Special Notice / Hearing: None
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Agreement with David Shields, MD to Provide Gastroenterology Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with David Shields, MD to provide gastroenterology services for the term of September 1, 2024, through August 31, 2027, in an amount not to exceed $1,514,160.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population. Dr. David Shields has provided gastroenterology services, including endoscopy. Currently Dr. Shields is the only physician serving the County that performs endoscopic retrograde cholangiopancreatography (ERCP) procedures to identify the presence of stones, tumors, infection, or narrowing in the biliary and pancreatic ducts utilizing contrast and x-rays, and he does so whether he is scheduled to be on-call or not.
DISCUSSION:
Under this agreement, each year Dr. Shields will provide 288 four-hour gastroenterology outpatient clinics, inclusive of consults to other physicians and ERCP procedures. Out of the 288 annual clinics, at least 180 will be dedicated to endoscopy if patients are available and the service is clinically appropriate. Dr. Shields will provide scheduled on-call coverage 96 weekdays, 16 weekends, and 4 holidays per year. To accommodate time spent personally evaluating patients and performing procedures during his on-call hours outside of his regular clinic schedule, and to accommodate situations when he is called in to provide unscheduled ERCP services on an emergency basis outside of his normal call schedule and clinic, the County would compensate Dr. Shields for 96 hours of supplemental clinical services annually. All clinical services provided while physically present would be compensated at a rate of $302.50 per hour while Dr. Shields’s unrestricted on-call time would be compensated at a rate of $50 per hour.
The rates in the new contract are within fair market value according to VMG Health, a nationally recognized medical services valuation firm that relies upon multiple industry-standard provider compensation surveys and aggregates that data.
County Attorney has reviewed and approved the resolution and agreement as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that the endoscopy complication leading to repeat procedure within 30 days, < 0.3% annually 100% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Endoscopy complication leading to repeat procedure within 30 days, < 0.3% annually |
100% |
100% |
EQUITY IMPACT: Dr. Shields’s continued gastroenterology coverage will positively impact equitable health outcomes because delivery of cardiology services at San Mateo Medical Center (SMMC), a public safety net hospital, addresses community need. Between May 2023 and May 2024, 68.3% of SMMC’s patients were enrolled in Medi-Cal with an additional 6.1% of SMMC’s patients enrolled in the “Access to Care For Everyone” (ACE) program. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Within the past 18 months the largest cohorts of specialty care patients at SMMC were female (56%), Hispanic or Latino (58%), and primarily Spanish speaking (55%). SMMC strives to eliminate bias in the medical profession by providing culturally competent training to its physicians and by following up with patients to ensure that they continue to have access to specialized care. SMMC specifically tracks physician satisfaction survey results and requires Dr. Shields to meet with SMMC and discuss patient feedback to improve patient satisfaction and remove potential barriers to care.
FISCAL IMPACT:
The term of the agreement is September 1, 2024, through August 31, 2027. The amount of the agreement is not to exceed $1,514,160 for the 3-year term. Funds in the amount of $504,720 are included in the SMMC FY 2024-25 Adopted Budget. Funds in the amount of $504,720 are included in the SMMC FY 2025-26 Recommended Budget Similar arrangements will be made for future years.
The payment provisions in this contract differ from that of the previous contract, due to an increase in the hourly rate for Dr. Shields’s clinical services from $272 per hour to $302.50 per hour. Varying hourly rates for on-call coverage based on whether the coverage was provided during the weekday, weekend, and holidays were replaced with a single $50 hourly rate that applies to all on-call coverage provided. The total value of the new contract represents a 12% increase compared to that of the previous contract.
Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care is covered by the County’s General Fund contribution to SMMC and is within the existing annual appropriation.