Hmm. Well,5 now they knew -- did you apply for6 something they don't know anything about?7
Now, when14 you -- will we have enough money to, when15 you're ready to proceed with this16 procedure of going to electronic records17 system, to keep up with the rolling and18 moving technology? Or will we implement19 or institute a system that's out-of-date20 by the time we finish it?21
If we receive the22 dollars from the hospital assessment, we23 should be fine. It will depend on the24 length of time for which those dollars are25 135 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 available, and that will depend on federal2 Medicare and Medicaid policy, so I can't3 make a guarantee.4 But I believe that over time,5 there should be savings, as suggested by6 Councilman Green, and I hope that those7 will be able to be used to sustain the8 record over time.9 The big leap is in the early10 implementation, and that's where11 additional dollars are particularly12 needed. And it's those dollars that I've13 been trying to get my hands on over the14 course of the last year.15
Will you be16 mindful of the need for confidentiality in17 how those records are maintained?18
Okay. Let20 me go to this question of the billing. I21 mean, this issue has been on the table in22 Council for -- I was here in '91, when we23 raised the whole issue about billing and24 the, uh... Just where are we? Is it --25 136 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 do we move forward and then move back? Or2 is there ongoing effort to bill for those3 patients, one, who have insurance; two,4 who may be on Medicaid, Medicare?5
Copayments.10 I mean, just where are we with that11 billing? It doesn't seem to keep up.12
So we have gone13 through the current system in the Health14 Department, looking at billing practices.15 And I think that for billing and16 private insurance, we're doing pretty17 well.18 (Timer bell rings.)19
There are a number20 of places where we can improve efficiency,21 and we have a plan that we are22 implementing to do just that.23 And I believe Councilman Green24 asked for information on how we're doing25 137 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 on billing, and we will provide that to2 the Chair.3
Mm-hmm.4 It's not enough to cover the cost of5 operating the --6
It's not. We have7 a very high proportion of people who are8 uninsured, and I believe a substantial9 portion of them are uninsurable, and10 that's a problem.11
You talked12 about Health Center 9 and you talked about13 the increase in the numbers of uninsured14 patients.15
I think the17 spillover to the Health Center 9 may be18 due to the closure of Germantown Hospital,19 do you suppose?20
It may be. I -- I24 don't know the answer to that, but I think25 138 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 it's certainly possible. And I worry a2 lot about the hospital networks in the3 City.4
So that as the6 financial situation for hospitals gets7 worse, I'm very concerned that they will8 be less and less able to do the care that9 they are currently doing, both for the10 insured, but particularly for the11 uninsured.12
Okay.13 Thank you. I'll come back.14 Thank you very much for your15 hard work. We appreciate what you're16 doing.17
Thank18 you.19 I assume Councilman Kenney is20 not in the room; therefore, the Chair21 recognizes Councilman Jones.22
Thank you,23 Madam President.24 I want to go on record again and25 139 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 say that I think the City of Philadelphia2 is fortunate and truly blessed to have you3 it at its helm for health care.4
And having6 said that on the record so that you know7 that I do appreciate your service, when we8 go back to the issue of the doctors versus9 employees, you said that 50 of them are10 consultants.11
About,13 approximately. And 50 of them are14 full-time employees?15
And you said17 that we do not pay for the medical18 malpractice insurance for them?19
Yes. We pay21 for the provider, which is the hospital.22
And so, what24 I'm saying to you --25 140 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
I'm sorry. I2 must -- I -- as you know, I try very hard3 to be clear, and I must have misunderstood4 what you were asking.5
That's all6 right.7 So we actually pay for their8 medical malpractice insurance, and we9 reimburse the hospital they are affiliated10 with as a part-time employee, so they11 benefit from that.12
Okay. Also,14 they don't have to follow our residency15 requirements, correct?16
Okay. And18 they don't have to follow our ethics19 requirements, correct? 'Cause they're20 consultants.21
Well, let's23 table that one; you don't have to answer24 that one. I'm going to table that cause25 141 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 you taking too long to answer it, and I2 only have a finite amount of time.3
