Yes. We are3 actively involved in that. And, in fact,4 Philadelphia and Pennsylvania was one of5 the first actually --6 (Addressing colleague.) Was it7 Philadelphia or was it Pennsylvania that8 first started trying to organize the9 recovery houses?10 UNIDENTIFIED SPEAKER: Well,11 Pennsylvania (inaudible.)12
Pennsylvania?13 Okay. So it was at the state level. So14 there were providing from around the15 State that were trying to do that, and16 our staff are going to be actively17 involved in that effort.18
Okay.19 It's a -- national best practices or20 standards is long overdue.21
My last23 question. Last year, you discussed the24 process of monitoring providers for those25 68 4.20.11 COMM. OF THE WHOLE - BILL 1101371 who were deemed inefficient, mostly2 resulting from duplicative inspectors and3 overlap of duties.4 What steps has the department5 taken to create efficiencies in that way?6
I am pleased to7 report that we've, I think, come a long8 way from last year. We now have what9 we're calling "an integrated monitoring10 team." The issue has been historically,11 because of the categorical nature of12 funding --13 (Timer bell rings.)14
-- each category of15 funding had a different monitoring16 process.17 So if it was Medicaid dollars,18 we had one group of funding; if it was19 State Block Grant dollars, it was another20 group of people.21
And so, a provider23 literally would have five, six different24 people coming out, all from my25 69 4.20.11 COMM. OF THE WHOLE - BILL 1101371 department, sometimes saying different2 things.3
And so, what we've5 moved to do is to put all of those people6 on one team.7
We have started9 that process; we started that process10 back in February as one team. And we're11 working to reduce the amount of time and12 the effort at doing this. And so,13 it's -- you know, it's rough.14
It's -- well, I17 think it's -- I mean, we're in the early18 stages, and I think it's very difficult19 when you have so many different views.20 But I have to give the staff a21 lot of credit. I think people understand22 why it's really important.23
And I think25 70 4.20.11 COMM. OF THE WHOLE - BILL 1101371 providers really appreciate it. They get2 one visit; it's a big visit.3
Just one7 quick story I'll close with.8 Decades ago, I worked for the9 Youth Services Coordinating Office during10 Mayor Rizzo's administrating in the11 Evaluation Unit, evaluating programs12 receiving City dollars, providing13 services to kids, and that was an issue14 then.15
Then, that's right.16 We've been dealing with issue for a long17 time in the field so we're --18
Okay, thank you.25 71 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Thank you2 Madam President.3 COUNCIL PRESIDENT VERNA:4 You're welcome.5 The Chair recognizes Councilman6 Green.7
Thank you,8 Madam Chair.9 Dr. Evans, you testified a10 little bit about crisis intervention11 teams and CIT training, first responders.12 Does that relate to the intercept program13 at all --14
Sure. So the21 intercept model basically is a model that22 was developed by Dr. Patty Griffith, who23 actually works with us, and another24 psychologist.25 72 4.20.11 COMM. OF THE WHOLE - BILL 1101371 And basically what they did2 was, because of the high overlap of3 people who have mental illness who find4 themselves in the criminal justice5 system, they wanted to create a framework6 that would guide how people could7 intervene.8 And so, basically, the9 intercept model is, you try to intercept10 people at various points in the criminal11 justice, starting with police officers12 who come into contact with people, the13 initial hearings that people have through14 people being incarcerated, all the way15 through reentry. And at each one of16 those points, there are a set of17 interventions that you try to implement.18 So what we've done, I think the19 City, over a number of years, I think,20 has quite successfully created21 interventions at each one of those steps.22 One of the last, frankly, that we needed23 to do was sort of the first two24 intercepts, which was law enforcement and25 73 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the initial arraignment portion.2 But that program has been3 enormously successful, we think.4 Commissioner Ramsey and I -- Commissioner5 Ramsey supports the program; in fact, he6 personally comes to the graduation of7 those officers who have gone through the8 training. So he and I do that graduation9 ceremony together, which, I think,10 reflects his commitment to this issue.11 And he believes -- I'm not12 putting words in his mouth -- but he has13 said that he thinks it's really important14 for officers to be able to spot and15 understand when someone's having a mental16 health problem versus someone who's just17 being belligerent or non-cooperative and18 be able to intervene effectively.19
