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 Esther Chang, MD to Provide Ophthalmology Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Esther Chang, MD to provide ophthalmology services, for the term of July 1, 2024, through June 30, 2027, in an amount not to exceed $685,000.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population. This includes services for ophthalmology disorders. The County’s need for ophthalmology services is increasing due to the aging of its patient population.
Dr. Esther Chang has served as an ophthalmologist at San Mateo Medical Center (SMMC) since 2018.
DISCUSSION:
Dr. Chang will continue to provide ophthalmology services that include 4-hour ophthalmology clinics and on-call coverage.
In response to increased community need, under this new agreement, Dr. Chang is willing to provide expanded ophthalmology services. Where previously Dr. Chang provided 288 annual hours of clinical ophthalmology services, the proposed contract would increase Dr. Chang’s maximum coverage obligation by 33%, up to 384 annual hours of clinical coverage services. Additionally, Dr. Chang is willing to increase her on-call coverage by 50%, covering up to 183 on-call shifts annually from 121.5.
County Administrative Memorandum B-1 provides that contracts for physician services are exempt from competitive procurement requirements.
The rates in Dr. Chang’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 Dr. Chang will provide retinopathy screening to diabetic patients evaluated by Contractor, if due, 100% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025 and Following Projected |
|
Percentage of diabetic patients evaluated by contractor receiving retinopathy screening, if due |
100% |
100% |
EQUITY IMPACT:
Dr. Chang’s continued ophthalmology coverage will positively impact equitable health outcomes because delivery of ophthalmology 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. Chang 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 $685,000 for the three-year term. Funds in the amount of $228,333 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 33% increase in the maximum number of annual clinical services hours and 50% increase in the number of annual on-call shifts covered, as well as migration from a flat monthly payment model to a model that pays Dr. Chang at a fair market value hourly rate. For these reasons, the total value of the new contract represents a 69% 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.