Where I'm5 going to now is, in light of the fact that6 you may say they cost us the same, I am of7 the opinion that they cost us considerably8 more for less, although we appreciate9 their service, and I will say that also.10 What is the definition of a11 physician's assistants?12
There is a13 profession that is trained as physician14 assistants, which are folks who can15 deliver care that would be called16 dependent on a physician. They're not17 independent practitioners.18
Nurse21 practitioners are nurses who are trained22 with advanced credentials to deliver an23 enhanced set of health services.24
Has there25 142 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 been a study recently to see if we can2 better deploy our complement of3 consultants, which cost us a considerable4 amount of money, versus employees, versus5 health practitioners, versus physician6 assistants, to better -- to better use7 technology such as telemedicine to get to8 patients within a shorter amount of time9 without the amount of delays?10 I'm saying, have we done a study11 to look at the efficiencies that can be12 achieved through increasing maybe the13 number of nurse practitioners, physician14 assistants that can give out aspirins just15 as well as a doctor? And better deploy16 them in a way that we get maximum benefit,17 maximum cost-savings, and maximize service18 to the people who are waiting three19 months?20
There have been a21 a number of studies looking at the22 ambulatory health centers, and a number of23 them have talked about the use of24 non-physician practicers.25 143 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 A substantial barrier to the2 hiring of those folks has been Civil3 Service salary, like with physicians, and4 the both willingness and the availability5 of those practitioners in the same way as6 physicians.7
So you're8 saying that it is -- if I understood you9 correctly, it is cheaper to pay for the10 physicians through the consulting process11 than go with physician assistants? I12 think the same problem would be at both13 levels.14
I want to be15 clear. The issues has to do with the16 Civil Service salary range and hourly17 range in -- under Civil Service for those18 classes and the dependent issue in terms19 of physician assistants.20 But I do believe that the Health21 Department can make substantial progress22 in both the deployment of nurse23 practitioners and physician assistants.24 And we are really committed to doing that.25 144 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
So does2 "committed" mean that we're actively3 looking at a study today?4
It means that5 we're actively looking at recruiting and6 hiring.7
Okay. I'm8 going to put a pin in that and I'm going9 to go back to telemedicine.10 Can we look to, sometime in this11 fiscal year, to see a demonstration12 program employed by the Public Health13 Department to use technology by way of14 telemedicine?15
I think our triage16 system -- you should come -- we'll invite17 you out to take a look, because I think18 the triage system may well qualify, based19 on the Controller's report, as20 telemedicine.21 So I think we maybe talking22 about the same thing, and I think I can be23 proud of what we're doing.24
All right.25 145 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Let me --2 (Timer bell rings.)3
In terms of4 enhancing that, I don't have the financial5 resource.6
Based on the10 American Recovery Investment Act, you're11 going after certain grants such as12 prevention and wellness category --13
Which has --15 what -- how much money is in that16 category? Are you familiar with that?17
Mm-hmm.25 146 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
So I'm2 saying, can we look and expand our vision3 by way of how technology can be used to4 relieve the waiting time in some of our5 centers?6 We can use technology and go to7 where the people are, whether it's a8 senior citizens facility, whether it is a9 recreation facility. We can do the same10 thing Doctors Without Borders does, but11 with technology, and going into the12 inner-city, into the heart, to reach13 clients and really alleviating some of the14 waiting time.15 And I'm just insistent upon it16 because I just found out that one of my17 federally-funded health centers is moving18 out of the district. So now I have one19 federally-funded health center and one20 hospital.21 And I'm saying to you, with the22 prospect of losing EMS workers, we need to23 do something different. We need to24 address some of our budgetary shortfalls25 147 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 with technology, and one use of technology2 is telemedicine.3
