Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Agreement with Jacqueline Baras Shreibati, MD, to Provide Non-Invasive Cardiology Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Jacqueline Baras Shreibati, MD to provide non-invasive cardiology services, for the term of July 1, 2024, through June 30, 2027, in an amount not to exceed $349,356.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population. This includes services for cardiology disorders and the management and supervision of those services. The County’s need for cardiology services is increasing due to the aging of its patient population.
Dr. Shreibati has served as a non-invasive cardiologist at San Mateo Medical Center (SMMC) since 2016.
DISCUSSION:
Dr. Shreibati will continue to provide cardiology services that include four-hour clinic blocks, inpatient cardiology consultations, and reading services including electrocardiograms, “stress echoes”, “stress tests”, and Holter monitors. Dr. Shreibati will also provide on-call coverage.
In response to increased community need, under this agreement, Dr. Shreibati is willing to provide expanded cardiology services. Where previously Dr. Shreibati provided 184 annual hours of clinical cardiology services, the proposed contract would increase Dr. Shreibati’s maximum coverage obligation by 46% compared to her previous contract, to a new total of 268 annual hours of clinical coverage services. There is no change in the amount of on-call services that will be provided.
County Administrative Memorandum B-1 provides that contracts for physician services are exempt from competitive procurement requirements.
The rates in Dr. Shreibati’s renewed contract are within fair market value according to Value Management Group 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 95% of the time, Dr. Shreibati will document and perform nutrition counseling for patients during ambulatory clinic visits when patients have Body Mass Index greater than twenty-five. In addition, it is anticipated that 85% of patients who complete the Patient Satisfaction Survey will recommend Dr. Shreibati as a provider.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025 and Following Projected |
|
Percentage of documentation and performance nutrition counseling for patients during ambulatory clinic visits when patients have Body Mass Index greater than twenty-five |
95% |
95% |
|
Percentage of patients who complete the Patient Satisfaction Survey recommending contractor as a provider |
85% |
85% |
EQUITY IMPACT:
Dr. Shreibati’s continued cardiology coverage will positively impact equitable health outcomes because delivery of cardiology services at SMMC, a public safety net hospital, addresses community need. Specifically, in the past 12 months 68.3% of SMMC’s patients were enrolled in Medi-Cal with an additional 6.1% of SMMC’s patients enrolled in the Access to Care for Everyone program. 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 (56%), Hispanic or Latino (58%), 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 Dr. Shreibati 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, 2024, through June 30, 2027. The amount of the agreement is not to exceed $349,356 for the three-year term. Funds in the amount of $116,452 are included in the SMMC FY 2024-25 Adopted Budget. Similar arrangements will be made for future years.
The payment provisions and levels of services in this contract differ from that of the previous contract, due to the 46% increase in the maximum number of annual clinical services hours and an adjustment from a flat combined monthly-rate compensation model to an hourly compensation model based on the same hourly rate recently offered to fellow SMMC cardiologists Drs. Bindra, Hassid, and Zheng. For these reasons, the total value of the new contract represents a 76% 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.