the --8 has the waiting time for service how much9 -- you know, I've asked that before. I10 think a lot of people have that in -- how11 much has that changed?12 Hopefully, you're going to tell13 me in a positive manner, but whatever.14
I'm going to tell15 you that last year, we had about a 516 percent increase in the budget for the17 health centers.18
So we're providing23 more service, but what it's meant is that24 we've not made much progress on waiting25 35 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 time.2 We've made progress on waiting3 time for prescriptions because we've been4 able to fill vacancies.5
But in terms of7 the waiting time overall in the system, it8 looked like the we were making progress, I9 have to say, through the spring of last10 year, but the numbers of people needing11 service have gone up.12 And as a result, our waiting13 time has gone up.14
Can you15 give anything to the Council President as16 far as the information?17
No, we23 don't have to go through each one, but I24 will ask about one particularly since it25 36 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 seems to get a lot of con -- District2 Center 10.3 And I know a lot of that is4 just -- it's -- the catchment area, if you5 will, is so large. But could you just go6 into that a little bit as far as what the7 timeframe problems are?8
-- can12 you tell us how long one has to wait for13 an initial visit?14
I can, I can tell15 you. I can tell you that it is about six16 months.17
For a new-patient23 visit at District 10, it's been six24 months.25 37 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Wow.13 What -- and is there -- I don't want to be14 taking away from other places, you know,15 'cause we'll get in -- being Councilmen-16 at-large, I'll get yelled at by somebody,17 but that sounds -- is that inordinately18 longer than other districts?19
I'm24 curious to know --25 38 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
What7 I'm curious to know, is that initial visit8 of six months just in the 10th District?9
So I have it. I'm13 sorry for the delay.14 It is about 190 days at Health15 Center 10 for a new visit -- for an adult,16 not a child.17 And Health Center 2, in the18 second Councilmatic District, is 18 days.19 Health Center 3, 41.20 Health Center 4, 96.21 Health Center 5, 4.22 Health Center 6, 63.23 Health Center 9, 5.24 Health Center 10, 190.25 39 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 In the Strawberry Mansion Health2 Center, 40, for an average of 58 days.3 We encourage people, when we4 schedule appointments, to use one of the5 other health centers. We also give them6 information about other health in their7 area.8 The issue with Health Center 109 is twofold: One is that there aren't many10 alternatives in the areas.11
And two is that13 the number of uninsured in that part of14 the City is growing more rapidly than15 anywhere else.16 So we have opened additional17 hours. We are looking carefully at18 staffing. And the hospital tax dollars19 will go to Health Center 10 in particular20 to try to meet demand.21
Thank24 you.25 40 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
-- I just5 was wondering if there's any6 possibility -- and I know I could get in7 trouble with other areas of -- you know,8 because that's such a big difference -- of9 some way readjusting something. I mean,10 that's easy for me to say, I know.11
And looking at22 ways to improve efficiency. And, in fact,23 Health Center 10 has done a very good job24 in terms of working on improvements to25 41 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 efficiency.2
But the physical4 plant there is limitation. It was built5 without the anticipation that things would6 grow as quickly or as much in the7 northeastern part of the City,8 particularly for uninsured individuals.9
Okay, all13 right. Thank you.14 Thank you, Madam President.15
You're16 welcome.17 The Chair recognizes Councilman18 Green.19
Thank you,20 Madam Chair.21 With respect to the President's22 earlier question, in addition to what else23 you're going to provide in response, if24 you could identify revenue expenses for25 42 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 each district health center, identify --2 and I just want to be clear about what it3 is I'm looking for.4 Identify any additional5 reimbursements from the state and federal6 governments that would be placed in7 jeopardy due to a net loss of patient8 visits or otherwise if the City closed the9 health center.10 In other words, using the11 revenue projections on Pages 13 and 18 of12 the Operating Budget Summary, detail the13 potential losses in revenue categories by14 health center from closing health centers.15 Okay.16
I can say that17 there shouldn't be any jeopardy in terms18 of additional federal or state dollars,19 but we would be happy to provide the rest20 of it.21
It doesn't -- we24 don't get reimbursed in that way.25 43 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Patient visits4 are, but it's -- I maybe misunderstood.5 I'm glad I'm clarifying.6
We get paid per8 visit, or capitated per head, for someone9 over the course of the year, but I think10 the word you had used is "additional."11 And I just want to make sure I understand12 that.13 There is no --14
Okay. Just18 out of curiosity, if part of the problem19 at District Health Center 10 is no nooks20 and crannies left in the building, have21 you looked at selling that building and22 relocating to a different location?23
Do you think25 44 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 that maybe is a good idea?2
I think it would3 be a good idea at a time when we have4 additional resources.5
