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: Amendment to Agreement with Nitin Prabhakar, MD to Provide Pain Management Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Nitin Prabhakar, MD to provide pain management medicine services, extending the term through November 30, 2027, and increasing the amount of the agreement by $463,762, to an amount not to exceed $700,050.
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BACKGROUND:
Dr. Prabhakar entered into a one-year agreement effective February 1, 2025 with the County to provide pain management services to aid patients in recovery and manage chronic discomfort. Dr. Prabhakar’s existing contract with the County runs from February 1, 2025 through January 31, 2026, in an amount not to exceed $236,288. In that contract, Dr. Prabhakar provides 208 four-hour shifts of outpatient in-clinic pain management services and 52 shifts of four-hour operating room coverage for epidural blocks annually. Pain management services help the County address and moderate opioid management of chronic pain.
DISCUSSION:
The proposed amendment to Dr. Prabhakar’s contract would extend the term of his existing agreement through November 30, 2027, and add 84 new nine-hour on-call coverage shifts annually at a rate of $17 per hour for each hour on-call coverage is provided. Dr. Prabhakar’s outpatient clinic and operating room coverage will remain unchanged with no changes to his current hourly compensation rate of $284 per hour for that coverage.
The rates for on-call coverage added to the amendment 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. Dr. Prabhakar’s compensation for outpatient clinic and operating room coverage was previously analyzed and addressed when this Board approved his underlying agreement.
The County Attorney has reviewed and approved the resolution and amended 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 less than 5% of patients (18 years or older) seen by pain management will have concurrent prescription for an opioid and benzodiazepine for 30 or more consecutive days (excluding patients in hospice or with cancer).
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of Patients (18 years or older) seen by Pain management will have concurrent prescription for an opioid and benzodiazepine for 30 or more consecutive days (excluding patients in hospice or with cancer). |
< 5% |
< 5% |
COMMUNITY IMPACT:
Dr. Prabhakar’s pain management coverage positively impacts health outcomes for San Mateo Medical Center (SMMC)’s patients by specifically addressing the behavioral and psychological needs of his patients in clinic while helping them manage their pain. 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 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. Prabhakar to meet with SMMC and discuss patient feedback to improve patient satisfaction and remove potential barriers to care.
FISCAL IMPACT:
The term of the proposed amended agreement is February 1, 2025 through November 30, 2027. The amount of the agreement is not to exceed $700,050 for the 34-month term. Funds in the amount of $247,076 are included in the SMMC FY 2025-26 Adopted Budget. Similar arrangements will be made for future years to cover the services provided over the remaining extended term of the proposed amendment.
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.