Is that20 program going to move into the Police21 Academy as part of the initial training22 of officers?23
No, the -- we24 already do some mental health training25 74 4.20.11 COMM. OF THE WHOLE - BILL 1101371 for officers within the Police Academy.2 What this is, is a much more extensive --3 it's a one-week long process.4 We have a variety of people5 that come in during that week. And it's6 geared for officers who've already had7 enough of an experience that they can8 actually integrate the training into what9 they do.10
Is the11 intercept model something that is applied12 to juveniles also or in the juvenile13 justice system?14
It is. It's -- we15 primarily thought about it more in terms16 of the adult criminal justice system17 here.18 With juveniles, we work a19 little differently in thinking about20 Family Court and the Youth Study Center21 and those kind of things. So we don't22 quite have the same kind of process that23 we have for adults.24
We've25 75 4.20.11 COMM. OF THE WHOLE - BILL 1101371 developed and we're developing and I2 think we're going to develop broader3 diversionary programs not just related to4 mental health but, you know, substance5 abuse and other things, sentencing people6 to almost community service and other7 things that are -- you know, trying to8 prevent people from going to jail,9 diverting them into useful things, get10 your GED within this, your records11 expunged, et cetera.12 I wonder if there's a model13 that you're aware of from around the14 country that we can -- an intercept-type15 model that we can apply in schools or in16 other places to help people identify17 problems that would allow social services18 to be applied when necessary before19 things get out of control and children20 end up in the juvenile justice system.21 I don't know if you know of22 anything, but you have a great staff, and23 if they see something like that, I'd be24 very interested in it.25 76 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Sure. We can look2 at it.3 I mean, I've actually spent a4 little time looking at that literature5 because of the school-violence issues6 that have come up.7 And there are a number of8 interventions that people have developed:9 school climate kinds of interventions;10 family interventions; interventions11 directed at individuals, whether those12 are individuals who are at risk or more13 universal kinds of applications.14 So there are a number of things15 that are out there that we can -- and, in16 fact, some of those things we're already17 using in the system.18
If your19 staff would be kind enough to forward20 what you think is relevant, I'd21 appreciate it.22
Thank you.24 Thank you, Madam Chair.25 77 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COUNCIL PRESIDENT VERNA:2 You're welcome.3 Are there any other questions4 from members of the committee?5 (No further questions.)6 COUNCIL PRESIDENT VERNA:7 Seeing none, Doctor, thank you very much.8
Thank15 you so much.16 Our next department...17 MR. McPHERSON: Is the Health18 Department.19 (Witnesses come forward.)20
And25 78 4.20.11 COMM. OF THE WHOLE - BILL 1101371 thank you for all the wonderful work that2 you do.3 Please identify yourself for4 the record and proceed with your5 testimony.6
Yes, ma'am. Good7 morning, Council President Verna and8 members of Council. 11 COMM. 2 Of the total Fiscal Year '123 Budget request, about $110 million is in4 the General Fund, a little over a hundred5 million is in the Grants Fund, and6 $145 million is in the Acute Care7 Hospital Assessment Fund. 10 The Fiscal Year '12 General11 Fund Budget represents a decrease of12 $3. 3 million from Fiscal Year '1113 estimated obligations. 11 COMM. 15 The City's eight health centers16 provided about 350,000 patient visits in17 Fiscal Year 2010, including18 comprehensive, primary care, prenatal19 care, dental care, family planning,20 podiatry, and specialty care to a little21 over 90,000 patients. 11 COMM. 13 For pediatric patients, the waiting times14 have gone down, though, from 3 days from15 an initial visit in March of 2010 to one16 day in March 2011. 18 We continue to provide care19 several evenings each week. At our20 busiest centers, we provide Saturday21 hours. 11 COMM. OF THE WHOLE - BILL 1101371 waiting time. 9 First-party collection of a10 modest fee was implemented in all eight11 health centers in the third quarter of12 Fiscal Year '10. In Fiscal Year '10,13 $150,000 was collected. 11 COMM. 2 The health centers continue to3 work diligently to provide excellent care4 for all those who present, including the5 uninsured, into improved health insurance6 coverage where possible. A few7 achievements:8 Approximately 70 percent of all9 pediatric visits are now made by insured10 patients. 