You're7 welcome.8 I would just like to announce9 that after the testimony of the Health10 Commissioner, we will break for about a11 half hour and then come back.12 So anybody who's not here for13 the Health Department can leave and maybe14 go out and get a bite to eat and come15 back.16 Thank you.17 The next person to be recognized18 is Councilman Green.19
-- you24 testified that in the course of the25 148 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 November 2008 Rebalancing Plan, the2 Department reduced the amounts of five of3 the Department's services contracts,4 quote, with no impact on services, for an5 additional savings of $1 million.6
I'm glad to8 hear about these savings, but it's9 troubling to think that the Department had10 $1 million in contract expenditures that11 provided no value to citizens.12 Please describe the contracts13 that were reduced, how you identified them14 as places to cut the, reason the cuts have15 no impact on services, and what the16 Department had been doing to monitor the17 contracts prior to identifying them as18 places to cut prior to the budget crisis.19
So one20 particular -- I mentioned earlier that we21 had a contract related to quarantine22 related to tuberculosis, which is a23 historic contract that the City has had.24 And it was not expensed; it was a contract25 149 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 in place in the event of a, what I would2 call, older time need.3 The contract in the budget had4 not been updated. The money was held5 aside annually. I didn't see a reason6 that it should be held aside annually.7 And rather than cutting personnel in the8 Health Department, I opted to cut the9 contract.10
Okay. Well,14 how do you get -- the million dollars15 is -- that's one contract.16
There was a STD19 contract for nursing services, and the20 services had not been used, and the21 contract had not been filled in years.22 That contract was...23 There was a contract through the24 AIDS Activity Coordinating Office for25 150 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 contract administration. It was felt that2 that role was not needed. It was a vacant3 position, and it was reduced and so forth.4 And I can go through the five of5 them if you want me to.6
Okay, yeah.7 If you could provide the detail to the8 Chair rather than take up time on it.9 So the next question is: Are10 there any other outstanding contracts that11 we can cut that have no impact on12 citizens?13
So as part of my14 budget rebalancing and then Fiscal '1015 Budget, we fairly well went through every16 division and every contract in the Health17 Department to look at just that question,18 because, as I've said, I don't want to19 close a health center.20 And what I think you see in21 front of you in the budget is a both22 well-intentioned and, I hope, adequate23 attempt to show that where we could cut24 dollars we did.25 151 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
All right.2 Would you please provide to the Chair a3 list of all contracts the Department plans4 to extend into FY '10 or enter into an5 FY '10, a description of the specific6 services to citizens provided under the7 contract, and an explanation of basically8 what the contract's for, and then how9 you're going to monitor them to make sure10 citizens receive value.11
Oh, that's14 terrific. Thank you. If you could15 provide that to the Chair formally also.16
Thank you.19 Some other revenue numbers that20 were mentioned, I guess, on of the21 Operating Budget Summary. First, the22 summary indicates $1.1 million, or a23 13.5 percent increase, in revenue source24 title payments for patient-care health25 152 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 centers. What's this revenue?2 Private insurers, payments by3 patients, both?4
So I want to be7 sure that we're on the same -- it's line8 27; is that correct?9
So it's14 $1.18 million. And it's a combination of15 two things: One is the first-party16 billing that we talked about this morning.17 And the second is efficiencies in the18 billing operation that I mentioned we were19 undertaking.20
Okay. So if21 that 1.18 includes the projected 767,00022 in direct patient fees, what's the balance23 comprised of and what accounts for it24 increasing in FY '10?25 153 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
We have, as I2 mentioned, been going through a fairly3 intensive review of our billing practices.4 There are both software improvements that5 we've been negotiating with our6 [indiscernible) vendor, and there are7 improvements that are coming from finally8 being able to fill positions in our9 billing office. And this reflects the10 revenue generation from that process.11 (Timer bell rings.)12
Thank15 you.16 The Chair recognizes17 Councilwoman Sanchez.18
Oh,21 I'm sorry, Councilwoman. I know you22 wanted to be recognized. I'm sorry.23