So it certainly is7 something that we're exploring with anyone8 we can find who might be able to provide9 us with additional resources, but I don't10 know if the best --11
We do. We have a14 PICA assessment of the building. And15 we've used that PICA assessment, working16 with Property, to look at all of the17 Health Department property.18 One of the questions that you19 might ask me next year, and we could talk20 about, is whether the solution for the21 Northeast is to close and reopen a larger22 health center or to have a second23 location. And I don't know the answer to24 that.25 45 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 I will say that one of the2 activities I have undertaken this year is3 to work with other providers of care in4 the City to encourage them to open other5 sites in the Northeast, because we're not6 the only potential provider of services.7 And there are others who have access to8 capital in other ways.9 I will say that we are pleased10 that Holy Redeemer Hospital has recently11 opened a new primary-care site in the12 Northeast. It has not been open long13 enough for us to see if it makes a14 difference for our waiting time.15 But we have actively sought16 partners based on the analysis, which I17 talked about here last year, in areas of18 the City where we know there's19 under-service, to assure that when20 providers are looking for new sites, they21 try to target those sites, to places where22 there's under-service in the City.23
And are we24 losing the opportunity to open our own25 46 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 sites?2 In other words, health centers,3 it would appear, based on the cost of the4 health center, compared to the amount of5 reimbursement we get, which is over6 $70 million for our health centers, if7 they cost 2.5 million to staff, which is8 what the benefit of closing one will get9 you, according to your testimony, maybe we10 ought to consider opening more health11 centers?12 I mean, we do have a capital13 budget, which is separate from our14 operating budget. They're separate15 dollars. It's surprising to me that we16 would not want that extra money in our17 health department versus, you know,18 encouraging other -- you know, we're19 either going to be in the health center20 business or not.21 And if it's kind of profitable22 compared to the -- the cost compared to23 the reimbursement we get, then I'm24 confused.25 47 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
So the cost to the5 City, net cost, is about 2.3 million in6 the budget. The cost to run a health7 center varies, but the City doesn't make8 money on the --9
Okay. We10 lose 2.3 million on average on each health11 center.12
Thank you,21 okay. But I still looking forward to that22 detail.23
In FY '08,25 48 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 there were 666 full-time employees.2 Leaving out overtime and bonuses, et3 cetera, the Class 100 expense was4 31.1 million.5 In FY '09, there were 757 budget6 full-time positions, an increase of 91.7 As of January 2009, only 662 --8 (Timer bell rings.)9
-- of these10 positions were filled. The estimated11 Class 100 spend for salaries, again12 leaving out overtime, bonuses and so on,13 for FY '09 is 34.6 million.14 As of January '09, we were down15 4, but the FY '09 spend is up $3.5 million16 versus '08.17 Can you explain that to me?18
I believe, if I'm19 following you correctly, it has to do with20 the hospital assessment.21 So the hospital assessment was22 booked for half a year in Fiscal Year '0923 and a full year in Fiscal '10, because we24 wanted to make sure that we had the25 49 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 authorization in here. And we've not2 received the revenue, so we've not3 increased the expenses, but we have the4 positions here so that Council could5 approve them should the money come6 through.7 Is that --8
Well, how are9 we spending -- it looks like we are10 actually going to spend 3.5 million more.11 So, like, what you're answering is a12 revenue question.13 The real question is: We're14 spending 3.5 million more even though we15 have 4 fewer positions.16
So the issue here17 is, we've booked both the revenue and the18 expenses for the hospital tax. So what19 you see is the increase in positions and20 the increase in anticipated expenditure21 that would match the revenue that would22 come in from the tax.23 We took half of it, half of the24 number for Fiscal Year '09 and a full25 50 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 year's worth for '10.2 Is that...3
Well,4 according to what I have in front of me,5 you are actually going to spend, for '09,6 3.5 million more than you spent. Like the7 expenditure, based on the number of8 positions, 662, not the fully budgeted,9 the expenditure, based on 662, 3.5 million10 more than you were spending in '08, which11 is at 666.12 So how can we spend more money13 with four fewer people? That's the14 question. This is what you are actually15 going to spend according to the increment16 line.17
So part of the18 issue here has to do with filled positions19 versus budgeted positions.20
So the Health22 Department has had in the past a large23 number, as have many other departments,24 but Health in particular, of unfilled25 51 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 positions. So the budgeted positions,2 these are actual.3
Actual '08,7 666; actual '09, 662. We're spending8 3.5 million more.9
Okay. The Fiscal10 Year '09 estimated obligation is the11 target -- or the mid-year adjusted budget12 number at this point. That includes the13 revenue from the hospital tax.14