17 We expanded the indigent fee18 drug program, utilizing 16 Americore19 workers to complete applications. 11 COMM. 4 And the AZ & Me Prescription5 Savings Program from AstraZenica provided6 3700 free prescriptions to more 13267 patients. I should point out that for8 each of these patients, we have to9 complete an application, including income10 verification, so the work for our staff11 is considerable. 15 Through pursuing every16 opportunity to improve our collection17 from insurance companies while utilizing18 all programs to cover expenses for the19 uninsured, our unreimbursed obligations20 for ambulatory health services for Fiscal21 Year '12 are estimated at just22 $14 million. 11 COMM. OF THE WHOLE - BILL 1101371 $17 million in 2010, and more than2 $19 million in 2009. 16 Through Get Healthy Philly,17 we're changing the environment to make it18 easier for people to engage in health19 behaviors. 11 COMM. OF THE WHOLE - BILL 1101371 thousands of low-income children. The2 Supper program offers healthy, age-3 appropriate meals, including fruit and4 vegetables, dairy products, and lean5 meats. 11 Through these activities, school wellness12 councils have been created that will13 incorporate physical activity into the14 school day and eliminate junk foods from15 classrooms, fundraisers, and school16 stores. 20 We've worked directly with the21 School District to deliver free breakfast22 to children's classrooms in schools23 eligible to participate in the federal24 school lunch programs. 11 COMM. OF THE WHOLE - BILL 1101371 breakfast carts were purchased and are2 now being used to bring food to3 classrooms in 60 schools. With this4 change, 18 percent more children are now5 eating breakfast in our schools. 9 We've launched multi-media10 campaigns to decrease consumption of11 sugar-sweetened beverages, and increase12 the proportion of those who smoke, who13 try to quit, with assistance. 15 We've launched the first-ever16 nicotine patch giveaway in Philadelphia,17 in partnership with the State of18 Pennsylvania Free Quit Line, 1-800-quit-19 now. Five thousand Philadelphians called20 for free counseling and free one-month21 supplies of nicotine patches. Usually22 only two to three Philadelphians call the23 quit line. 11 COMM. OF THE WHOLE - BILL 1101371 We've mapped so-called "food2 deserts" in Philadelphia for the first3 time ever. These are areas where people4 have poor access to fresh produce.
From5 these maps, we have recruited nearly 5006 corner stores into our new Healthy Corner7 Store Initiative. 13 We've sponsored the first four14 of ten new farmers markets and helped15 farmers markets get equipped to be able16 to accept SNAP, or food stamp benefits,17 in areas with poor access. 11 COMM. 7 This increased the farmers market voucher8 benefit from $20 to $80 for WIC9 participants. 12 With unanimous City Council13 support, fines for merchants that sell14 tobacco products illegally to our youth15 were increased. 11 COMM. OF THE WHOLE - BILL 1101371 have noticed in City Hall and today on2 this floor -- there are about 250 overall3 in the City -- are now giving healthier4 drink choices. 8 The Environmental Health Services9 Division implemented a performance10 management system for food service11 inspections to reduce the time interval12 between inspections. 11 COMM. OF THE WHOLE - BILL 1101371 and the AIDS Activities Coordinating2 Office. As I hope all of you have heard,3 rates of sexually-transmitted infection4 among our youth are too high. 14 We got there first. 17 Our campaign is modeled after18 successful efforts in Washington and New19 York. Through this campaign, we hope to20 encourage our young people to delay the21 onset of their sexual activities, while22 promoting safer sexual practices among23 those who are sexually experienced. 11 COMM. 11 COMM. 6 Electronic health records. The7 department, in concert with the8 Philadelphia Prison System, is9 establishing an innovative electronic10 health record that will support the11 integration of health services. 11 COMM. 11 COMM. OF THE WHOLE - BILL 1101371 received a 96 percent overall rating for2 its health and safety program, as3 evaluated by the Office of Risk4 Management. 22 We are happy to report that the23 Department of Public Health has surpassed24 that goal for Fiscal Year '11. 11 COMM. 12 percent minority participation for our3 for-profit contracts. 313 percent, which still exceeds our goal,14 but we believe that it's a more accurate15 reflection of all City dollars used in16 for-profit contracting. 11 COMM. 4 General Health Care Resources primarily5 provides staffing for pharmaceutical6 services at our health centers and7 nursing services at Riverview. The staff8 working under this contract is 90 percent9 minority and all female. 