We've24 had some [indiscernible] with the Office25 154 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 of Supportive Housing, but they've been2 here all morning and have to leave. If I3 might, I'd like to introduce them and ask4 them to stand up as we do. We have:5 The Vote for Homes Coalition.6 Project H.O.M.E.7 SELF.8 Ready, Willing and Able.9 IMPACT.10 TURN.11 The Salvation Army.12 Bethesda Project.13 Women Against Rape.14 Homeless Advocacy Project.15 And I'm missing one group and I16 can't read it.17 And many others who care about18 affordable housing and services in our19 community.20 There's something more, I'm21 missing it.22 So we want to thank you.23 (Applause.)24
I know25 155 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 that some of you have commitments.2 And, Madam President, I note3 that we work so well together, and we have4 such a committed group of people, and many5 of 'em come to our affairs, come to your6 affairs, and they're just a blessing. And7 we just say thank you. Did I forget8 somebody?9 Thank you all.10 And thank you, Councilwoman11 Sanchez, for yielding.12 Thank you, Madam Chair.13
And14 thank you for coming in. Thank you.15 Councilwoman Sanchez.16
I always17 yield to my senior colleagues.18 (Laughter.)19
Yes, I do20 want to acknowledge some of these groups,21 including Ready, Willing and Able is one22 of the folks that works very hard in the23 7th Councilmatic District. So I agree24 this coalition is important, and I look25 156 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 forward to our discussion and Councilwoman2 Blackwell's leadership as we go through3 that budget and its pending cuts.4 I wanted to talk to you a little5 bit our hospital policy plan.6 Northeastern Hospital, while located in7 the 1st Councilmatic District, serves a8 high population both in the 7th and, I9 know Councilwoman Krajewski, in the 6th.10 Were there discussions with11 Temple at all prior to this? And I say12 this in light of the fact that, as you13 well know, Dr. Schwarz, we've been in14 conversations about Frankford Hospital in15 my district and my concern to try to be as16 proactive as we possibly can with these17 institutions.18 What has been our discussions19 with Temple as it relates to Northeastern?20 And what is the plan for the births, the21 maternity-care situation?22
I was made aware,23 at about the time that the boards of both24 Northeastern and Temple were voting, that25 157 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 the vote was going to happen.2 We quickly began to try to3 figure out, did we have capacity,4 particularly around prenatal care. It is5 as you know, the most urgent need around6 the City and delivery service.7 And we went to the other8 providers, who are now, I'm happy to say,9 working with the Health Department to10 provide prenatal care in our sites, so11 that they're partners with the Health12 Department since there are only going to13 be six sites remaining for delivery in the14 City.15 And our understanding is that16 there's adequate capacity. Then the17 question became: What about18 transportation and timing?19 So we looked at -- and I'm happy20 to provide to you -- the distance based on21 the women who delivered at Northeastern22 Hospital, the distance each of those23 women, based on home address, would have24 had to go to another delivery site and how25 158 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 long it would take both by driving and by2 cab and, as best we can, public3 transportation.4 So for driving and cab, it's5 about, we estimate, 13 minutes'6 difference, which we think, from the point7 of view of delivery, should be okay.8 What we're looking at now is to9 validate and verify what are the public10 transportation routes, and we have had11 conversations with Temple about providing12 transportation. So that if there's a13 woman in the neighborhood who's receiving14 prenatal care, can they facilitate15 transportation to Temple.16 There's an incentive for Temple17 to do that because we receive revenue from18 the delivery. There's an incentive for19 other hospitals to do that if they have20 excess capacity.21 So we are very working with the22 other OB providers and doing everything23 that we can do as a city to at least24 assure that we have safe deliveries.25 159 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 And we continue to look and talk2 to people about what are the ways that we3 can help people come into the prenatal4 care field, because we need more prenatal5 care in Philadelphia/6
Are there7 any existing hospitals potentially --8 'cause, as you know, this will mean no9 maternity care in the Northeast. Are10 there any existing providers that have11 facilities that could potentially open up12 maternity-care coalitions further up in13 the Northeast.14 I know one of the issues at15 Northeastern is because they hit their16 50/50 Medicaid private-pay situation.17
