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 Gordon Mak, MD to Provide Pulmonary and Critical Care Medicine Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Gordon Mak, MD to provide pulmonary and critical care services, for the term of October 1, 2025 through September 30, 2028, for an amount not to exceed $1,788,216.
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BACKGROUND:
San Mateo Medical Center (SMMC)’s medical-surgical and critical care units require round-the-clock coverage and medical administrative leadership in the specialty of pulmonary and critical care medicine due to patients presenting to the hospital with acute and complex respiratory ailments. Since 2007, Dr. Mak has provided services in the specialty of caring for patients who are admitted to the hospital’s medical-surgical and critical care units.
DISCUSSION:
Dr. Mak’s expiring agreement required annual coverage of 96 four-hour shifts of pulmonary and critical care medicine ambulatory clinic blocks, 24-hour on-call coverage 180 days per year, and medical-administrative leadership services as the Medical Director of ICU and Pulmonology. The expiring agreement paid Dr. Mak a flat monthly rate of $45,297. SMMC amended the expiring agreement and sought Board approval to add funds to the agreement to cover 39 extra shifts of pulmonary and critical care services in the hospital, which brought the total “not to exceed” amount for Dr. Mak’s expiring agreement to $1,752,540 for the three-year term.
The proposed agreement adds specificity to Dr. Mak’s services and converts the compensation formula from a fixed rate to hourly compensation for each hour of services worked. Annually, Dr. Mak would provide 91 four-hour ambulatory pulmonary and critical care medicine clinics, up to 1356 hours of inpatient pulmonary and critical care medicine coverage to SMMC’s medical surgical and critical care units, up to 2864 hours of on-call coverage, and 10 hours per month as SMMC’s Medical Director of Pulmonary and Critical Care Medicine. In exchange for this coverage commitment, SMMC will pay Dr. Mak $261 per hour for clinical services, $43 per hour for unrestricted on-call coverage, and $200 per hour for Medical Director services, for an amount not to exceed $1,788,216 over the three-year term of the proposed agreement.
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 tobacco-using patients will receive cessation counseling.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of tobacco-using patients who will receive cessation counseling |
100% |
100% |
COMMUNITY IMPACT:
Dr. Mak’s continued pulmonology and critical care coverage will positively impact health outcomes because delivery of 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 training to its physicians and 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. Mak 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 October 1, 2025 through September 30, 2028. The amount of the agreement is not to exceed $1,788,216 for the three-year term. Funds in the amount of $596,072 are included in the SMMC FY 2025-26 Recommended Budget. Funds in the amount of $591,272 are included in the SMMC FY 2026-27 Recommended Budget. Similar arrangements will be made for future years.
SMMC believes that the hours of total service described in the proposed agreement will approximate the actual number of hours Dr. Mak provided under the expiring agreement. The cost of the proposed agreement is expected to increase by 2% compared to the expiring agreement.
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.