11 Caremark, LLC, or Procare/CVS,12 is used for pharmaceutical and drug13 services people with HIV. 1 million. 18 Our three largest nonprofit19 contractors are Fairmount Long-Term Care,20 the Public health Management Corporation,21 and the Health Federation of22 Philadelphia. 11 COMM. OF THE WHOLE - BILL 1101371 Home. The Fairmount Long-Term Care board2 is 80 percent minority and 20 percent3 women. 6 million. 7 percent minority and15 three-quarters female. Health Federation16 has a board that's 55 percent minority17 and 64 percent female. Approximately 9018 percent of Health Federation contract19 dollars go to staff. 21 We are proud of the work we22 have done this year to improve public23 health in Philadelphia. 11 COMM. OF THE WHOLE - BILL 1101371 areas. 14 Thank you for the opportunity15 to present testimony today. 17
Thank18 you, Doctor.19 As of December, we're told that20 you had 72 vacancies in your department.21
That is the22 number that is recorded in the budget,23 yes.24
Yes.25 100 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Were you able to fill any of those2 vacancies?3
And5 can you give us a little more information6 --7
-- A,9 on the vacancies, what types of positions10 they were, who you've been able to hire.11
So first, let me16 clarify. As you know from City budgets,17 the number of positions listed is not18 necessarily the number of positions19 funded. That gives departments20 flexibility in times of change.21 So a good example of that, I22 think, is pharmacists. The Department of23 Public Health has eight pharmacists24 listed in our budget, and eight25 101 4.20.11 COMM. OF THE WHOLE - BILL 1101371 pharmacists is the number that we needed2 before we took away over-the-counter3 medications as part of our budget4 reductions during the recession and5 before we brought in all of the new6 vendor -- opportunities for free7 medications that I mentioned in my8 testimony.9 With that, we no longer need10 eight pharmacists at all of our health11 centers, but we have eight in the budget.12 And the reason is that should any of13 those programs go away and demand14 increase during the year, we have the15 flexibility to hire pharmacists.16 At the moment, there are 2017 pharmacists on the City's list, so we18 believe that we could hire pharmacists if19 we need to, and we're working on that20 issue actively.21 But that speaks to the issue of22 what is the number of funded versus23 unfunded positions for the department.24 So we have 72 positions in the budget.25 102 4.20.11 COMM. OF THE WHOLE - BILL 1101371 We had 659 in the increment run that you2 saw people hired.3 If we look at funded positions,4 the actual number of funded positions for5 the Health Department is not the 731 in6 the budget but, rather, 710 based on7 average salaries for workers and the8 average salaries of vacant classes. That9 means that we have 21 unfunded positions10 in the department, or actually 5111 vacancies.12 Fifty-one real vacancies13 translates to about 7.2 percent of our14 workforce. I should point out that in15 the health-care sector in the City of16 Philadelphia, the average for hospital HR17 folks is about 5 percent. Given the18 Civil Service system in Philadelphia and19 the difficulty of hiring, we believe that20 the extra 2.2 percent is reasonable.21 So I actually believe norming22 our HR services, based on performance23 management, that we are actually on24 target for a system that provides health25 103 4.20.11 COMM. OF THE WHOLE - BILL 1101371 care services in Philadelphia.2 But you asked specifically3 about vacancies, and I'm happy to go4 through that in detail with you.5 So, I don't know how it would6 be easiest for you to hear it. I can7 present you with the information. There8 are a lot of vacancies, and I have9 information on each one, and I believe10 that Council received a report on our11 vacancies, or I can go through specific12 ones of interest.13 What would be best?14
I15 don't recall seeing that.16 Do any of the Councilmembers17 have that list?18 Can you just give us the title19 of the positions that are vacant, please?20
Okay. We have:21 One administrative services22 supervisor position.23 One clerical supervisor II24 position.25 104 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Seven clerk typist I positions.2 Five community health3 registered nurses.4 Two community care5 coordinators.6 One health services analyst7 director.8 One social work services9 trainee, which we're using to replace, as10 in the budget, a social worker II.11 Three medical assistants.12 One medical clerk.13 Would you like me to continue?14
