Do we know18 we're not getting the revenue from the19 hospital tax?20
So what you see is21 -- let me -- I'll walk you through.22 So, you see 757 budgeted23 positions in Fiscal Year '09.24
Right.25 52 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
That matches the2 34,654,664 in budgeted revenue essentially3 at mid-year.4
Excuse me,7 budgeted expense, which is matched8 essentially incrementally to the revenue9 coming in from the hospital tax.10 You then see the incremental run11 on personnel, 662. So that the 662 will12 match the actual expense for the13 Department at the end of the year.14 If we receive the hospital tax15 --16
Does the 66217 number include employees from the hospital18 tax?19
Well, why are21 you including revenue from the hospital?22 If it doesn't include it, then it is23 apples to apples, the hospital tax is24 irrelevant. You're increasing spending25 53 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 3.5 million.2
I understand both3 the confusing nature of it. I can tell4 you the -- what it represents. I can't5 tell you why it represents it that way in6 terms of history of budgeting for the7 City, but Mr. Lemmo may be able to help us8 both.9
I'm Carmen Lemmo,10 Deputy Health Commissioner.11 You're absolutely right. The12 number at 34-million-634, it is an13 estimated number. It's not necessarily a14 natural number and has nothing to do with15 the hospital tax, is not even associated16 with that. That is plain General Fund17 that you're referring to.18
The reason is that21 for Fiscal '08, actual is obligations.22 The (indiscernible) were a lot lower than23 we're currently estimating.24 If you look at the 34 million,25 54 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 it's really a projected number. We expect2 that the numbers to go up at year-end to3 close to maybe, like, 700 positions in4 terms of total numbers.5 So we are -- in addition to6 that, what happened between Fiscal Year7 '08 and Fiscal Year '09, there was a lot8 of salary increases for doctors, medicals,9 pharmacists, okay? Which, okay, were not10 necessarily reflected in Fiscal Year '08,11 but most of them were reflected in Fiscal12 Year '09. So that's another reason why we13 have a large increase in terms of dollars.14
Can you15 provide a detailed breakdown of what you16 expect of the actual numbers that you're17 going to spend in '09, what positions you18 anticipate will be filled by the end of19 the year.20 And, I guess, what your -- based21 on your current spend right now, with the22 number of employees you have, if you were23 to maintain that number through the end of24 the year, how much you'd actually spend in25 55 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Class 100 Funds.2
For the end of the6 year, we expected it to be 713 positions.7 Hopefully that we expect a lot of these8 positions to be increasing between the9 November numbers, which was in the budget10 document, versus year-end numbers.11
Yeah. You're12 not giving me the number I want, so why13 don't you just reply in writing.14 The number I want is: Assuming15 your current staffing level through the16 end of the year, what will you actually17 spend?18
And then you23 can show me what positions you plan to24 hire and other stuff but --25 56 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Yeah, based on our2 current level, the actual estimate will be3 lower than what is right now.4
Thank7 you.8 The Chair recognizes9 Councilwoman Brown.10
Thank you,11 Madam President.12 Good morning, gentlemen.13
I would15 like to continue with on this round of16 questioning the questioning from17 Councilman W. Wilson Goode --18
-- around20 our -- and I quote him, to dig into what21 is happening with the entire22 subcontracting picture across departments.23 And we were under -- well, we asked that24 all departments come prepared to tell us25 57 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 not only the number of contracts and the2 value of the contracts, but also the3 number of prime contracts and the number4 of subcontracts in the material that you5 send us.6 So we want to be clear that you7 understand what we're looking for.8
And this is10 one clear reason why. I have here a11 document of 37 pages, which are contract12 summary informations. And of the 3713 pages, 29 cite the vendor name PHMC. Of14 these, there is no indication of MBE/WBE15 participation.16
So this20 becomes an example of why we need and want21 that information.22 On of your budget23 material, there are major cuts in prenatal24 care:25 58 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 $281,000 to Temple Physicians.2 $291,000 to Tenet Health.3 $129,000 to University of Penn.4 And $381,000 to Albert Einstein5 Medical Center.6 Can you tell us now that these7 services are no longer available at these8 institutions for prenatal care, how and9 what is the Department doing with regards10 to referring that constituency to other11 programs?12
I'm sorry,13 Councilwoman. Can you show me from where14 you're --15
... the24 prenatal services.25 59 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Yeah. This2 doesn't actually represent a reduction in3 prenatal services; it represents a4 movement of the responsibility from one5 area in the Health Department, the6 Maternal, Child and Family Health, to7 Ambulatory Services.8
