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: Fourth Amendment to the Agreement with The Wilshire Group Associates, LLC to Provide Revenue Cycle Advisor Services
RECOMMENDATION:
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Adopt a resolution authorizing a fourth amendment to the agreement with The Wilshire Group Associates, LLC to provide revenue cycle advisor services, extending the term of the agreement by one year through May 31, 2027, and increasing the amount of the agreement by $350,000, to an amount not to exceed $2,850,000.
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BACKGROUND:
To support the implementation of San Mateo County Health’s and San Mateo Medical Center’s (SMMC) new electronic health record system, Epic, a Request for Proposals for an Epic Transition Business Advisor to provide revenue cycle advisory services for the Epic transition was completed in June 2023. Trifecta Group, Inc. (Trifecta) was elevated due to their knowledge and expertise of California safety net public hospitals, Federally Qualified Health Center (FQHC) billing, and the Epic system.
On October 17, 2023, this Board approved an agreement with Trifecta for the term of October 1, 2023, through September 30, 2025, in an amount not to exceed $1,000,000. This agreement has gone through multiple amendments, reassigning the original agreement from Trifecta to The Wilshire Group Associates, LLC (Wilshire) incident to Wilshire’s acquisition of Trifecta, extending the term of the agreement through May 31, 2026, and increasing the maximum amount expendable of the agreement to an amount not to exceed $2,500,000.
DISCUSSION:
SMMC has an ongoing need for revenue cycle optimization and stabilization services in Epic. Wilshire has provided expertise in account adjustments, accounts receivable monitoring, FQHC claims processing and submission, and work-queue optimization. Wilshire’s commitment to supporting Epic optimization and stabilization has been realized through various SMMC workgroups to solve work-queue discrepancies - identifying billing errors, highlighting payer/adjudication errors, ticket initiating, and areas that are still in the implementation phase. This amendment will extend the term of the agreement by one year through May 31, 2027, and increase the amount of the agreement by $350,000, to an amount not to exceed $2,850,000. This action ensures that Wilshire can continue supporting SMMC in its legacy system, as well as support and encourage revenue cycle optimization and stabilization in Epic.
The County Attorney has reviewed and approved the resolution and amendment 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 all electronic payments received will be posted within 90 days of receipt.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Number of days for all electronic payments received to be posted |
≤90 days |
≤90 days |
COMMUNITY IMPACT:
Although Wilshire’s services do not directly impact SMMC’s patients, optimizing and stabilizing the revenue cycle services in Epic will assist SMMC, a public safety net hospital, in providing health services to the community. 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 cohorts being Hispanic or Latino (58%) and primarily Spanish-speaking (48%).
FISCAL IMPACT:
The term of the amended agreement is October 1, 2023, through May 31, 2027. The amendment increases the amount payable under the agreement by $350,000 to an amount not to exceed $2,850,000 for the 44-month term. Funds in the amount of $29,167 are included in the SMMC FY 2025-26 Adopted Budget. Funds in the amount of $320,833 are included in the SMMC FY 2026-27 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.