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: Amendment to the Agreement with Andrew J. Maxwell, MD, Inc. to Provide Pediatric Cardiology Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to extend the agreement with Andrew J. Maxwell, MD, Inc. and to increase the amount of the agreement by $30,000 to an amount not to exceed $200,560.
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BACKGROUND:
Dr. Maxwell entered into a contract with San Mateo Medical Center (SMMC) effective September 1, 2023, through August 31, 2024, to provide pediatric cardiology services in an amount not to exceed $170,560.
DISCUSSION:
SMMC decided that it will not renew Dr. Maxwell’s agreement. SMMC believes that going forward pediatric cardiology services are best provided by specialists in a hospital setting that is fully equipped to provide such services, which SMMC is not. SMMC believes that there would be less risk of a potential data breach if all services were provided within the four walls of a single institution with greater control over data security, rather than relying on a contractor like Dr. Maxwell to provide additional mobile equipment for services and interpretation. SMMC therefore believes that transferring pediatric cardiology patients to hospitals specialized in such services would be in the best interests of patients.
However, SMMC and Dr. Maxwell desire to extend Dr. Maxwell’s agreement through October 31, 2024, to ensure that making the transition to transferring pediatric cardiology services occurs thoughtfully and safely. The Board of Supervisors’ approval is being requested because the parties estimate that approximately $30,000 will be needed to bridge Dr. Maxwell’s services through the extended term. Doing so would increase the agreement’s “not to exceed” amount above the $200,000 threshold required for the Board’s review and approval.
The rates in the extended 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. Maxwell will continue to meet or exceed the following performance measures through the extended term of the agreement.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Actual |
FY 2024-25 Estimated |
|
Percentage of patients who complete the patient satisfaction survey would recommend the contractor as a provider |
85% |
85% |
EQUITY IMPACT:
Dr. Maxwell’s continued pediatric cardiology coverage positively impacts equitable health outcomes because delivery of cardiology services at SMMC, a public safety net hospital, and addresses community need. Between May 2023 and May 2024, 68.3% of SMMC’s patients were enrolled in Medi-Cal with an additional 6.1% of SMMC’s patients enrolled in the “Access to Care For Everyone” (ACE) program. 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 (56%), Hispanic or Latino (58%), 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. Maxwell to meet with SMMC and discuss patient feedback to improve patient satisfaction and remove potential barriers to care.
FISCAL IMPACT:
The term of the amended and extended agreement is September 1, 2023, through October 31, 2024. The amount of the agreement is not to exceed $200,560 for the 1 year 2-month term. The amount of the agreement prior to the amendment was fully budgeted in the amount of $ 170,560. Funds in the amount of $30,000 are included in the SMMC FY 2024-25 Recommended 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.