So under11 Ambulatory now, we've moved these12 contracts to provide prenatal care13 services.14
We haven't removed16 them, reduced them, made them less17 accessible. In fact, we think they're18 hopefully more accessible because now19 they're integrated in between the two20 areas -- general care and prenatal care.21
So -- okay.22 And so those families are still being23 taken care of.24
Thank you.2 I know an expansion of lead3 prevention included in the Budget as a4 result of a new grant of revenue. Update5 us, if you will, on what's been happening6 with the lead prevention efforts.7
I'd be happy to.8 So we currently have about 1559 homes waiting for lead abatement.10
Yes, ma'am.13 That represents the good news14 because we were, at the middle of this15 year, waiting for the housing urban16 development agency from Washington to let17 us know what our allocation was going to18 be and whether we were going to be funded.19 So we, I'm proud to say, have20 received the $7 million grant that's21 referenced in my testimony. That will22 allow us to continue abatement services.23 And we have, as you know, a24 sufficiently large number of homes in the25 61 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 City of Philadelphia which are not2 lead-free.3
And that we are6 going to have to continue providing7 abatement services for a very long period8 of time.9 We have a waiting list largely10 because we have to know clear title, owner11 of the property, and so forth.12
-- as much as it17 is resource-related.18 And as homes are cleared, we are19 able to abate them promptly.20
We need to know23 who owns the building often, and we need24 permission of the owner of the building to25 62 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 do abatement. And we need to relocate the2 family, and they have to be willing to be3 relocated.4 So all of that takes a bit of5 time.6
And during that8 time, we both educate the family, as you9 know.10
We help them with12 cleaning, to remove as much lead dust as13 possible.14 But the actual abatement is a15 fairly protracted process that involves16 many steps in order to assure that we have17 the right permission and we have the18 family out so that children aren't exposed19 to the increase in lead dust that occurs20 during the abatement process.21
Okay.22 According to the Center for Disease23 Control, the number-one cause of death for24 African-American women between the ages of25 63 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 24 and 35 is HIV AIDS.2 On of your budget,3 entitled, "AIDS Education Counseling and4 Medical Services," cuts are shown in a5 number of those areas -- rapid HIV6 testing, medical-care facilities, and7 counseling and referral services.8 Please speak to us as to how the9 Department -- well, let me say this also.10 On Monday, we learned that the Prison11 systems spends 60 percent of its12 prescription drug money --13 (Timer bell rings.)14
-- on15 HIV/AIDS medication.16 So just share with us how and17 what the Department has in mind to address18 what will now be these services being cut19 from your budget?20
All right. So21 what you are looking at isn't actually22 HIV-related. It's under disease control23 --24
Page?25 64 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
So what these cuts10 represent is, in the rebalancing, there11 were a number of historic positions in the12 Health Department.13
Historic positions16 related to contagion and quarantine,17 things like that, which we removed.18
And that's what20 this represents.21 I have good news. The Health22 Resources and Services Administration is23 here, going through its audit and24 oversight of our program for HIV services,25 65 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 and we've been just been informed that our2 Ryan White Part A allocation is going to3 be increased by about three-quarters of a4 million dollars for the next year, which5 is stupendous news; it will get us up to6 about $21 million in funding.7 So, actually, instead of8 reducing HIV services, I'm happy to say we9 should be able to improve our HIV10 services.11
And thereby12 capture these services, as stipulated.13
No, there's no14 reduction. This budget shows no reduction15 in HIV services.16 What you're looking at in terms17 of line items here are in Disease Control,18 which is different from HIV. These have19 to do with historic positions in both20 tuberculosis and STD control, which are21 not needed, not used.22
We kept them in a24 sense in reserve. And when we rebalanced,25 66 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 we decided that historically, we hadn't2 used them, we didn't need to, so they've3 been eliminated.4
So that doesn't6 affect HIV care, it doesn't affect HIV7 services, it doesn't affect actually STD8 or TB services.9
How you22 doing.23 I have a lot of questions, but I24 want to go back to this issue of the25 67 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 federally qualified centers. Could you2 explain what these centers are and why3 they were created, and then why we want to4 look like them. Is there an advantage?5
And is10 there an advantage to being a federally11 qualified lookalike? What are the12 advantages and disadvantages?13 COUNCIL PRESIDENT VERNA:14 Councilwoman, if you would please speak15 into your mic.16