Three17 pharmaceutical technicians.18 Six pharmacists at the time of19 the increment run, but I've talked about20 pharmacists.21 One pharmacy manager; that22 position is currently filled.23 Public health administration24 analyst, which replaces a health services25 105 4.20.11 COMM. OF THE WHOLE - BILL 1101371 administrator II.2 One vacant position for a3 physician.4 One vacant position for a5 public health dental hygienist.6 One vacant position for a7 radiographer.8 Two positions for a medical9 technologist.10 That's in our health centers.11 I move on to the Division of12 Maternal, Child and Family Health.13 We have one position that's14 vacant for the director of Maternal,15 Child and Family Health.16 One for a semiskilled laborer,17 with lead as a specialty.18 One for an abatement worker.19 One for a sanitarian.20 One for a budget analyst II,21 which replaces a field investigator.22 One for a laborer.23 In the Public Health Nursing24 Home, we have one position for a25 106 4.20.11 COMM. OF THE WHOLE - BILL 1101371 registered nurse supervisor.2 In Environmental Protection3 Services, we have one electronic4 technician. We have one graduate5 environmental engineer, one clerk typist6 I, one semiskilled laborer, and one7 sanitarian.8 In the area of Administration9 and Support Services: One public10 administration analyst, one secretary,11 one public relations officer, one account12 clerk, one industrial hygienist, one13 automotive driver, two custodial workers,14 one HVAC mechanic I, one HVAC mechanic15 II.16 In the Medical Examiner's17 Office, one deputy medical examiner18 position is open, one forensic19 investigator I, one forensic investigator20 supervisor, and one municipal guard.21 In the Division of Disease22 Control: Three management trainees; one23 public administration analyst; one24 physician; two clerk-typists I's, which25 107 4.20.11 COMM. OF THE WHOLE - BILL 1101371 replace clerk-typists IIs; and one2 licensed practical nurse.3
You're welcome.6 COUNCIL PRESIDENT VERNA:7 Doctor, how many physicians do we have8 for the clinics?9
And11 are they all part-time? Are some of them12 full-time? Have we hired any recently?13 Have those doctors been given waivers?14 I'd just like to...15
Okay. I'm sorry19 to have to go through papers. But as you20 know, there's a lot of detail.21
Thank you.24 So we have a total of three in25 108 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the -- should I do it by division or2 overall for the department? Do you want3 it just in the health centers?4
Just in the7 health centers, yes, ma'am.8 We have 3 full-time and 919 part-time physicians. Of those, 48 are10 in civil service, and 40 are on contract.11 And six of them are both.12
-- part-time,19 correct. And 48 of them are in civil20 service, 40 of them are on contract.21
They are -- uh,24 no. Of the 48, three of them are25 109 4.20.11 COMM. OF THE WHOLE - BILL 1101371 full-time.2
Okay.3 Is that the full-time complement that we4 need?5
We need more6 physicians. We recruit constantly for7 physicians.8 In general, the competition in9 Philadelphia for hiring physicians is10 pretty fierce. So, for instance,11 Miss Scott mentioned in her testimony12 that one of the incentives we should use13 is loan repayment.14 We currently have about --15
Loan repayment.18 So the federal government19 provides the opportunity for physicians,20 nurses, and other personnel who work in21 areas with poor access to care.22 Particularly in federally qualified23 health centers, the government offers24 repayment of student loans because the25 110 4.20.11 COMM. OF THE WHOLE - BILL 1101371 loan burden for health care professionals2 is often quite large.3 COUNCIL PRESIDENT VERNA:4 That's wonderful.5
It is wonderful.6 We have about six people, I7 believe, now who are taking advantage of8 that program, but we have 90 positions9 that have been approved by the federal10 government to offer loan repayment.11 We advertise widely, we12 advertise on the federal website, and so13 forth.14 The problem is, we compete with15 the other federally qualified health16 centers in town and other centers that17 are based in low-income, high-need areas.18 So the competition is large. And we're19 competing nationally with anyone who20 wants to go anywhere for loan repayment21 in practice a low-income community.22 So I think our efforts are23 substantial. We're looking for people24 who will be successful with us, who will25 111 4.20.11 COMM. OF THE WHOLE - BILL 1101371 come, like the job, and stay. It's2 difficult to find physicians who would3 like to work under the conditions we4 have, which are very high-volume5 practice. We have a lot of scrutiny on6 quality. We work very hard to keep7 people out of the emergency room; and as8 a result, we have a large number of9 people who walk into our centers because,10 on a given day, they're sick and they11 want care, and you've seen other waiting12 times.13 That's not the most desirable14 set of conditions. And as a result, the15 people who succeed in our health centers16 generally are fairly mission-driven.17 They really want to serve people who need18 care and don't have other sources for19 care.20 So I'm proud of the workforce21 we have, but it is a struggle to maintain22 that workforce.23
