Health commission approves patient‑rate adjustments; CFO reports $34.2M projected surplus

The commission voted to accept proposed annual patient‑rate adjustments the department described as part of a multi‑year effort to bring the hospital’s cost‑to‑charge ratio closer to industry standards.

Greg Wagner, chief financial officer, said the department has been implementing incremental rate increases—about 10% per year over the previous three years—based on an outside consultant’s recommendation that the department’s rates were low relative to industry norms. Wagner said commercial payers generate a significant share of patient revenue (he estimated ‘‘about a quarter to 30%’’ of patient revenues), though the majority of actual accounts are uninsured or Medi‑Cal and pay lower rates or sliding‑scale fees.

On the department’s financial position, Wagner told commissioners the third‑quarter report projects a $34,200,000 surplus for the fiscal year and noted the mayor’s budget restored $8.8 million in community‑services funding and backfilled federal HIV funding cuts. He cautioned that large federal program payments and enrollment shifts under the ACA create ongoing uncertainty and said he would provide more detailed fee‑for‑service analysis offline in response to commissioner questions.

Commissioners also raised staffing and bad‑debt concerns. Wagner said San Francisco General has about 80 unfilled nursing positions and that bad‑debt projections can increase when billings rise; he offered to provide a detailed fee‑for‑service breakdown to explain the drivers of a projected increase in bad debt.

The motion to adopt the patient rates carried following a second and a roll‑call affirmation by the commissioners.