Department of Public Health FISCAL YEAR 2017 BUDGET TESTIMONY May 3, 2016 INTRODUCTION Good morning, President Clarke and Members of City Council. I am Dr. Thomas A. Farley, Health Commissioner. Joining me today are Tara Mohr, Deputy Commissioner for Finance and Jane Baker, Chief of Staff. I am pleased to provide testimony on the Department of Public Health s Fiscal Year 2017 operating budget. DEPARTMENT MISSION/PLANS Mission: To protect and promote the health of all Philadelphians and to provide a safety net for the most vulnerable. Improvements in Primary Care Services Plans for Fiscal Year 2017: Our Ambulatory Health Services Division is now using an electronic health record at all eight neighborhood health centers, which will help give our providers better access to information about their patients and help us to improve the quality of care across the whole network. Adoption of the electronic health record was a huge undertaking, which required upgrades to our IT infrastructure, a stepwise roll-out at successive centers, and training of all staff. Our next step over the coming year will be completion of the interfaces of this system with laboratories and pharmacies. We continue to help patients in our health centers get health insurance coverage. In FY15, 49% of visits in the health centers were for people who were uninsured. For the first six months of FY16, that fell to 42%. While we will never turn away patients without health insurance, we work to help every patient who is eligible for health insurance become enrolled. Specifically, we have benefits counselors at every health center who spend time with uninsured patients to review their eligibility and to process their insurance applications. Renovations to Health Center #10 in Northeast Philadelphia are scheduled to begin this summer. This area of the City has a growing population of immigrants and few other neighborhood health clinics. Because of this demand, waiting times for new patients to get elective appointments are too long. We plan to increase the number of examination rooms, which will in turn increase the number of patients we are able to see in a day. In addition, we are actively looking for expansion space. The new Health Center #2 in South Philadelphia opened on April 25, 2016. This joint venture between the City and the Children s Hospital of Philadelphia (CHOP) will provide health care to South Philadelphia adults and children in a unique arrangement that will allow the City to expand its provision of dental care, mammography, prenatal care and a wide range of other children's and adult health care services. The venture relocates two existing clinics: one, a pediatric primary care practice in South Philadelphia owned by CHOP, and, the other, PDPH Health Center #2 that mainly serves adults. The new facility will co-locate the two clinics as well as house a City recreation center and the South Philadelphia branch of the Free Library. 1 P a g e
Preventing Chronic Diseases We are hopeful that the $2-per-pack cigarette tax enacted in the fall of 2014 will help smokers quit. The Division of Chronic Disease Prevention will continue to educate and encourage smokers to quit in other ways and work with retailers to enforce the law preventing tobacco sales to youth. The Division of Chronic Disease Prevention, through the Get Healthy Philly initiative, plans to work with early childcare providers to promote nutrition and physical activity among children. They will conduct baseline assessments of current activities by stakeholders at early childcare providers, including barriers to Child and Adult Care Food Program participation, as well as outdoor physical activity space availability. Air Quality Improvements Air Management Services will install and operate an air monitoring station near the Port of Philadelphia. This area has become a contributor to health risks associated with toxic emissions from traffic along the Delaware River. AMS plans to monitor PM2.5, PM10, toxics, carbonyls, and metals. Data will be collected to provide the public with information about port emissions and local air quality and to assist in developing a strategy to reduce these hazardous toxic substances. HIV Prevention and Services Safer Food The AIDS Activities Coordinating Office plans to expand a program to reengage HIV-positive individuals who are not receiving medical care. The Philadelphia Cooperative Agreement Controlled Trial (CoRECT) attempts to demonstrate the feasibility of active care re-engagement intervention jointly implemented by the Philadelphia Department of Public Health and seven freestanding HIV clinics in the City of Philadelphia. In Philadelphia, African-American and Latino men who have sex with men are disproportionately affected by HIV. Through a new initiative funded by the Centers for Disease Control and Prevention, high-risk HIV-negative men will be offered a variety of services, including assessing for, linking to, and monitoring of Pre-Exposure Prophylaxis (PrEP). We will also expand social marketing efforts to increase HIV testing and to increase awareness of PrEP to prevent HIV infection. Environmental Health Services will continue to work to improve food safety. The FY17 goal is to achieve the inspection interval of 12 months for all food establishments and to complete all re-inspections within 30 days. The department is now posting inspection reports online immediately. We are hopeful that by making information available and readily accessible, it will provide an incentive for restaurants to follow the best food safety practices. Reduced Health and Safety Hazards in Homes of Children Environmental Health Services will work to reduce lead poisoning by improving property owner awareness and compliance with the Health Code. Environmental Health Services will also work to reduce in-home asthma triggers through collaboration with others. We currently receive referrals for children who have chronic, persistent asthma and perform home visits, inspections and remediation of health hazards when possible. We hope to expand this activity by working with health care providers and health plans. 2 P a g e
Improved Immunization of Adults The Division of Disease Control has recently been funded by the Centers for Disease Control and Prevention to develop a comprehensive approach to improving adult immunization rates across the City. The new initiative focuses on promoting use of pneumococcal, hepatitis B, shingles, and influenza vaccines in older adults, using strategies directed at local pharmacies, community health centers and large hospital systems. Preparation for Zika Virus The Divisions of Disease Control and Environmental Health Services will respond to protect Philadelphians from the threat of Zika virus infection. We will identify cases of infection in travelers, make laboratory testing for Zika available, use larvicides and insecticides where appropriate to reduce the risk of spread from mosquitoes, help prevent Zika infection in pregnant women, and communicate relevant information to pregnant women, travelers, healthcare providers, and the general public. Department-wide: The Department of Public Health successfully achieved Public Health Accreditation in November 2015 after a rigorous multi-year peer-reviewed assessment to ensure it met approximately 300 standards. While accreditation is not currently required for health departments, federal agencies such as the Centers for Disease Control and Prevention (CDC) will likely require accreditation as a condition of grant awards in the future. Accreditation is awarded for a period of five years. 3 P a g e
Department of Public Health BUDGET SUMMARY AND OTHER BUDGET DRIVERS Staff Demographics Summary (as of January 2016) Total Minority White Female Full-Time Staff 830 636 194 590 Executive Staff 18 7 11 10 Average Salary - Full-Time Staff $54,684 $52,195 $62,823 $53,906 Average Salary - Executive Staff $138,210 $126,203 $145,851 $130,179 Median Salary - Full-Time Staff $43,942 $42,178 $50,190 $42,979 Median Salary - Executive Staff $105,113 $100,779 $110,345 $107,679 Employment Levels (as of January 2016) Budgeted Approved Filled Full-Time Positions 983 983 830 Part-Time Positions 91 91 64 Executive Positions 23 23 18 Overall Average Salary (full-time only) N/A N/A $54,684 Overall Median Salary (full-time only) N/A N/A $43,942 Financial Summary by Class - General Fund Fiscal 2015 Fiscal 2016 Fiscal 2016 Fiscal 2017 Difference Actual Obligations Original Appropriations Estimated Obligations Proposed Appropriations FY17-FY16 Class 100 - Employee Compensation $48,078,460 $50,298,254 $50,298,254 $50,960,468 $662,214 Class 200 - Purchase of Services $59,364,137 $60,003,424 $65,742,802 $66,382,802 $640,000 Class 300 - Materials and Supplies $4,748,706 $5,305,674 $5,297,566 $5,277,881 ($19,685) Class 400 - Equipment $636,670 $185,094 $193,202 $212,887 $19,685 Class 500 - Contributions $151,799 $0 $0 $0 $0 Class 700 - Debt Service $0 $0 $0 $0 $0 Class 800 - Payment to Other Funds $500,000 $500,000 $500,000 $500,000 $0 Class 900 - Advances/Misc. Payments $0 $0 $0 $0 $0 TOTAL $113,479,772 $116,292,446 $122,031,824 $123,334,038 $1,302,214 4 P a g e