Madam24 President?25 112 4.20.11 COMM. OF THE WHOLE - BILL 1101371
The2 Chair recognizes Councilman Rizzo for a3 point of information.4
Doctor, I'm5 trying to keep track of this, but could6 you just get right to the number? How7 many doctors work without any benefits at8 all?9
The majority of10 our doctors work on the -- of the11 physicians who are contract physicians,12 the majority do not get benefits through13 their work with the City. Most of them14 are part-time, many of them work in other15 places, and many of them rely on their16 spouses.17 And of the physicians who work18 in the City, being hourly employees, they19 receive pension benefits; they don't20 receive other benefits.21
So why would22 some doctors work for 40 hours a week and23 not get benefits?24
They generally25 113 4.20.11 COMM. OF THE WHOLE - BILL 1101371 don't work for 40 hours a week.2
They are4 part-time folks. Many of them5 historically have had other practice6 areas, and we've been able to get their7 time to come and work in the City part-8 time.9
So there's10 no doctors who work 40 hours, like a full11 schedule.12
They do, but17 their salary, their actual take-home pay18 on a weekly basis, is substantially less19 in order to cover the benefit costs.20
And generally22 folks, particularly if they have a spouse23 or someone else who can provide health24 insurance, would prefer to get higher25 114 4.20.11 COMM. OF THE WHOLE - BILL 1101371 take-home pay from the City.2 And we do that by doing3 essentially a dollar-for dollar match.4 If you don't get benefits, we build it5 into your cost.6
I'll wait7 for my turn to come back around.8 Thanks, Madam Chair.9
Thank10 you.11 Doctor, you mention in your12 testimony that the average waiting time13 for an initial visit is 66 days.14
That is correct,15 on average.16 COUNCIL PRESIDENT VERNA:17 However, however, the waiting time in18 District 10 Health Center is, we're told,19 244 days.20
You22 know, I think we went through this last23 year too.24
Can2 you give us an explanation as to why that3 is and what could possibly be done to4 reduce the waiting time?5
Yes, ma'am.6 So waiting time -- I should7 point out that waiting time is for8 adults, not for children. It's not the9 waiting time for family planning10 services, dental services, which are much11 shorter. So it is an outlier, it is for12 adults.13 We know that the Northeast,14 particularly the lower Northeast, has15 been growing quickly, particularly with16 folks who are new immigrants to17 Philadelphia and are uninsured. And we18 know that that area of the City was19 particularly hit hard during the20 recession.21 So demand for our services has22 gone up disproportionately in that area,23 but it's always been high. When I first24 got here, as you know, demand for our25 116 4.20.11 COMM. OF THE WHOLE - BILL 1101371 services there was high and our waiting2 times were long.3 So we have, with various4 budgets, tried over time to increase the5 number of folks who are working in the6 health centers. And each time, we7 diligently put it in, the recession, and8 we've cut back no less than the number9 that we've had, but we've had an issue.10 What we've done in this year is11 tried very hard to at least fill the12 complement of staff at Health Center 10,13 so they have all the people that they14 can. But, again, remember, Health Center15 10, because it's got such a long waiting16 time, it's very hard working conditions;17 people work very hard at Health Center18 10.19 They work hard at all of our20 health centers, 'cause we have waiting21 times at all of them, but they22 particularly very hard at Health Center23 10. The volume is overwhelming.24 So it's not easy to hire people25 117 4.20.11 COMM. OF THE WHOLE - BILL 1101371 to do it. We don't have huge amounts of2 space. The health centers were built3 generally in the '50s and '60s, as you4 know, and we've expanded too the space5 that we have. We've opened on Saturdays,6 we've opened in the evening.7 So coming up with the best8 solution, as Council has heard, I9 believe, is another health center. I10 think we need another health center in11 the lower Northeast.12 The challenge is finding the13 capital and the property to build that14 health center. The first step in this15 was to create a mechanism that was the16 Health Center Authority for the City --17 and I appreciate Council's support on18 that -- to allow us, at least for one19 health center, to try to identify a20 property and the support needed. And21 we're working actively on that.22 But I think with a waiting time23 like this, the answer is not going to be,24 given the constraints on the space, that25 118 4.20.11 COMM. OF THE WHOLE - BILL 1101371 we're going to staff up and fix this. I2 think the answer is that the demand is3 increasing, that it's going to continue4 to increase, we're not able to keep up;5 we need another health center in the6 Northeast.7
