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 Crystal Chen, OD for Optometry Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Crystal Chen, OD for optometry services for the term of October 1, 2025 through October 31, 2026, increasing the amount of the agreement by $45,000, to an amount not to exceed $228,658, and increasing Dr. Chen’s optometry clinic coverage by 86 additional 4-hour clinic blocks with a reserve for supplemental consultations and courtesy coverage.
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BACKGROUND:
Dr. Chen has been an independently contracted optometrist providing coverage to the County’s optometry clinics since 2011. Most recently, she entered into a one-year contract to provide optometry services for the term of October 1, 2025 through October 31, 2026, in an amount not to exceed $183,658. Under that arrangement, Dr. Chen was originally scheduled to provide 345 4-hour blocks of in-clinic coverage and supplemental diabetic retinopathy screening upon consultation from the County’s primary care physicians from their primary care examinations.
DISCUSSION:
San Mateo Medical Center (SMMC) is proposing to add $45,000 to the not-to-exceed amount of Dr. Chen’s contract and increase her optometry clinic coverage from 345 4-hour blocks to 431 4-hour blocks for the remainder of the term. Of the added cost, $41,624 is attributable to the expansion of clinic blocks. The remainder is attributable to a reserve for additional diabetic retinopathy consultations from the County’s primary care physicians and possible coverage of other optometrists’ clinics should they be unavailable to provide care.
The rates in Dr. Chen’s 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.
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 100% of diabetic patients seen by Dr. Chen in the optometry clinic will have retinopathy screening documented in the electronic health record.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Actual |
FY 2026-27 Estimated |
|
Percentage of diabetic patients seen by Dr. Chen in the optometry clinic that have retinopathy screening documented in the electronic health record |
100% |
100% |
COMMUNITY IMPACT:
Dr. Chen’s optometry coverage positively impacts equitable health outcomes because delivery of optometry services at the County’s optometry clinics addresses community need. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Since November 1, 2024, half of specialty care patients at SMMC were female and half were male, with the largest ethnic cohorts being Hispanic or Latino (58%) and primarily Spanish-speaking (48%). 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. Chen to meet with SMMC to discuss patient feedback to improve patient satisfaction and remove potential barriers to care.
FISCAL IMPACT:
The term of the amended agreement is October 1, 2025 through October 31, 2026. The amount of the agreement is not to exceed $228,658 for the one-year term. Funds in the amount of $45,000 are included in the SMMC FY 2026-27 Adopted Budget.
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.