Okay. So the19 federal government created -- and I20 apologize for not knowing whether it was21 in the '60s or '70s -- a funding stream to22 stabilize health provision in particularly23 underserved communities. They included24 both rural and urban, although they were25 68 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 particularly, at that time, focused on2 rural, but urban communities were able to3 have them.4 Those are ideally health centers5 that serve a community of people who don't6 have a lot of other health places to go,7 particularly those who are poor. And they8 have a board of folks, a private9 enterprise with a board, that controls the10 fiduciary decision-making and is11 responsible fiduciarily for any profit or12 loss of one of those health centers.13
But they have to20 break even. And they're frequent --21 they're nonprofit. And they frequently22 raise charitable dollars as well as using23 existing resources.24 The federal government, in order25 69 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 to help those centers break even, allowed2 them, when they billed for Medicare and3 Medicaid services, to actually be paid at4 their cost for those services, which is5 considerably higher than another private6 provider would be paid for Medicare or7 Medicaid primary services.8 So you get more dollars every9 time you see a patient who has Medicare10 and Medicaid insurance. And, in fact,11 that amount is determined by the cost to12 deliver care at the site.13
But in addition,15 those sites are directly encouraged by the16 federal government to provide care for17 those who are uninsured.18 The federal government says, We,19 the federal government, can't pay for care20 for the uninsured. We can help you with21 those who are insured by public insurance,22 but if you are uninsured, you must pay23 something.24 Those whose incomes are less25 70 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 than a hundred percent of the poverty2 level should be charged what the3 regulation says is nominal fee. If your4 income is between 100 and 200 percent of5 poverty, it should be an increment on6 that. And above 200 percent of poverty,7 it should be the full cost.8 So it should be the equivalent9 of what the federal government is paying10 for Medicare and Medicaid services.11 There are a number of agencies12 around the country, notably public13 agencies, where the control, the fiscal14 control, isn't housed in a community15 board; it's housed in the city.16
And as a result,18 in order to allow these entities to have19 the same benefit of enhanced payment,20 cost-based payment, for Medicare and21 Medicaid, the federal government has22 labeled those centers "lookalikes."23
We, as a public25 71 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 entity financially responsible, even2 though each health center has a board, and3 the board helps in decision-making, those4 individuals as a board are not financially5 responsible for the health centers. And6 so, we are called lookalikes. The other7 difference is that non-lookalikes, real8 federally-qualified health centers,9 receive dollars for capital from the10 federal government and some dollars for11 operations. We're not eligible for those12 dollars because our centers are lookalike13 centers.14
Well, you15 talked about -- and I'm going back to the16 question that Councilwoman Blackwell17 raised about the -- about the pharmacy and18 not being able to provide the medication19 to the clients.20 And is that a -- they can't --21 the federal qualified agencies can't22 provide --23
That's not the24 issue. That is a decision that we made25 72 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 for over-the-counter medications, which2 are available in pharmacies and other3 places without a prescription. And we4 made that decision because of the budget5 constraints.6 We receive a subset -- we7 receive a special rate for pharmaceuticals8 that are by prescription, non-over-the-9 counter ones. So, for instance, blood10 pressure medications, we receive a special11 rate called 340B rates, and we can buy12 them at a lower rate, and we give them to13 people at no charge.14 We're not proposing to change15 that; we will still give all prescription16 medications to folks who need them, at no17 charge.18 But instead of continuing to19 purchase and distribute over-the-counter20 medications, since they're widely21 available at pharmacies and people don't22 need prescriptions for them, we made the23 decision that rather than closing a health24 center, we would economize in that way.25 73 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 And so, we're removing over-the- counter2 medications for free at our health3 centers.4 (Timer bell rings.)5
Thank8 you.9 The Chair recognizes Councilman10 Goode.11
Thank you,12 Madam President.13 Dr. Schwarz, continuing on the14 other line of questioning previously on15 business diversity, pursuant to Bill No.16 060855, which I cited before, in June of17 2008, the Minority Business Enterprise18 Council, under the direction of the19 Finance Director, which is now the Office20 of Economic Opportunity, produced annual21 participation goals related to business22 diversity.23 Are you familiar with those24 goals?25 74 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
