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 Remedy Medical Group, a California Corporation to Provide Pain Management Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Remedy Medical Group, a California Corporation for Dr. Elaine Date to provide pain management medicine services for the term of December 1, 2024, through November 30, 2027, in an amount not to exceed $618,696.
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BACKGROUND:
Since 2008, Dr. Date has provided pain management services at San Mateo Medical Center (SMMC). Pain management is an important service which benefits County patients by aiding in their recovery and managing chronic discomfort.
DISCUSSION:
The County has a continuing need for pain management services. Dr. Date will continue to provide these services at SMMC’s main campus and affiliated offsite County clinic locations. Dr. Date’s services include providing patient management services, physician supervision at clinic for behavioral and psychological assessment, medical assessment, and interventional medication management. The proposed agreement continues to leverage Dr. Date’s expertise to provide a balanced approach to treating patients’ pain symptoms.
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 less than 5% of patients who are 18 years of age or older seen by Pain Management will have an overlapping supply of an opioid and a benzodiazepine for 30 or more days in a row (excluding those in hospice or with cancer):
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of patients who are 18 years of age or older seen by Pain Management that will have an overlapping supply of an opioid and a benzodiazepine for 30 or more days in a row (excluding those in hospice or with cancer) |
<5% |
<5% |
EQUITY IMPACT:
Dr. Date’s continued pain management coverage positively impacts equitable health outcomes for SMMC’s patients by specifically addressing the behavioral and psychological needs of her patients in clinic while helping them manage their pain. 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 requires Dr. Date 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, 2024 through November 30, 2027. The amount of the agreement is not to exceed $618,696 for the three-year term. Funds in the amount of $120,302 are included in the SMMC FY 2024-25 Adopted Budget. Funds in the amount of $206,232 are included in the SMMC FY 2025-26 Recommended Budget. Similar arrangements will be made for future years.
The non-compounded annual cost of the new contract increased by 2% compared to the County’s previous agreement with Dr. Date. Although Dr. Date’s hourly rate increased from $217 per hour to $284 per hour for clinical services, SMMC negotiated an hourly rate reduction for Dr. Date’s on-call from approximately $21 per hour to $17 per hour. SMMC and Dr. Date also agreed to consolidate on-call hours such that Dr. Date will respond to consults during clinic time. This change will result in fewer dedicated on-call hours, but more efficient scheduling of on-call shifts, without any reduction in responsiveness to patients or their consulting physicians. These efficiencies contained the overall increase in cost in spite of the larger increase in Dr. Date’s hourly rate for her clinical services.
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.