As we19 look at redistributing -- 'cause on the20 lower part, I can see the Temple Hospital21 being nearby or Episcopal, but are we22 looking at who's currently up in the23 Northeast that might -- and what is it24 that we're willing to do in terms of25 160 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 providing incentives, as we did last year,2 in terms of acute care? What other things3 can we do to provide an incentive?4
We don't have a5 lot that we can do for incentives, as you6 know.7 The closest provider up in the8 Northeast is Holy Redeemer.9
Yes, Holy11 Redeemer. And I have talked with them at12 length. And they have been, I would say,13 good citizens in terms of not backing away14 from their commitment to the City. And,15 actually, they're interested in looking at16 whether or not they could provide prenatal17 care in the City.18 As you also know, Abington is19 not that far from the far Northeast, and20 many women deliver at Abington.21 So that for the further22 Northeast, there are two providers who23 have maternity services, where women can24 go and do go.25 161 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 I have to say I'm particularly2 concerned about uninsured women.3
And assuring that,5 particularly for those who are6 undocumented, they're not turned away.7
And we are talking9 with the six providers in the City and the10 providers from outside the City to both11 reaffirm their commitment to all women who12 need to deliver and their service13 commitment to providing care to those14 women who are not insured.15
In light16 of our growth patterns in our northeast17 health center, what are we doing to18 increase health care access than in the19 Northeast than on the preventive side for20 that population that we know continues to21 grow?22 (Timer bell rings.)23
I think the answer24 is: Not enough. The growth rate there is25 162 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 extraordinary, and it's going to get worse2 with this economic situation.3
And so that5 without additional resources, I'm in a6 difficult position. I'm trying to improve7 efficiency, I'm trying to make cuts that8 are tactical and don't cut services, and9 I'm trying to spare as much as possible10 ambulatory services and supplements for11 prenatal care.12
Is there13 any potential revenue through the Stimulus14 to address this, since we know that15 there's going to be a bigger need for16 people who are losing their jobs?17
So this relates to18 Councilwoman Tasco's question about19 federally-qualified health centers and20 federally-qualified lookalikes.21
No. I'm22 talking about in the Economic Stimulus, is23 there anything to provide safety nets for24 people losing their jobs?25 163 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
It helps. It5 won't help the City, but it will help the6 workers.7 There are, um... There's an8 extension of unemployment benefits.9 There's nothing -- there is10 nothing that will come to the City that11 can do that. The City is government.12
But there14 certainly are bits of the Stimulus that15 have been designed to help people who are16 losing their jobs. And one of the things17 that we're doing as a city is trying to18 make sure that we make people aware of19 them and match people to those potential20 assistance sources.21 COUNCIL PRESIDENT VERNA:22 Councilwoman, your time is up.23
Are we24 going to -- you said we're going to break25 164 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 and then we're going to have another --2
No,3 we're going to break after we're finished4 with the Health Department.5
Okay,7 thank you.8 The Chair recognizes9 Councilwoman Brown.10
I just want11 to comment.12 I'm pleased to hear that you, as13 a department -- and I don't know yet if14 we, as a city -- will be opposing the15 legislation currently in Harrisburg that16 will prohibit children of immigrants...17 complete the sentence for me, who may not18 be eligible or will not be eligible for19 health insurance, correct?20
And we're23 doing that by way of a letter or meetings24 or what?25 165 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
The4 Chair recognizes Councilwoman Sanchez for5 a point of information.6
So for7 the benefit of my colleagues, these types8 of legislation, both on the education side9 and on the health care side, are always10 introduced in Harrisburg. There has11 always been a consistent anti-immigration12 from all the different departments.13 So I'm pleased to hear that14 we're taking a role and I do -- but15 just -- I don't want it to be -- it is a16 crisis, and it's one that we fight, but17 every legislative session, there is an18 introduction of a bill to eliminate these19 programs, these safety net programs, in20 education and health, every session.21
