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: Agreement with Daniel J. Buckley, MD to Provide Ophthalmology Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Daniel J. Buckley, MD to provide ophthalmology services, for the term of July 1, 2026 through June 30, 2028, in an amount not to exceed $330,144.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population, which includes services for ophthalmology disorders. Dr. Buckley has served as an ophthalmologist at San Mateo Medical Center (SMMC) for more than 25 years.
DISCUSSION:
Dr. Buckley will be providing coverage to 72 four-hour outpatient ophthalmology clinics annually and will be available to provide 122 shifts annually of 24-hour on-call coverage for consultation and in response to the emergency department.
In this agreement, Dr. Buckley will no longer be providing coverage to SMMC’s operating room, resulting in a savings of $66,000 annually compared to the previous agreement. Also, Dr. Buckley will be providing fewer on-call shifts, a total of 122 compared to 183 previously, resulting in a net decrease in annual cost of $40,992 compared to the previous agreement. Dr. Buckley increased the hours of service in his prior agreement to fill hours that were previously provided but lost due to Dr. McNamara’s passing. Since then, SMMC recruited Dr. Louisa Lu to help stabilize coverage among the contracted ophthalmologists at SMMC.
Dr. Buckley’s hourly compensation rate for outpatient clinic coverage will increase from $250 per hour to $258 per hour, while the compensation rate for on-call coverage will increase from $30 per hour to $31 per hour.
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.
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 evaluated by Dr. Buckley will receive retinopathy screening if due.
PERFORMANCE MEASURE:
|
Measure |
FY 2026-27 Projected |
FY 2027-28 Projected |
|
Percentage of patients evaluated by Dr. Buckley that will receive retinopathy screening if due |
100% |
100% |
COMMUNITY IMPACT:
Dr. Buckley’s continued ophthalmology coverage will positively impact equitable health outcomes because delivery of ophthalmology services at SMMC, a public safety net hospital, addresses community need. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Since November 1, 2024, half of the specialty care patients at SMMC were female and half were male, with the largest ethnic cohort being Hispanic or Latino (58%), and a plurality of patients spoke primarily Spanish (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. Buckley 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, 2026 through June 30, 2028. The amount of the agreement is not to exceed $330,144 for the two-year term. Funds in the amount of $165,072 are included in the SMMC FY 2026-27 Adopted Budget. Similar arrangements will be made for future years.
The payment provisions and levels of services in this contract differ from those of the previous contract due to the elimination of operating room coverage and a reduction in annual on-call shifts. The total value of the new contract represents a 39% decrease compared to that of the previous contract. As noted above, the cost reduction is attributable to the normalization of ophthalmology service hours in the wake of Dr. McNamara’s passing and following the recruitment of Dr. Louisa Lu.
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.