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DPH reports $147.9M FY23-24 surplus; Laguna Honda cited for patient-revenue shortfall
Summary
DPH CFO reported a $147.9 million FY23-24 surplus driven by revenue gains largely outside the general fund, while Laguna Honda posted a roughly $41 million deficit tied to lower patient revenue; public commenters called for greater divisional transparency and faster admissions at LHH.
Drew Murrell, chief financial officer for the San Francisco Department of Public Health, told the Health Commission that the department closed FY23-24 with a $147,900,000 surplus driven primarily by unexpected revenue and some expenditure savings.
"Overall, we ended the year to the good $147,900,000," Murrell said, explaining that about $124,000,000 of the surplus reflected revenue above budget and roughly $23,900,000 reflected expenditure savings. He said the revenue surplus includes $32,000,000 tied to the mayor—s midyear instructions and that the department deposited $18,600,000 into its management reserve under the Administrative Annual Appropriation Ordinance, which allows retention up to 5% to buffer against revenue uncertainty.
Murrell walked commissioners through divisional results: Zuckerberg San Francisco Hospital posted a net surplus (Murrell cited a $116,400,000 figure, including roughly $70,000,000 in net patient revenue tied to fee-for-service changes and prior-year settlements), while Laguna Honda Hospital ended the year in an approximately $41,000,000 deficit largely driven by about $46,000,000 in patient-revenue shortfalls attributed to a drop in census during recertification. He flagged behavioral health as $43,000,000 over budget largely from improved Medi-Cal billing tied to the EPIC implementation.
Commissioners pressed for more granular line-item detail, especially to restore the previously published departmental breakout pages that had shown general-fund contributions and program-level revenue streams. Murrell said those detailed breakout pages exist and he can present the General Fund contribution trends and divisional detail in a follow-up.
Public commenter Manetshaw criticized the presentation as opaque and accused the department of hiding details, calling the difference between some slides "a slight of hand accounting gimmick" and urging the department to speed admissions at Laguna Honda to reduce reliance on general-fund support. The commission did not take a binding financial action at this meeting but approved the consent calendar and requested additional divisional detail for future presentations.
Next steps: CFO agreed to provide divisional breakout pages and additional General Fund contribution detail in a forthcoming report to address commissioner and public concerns about transparency.