Thank8 you.9 Doctor, you also mention on10 of your testimony the initiatives11 that have been undertaken to reduce the12 City's unreimbursed obligations for13 ambulatory health services and have14 reduced this cost by over $5 million from15 your Fiscal 2009 level.16 The revenue estimates for17 payments for patient care in the18 Five-Year Plan are a consistent19 $7.4 million for Fiscal 2011 through20 2016. Why are the revenue estimates not21 increasing each year?22
The issue here is23 one that relates to how we are reimbursed24 as federally qualified, look-alike health25 119 4.20.11 COMM. OF THE WHOLE - BILL 1101371 centers; and that is, we get an enhanced2 rate for Medicaid payment. And the3 timing issues with how we're paid4 determines ultimately how much money5 comes in.6 So I've talked about as best I7 can actual and compared it to the8 budgeted amount to give you a sense9 that -- and the comparison was done to10 give Council a sense that the revenue11 estimates are conservative. Based on12 reality and what we've achieved in the13 past, we have been able, through14 appropriate and adequate billing, to15 reduce the dependence on the General Fund16 slightly.17
Oh,18 my. Everybody wants to ask questions. I19 just want one more minute.20 In your testimony that we21 received from District Council 47,22 Catherine Scott indicated that the23 district health centers would be more24 efficient and more cost-effective with25 120 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the use of additional certified2 registered nurse practitioners and3 physician assistants to aid physicians in4 providing health services.5 What is your position on that6 issue?7
Well,9 now that she agrees and you agree, where10 do we go from here?11
Okay. So three12 years ago, we were far behind the market13 in the salaries for nurse practitioners,14 physicians, and physician assistants.15 The department's solution on16 physicians has been to contract physician17 positions. It gives us flexibility. It18 also is the case that many physicians19 actually don't want to work for the City,20 be that as it may.21 For nurse practicers, we were22 way behind market rates. So we worked23 very diligently with the Civil Service24 Commission and the Office of Human25 121 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Resources for the City to increase the2 salary for nurse practitioners, and we've3 increased the hiring of nurse4 practitioners. We hope to continue to do5 that.6 The problem is that in this7 health care market, as quickly as we8 increase salaries, the market readjusts,9 and it's very hard through civil service10 to keep up with market rates.11 So it is our intention to hire12 more nurse practicers. At the moment,13 the chief, most attractive criterion for14 a nurse practitioner to come to the City15 is the other nurse practitioners working16 with us. So nurse practitioners working17 in an environment like ours, which has18 primarily had physicians as leaders and19 practitioners, they're a little leery20 about coming in to our workforce. So we21 have to convince them to do, which we're22 trying actively to do.23 On physician assistants, we24 have not yet been able to do the work we25 122 4.20.11 COMM. OF THE WHOLE - BILL 1101371 need to while doing everything else to2 hire folks to increase the salaries for3 physician assistants.4 But that is on our list for5 this year, and we will increase the6 salary -- we will go back with the Office7 of Human Relations to the Civil Service8 Commission and attempt to increase9 salaries for physician assistants so that10 we can get again begin to hire them into11 the City.12 Miss Scott mentioned a number13 of about 60-some thousand dollars for a14 salary in the City for a physician15 assistant. And based on that, she thinks16 it's a real bargain. It is a real17 bargain at that rate.18 Unfortunately, the market rate19 for a physician assistant in Philadelphia20 is about $94,000, so...21
Okay.22 And what is it for the nurse23 practitioner?24
Very similar.25 123 4.20.11 COMM. OF THE WHOLE - BILL 1101371
That's not market6 rate; we've still below market, but we're7 at least in a competitive range.8
I'm9 sorry. Was that civil service or under10 contract?11