Contracts Summary (as of December 2015) FY11 FY12 FY13 FY14 FY15 FY16* Total amount of contracts $20,721,079 $6,205,317 $6,258,257 $6,098,748 $7,009,296 $4,791,820 Total amount to M/W/DBE $10,983,826 $929,425 $1,334,834 $2,392,181 $2,259,576 $2,369,190 Participation Rate 53% 15% 21% 39% 32% 49% * as of December 2015 5 P a g e
Department of Public Health PROPOSED BUDGET OVERVIEW PROPOSED FUNDING REQUEST The proposed Fiscal Year 2017 general fund budget totals $123,334,038, an increase of $1,302,214 over Fiscal Year 2016 estimated obligation levels. This increase is primarily due to staff salary increases and a share services agreement for the South Philadelphia Family Center. The proposed budget includes: $50,960,468 in Class 100, an $662,214 increase over FY16. This funding will support the planned salary increases for DC47-represented and non-represented employees. $66,382,802 in Class 200, an $640,000 increase over FY16. This funding will support a shared services agreement for the new South Philadelphia Family Center. $5,490,768 in Class 300/400 is equal to FY16 estimated obligations. $500,000 in Class 500 is equal to FY16 estimated obligations. STAFFING LEVELS Among 830 staff in full-time positions as of January 2016, over 75% are of minority race/ethnicity, a proportion that is similar for the 70 new full-time permanent staff hired to date in the current fiscal year. Women account for 71% and 67%, respectively, for all full-time staff and new hires. People who are bi- or multi-lingual represent 18% for all full-time staff and 10% of new hires, with Spanish being the predominant language but many other languages are also spoken. See appendix for Bilingual Employees Chart. 6 P a g e
Department of Public Health PERFORMANCE, CHALLENGES AND INITIATIVES DEPARTMENT PERFORMANCE (OPERATIONS) Performance Measure FY15 Actual FY16 YTD FY17 Target Percent of visits in which patients are uninsured Children (19-35 months) with complete immunizations 4:3:1:3:3:1 49% 42.4% 45% 85.8% 77.8% 80.0% Number of new HIV diagnoses 624 257 605 Inspection interval for Category 1 food establishments (months) Percent of all cases with autopsy reports completed within 90 days 15.5 14.6 13 94% 94% 90% 7 P a g e
Department of Public Health OTHER BUDGETARY IMPACTS FEDERAL AND STATE (WHERE APPLICABLE) The Healthy Intervention Program for Families (HIP) is being defunded by the Pennsylvania Department of Health. This home-visiting program serves families caring children with special health care needs services that are now reimbursable under Medicaid. The health department is working with the state to extend this program long enough to help the home-visiting teams funded by it to transition to other funding sources or other activities. Due to a change by the Environmental Protection Agency in the manner in which funds are shared between outside organizations, the number of sites in Philadelphia in which toxic chemicals are measured in the air was reduced in FY16 from five sites to four. This also led to reductions in the number of samples collected and analyzed by the Air Management Laboratory for outside agencies. Collectively this will lead to a reduction in carbonyl samples analyzed by 50% and volatile organic chemical samples by 20%. 8 P a g e
Department of Public Health CONTRACTING EXPERIENCE Vendor Alpha Medical Group Walgreen Eastern Co., Inc. General Healthcare Resources MEE Productions, Inc. Mighty Engine Service Provided Radiology Services Dispensation of HIV Medications Nursing Services Anti-Tobacco Media Physical Activity Promotion Amount of Contract RFP Issue Date M/W/DSBE Participation on Large Contracts Contract Start Date $1,565,530 6/7/13 7/1/13 $1,290,931 $652,311 $343,062 $327,098 3/11/1 4 5/30/1 3 8/15/1 2 8/15/1 2 6/30/14 7/1/13 1/20/13 1/20/13 FY16 Contracts Ranges in RFP % of M/W/DSBE Participatio n Achieved $ Value of M/W/DSBE Participation MBE: Best Efforts 0% $0 Total % and $ Value Participation - All DSBEs Local Business Living Wage Compliant? WBE: Best Efforts 100% $1,565,530 100% Yes Yes DSBE: Best Efforts 0% $0 $1,565,530 MBE: Best Efforts 0% $0 WBE: Best Efforts 0% $0 0% No Yes DSBE: Best Efforts 0% $0 $0 MBE: none set 0% $0 WBE: 1-5% 0% $0 0% No Yes DSBE: none set 0% $0 $0 MBE: 10-15% 100% $343,062 WBE: 10-15% 0% $0 100% Yes Yes DSBE: none set 0% $0 $343,062 MBE: 15-18% 0% $0 WBE: 15-18% 100% $327,098 100% Yes Yes DSBE: none set 0% $0 $327,098 9 P a g e
