SAN MATEO MEDICAL CENTER

ADMINISTRATIVE AND QUALITY MANAGEMENT - Accounting/Payroll - Finance and Decision Support - Patient Financial Services - Revenue and Reimbursement - Compliance/HIPAA - Materials Management - Community Relations and Marketing - WELL Program Management - Quality Management - Medical Records - Case Management -Education - Medical Library - Human Resources PATIENT CARE SERVICES - Psychiatry - Critical Care (ICU) - Nursing - Keller Center - Infection Control/ Employee - Recruitment - Volunteers/Interpreters - Medical/Surgical Unit SAN MATEO MEDICAL CENTER CHIEF EXECUTIVE OFFICER San Mateo Medical Center CLINICAL ANCILLARY AND SUPPORT SERVICES - Clinical Trials And Research - Environmental Services and Safety - Laboratory -Pharmacy - Radiology/Diagnostic Imaging - Rehabilitation Services/CART - Food and Nutrition Services LONG TERM CARE SERVICES - SMMC Long Term Care - Burlingame Long Term Care AMBULATORY AND MEDICAL STAFF SERVICES - Chronic Disease - Ron Robinson Senior Care Center - Medical Staff Office/ Physician Relations - Program Services - North County Clinics - Mid County Clinics - South County Clinics 4-119

4-120 San Mateo Medical Center FY 2007-08 Adopted Sources Intergov ernmental Rev enue 16% Miscellaneous Rev enue 2% Interfund Revenue 1% Charges for Services 48% General Fund Loan 8% Other Financing Sources (County Contribution) 22% FY 2007-08 Adopted Requirements Ambulatory and Medical Staff Services 17% Long-Term Care Services 11% Administrative and Quality Management Services 31% * Patient Care Services 19% *includes contribution from County General Fund Clinical Ancillary and Support Services 20%

4-121 Department Locator County Department San Mateo Medical Center Operating Budget San Mateo Medical Center Capital Purchases General Fund Contributions to Medical Center Department Mission Statement The mission of the San Mateo Medical Center (SMMC) is to open doors to excellence in healthcare. To live its mission, SMMC offers services to all residents of San Mateo County, regardless of ability to pay. SMMC serves the entire community and, by setting a standard of excellence, aspires to be the best public hospital and clinic system in California. Department Measures Quality and Outcomes Measures Meeting Performance s 100% 80% 60% 59% 62% 80% 75% 75% 40% 20% The San Mateo Medical Center s Ron Robinson Senior Care Center w as aw arded the San Mateo County STARS Aw ard for outstanding program performance. 0% 04-05 05-06 06-07 07-08 08-09 Contributions to Shared Vision 2010 (Fiscal Years 2000-2006) Cost per Adjusted Patient Day PEOPLE $900 $850 $800 $750 $700 $650 $756 04-05 $773 05-06 $841 $831 06-07 07-08 $831 08-09 Ensure Basic Heath and Safety for All Serving Victims of Violent Crime In September 2001, the Medical Center opened the Keller Center for Family Violence Intervention to serve victims of violent crime not only immediately after the crime but also during the recovery period. Clinicians at the Keller Center perform comprehensive forensic examinations and collect legal evidence in a manner that is compassionate and culturally sensitive, while protecting the rights of the patient, seeing more than 400 victims each year and working closely with other agencies addressing domestic violence. Access to care SMMC provides access to healthcare across the county, through a network of 11 community clinics. The clinics currently accommodate over 210,000 visits per year. Additionally, SMMC operates both an acute and psychiatric emergency department (ED). The acute ED has over 30,000 visits while the psychiatric ED has almost 3,000 visits each year. SMMC also provides general and acute inpatient psychiatric services. The medical/ surgical, psychiatric, and intensive care units have an annual total of about 24,000 inpatient days. The surgery department also accommodates almost 2,400 surgeries annually.

