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 Ronald Greenwald, MD for Neurosurgery Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Ronald Greenwald, MD for neurosurgery services, for the term of November 1, 2025, through October 31, 2028, in an amount not to exceed $1,800,531.
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BACKGROUND:
Dr. Greenwald’s neurosurgery services have been provided at San Mateo Medical Center (SMMC) since 1991. In his time providing services at SMMC, Dr. Greenwald offered County patients access to the evaluation and treatment of brain, spinal cord, and peripheral nervous system diseases, including brain cancer, brain aneurysms, spinal cord, nerve root impingement syndromes (ruptured/herniated discs), and peripheral nerve impingement syndromes (carpal tunnel).
DISCUSSION:
Between 2022 and 2025, Dr. Greenwald provided 48 four-hour outpatient clinics, 48 four-hour blocks of surgery, and 336 days of on-call coverage per year under the terms of his previous contract. The previous contract provided payment at a fixed monthly rate of $44,614 per month and the per-block/per-shift rate triggered extra services aligned with penalties if the minimum service levels were not provided. One feature within Dr. Greenwald’s previous contract gave him the option to provide on-call services remotely at a lower on-call shift rate.
The proposed agreement eliminates the fixed monthly payment structure of Dr. Greenwald’s previous contract and eliminates the option for Dr. Greenwald to provide remote on-call services. For the next three years, Dr. Greenwald will provide up to 42 four-hour outpatient clinics, 24 four-hour surgical blocks in the operating room, up to 275 24-hour shifts of unrestricted on-call services (which will require in person and not remote attendance to patient emergencies), and up to 43 hours annually for supplemental clinical or surgical services. In clinic and in the operating room, Dr. Greenwald will earn $555 per hour while he will earn $66 per hour for his on-call coverage excluding time he is scheduled to be in clinic or in the operating room.
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 Dr. Greenwald will see inpatient post-ops in person within 24 hours, excluding observation patients, 100% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of time Dr. Greenwald will see inpatient post-ops in person within 24 hours, excluding observation patients. |
100% |
100% |
COMMUNITY IMPACT:
Dr. Greenwald’s continued neurosurgery coverage will positively impact health outcomes because delivery of neurosurgery 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. 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 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. Greenwald 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 November 1, 2025 through October 31, 2028. The amount of the agreement is not to exceed $1,800,531 for the three-year term. Funds in the amount of $600,177 are included in the SMMC FY 2025-26 Adopted Budget. Similar arrangements will be made for future years.
The payment provisions and levels of services in the proposed contract differ from those of the previous contract, due to a decrease in the number of annual four-hour operating room blocks from 42 to 24 as well as a decrease in the number of 24-hour on-call shifts from 336 to 275. At the same time, Dr. Greenwald’s effective hourly rate has also increased approximately 27%, in order to reflect current market rates. As a result, the total value of the new contract represents a 9% increase compared to that of the previous contract.
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.