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: First Amendment to Agreement with Jacqueline Baras Shreibati, MD to Provide Non-Invasive Cardiology Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Jacqueline Baras Shreibati, MD to add 96 hours of supplemental clinical services annually and increase the amount of the agreement by $80,000, to an amount not to exceed $429,356.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population. This includes services for cardiology disorders and the management and supervision of those services. The County’s need for cardiology services is increasing due to the aging of its patient population.
DISCUSSION:
Dr. Shreibati has worked as a non-invasive cardiologist at San Mateo Medical Center (SMMC) since at least 2016. She provides cardiology services that include 4-hour clinic blocks, inpatient cardiology consultations, and reading services including electrocardiograms, “stress echoes”, “stress tests”, and Holter monitors. Dr. Shreibati also provides on-call coverage.
To provide scheduling flexibility and to improve cardiology services provided to patients, SMMC is recommending amending Dr. Shreibati’s agreement to further expand her cardiology services to provide an additional 96 hours of supplemental clinical services annually, in addition to her 268 annual hours of clinic coverage. There is no proposed change in the amount of on-call services that will be provided.
Dr. Shreibati’s supplemental services would take the form of extending her existing clinic hours to ensure efficiency of clinic operations and to maximize the number of patients that a physician can evaluate, treat, order medications, order tests, and document care.
County Administrative Memorandum B-1 provides that contracts for physician services are exempt from competitive procurement requirements.
There is no change in Dr. Shreibati’s hourly compensation rate, which is 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. Shreibati will document and perform nutrition counseling for
patients during ambulatory clinic visits when patients have Body Mass Index greater than 25 95% of the time. It is also anticipated that Patients who completed the Patient Satisfaction Survey would recommend Dr. Shreibati as a provider 85% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Contractor will document and perform nutrition counseling for patients during ambulatory clinic visits when patients have a Body Mass Index of >25 |
95% |
95% |
|
Patients who completed the Patient Satisfaction Survey would recommend Dr. Shreibati as a Provider |
85% |
85% |
EQUITY IMPACT:
Dr. Shreibati’s expanded cardiology coverage will positively impact equitable health outcomes because delivery of cardiology services at SMMC, a public safety net hospital, addresses community need. Specifically, in the past 12 months 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. Shreibati 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 July 1, 2024 through June 30, 2027. The amendment would increase the amount of the agreement by $80,000 from $349,356 to $429,356 for the 3-year term. Funds to cover the amendment’s annual increased cost in the amount of $26,667 is included in the SMMC FY 2024-25 Adopted Budget. Similar arrangements will be made for future years.
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.