Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to Agreement with Hubert B. Shih, MD to Provide Plastic Surgery Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Hubert B. Shih, MD to provide plastic surgery services for the term of December 1, 2022 through November 30, 2025, increasing the amount of clinical coverage, authorizing the assumption of medical director services, and increasing the “not to exceed amount” by $107,823, from $1,826,590 to an amount not to exceed $1,934,413.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population, which includes plastic surgery in cases of trauma. Dr. Shih has been providing plastic surgery services at San Mateo Medical Center (SMMC) since 2018. When the County entered into its initial agreement with Dr. Shih, he agreed to provide a minimum of 144 4-hour outpatient and surgery clinics per year and provide on-call coverage 183 days per year. On December 20, 2023, SMMC and Dr. Shih entered into an amendment to the agreement with no fiscal impact, adding clarifying language regarding Dr. Shih’s coverage expectations. The County and Dr. Shih then entered into a subsequent amendment to the agreement on June 25, 2024, where Dr. Shih agreed to expand his services in exchange for an increase in his hourly rate for on-call coverage from $41.67 per hour to $48.52 per hour while maintaining his services for clinic coverage and surgery at the existing contract rates (which are unchanged at $294 per hour). Dr. Shih increased his outpatient (ambulatory) clinic coverage from 48 4-hour clinics to 72 clinics annually, from 96 4-hour surgery blocks to 168 4-hour surgery blocks annually, and from 183 on-call shifts to 306 on-call shifts annually. Dr. Shih additionally assumed ten hours per month of Medical Director services at a rate of $269.00 per hour. The expansion of services in the latter amendment was necessary because Dr. Shih’s colleague, Dr. Fong, stepped back from practicing medicine at SMMC to pursue other ventures. Dr. Shih increased service to prevent patients from having to wait for services due to Dr. Fong’s departure.
DISCUSSION:
The proposed current amendment is needed for the same reason as the previous amendment: to increase Dr. Shih’s availability to provide patient care in the wake of Dr. Fong’s departure. Here, Dr. Shih’s clinic coverage would expand from 72 4-hour clinics to 96 annually. Dr. Shih would increase 4-hour surgical blocks from 168 to 192 blocks. On-call coverage would expand from 306 to 338 24-hour shifts per year. To provide time for Dr. Shih to finish documenting patient care, provide orders, or provide extra flexibility in the form of additional appointment windows, Dr. Shih’s ability to provide “as needed” supplemental clinical services would increase from up to 144 hours per year to 342. The increase in the “not to exceed amount” is entirely attributable to the expansion of services and not attributable to any change in compensation method or formula.
As with Dr. Shih’s prior amendments, the rates in the current amendment to the agreement 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 Dr. Shih will arrive on time (within 15 minutes of the start time) for each surgery scheduled 100% of the time. It is anticipated that Dr. Shih will arrive on time for clinic scheduled 90% of the time. It is also anticipated that 70% of the patients who completed the Patient Satisfaction Survey would recommend Dr. Shih as a provider.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of times that Dr. Shih will arrive on time (within 15 minutes of the start time) for each surgery scheduled |
100% |
100% |
|
Percentage of times that Dr. Shih will aarrive on time for clinic scheduled |
90% |
90% |
|
Percentage of patients who completed the Patient Satisfaction Survey would recommend Contractor as a provider |
70% |
70% |
COMMUNITY IMPACT:
Dr. Shih’s continued plastic surgery coverage will positively impact equitable health outcomes because delivery of plastic surgery services at SMMC, a public safety net hospital, addresses community need. Demographically, 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 requires Dr. Shih 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 December 1, 2022 through November 30, 2025. The amount of the agreement is not to exceed $1,934,413 for the full three-year term. Funds in the amount of $107,823 are included in the SMMC FY 2025-26 Recommended Budget. Similar arrangements will be made for future years. As discussed earlier, the increase in the “not to exceed” amount compared to Dr. Shih’s second amendment is entirely attributable to the increased hours of service he would provide under the proposed third amendment and is not attributable to any change in the previously negotiated compensation rate.
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.