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 California Advanced Imaging Medical Associates, Inc. for Radiology Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with California Advanced Imaging Medical Associates, Inc. to provide radiology services for the term of June 1, 2025 through May 31, 2028, in an amount not to exceed $12,669,077.
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BACKGROUND:
San Mateo County is obligated to maintain a diagnostic radiological service at San Mateo Medical Center (SMMC) under California’s hospital licensing regulations known collectively and colloquially as “Title 22” at 22 Cal. Code Regs § 70253(a). Physician oversight of the service is required under § 70255. Since 2008, the County has contracted with California Advanced Imaging Medical Associates, Inc. (CAIMA) to provide professional radiology coverage at SMMC to meet these requirements. The proposed agreement would continue CAIMA’s radiology coverage at SMMC by providing physician staffing and a designated Medical Director to help lead the hospital’s radiology services.
DISCUSSION:
The proposed agreement estimates that six full-time radiologists are needed to provide diagnostic radiology coverage, interventional radiology coverage, up to 30 hours of Medical Director services per month, and up to 104 hours over 13 Saturdays per year to address potential backlogs in diagnostic imaging interpretation should such backlogs arise. CAIMA’s radiologists will also provide remote interpretation and diagnostic services outside of standard business hours, overnight and on holidays, for all emergent and urgent patient care concerns that require immediate interpretation and diagnosis. CAIMA will be paid $326,222 per month during the first contract year, $352,319 per month during the second contract year, and $369,935 per month during the final contract year. The monthly fee includes the Medical Director of Radiology’s time and leadership services, which are valued at $280 per hour and up to $8,400 per month. Supplemental diagnostic and interpretation services, if needed, would be separately and additionally invoiced at the same rate of $280 per hour. The physician staffing levels, and scope of services are unchanged from the County’s prior agreement with CAIMA.
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 100% of all routine non-urgent interpretation and diagnostic services performed between the hours of 5:00 p.m. Friday and 8:00 a.m. the following Monday will be completed by the end of the following business day.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Projected |
FY 2026-27 Projected |
|
Percentage of all routine non-urgent interpretation and diagnostic services performed between 5:00 p.m. Friday and 8:00 a.m. the following Monday will be completed by the end of the following business day |
100% |
100% |
COMMUNITY IMPACT:
CAIMA’s continued radiology coverage will positively impact equitable health outcomes because delivery of cardiology services at SMMC, a public safety net hospital, addresses community need. Demographically, 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 CAIMA 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 June 1, 2025 through May 31, 2028. The amount of the agreement is not to exceed $12,669,077 for the three-year term. Funds in the amount of $3,914,660 are included in the SMMC FY 2025-26 Adopted Budget for base radiology coverage and Medical Director services, with an additional allowance of $87,360 for supplemental services, if needed. Funds in the amount of $4,227,833 for base radiology coverage and Medical Director services will be included in the SMMC FY 2026-27 Recommended Budget. Funds in the amount of $4,439,225 for base radiology coverage and Medical Director services will also be included in the SMMC FY 2027-2028 Recommended Budget. As with the first contract year, supplemental service allowances in the amount of $87,360 will be additionally accounted for in SMMC’s Recommended Budgets for 2026-2027 and 2027-2028.
The payment provisions and levels of services in this contract differ from those of the previous contract due to CAIMA’s concern about its ability to retain and attract physicians. Because of this concern, CAIMA opened negotiations requesting a 43% increase in compensation compared to its previous contract. CAIMA and SMMC negotiated in good faith and at arm’s length. The proposed arrangement reflects a 23% increase in total compensation arrived at by compounding increases over three years: 15% in year 1, 8% in year 2, and 5% in year 3. While CAIMA’s opening request would have been at the highest end of fair market value according to VMG yielding average annual compensation per full-time physician in the 90th percentile among radiologists at $809,949 - the negotiation resulted in compensation at $702,666 per full-time physician, which is in the middle of VMG’s FMV range.
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.