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 Lucile Salter Packard Children’s Hospital at Stanford for Child Abuse Consultation Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Lucile Salter Packard Children’s Hospital at Stanford for child abuse consultation services for the term of January 1, 2025 through December 31, 2027, in an amount not to exceed $990,000.
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BACKGROUND:
In 2021, on behalf of the County of San Mateo, San Mateo Medical Center (SMMC) engaged Lucile Salter Packard Children’s Hospital at Stanford (LSCPH) to provide “expert consultation services” at the Keller Center for Family Violence. These services consisted of child abuse pediatricians providing care to abused minors, providing forensic evaluation services to the County to aid court proceedings, and acting as a liaison among SMMC physicians and nursing professionals to ensure that best practices in treating and evaluating child abuse may be followed.
DISCUSSION:
The proposed agreement between the County and LSPCH would be effective January 1, 2025 for a three year term through December 31, 2027. To fulfill its coverage obligations, LSPCH provides Dr. Melissa Egge, board certified by the American Board of Pediatrics (ABP) in the specialty of Child Abuse Pediatrics to provide the onsite coverage to the Keller Center, on-call coverage to respond to consultation requests from SMMC physicians, and forensic expert services in aid of child abuse investigations. Dr. Egge was board certified in pediatrics in 2007, and board certified in child abuse pediatrics in 2011, currently practicing in both areas of certification, and in fulfillment of the ABP’s requirements to maintain certification. Dr. Egge is privileged to practice medicine at SMMC.
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 proposed contract was not competitively procured. The proposed agreement is exempt from competitive procurement requirements under County Administrative Memorandum B-1, Section IV.B.15 due to the provision of physician and urgent medical services.
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 Dr. Egge or any substitute physician similarly qualified by LSPCH will be “up to date” (defined as 6 hours initial training and updated training every 2 years) regarding Keller Center exams and protocols based on standards developed by the American Academy of Pediatrics and the American Professional Society on the Abuse of Children 100% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 and Future Years |
|
Percentage in time Dr. Egge or any substitute physician similarly qualified by LSPCH will be “up to date” (defined as 6 hours initial training and updated training every 2 years) regarding Keller Center exams and protocols based on standards developed by the American Academy of Pediatrics and the American Professional Society on the Abuse of Children |
100% |
100% |
EQUITY IMPACT:
LSPCH’s continued child abuse pediatric coverage, forensic support to County law enforcement, and medical directorship leadership at the Keller Center for Family Violence positively impacts equitable health outcomes for SMMC’s patients by specifically addressing child and family trauma due to child abuse, neglect, and domestic violence. 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 (52%), Hispanic or Latino (63%), 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 shares that information with Dr. Egge to improve patient satisfaction and remove potential barriers to care
FISCAL IMPACT:
The term of the agreement is January 1, 2025 through December 31, 2027. The amount of the agreement is not to exceed $990,000 for the 3-year term. Funds in the amount of $165,000 are included in the SMMC FY 2024-2025 Adopted Budget. Funds in the amount of $330,000 are included in the Recommended Budget for FY 2025-2026.
The “not to exceed” (NTE) amount for LSPCH’s services for the term of October 1, 2023 through December 31, 2024 was $295,000. The NTE amount of the proposed agreement is $990,000, reflecting an annualized cost of $330,000 and an increase of approximately 11%. The annualized increase is attributable to 1) an increase in the hourly rates charged by LSPCH for clinical consultation services from $180 to $200 per hour, 2) an increase in the hourly rates charged for on-call services from $28 to $30 per hour, and 3) an increase in the hourly rates charged for medical director services from $180 per hour to $97 per hour.
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.