And our civil16 service rates, if they're hourly rates,17 not annual salary, but hourly rates for18 part-time people, our civil service rates19 and our contract rates are the same.20 We've done a lot of work to keep them the21 same.22
We do. For nurse25 124 4.20.11 COMM. OF THE WHOLE - BILL 1101371 practitioners, we do.2
No, we are --5 there are four people on the list. We've6 been hiring off the list.7
Very8 well.9 I'm sorry to my colleagues. I10 know that you've all been waiting.11 Councilman Goode.12
Thank you,13 Madam President.14 Good afternoon, Dr. Schwarz.15
My first few18 questions are related to your capacity as19 Deputy Mayor.20
Will all22 Fiscal Year '12 contracts under your23 control as Deputy Mayor contain24 provisions related to the living-wage-25 125 4.20.11 COMM. OF THE WHOLE - BILL 1101371 and- benefits standard?2
I don't know the3 answer to that because that depends on4 people who are above me in the hierarchy.5 I'm not the decision-maker.6
I'm not the9 decision-maker on the terms in the10 contracts related to that. They're a11 part of the general provisions for12 contracts. So it's its the Law13 Department who makes that decision.14
Would you15 like all of the contracts under your16 control to contain provisions related to17 living-wage-and-benefits standard?18
So the more19 difficult answer to the question is, I20 believe in a living wage. The challenge21 is the amount that it will cost the City22 and what that will do to the budget over23 time.24 So what we've tried to do is to25 126 4.20.11 COMM. OF THE WHOLE - BILL 1101371 increase as best we can over time the2 proportion of contracted workforces who3 are earning a living wage. And I believe4 we need to continue to push in that5 direction.6 The challenge is the budget7 constraints, particularly the constraints8 we've had over the last few years and the9 ones that I anticipate with --10
Have any11 firms requested waivers for Fiscal Year12 '12 or Fiscal Year '11?13
If it's in the25 127 4.20.11 COMM. OF THE WHOLE - BILL 1101371 general provisions, that would be2 correct.3
Okay. What4 is the largest contract that you will5 award in Fiscal Year '12, for-profit and6 nonprofit?7
In Fiscal Year8 '12. Yes, sir.9 The largest contract awarded10 for '12 is the contract that --11
-- will be14 awarded is the contract for Fairmount15 Long-Term Care.16
For '12, it's25 128 4.20.11 COMM. OF THE WHOLE - BILL 1101371 $39,010,860.2
And when's9 the last time you bid the contract or an10 RFP?11
It's a nonprofit,12 so it actually hasn't been bid in a13 while, since the beginning.14
Okay. Is15 that firm in compliance with the City's16 living-wage-and-benefits standard?17
Okay. Will19 that firm be required to have a supplier20 diversity plan and do they have it?21
They already have22 one, and we've worked with them on that.23 As is in my testimony, they've done24 pretty well. I can also give you a25 129 4.20.11 COMM. OF THE WHOLE - BILL 1101371 summary of that for them for at least2 Fiscal Year '11.3
And the9 other contract, the other largest10 contract?11
Yes, sir. The15 largest for-profit contract is for CVS16 Caremark. It is for $1.121840 million in17 '12.18
And are they25 130 4.20.11 COMM. OF THE WHOLE - BILL 1101371 in compliance with the City's living-2 wage-and-benefits standard?3
We believe7 that since -- there aren't very many8 opportunities for them with us to do so,9 but we are in active conversation with10 them about that.11
For Fiscal15 Year '11, your participation rate is 4916 percent.17
I want to be sure18 you heard. I corrected it in my19 testimony not because the number's wrong.20 Based on -- as you know and we've talked21 about over time, how you calculate that22 number matters. And the question of the,23 do we count all of the contracts which go24 through Procurement but use health25 131 4.20.11 COMM. OF THE WHOLE - BILL 1101371 dollars.2 Having listened to you last3 year, you were very clear that you wanted4 all contract dollars for the department.5 So that number, using all contract6 dollars, is 33.3 percent.7
Okay. And8 you have a contract with eClinical Works,9 LLC?10
It's a new11 contract, a capital contract that we just12 signed, yes.13 (Timer bell rings.)14
And the15 question is: When was that contract16 awarded? And what was your participation17 rate without that contract?18
And then,24 what was the participation rate without25 132 4.20.11 COMM. OF THE WHOLE - BILL 1101371 that contract?2
Okay. It was3 awarded the last week in March, and it4 was awarded, I believe, with best5 efforts. And the reason for that was6 that at the time that that RFP went out7 --8
The question9 is: If you subtract that contact from10 the other contracts, what would be your11 participation rate without that one12 contract?13
Understood. Much14 lower. It's, I think, probably somewhere15 around 1 percent.16
Okay. So20 it's about 1 percent without that21 contract.22