And so, the5 overall participation goal, in terms of6 disadvantaged businesses, was 25 to 287 percent, which I believe your particular8 department, in terms of the Health9 Department, outperformed considerably.10
But were you12 aware that there was a goal in terms of13 for-profit opportunities for disadvantaged14 businesses in the City nonprofit15 contracts?16
But you are21 not aware of how close you are to that22 5 percent or whether you've exceeded that23 5 percent yet.24
I don't -- I don't25 75 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 have all of the information yet. We've2 requested it, but I don't have all of the3 information, and I don't want to mislead4 Council.5
Okay. The6 Office of Supportive Housing, in the Class7 200, has $31 million. The Health8 Department, the Class 200, has $689 million. DHS, in Class 200, has10 $487 million.11 In addition to providing us with12 the information regarding Fiscal Year '09,13 as the Office of Economic Opportunity is14 finalizing its participation goal for15 Fiscal Year '10, will you be setting goals16 for those nonprofit contracts?17
Okay. The19 last question, then, is: At what point20 will we become aware of those goals? And21 are those goals that you would negotiate22 with the Office of Economic Opportunity or23 will you be setting them yourself?24
My understanding25 76 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 is that we will likely discuss them with2 OEO, but I don't know that for sure.3
And do you4 know what portion of nonprofit contracting5 you're responsible for?6 In terms of nonprofit7 contracting in the City, there is that8 which is done through the Health9 Department; or, in terms of Health and10 Opportunity, that which is done in terms11 of Community Development.12 In terms of the whole scale of13 nonprofit contracts --14
-- what16 portion do you think, in your capacity as17 Deputy Mayor for Health and Opportunity,18 are you responsible for?19
For nonprofits, I20 know it's a high proportion, but I don't21 know a number.22
Okay. Thank23 you.24 Thank you, Madam President.25 77 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
You're2 welcome.3 The Chair recognizes Councilman4 Rizzo.5
I just have a10 short question, more so an update. And11 maybe I should know this, but I don't.12 There was conversation recently13 or a few months back, maybe more months14 than I can remember, that the South Broad15 Street health center would be closing16 because there was some suggestion that17 there was going to be a nonprofit moving18 into that location.19 Could you give us an update?20 Was that actually being considered, the21 closing of the South Broad health center?22 And what is happening?23
I appreciate the24 follow-up, because I think you and I25 78 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 talked about this last year in my Council2 testimony.3 You may know that there was a4 report of --5
No, I appreciate8 it.9 The Controller's Office actually10 produced a report -- and my memory is bad11 as to precisely when it came out, but I12 would say in the summer, but I'm not -- I13 can't guarantee it -- in which they14 recommended that we sell the Health Center15 1, which is actually the headquarters for16 many of the offices within the Health17 Department, and it has the STD Clinic for18 the City. They recommended we sell the19 health center and relocate, and they20 believed it was a cost-saving measure.21 We have responded and actually22 spoken with the Controller and spoken with23 others because that assessment didn't24 include the expense for moving. And when25 79 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 we include the expense for moving, it2 actually is more expensive to move that3 health center and the whole set of offices4 to sell the property.5 But Public Property knows of6 this issue. There have been a number of7 people who have expressed some interest.8 The price of real estate in Center City is9 holding fairly well. It still doesn't10 cover adequately the cost for moving all11 of the facility, all of the functions out.12 So we're well aware of it. We13 are working with Public Property on that14 issue, but at the moment, there is no plan15 to sell the health center or sell the16 building.17
So I got it18 right. If, in fact, that is something19 that would be pursued, you're not talking20 about closing; you're talking about21 relocating from the valuable South Broad22 Avenue of the Arts location to some other23 location in the area?24
That is correct.25 80 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
As soon as I9 get a microphone... Thank you.10 Doctor --11
-- we had a13 recent discussion about my not-so-long-ago14 visit to an emergency room in15 Philadelphia, CHOP, with my daughter. And16 after five, six hours there, which is kind17 of the normal in an emergency room on a18 Saturday afternoon, just being able to19 view the people coming and going, I20 realized that probably 90, 95 percent of21 the people were coming in there with their22 sick children, and the children were, in23 fact, sick, but it was not a emergency-24 room event. And people are coming there25 81 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 because they really have nowhere else to2 go.3 What initiatives can the Health4 Department, the hospitals, the insurance5 companies bring to bear with getting6 people primary care for their children,7 whether it's a health center, whether it's8 a private doc, in the neighborhood, or9 whether it's some other form, to get these10 folks out of the emergency room and the11 expense associated with it and get the12 care that their children need when they13 have the flu or a cold or whatever.14
