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 No. One to Professional Services Agreement Between the County of San Mateo and Bay Area Peninsula Anesthesia Associates, Inc. for Anesthesiology Services
RECOMMENDATION:
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Adopt a resolution authorizing a first amendment to the agreement with Bay Area Peninsula Anesthesia Associates, Inc., adding additional anesthesia coverage for endoscopy procedures, for a term of March 1, 2026 through February 28, 2029, increasing the amount payable by $356,050, for a new amount not to exceed $7,962,578.
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BACKGROUND:
Bay Area Peninsula Anesthesia Associates, Inc. (BAPAA) began providing anesthesia coverage to San Mateo Medical Center (SMMC) for operative and outpatient procedures and on-call coverage on March 1, 2023. BAPAA was incorporated by Dr. Currie Lee, an experienced anesthesiologist who historically provided anesthesiology services under contract individually and under his prior affiliation with Medical Anesthesia Consultants Medical Group, Inc. Under Dr. Lee’s leadership, BAPAA has grown from a team of three anesthesiologists to twelve anesthesiologists who work together to serve the County and also serve selected outside institutions.
BAPAA staffs three SMMC operating rooms during business hours, Monday through Friday each week, covers SMMC’s endoscopy clinic on Fridays during business hours, provides on-call coverage around the clock for medical emergencies, and provides Medical Director services with Dr. Lee as the designated director. The County pays BAPAA using a compensation formula based upon the number of full-time physician equivalents to maintain the foregoing coverage, which is presently 3.89 physicians and these services are paid for in monthly installments, except for endoscopy coverage, which is billed separately by the group at a rate of $295 per hour. Professional anesthesia services are legally required as a “basic service” to operate SMMC as a general acute care hospital and to perform surgical services by California law and related hospital licensing regulations.
DISCUSSION:
The amendment to the agreement presented for approval here adds one more day each week of anesthesia coverage for endoscopy procedures, which will now occur on Tuesdays and Fridays. The extra day of coverage over the remaining term will be billed at the same rate of $295 per hour, and therefore, the current agreement’s not-to-exceed amount will need to be increased from $7,606,528 to $7,962,578.
The rates in the new 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.
The 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 there will be 0% cancellations by anesthesiologists for pre-existing conditions within one month of the Operating Room date (for surgeries scheduled less than 30 days out, within 24 hours of receiving the chart).
PERFORMANCE MEASURE:
|
Measure |
FY 2026-27 Estimated |
FY 2027-28 Projected |
|
Percentage of cancellations by anesthesiologists for pre-existing conditions within one month of the Operating Room date (for surgeries scheduled less than 30 days out, within 24 hours of receiving the chart) |
0% |
0% |
COMMUNITY IMPACT:
BAPAA’s continued anesthesia coverage at SMMC will positively impact equitable health outcomes because delivery of those services ensures SMMC’s continuing operation addresses community need for hospital and surgical services. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Since November 1, 2024, 51% of the patients cared for at SMMC were female and 49% were male, the largest ethnic cohort was Hispanic or Latino (54%), and a plurality primarily spoke Spanish (45%). 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 BAPAA and Dr. Lee 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 March 1, 2026 through February 28, 2029. The amount of the amended agreement is not to exceed $7,962,578 for the three-year term. The total cost to cover the extra day of anesthesia coverage for endoscopy is $356,050. Of that total, $118,683 is included in the SMMC FY 2026-2027 Recommended Budget. That same amount will be included in the Recommended Budgets for FY 2027-2028 and FY 2028-2029.
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.