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 the Agreement with The Wilshire Group Associates, LLC to Provide Revenue Cycle Advisor Services
RECOMMENDATION:
title
Adopt a resolution authorizing an amendment to the agreement with The Wilshire Group Associates, LLC to provide revenue cycle advisor services, increasing the amount of the agreement by $765,000, to an amount not to exceed $2,500,000.
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BACKGROUND:
To support the implementation of San Mateo County Health’s and San Mateo Medical Center’s (SMMC) new electronic health record (EHR) system, EPIC, a Request for Proposals for an Epic Transition Business Advisor to provide revenue cycle advisory services for the Epic transition was completed in June 2023. Trifecta Group, Inc. (Trifecta) was elevated due to their knowledge and expertise of California safety net public hospitals, FQHC billing, and the Epic system.
On October 17, 2023, this Board approved an agreement with Trifecta for the term of October 1, 2023, through September 30, 2025, in an amount not to exceed $1,000,000. This agreement has gone through a few amendments, reassigning the original agreement from Trifecta to The Wilshire Group Associates, LLC (Wilshire) incident to Wilshire’s acquisition of Trifecta, extending the term of the agreement through May 31, 2026, and increasing the maximum amount expendable of the agreement to an amount not to exceed $1,735,000.
DISCUSSION:
SMMC has an ongoing need for revenue cycle optimization and stabilization services in EPIC. Wilshire has provided expertise in account adjustments, accounts receivable monitoring, FQHC claims processing and submission, and work-queue optimization. Wilshire’s commitment to supporting EPIC optimization and stabilization has been realized through various workgroups to solve work-queue discrepancies - identifying billing errors, highlighting payer/adjudication errors, ticket initiating, and areas that are still in the implementation phase. This amendment will increase the amount of the agreement by $765,000, to an amount not to exceed $2,500,000, to ensure Wilshire can continue supporting SMMC in the legacy system as well as support and encourage Revenue Cycle optimization and stabilization in Epic with additional committed workgroups.
Upon the end of this agreement, SMMC plans to either issue a Request for Proposals or purchase services from a participant of SMMC’s chosen Group Purchasing Organization vendor, Vizient.
County Attorney has reviewed and approved the resolution and amendment 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 all electronic payments received will be posted within 90 days of receipt.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Number of days for all electronic payments received to be posted |
≤90 days |
≤90 days |
COMMUNITY IMPACT:
Although Wilshire’s services do not directly impact SMMC’s patients, optimizing and stabilizing the revenue cycle services in EPIC will assist SMMC, a public safety net hospital, in providing health services to the community. 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%). By prioritizing accessibility, reducing bias, and providing patient-centered financial practices, SMMC can use revenue cycle services in EPIC to improve health equity while maintaining financial sustainability.
FISCAL IMPACT:
The term of the amended agreement is October 1, 2023, through May 31, 2026. The amendment increases the amount payable under the agreement by $765,000, to an amount not to exceed $2,500,000 for the 32-month term. Funds in the amount of $163,929 are included in the SMMC FY 2024-25 Adopted Budget. Funds in the amount of $601,071 are included in the SMMC FY 2025-26 Recommended Budget. Similar arrangements will be made for future years.
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.