And the22 history of the passage of those bills has23 been what?24
There's a25 166 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 growing number of support. As evidenced2 in the Hazelton's situation, there's3 growing support to increase this as large4 immigrant communities grow throughout the5 State.6 But every session, there's these7 bills all the time.8
And so,9 Commissioner, we're doing that by way of a10 letter or by way of a meeting; what is the11 strategy on behalf of the City?12
Okay.15 Thank you very much.16 Thank you, Madam Chair.17
You're18 welcome.19 The Chair recognizes20 Councilwoman Tasco.21
Oh, thank22 you very much.23 Dr. Schwarz, in 2008, the Health24 Department released the Taking25 167 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Philadelphia's Temperature Report. That2 documented the City's health status within3 the parameters of Healthy People 2010.4
A ten-year6 national health objective that uses7 leading indicators to define the health of8 a community.9 In reviewing this report,10 mortality rates, poverty, disease11 prevalence, unhealthy behaviors, and other12 problems plagued Philadelphia and, in many13 cases, impact multicultural and minority14 populations in clearly disproportionate15 numbers.16 Considering this report and17 national mandate, what action is the18 Health Department taking to address these19 issues?20
I'd like to think21 that our health services at the health22 centers, which are provided in many of the23 communities where we have the worst health24 statistics in the City, are a part of25 168 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 that, a part of our response.2 In addition, we're looking3 issue-by-issue, I have to say.4 So there are ways that we can5 promote health by making people aware of6 resources. There are partnerships that we7 can make with the School District or the8 Philadelphia Corporation on Aging and9 others. We're working on those. There10 are efficiencies that we can provide11 across areas of government.12 So within the four -- with my13 other hat on, the four areas of the14 deputy, so that whenever an individual15 comes in who has a health need, we assure16 that they're provided with appropriate17 information.18 And there are a number of19 programs in the Health Department, which20 you see in the budget, where we actually21 provide outreach to people, home-visiting22 services and others like that. So we are23 trying.24 We have the difficulty of25 169 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 resources, in assuring that we have2 resources to use, but we are -- for3 instance, on immunization, in other cities4 if we look around the country, we would5 find that immunization rates are abysmal6 for people who are less well-represented7 in the majority.8 And in Philadelphia, while9 there's some difference, we are in much10 better shape than any of the other cities11 in the country. I'm proud of that.12 Similarly, around HIV services,13 we are trying very hard to address the14 needs of those who are particularly15 disproportionately under-represented and16 make sure they have access to care and17 target our services to people who would18 otherwise have less access and whose19 health status is likely to be worse20 because of, unfortunately, where they live21 or poverty.22
Many of the23 Philadelphians do not use health centers.24 However, the Health Department is still25 170 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 responsible for promoting good health care2 for all residents of the City.3 How do you see your role as a4 service provider through the health5 centers? You just answered that, and in6 promoting good health, and I know you are7 limited by resources, 'cause we'd like to8 see the Health Department be more9 proactive in the outreach to the citizens10 of Philadelphia, 'cause that's our job, to11 promote the health and welfare of the12 community. So...13
So we are working17 to make sure that there's appropriate18 training in issues that affect19 disproportionately Philadelphians.20 We are working with the State to21 make sure that State dollars come here in22 appropriate representation and that23 they're used wisely.24 And we're working, actually,25 171 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 through the new Board of Health to look2 very, I would say, tactically at what the3 Board can do as a regulatory body, both to4 provide information and to ensure that5 messages and education is provided6 appropriately.7 And I'm happy to talk more but8 that, although I know your time is limited9 at the moment.10