4-122 care for Aging Population SMMC, the second largest distinct skilled nursing facility in the state, continues to improve the Burlingame Long-Term Care facility to ensure the availability of skilled nursing beds for residents in San Mateo County. The facility now maintains a census of about 250 patients per day and has been operated by the County since October 2003. The opening of the Ron Robinson Senior Care Center (RRSCC) has also provided increased healthcare access for the aging population. RRSCC accommodates approximately 8,800 visits per year. PROSPERITY Sow the Seeds of our Future Prosperity Silicon Valley Workforce Initiative The Medical Center has partnered with local schools, hospitals, and other organizations through the Silicon Valley Workforce Initiative to increase nursing and other professional labor pools. Serving as a Training Site The Medical Center strives to be an employer of choice, serving as a training site for nursing students, radiology students, psychiatric residents, and fellows in infectious disease. PARTNERSHIPS Leaders Work Together Across Boundaries to Preserve and Enhance Our Quality of Life Expansion of Service Through a partnership with University of the Pacific School of Dentistry, the Medical Center has expanded access to dental services for county residents. It has also partnered with Stanford Hospital on a National Institutes of grant to manage chronic disease. Together with the San Mateo County Department, SMMC has joined forces with Stanford University and the San Francisco Department of Public to innovate new approaches for the detection, prevention, and treatment of HIV/AIDS in the San Francisco Bay Area. SMMC has also partnered with distinguished organizations such as Kaiser Permanent, California Care Foundation, Safety Net Institute, and the California Association of Public Hospitals on a variety of clinical and quality improvements. Responsive, Effective, and Collaborative Government Providing Care to the Elderly and Homeless Populations As part of the Senior Care Collaborative to provide comprehensive services, the Medical Center has partnered with Mental and Aging and Adult Services to enhance mental health care for the elderly. The Medical Center has also partnered with the Human Services Agency, Shelter Network, and Samaritan House to place homeless patients in safe housing upon discharge. Reducing Workplace Violence The Medical Center has partnered with the San Mateo Police Department, the Sheriff s Office and Department in a program to reduce workplace violence. San Mateo County has led by example in rolling out a countywide workplace violence prevention program. Patient Volume at San Mateo Medical Center 250,000 200,000 150,000 100,000 50,000 0 04-05 05-06 06-07 07-08 08-09 Inpatient Day s 128,539 134,170 139,031 141,017 141,017 Outpatient Visits 216,879 208,321 212,109 219,000 219,000 Major Accomplishments in FY 2006-07 Ensure Basic and Safety For All Participated in the 100k Lives Campaign to implement evidencebased interventions that improve patient safety Continued improvements in quality through innovations in the emergency department information system and radiology transcription system Participated in the Integrated Nurse Leadership Program and implemented unit-based councils in pilot units to improve patient outcomes Became one of the first hospitals in the nation to implement video interpretation ( Care Interpreter Network) Received leadership award for innovative use of donated cell phones to manage asthma Participated in the statewide emergency preparedness drills Partnered with Mariner s Medical Group to expand access for county residents Responsive, Effective and Collaborative Government Continued partnership with the County Manager s Office to refine eligibility criteria for financial assistance programs Began implementation of programs to improve the revenue cycle Instituted customer service training for all employees Participated in a Blue Ribbon Task Force to provide comprehensive health care access and/or insurance to uninsured adults in the county