I appreciate the15 question, and I think it is very much a16 need.17 Nationally, we're not different18 from the rest of the country. There is, I19 think, a crisis at the moment in emergency20 care. And it's not what would ordinarily21 be called routine well care. It's acute,22 but not emergency-level, care.23
There are a number25 82 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 of for-profit entities, so a number of2 pharmacies like Walgreen's and a number of3 other companies like Wal-Mart, which are4 beginning to place nurse practitioners in5 those sites to provide an alternative to6 emergency rooms and provide acute care in7 those locations.8 One of the substantial issues9 with providing acute care is that much of10 primary care in this country has become11 capitated, which means providers are paid12 in a sense one payment for a month or a13 year to provide care, and it's meant to14 include routine acute care. But the15 policing of that isn't terribly rigorous.16 And so, there are a fair number17 of Americans now who have health coverage18 to go for primary care and health coverage19 for emergency care, but acute care falls20 somewhere in the middle. Figuring out how21 to finance just acute care is difficult.22 It comes at the same time that23 we see that, nationally, there is a24 increasing lack of primary-care providers,25 83 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 so that coming up with solutions to this2 is going to be particularly difficult.3 And since the decision is to do4 no harm first, people are permitted to go5 to emergency rooms for non-emergency, but6 acute-care, needs.7
I recognize8 that we're constrained 'cause of HIPAA and9 a number of other federal regulations on10 the sharing of information.11 But is there some way to figure12 out or at least have people agree that13 when they go through an emergency room for14 a child with the flu, that we can somehow15 follow up with them to get them into a16 health center the next time or to get them17 to a primary-care doc in their community18 or to get them signed up for medical19 benefits through the State?20 I mean, I recognize again the21 constraints of the federal law, but there22 must be something that can be done to23 access those folks.24
If people have a25 84 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 primary-care provider, there's not very2 much actually HIPAA constraint.3
So emergency rooms5 do often fax emergency-room visits to6 health centers. It's not enough, it's not7 always, it's not every emergency room, but8 many are doing it and more are.9
But isn't10 that financially in their interest to do11 that? I mean it would seem that if you12 treat the child in an emergency-room13 setting and, you know, the child obviously14 needs to see a doctor, the next time15 keeping that child or having that parent16 having an alternative to that emergency17 room would seem to be in the hospital's18 best interest and, certainly, secondarily,19 in the insurance company's best interest20 and in the State's best interest of their21 own Medicaid.22
It's very much in23 the insurance company's best interest.24 It's very much in the child's best25 85 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 interest. For the hospitals, it depends2 on how busy the emergency room is and what3 --4
CHOP actually, I10 happen to know, faxes its emergency-room11 visit sheets or delivers them12 electronically to every one of the13 primary-care providers from where children14 come.15
Relative to16 the 3-1-1, when we were doing research on17 3-1-1 and what the Chicago -- I attended a18 City STAT kind of situation at the health19 department, and one of the things that20 came about as a result of the City STAT21 data was that one health center wound up22 treating more people with less staff for23 certain behavioral-health issues.24 And as a result of the City STAT25 86 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 meeting, they determined that the health2 center with the less number of employees3 saw more people because they developed a4 group therapy session for some of the5 behavioral-health issues and were able to6 see more people, and the sharing of that7 information between health center -- the8 people who run the health centers was9 critical in sharing that best practice.10 Have you been able to use data11 and correlate data yet on 3-1-1 City STAT12 issues that have helped you kind of13 streamline or change practices?14
We have15 independent information that we collect on16 each visit.17 3-1-1, to date, because we have18 a center for scheduling appointments for19 the Health Department, that doesn't make20 sense financially to put into 3-1-1.21
We collect it from23 our own data sources.24 (Timer bell rings.)25 87 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
But do you2 conduct City STAT-type meetings relative3 to people who are running health centers?4