Okay.11 Thank you. And Maria asked the question12 about Northeastern Hospital.13 Are we trying to develop14 additional services for women who are --15 you talked about going to Abington from16 that Northeast area. You know, one of the17 problems we have with that is18 transportation.19
We haven't yet,23 and I think that's a really good question24 and an important point. And I have not25 172 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 yet had that conversation.2 I know that Temple has had that3 conversation; I've asked that question.4 We have not, as a city, had that5 conversation, but we need to; you're6 correct.7
Well,8 they're right now in the midst of9 developing their plans and budget and10 having a public hearing, so it would nice11 if this issue could be put on the table12 with them.13
Because if15 they can -- 'cause they're getting a lot16 of Stimulus money from the federal17 government. Maybe we can get some of that18 money to provide transportation to those19 areas.20 (Timer bell rings.)21
Thank24 you.25 173 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 The Chair recognizes Councilman2 Green.3
Thank you,4 Madam Chair.5 With respect to other revenues6 from other governments, the Medicare7 payment for the Philadelphia Nursing Home8 is projected to increase by 30.8 percent,9 or $400,000. And the medical assistance10 outpatient payment is projected to11 increase by 46.4 percent, or $964,000.12 Are these increases due to an13 increase in eligible patients, an14 increased payment standard, more efficient15 and effective claims submission?16 It's of the...17
16 to 18. If20 you want to get back to us, that's fine21 also.22
No. I think we can23 answer that. You're looking at line 19 or24 18?25 174 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
That is -- we4 expected that there will be an increase in5 prenatal services.6
The nursing home?11 The nursing home primarily we always12 budgeted at a higher revenue numbers.13 It's also based on the cost in Class 20014 for contractually. So we always budgeted15 based on the beds that are going to be16 filled at the highest level.17 So the actual is that we receive18 the revenue, the -- it is based on the19 lower census, the lower number of beds20 that are filled at the nursing home. So21 the actual number's always going to be22 lower than it was the budgeted number.23 So...24
I'm confused25 175 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 by that.2
We will provide6 you with an answer through the Council7 President.8
Okay, thank9 you. And the -- I mean, it looks like an10 increase of $964,000, so...11
But I think the15 easier thing to do is, we'll provide it in16 writing, and it will answer your question.17
-- so we can21 avoid a memo-writing campaign.22 Thank you.23
You testified25 176 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 -- I mean, I guess this has nothing to do,2 though, the short answer is, with more3 effective claim submissions or an increase4 in the standard of --5
You testified9 that additional physicians funded by the10 Acute-Care Hospital Assessment Fund would11 provide partial support of an electronic12 medical-records systems.13 Are there other departments,14 such as Behavioral Health, that you have15 considered including in the EMR16 initiative?17
The answer to that18 is, the Prisons have been included. And19 the reason is, remember that Behavioral20 Health is not a -- does not directly21 provide service. Behavioral Health22 contracts out essentially State dollars,23 through the County, for services to24 providers.25 177 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 So the electronic record itself,2 which includes the record by a provider of3 a visit with a patient, is, in a sense,4 most appropriate in public health centers.5 And --6
Right but, we7 don't have to outsource it. We could8 provide the service ourselves -- or, I9 mean, maybe we do have to outsource it; I10 don't know the answer to that question.11 But the point is, that's what12 sort of DSS Cares or -- was that a part of13 that Behavioral Health? No?14 So how do we track patient data15 like people could be patients of...16 (Timer bell rings.)17
People could18 be patients of the Behavioral Health19 Program and our medical centers -- I mean,20 our health centers. How are we21 coordinating that if we're not including22 sort of everybody we give dollars to in23 the initiative?24
So everybody we25 178 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 give dollars to on the Behavioral Health2 side provides some level of information.3 Part of the information here has to do4 with HIPAA and the requirements on the5 Behavioral Health side. So psychotherapy6 records, for instance, aren't something7 that can be shared with the insurer or8 through some system of government.9 So the standard practice in10 medicine is to ask the patient.11