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 Sutter Bay Medical Foundation, a California nonprofit public benefit corporation dba Palo Alto Medical Foundation for Health Care, Research, and Education to Provide Otorhinolaryngology Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Sutter Bay Medical Foundation, a California nonprofit public benefit corporation dba Palo Alto Medical Foundation for Health Care, Research, and Education (PAMF), to provide otorhinolaryngology services, for the term of April 1, 2025 through March 31, 2026, in an amount not to exceed $742,272.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population. This care includes otorhinolaryngology (ENT or “ear, nose, and throat”) surgery, and the management and supervision of the service. PAMF has provided surgery services at San Mateo Medical Center (SMMC) for the past 16 years.
DISCUSSION:
The terms of the agreement require staffing up to 228 4-hour outpatient ENT clinics, 60 4-hour shifts in SMMC’s operating room, 24-hour on-call coverage every day during the one-year term, up to 9 hours of medical director services per month in the specialty, and up to 440 hours over the one-year term of the agreement for supplemental clinical services. The coverage amounts are unchanged from the prior agreement except for the addition of the 440 hours of potential supplemental clinical services time, which did not exist in the prior agreement. SMMC needs flexibility to add supplemental clinical time in the specialty to meet community need. The renewed agreement adds a reconciliation clause that would empower the County to claw back funds if the enumerated hours of service above are not actually provided.
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 surgical site infection rates for ENT surgeries will be less than the higher of 2.5% or the SMMC Department of Surgery Average (excluding PAMF), 100% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-2026 Projected |
|
Percentage of times when surgical site infection rates for ENT surgeries will be less than the higher of 2.5% or the SMMC Department of Surgery Average (excluding PAMF) |
100% |
100% |
EQUITY IMPACT:
PAMF’s continued ENT coverage positively impacts equitable health outcomes for SMMC’s patients by specifically addressing the ear, nose, and throat specialty needs of the County’s most medically and financially vulnerable patients. 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 (53%), Hispanic or Latino (57%), and primarily Spanish-speaking (54%). 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 PAMF’s providers 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 April 1, 2025 through March 31, 2026. The amount of the agreement is not to exceed $742,272 for the one-year term. Funds in the amount of $185,568 are included in the SMMC FY 2024-25 Adopted Budget. Funds in the amount of $556,704 will be included in the SMMC FY 2025-26 Recommended Budget.
The previous annual cost of the agreement was $548,784, which represents a 35% increase in cost. The base monthly cost will increase 13% from $45,732 to $51,736. The remaining increase in cost is associated with budgeting for the addition of 440 hours of supplemental clinical services that did not exist in the previous contract. The latter hours would create new capacity to meet patient demand for ENT services and as previously noted above, are covered by a reconciliation clause that would empower the County to claw back funds if the hours are not actually provided. The services would be delivered at an incremental hourly rate of $276.00 per hour, which is within fair market value.
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.