Department of Public Health EMPLOYEE DATA Full-Time Staff Staff Demographics (as of January 2016) Executive Staff Male Female Male Female African-American African-American African-American African-American Total 112 403 Total 2 2 % of Total 13.5% 48.6% % of Total 11.1% 11.1% Average Salary $49,270 $50,568 Average Salary $123,863 $107,690 Median Salary $39,592 $41,578 Median Salary $98,310 $107,690 White White White White Total 81 113 Total 6 5 % of Total 9.8% 13.6% % of Total 33.3% 27.8% Average Salary $63,679 $62,207 Average Salary $166,586 $120,969 Median Salary $52,551 $47,849 Median Salary $135,486 $110,345 Hispanic Hispanic Hispanic Hispanic Total 12 26 Total 0 0 % of Total 1.4% 3.1% % of Total 0.0% 0.0% Average Salary $45,432 $49,968 Average Salary N/A N/A Median Salary $39,223 $41,578 Median Salary N/A N/A Asian Asian Asian Asian Total 30 38 Total 0 3 % of Total 3.6% 4.6% % of Total 0.0% 16.7% Average Salary $72,095 $65,499 Average Salary N/A $160,523 Median Salary $69,915 $66,894 Median Salary N/A $105,013 Other Other Other Other Total 5 10 Total 0 0 % of Total 0.6% 1.2% % of Total 0.0% 0.0% Average Salary $39,877 $59,794 Average Salary N/A N/A Median Salary $39,392 $50,990 Median Salary N/A N/A Bi-lingual Bi-lingual Bi-lingual Bi-lingual Total 48 104 Total 2 4 % of Total 5.8% 12.5% % of Total 11.1% 22.2% Average Salary * $57,502 $67,338 Average Salary $91,296 $149,142 Median Salary * $53,354 $65,980 Median Salary $91,296 $110,007 Male Female Male Female Total 240 590 Total 8 10 % of Total 28.9% 71.1% % of Total 44.4% 55.6% Average Salary $56,598 $53,906 Average Salary $148,249 $130,179 Median Salary $47,282 $42,979 Median Salary $102,996 $107,679 * Total number of bilingual employees is based on independently collected data. Average and median salaries for bilingual staff are based on a subset of employees whose multilingual capabilities was entered into the OHR Oracle system. 10 P a g e
Department of Public Health APPENDIX (Other Relevant Data and Charts) Number of Bilingual Employees (as of January 2016) Spanish Malayalam Hindi Cantonese & Mandarin French Russian Gujarati Vietnamese Korean Amharic Creole Arabic Ambulatory Health Services 23 18 10 4 5 5 4 4 2 1 2 1 Maternal Child Family Health 0 0 0 0 0 0 0 0 0 0 1 0 Environmental Health Services 8 3 2 4 1 0 2 0 2 3 0 1 Administration and Support Services 6 2 0 2 1 0 0 0 1 0 0 1 Medical Examiner's Office 1 0 0 0 0 1 0 0 0 0 0 0 Infectious Disease Control 10 2 1 1 4 1 0 1 0 0 1 0 Chronic Disease 0 0 0 1 0 0 1 0 0 0 0 0 Total 48 25 13 12 11 7 7 5 5 4 4 3 Total - # of Bilingual Employees 152 Total - # of Languages Spoken 46 Additional information on bilingual employees appears on page 12. 11 P a g e
Languages Spoken by 2 or Fewer Employees (as of January 2016) Language # of Employees Division Language # of Employees Division American Sign Ambulatory Health Services -1 Ga 1 Ambulatory Health Services 2 Language Health Commissioner's Office - 1 German 1 Infectious Disease Control Igbo Ambulatory Health Services -1 Hebrew 1 Ambulatory Health Services 2 Infectious Disease Control - 1 Ibibio 1 Ambulatory Health Services Indonesian 2 Ambulatory Health Services -1 Italian 1 Ambulatory Health Services Environmental Health Services - 1 Japanese 1 Ambulatory Health Services Swahili 2 Ambulatory Health Services -1 Kannada 1 Ambulatory Health Services Chronic Disease - 1 Mandingo 1 Environmental Health Services Tagalog 2 Ambulatory Health Services -2 Marathi 1 Ambulatory Health Services Ukrainian 2 Ambulatory Health Services -1 Pashto 1 Medical Examiner's Office Medical Examiner's Office - 1 Patois 1 Ambulatory Health Services Urdu 2 Ambulatory Health Services -2 Polish 1 Ambulatory Health Services Cambodian 1 Ambulatory Health Services Punjabi 1 Ambulatory Health Services Edo 1 Infectious Disease Control Taiwanese 1 Ambulatory Health Services Dari 1 Medical Examiner's Office Telugu 1 Ambulatory Health Services Fante 1 Ambulatory Health Services Tigrigna 1 Ambulatory Health Services Farsi 1 Ambulatory Health Services Twi 1 Ambulatory Health Services Filipino 1 Ambulatory Health Services Yoruba 1 Ambulatory Health Services Fula 1 Maternal Child Family Health 12 P a g e