4-123 Major Issues to be Addressed Increasing care Costs - The Care Advisory Board has indicated that medical cost inflation has ranged from 9-12% between 2001 and 2004. This trend is expected to continue upward with pressures from workforce shortages, development of new technologies, and increasing drug costs. Enhancement of Revenue Sources - With the rising costs of healthcare, public hospitals must maximize their current revenue streams while also finding new sources. Business development is also critical to help identify revenue-generating services that are needed in the community. A challenge that public hospitals face is keeping current on the rapid changes in public policy and funding such as the ongoing redesign of Medi-Cal. Rising Number of Uninsured and Underinsured - According to the California Association of Public Hospitals, there are over 6.5 million uninsured people in California. As this number continues to grow, the strain on public and private hospitals will continue. Key Department Initiatives 1. Service Line Expansion Major Issues to be Addressed: There is a need for the County to not only expand the scope and reach of current services, but to also offer new services which would generate additional revenues. Alignment to Shared Vision: Ensure Basic and Safety for All Goals: Provide continuity of care through expanded services to patients Generate new revenue to help offset rising operational costs Objectives: By Fall 2007, expand Ron Robinson Senior Care Center in order to serve more seniors in the Main Campus and establish a satellite at the Daly City Clinic By Fall 2007, expand night and weekend hours for scheduled and urgent care pediatric visits at Main Campus, Daly City, and South San Francisco clinics By June 2008, determine use for vacant ground floor space Major Milestones: Complete staffing and recruitment plans for senior and pediatric care expansions (September 2007) Explore possible uses for vacant ground floor and prepare operational and financial assessment (June 2008) Partners: Public Department of Public Works FY 2007-08 Budget Impact: The cost of the Ron Robinson Senior Care expansion is approximately $545,876 which includes the addition of four positions. The cost of the pediatric clinic expansion is approximately $937,016 which includes the addition of fifteen positions. The cost of implementing a new service line in the vacant ground floor space is still undetermined. 2. Revenue Cycle Improvement Major Issues to be Addressed: SMMC strives to be a good steward of the County s resources while providing the maximum level of service to patients. Internal and external assessments indicate that there are opportunities to enhance cash collections and improve the financial standing of the Medical Center. Alignment to Shared Vision: Responsive, Effective and Collaborative Government Goals: Improve patient access and billing through enhanced reporting, process redesign, and staff training Work with inpatient and outpatient departments to improve timeliness of gathering supporting documentation for billing Objectives: Increase percentage of cash collection Reduce claim denials Reduce bad debt Reduce days and dollars in accounts receivable Major Milestones: Partnering with the care Advisory Board to implement the Revenue Compass by September 2007 Develop targets for each fiscal year Partners: Revenue Services Patients/Payor Sources U.S. Post Office care Advisory Board FY 2007-08 Budget Impact: The cost of implementing this initiative is still undetermined. SMMC is committed to reaching these goals at a minimal cost by leveraging internal staff and developing effective reporting tools. Other Significant Objectives by Program The San Mateo Medical Center includes the following programs: Administrative and Quality Management Services Patient Care Services Clinical and Ancillary Support Services Long-Term Care Services Ambulatory and Medical Staff Services

4-124 The following program objectives contribute to department success (additional program-level objectives are included in individual Program Plans): Administrative and Quality Management Services Continue patient safety initiatives Enhance regulatory readiness Increase the number of managed care contracts Improve internal controls in accounting Enhance the contracting process and systems Patient Care Services Educate and maintain a culturally competent workforce Continue improving patient safety and clinical quality Continue technological enhancements Clinical Ancillary and Support Services Maintain efforts in optimizing drug and supplies savings Continue technological enhancements in imaging and lab Long-Term Care Services Increase average daily census through marketing efforts Optimize staffing to improve efficiency Continue to address facility needs of Burlingame Long-Term Care Center Ambulatory and Medical Staff Services Monitor and report the percentage of patients being assigned a primary care provider Educate staff at all levels on the eligibility requirements of all available payor programs Continue efforts to decrease clinic wait times through continuous review of patient flow

4-125 San Mateo Medical Center (6600B) ALL FUNDS FY 2007-08 and 2008-09 Budget Unit Summary 2005-06 2006-07 Revised 2006-07 Adopted 2007-08 Change 2007-08 Adopted 2008-09 SOURCES Taxes 984 5 37,657 80 (37,577) 80 Use of Money and Property 2,636 3,872 5,000 811 (4,189) 811 Intergovernmental Revenues 51,607,362 39,970,861 15,758,050 36,019,504 20,261,454 36,019,504 Charges for Services 95,311,383 110,292,051 129,434,271 117,330,959 (12,103,312) 122,007,832 Interfund Revenue 6,779,689 4,230,823 14,337,923 18,128,012 3,790,089 18,128,012 Miscellaneous Revenue 3,498,856 7,175,173 3,586,725 5,508,761 1,922,036 5,508,761 Other Financing Sources 40,012,515 54,652,211 54,047,737 55,074,754 1,027,017 55,074,754 Total Revenue 197,213,425 216,324,996 217,207,363 232,062,881 14,855,518 236,739,754 TOTAL SOURCES 197,213,425 216,324,996 217,207,363 232,062,881 14,855,518 236,739,754 REQUIREMENTS Salaries and Benefits 112,119,182 126,534,173 128,142,839 136,574,341 8,431,502 141,117,771 Services and Supplies 54,474,817 56,718,885 51,910,607 54,333,168 2,422,561 54,465,770 Other Charges 20,751,263 23,165,678 27,163,755 31,131,708 3,967,953 31,132,549 Fixed Assets 15,669 Other Financing Uses 9,868,163 9,890,591 9,990,162 10,023,664 33,502 10,023,664 Gross Appropriations 197,213,424 216,324,996 217,207,363 232,062,881 14,855,518 236,739,754 TOTAL REQUIREMENTS 197,213,424 216,324,996 217,207,363 232,062,881 14,855,518 236,739,754 AUTHORIZED POSITIONS Salary Resolution 1,306.0 1,314.0 1,313.0 1,312.0 (1.0) 1,312.0 Funded FTE 1,148.9 1,180.3 1,173.0 1,184.3 11.3 1,184.3

