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 Abhishek Gowda, MD to Provide Pain Management and Medical Director Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Abhishek Gowda, MD to provide pain management medicine and medical director services for the term of December 1, 2024 through November 30, 2027, in an amount not to exceed $1,265,112.
body
BACKGROUND:
Dr. Abhishek Gowda has provided pain management services at San Mateo Medical Center (SMMC) since June 2015. Dr. Gowda also serves as a Medical Director at SMMC within his specialty, providing medical leadership and assistance with process improvement. 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. Gowda will continue to provide these services at SMMC’s main campus and the County’s Daly City clinic. Dr. Gowda’s clinic is critical to addressing behavioral and psychological issues associated with pain.
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 the patients who are 18 years of age or older seen by an SMMC pain management provider 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 an SMMC pain management provider 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. Gowda’s continued pain management coverage positively impacts equitable health outcomes for SMMC’s patients by specifically addressing the behavioral and psychological needs of his 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. Gowda 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 $1,265,112 for the 3-year term. Funds in the amount of $245,994 are included in the SMMC FY 2024-25 Adopted Budget. Funds in the amount of $421,704 are included in the SMMC FY 2025-26 Adopted Budget. Similar arrangements will be made for future years.
The non-compounded annual cost of the new contract increased by 6% compared to the County’s previous agreement with Dr. Gowda. Although Dr. Gowda’s hourly rate increased from $217 per hour to $284 per hour for clinical and surgical services and increased from $250 per hour to $273 per hour for Medical Director services, SMMC negotiated an hourly rate reduction for Dr. Gowda’s on-call from approximately $21 per hour to $17 per hour. SMMC and Dr. Gowda also agreed to consolidate on-call hours such that Dr. Gowda will respond to consults during clinic time. This change results 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, despite the larger increases in Dr. Gowda’s hourly rate for his clinical, surgical, and Medical Director 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.