We've actually had5 a number of PhillyStat sessions on our6 health centers.7
And it's helped us9 to look at a number of, I would say,10 critical variables in the running of those11 health centers.12
I will25 88 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 dispense with my customary citing that2 there are no City-owned health districts3 in the 4th Councilmatic District. I will4 switch, however, to ask how we can better,5 more effectively get coverage for the6 155,000 people in my district and7 throughout the City.8 I will raise the question of the9 use -- and I don't know if you had a10 opportunity to read the telenursing report11 that was done by the City Controller12 recently.13
I haven't read it.14 I actually heard it cited just yesterday15 for the first time.16
Well, in that17 report, it cites how telenursing, which is18 similar in respects to telemedicine, could19 be used to cut costs by way of EMS travel,20 by way of efficiencies of transmission of21 data almost on a realtime basis, allowing22 for respondents to get good, accurate care23 health-care information about a individual24 in a lifesaving matter and how on and on25 89 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 and on the benefits of this both2 cost-effective and by way of service3 delivery have been proven in other cities.4
Transitioning6 from that, I know that I will never in7 this economy get a health center in my8 district. And, God forbid, I don't want9 to prove the editorial boards right by10 saying that only District Councilpeople11 think about their own district.12 But I will say: How have you13 researched the possibility of using14 telemedicine in our health centers, and15 where are we with that?16
The term17 "telemedicine" that's described, I think,18 having not seen the report, I can only19 tell you what the press said.20
And I think I22 understand the issues, which is to use, in23 the triage office, nurses as opposed to24 the EMS -- current EMS routers for calls.25 90 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
There are what are3 called "nursing call centers" that have4 been set up across the country. I know it5 because we had one at Children's Hospital.6 Those centers field questions7 from people about appropriate use of8 health services, and they can give advice9 to people by phone.10
We, I think,11 agree that they are worthwhile having.12 The specific question is: Have we, in13 public policy, started to research and14 develop usage in an already-strapped15 situation by way of money, by way of16 resources? And I'm going to get into some17 of the specifics of that. But have we18 started the process?19 'Cause I asked this last year20 and I'm going to stay consistent.21
No, we're24 talking about telemedicine in general --25 91 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Okay. In our5 health centers, we call it -- I think the6 best term is "nurse triage."7 So as with the Controller's8 report with EMS, which is in the Fire9 Department, we do nurse triage in the10 health centers. When a call comes in,11 nurses will take the call, answer12 questions, refer a question which they13 cannot answer to a physician. And that14 provides, I think, additional service to15 the public.16
All right.17 My question is: In light of the fact that18 we're in the -- I'm going to make it real19 simple. In light of the fact that we're20 not going to build buildings, and one of21 the good ideas that came from the second22 floor, of which there are many, and I want23 to say that on the record, that we could24 use multipurpose centers so that a25 92 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 equipment van could pull up to a senior2 citizen center, a rec center, and within a3 hour or so, transform it into a triage4 center or at least a first-level of care5 interview with people.6 So that we could reduce the7 three-month wait time at our health8 centers, so we could take the show on the9 road, if you would, and be able to use10 this technology that exists currently and11 reduce our expenses and increase our12 effectiveness.13 And I want to know specifically,14 are we moving in that regard?15
We have pursued16 part of the reimbursement issues for that17 kind of service. There are substantial18 reimbursement issues for us starting out19 in this financial climate with a new20 service.21 So yesterday in Harrisburg, in22 fact, I talked with the Secretary of the23 Department of Public Welfare about some24 ways that we might think about financing25 93 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 services that weren't just center-based,2 as we currently have. So to that extent,3 I have pursued it.4 Part of the reluctance I've had5 is that we've been living in a difficult6 financial climate, I have to admit, and I7 would be happy to talk more about it, and8 I will certainly read the report.9
Under one10 category of the Stimulus Package --11 (Timer bell rings.)12
-- which is13 updating technology for hospitals, there14 might be a line item that applies to this15 particular type of delivery of health16 service, and I'd like you specifically to17 look into that.18 My other question is: How many19 doctors do we have employed by the City of20 Philadelphia versus a contractual21 relationship with as consultants?22