4-126 FY 2007-08 Budget Overview TOTAL SOURCES Total Sources increased by $14,855,518 or 6.8% from FY 2006-07 Revised to the FY 2007-08 Adopted Budget due to the following changes: Taxes There is a decrease of $37,577 in this funding source to align budgets with actual collections. Uses of Money and Property There is a decrease of $4,189 in this funding source to reflect the actual net revenue from service machine concessions. Intergovernmental Revenues There is an increase of $20,261,454 in this funding source. The majority of the increase is a shift of Medi-Cal funds from Charges for Services to Intergovernmental Revenues to align the budget to where actual funds are accounted for. There is also a decrease in grants to account for one-time awards and an increase in funding for other state aid and supplemental payments. Charges for Services There is a decrease of $12,103,312 in this funding source due to a shift of Medi-Cal funds to Intergovernmental Revenues. This is partially offset by increased revenue from higher patient volume and the annual charge master increase. Interfund Revenue There is an increase of $3,790,089 in this funding source due to an increase in loans from the General Fund. This is partially offset by a decrease in revenue to align the budget to actual revenue experience. Miscellaneous Revenue There is an increase of $1,922,036 in this funding source. The majority of this change is due to the Sequoia care District grant. There are offsetting decreases in SDI payments, grants, and food sales. Other Financing Sources There is an increase of $1,027,017 in this funding source due to an increase in the Medical Center contribution to offset the elimination of the Half Cent Transportation funds, which will no longer be used to fund client transportation programs. TOTAL REQUIREMENTS Total Requirements increased by $14,855,518 or 6.8% from FY 2006-07 Revised to the FY 2007-08 Adopted Budget due to the following changes: Salaries and Benefits There is a $8,431,502 increase in this expenditure category due to negotiated labor and merit increases, increases due to the recently signed Memorandum of Understanding with Union of American Physicians and Dentists (UAPD), and the addition of 19 positions for the expansion of the pediatric clinic and Ron Robinson Senior Care Center. These increases are partially offset by the elimination of 23 positions in the Medical Center s long-term care unit, the creation of a nurse float pool, the elimination of vacant positions, and the downsizing of library services. Services and Supplies There is an increase of $2,422,561 in this expenditure category due to an increase in contract professional services to reflect the increased cost and volume of physician services and hospital referrals. The remaining increases are due to inflation and increased use of supplies with significant increases in blood products and medical supplies. Other Charges There is an increase of $3,967,953 in this expenditure category due to equipment depreciation, increases in departmental service charges, lease charges, and insurance. Other Financing Uses There is an increase of $33,502 in this expenditure category due to an increase in debt service for the Medical Center facility.

4-127 FY 2008-09 Budget Overview TOTAL SOURCES Total Sources increased by $4,676,873 or 2% from FY 2007-08 to the FY 2008-09 Adopted Budget due to the following changes: Charges for Services There is an increase of $4,676,873 in this funding source due to increased volume and charges. TOTAL REQUIREMENTS Total Requirements increased by $4,676,873 or 2% from FY 2007-08 to the FY 2008-09 Adopted Budget due to the following changes: Salaries and Benefits There is an increase of $4,543,430 in this expenditure category due to cost of living increases, step increases, and inflation of benefits expenses. Services and Supplies There is an increase of $132,602 in this expenditure category due to inflation of supplies expense. Other Charges There is an increase of $841 in this expenditure category due to inflation of contract security services.