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 Hong Zheng, D.O., Inc. to Provide Non-Invasive Cardiology Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Hong Zheng, D.O., Inc. to provide non-invasive cardiology services, for the term of July 1, 2024, through June 30, 2027, in an amount not to exceed $1,254,000.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population. This includes services for cardiology disorders and the management and supervision of those services. The County’s need for cardiology services is increasing due to the aging of its patient population.
Dr. Hong Zheng has serviced as a non-invasive cardiologist at San Mateo Medical Center (SMMC) since 2020 and expanded her services to cover the County Jail in 2023.
DISCUSSION:
Dr. Zheng will continue to provide non-invasive cardiology services that include four-hour cardiology clinics, testing, and reading and interpretation services, which include transesophageal echocardiogram interpretations, electrocardiogram readings, “stress echoes”, “stress tests”, and Holter monitors. Dr. Zheng will also provide on-call coverage and will continue to provide coverage to the County Jail in addition to SMMC.
In response to increased community need under this agreement Dr. Zheng is now willing to provide expanded cardiology services. Where previously Dr. Zheng provided 768 annual hours of clinical cardiology services, the proposed contract would increase Dr. Zheng’s maximum coverage obligation by 44% up to 1,110 annual hours of clinical coverage services. There is no change in the amount of on-call services that will be provided.
County Administrative Memorandum B-1 provides that contracts for physician services are exempt from competitive procurement requirements.
The rates in Dr. Zheng’s renewed 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 100% of consulted patients discharged with Acute Myocardial Infarction will be on antiplatelet and ACE/ARB therapy. It is also anticipated that 100% of consulted patients discharged with Congestive Heart Failure (CHF) will be on ACE/ARB/ARNI or reasons will be documented in the medical record. Finally, it is anticipated that 85% of patients who complete the Patient Satisfaction Survey will recommend Dr. Zheng as a provider.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of consulted patients discharged with Acute Myocardial Infarction will be on antiplatelet and ACE/ARB therapy |
100% |
100% |
|
Percentage of consulted patients discharged with CHF will be on ACE/ARB/ARNI or reasons will be documented in the medical record. |
100% |
100% |
|
Percentage of patients who complete the Patient Satisfaction Survey recommending contractor as a provider |
85% |
85% |
EQUITY IMPACT:
Dr. Zheng’s continued cardiology coverage will positively impact equitable health outcomes because delivery of cardiology services at SMMC, a public safety net hospital, addresses community need. Specifically, in the past 12 months, 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 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. Zheng 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 July 1, 2024 through June 30, 2027. The amount of the agreement is not to exceed $1,254,000 for the three-year term. Funds in the amount of $418,000 are included in the SMMC FY 2024-25 Adopted Budget. Similar arrangements will be made for future years.
The payment provisions and levels of services in this contract differ from that of the previous contract, due to the 44% increase in the maximum number of annual clinical services hours at both SMMC and the County Jail based on the same hourly rate recently offered to fellow SMMC cardiologists Drs. Bindra, Shreibati, and Hassid. For these reasons, the total value of the new contract represents a 37% 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.