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 Fred Lui, MD for Nephrology Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Fred Lui, MD to provide nephrology services through his practice group for the term of November 1, 2026 through October 31, 2029 in an amount not to exceed $1,221,913.
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BACKGROUND:
Nephrology is the specialty of internal medicine that focuses on the diagnosis and treatment of kidney diseases. Because the kidney performs many critical functions, nephrologists maintain expertise in primary kidney disorders and the management of the systemic consequences of kidney dysfunction. Fred Lui, MD (“Dr. Lui”) and his group of nephrologists have provided specialty care to San Mateo Medical Center (SMMC) patients since 2005.
DISCUSSION:
The County’s need for nephrology services increases with the aging of the population. SMMC will continue to meet community need for nephrology services through the agreement with Dr. Lui and his group. Dr. Lui and his group will provide the same amount of coverage as under his preceding November 1, 2023 through October 31, 2026 agreement: two four-hour nephrology clinics per week, 24/7/365 on-call coverage, up to an additional eight hours of supplemental clinical services per week as clinical needs require, and ten hours of medical director services per month. The new agreement is for a term of November 1, 2026 through October 31, 2029, in an amount not-to-exceed $1,221,913 (“Agreement”).
The rates in the new Agreement 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.
The 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. Lui and his group shall document tobacco risk and cessation counseling in the medical record for each patient they assume responsibility for that admits to (or has a record of) tobacco use 100% of the time.
PERFORMANCE MEASURE:
|
Measure |
FY 2026-27 Estimated |
FY 2027-2028 Projected |
|
Percentage of time Dr. Lui and his group shall document tobacco risk and cessation counseling in the medical record for each patient they assume responsibility for that admits to (or has a record of) tobacco use. |
100% |
100% |
COMMUNITY IMPACT:
Dr. Lui and his nephrology group’s continued coverage will positively impact equitable health outcomes because delivery of nephrology services at SMMC, a public safety net hospital, addresses community need. Between September 1, 2025 through August 31, 2026, half of SMMC’s patients were female, half were male, the largest ethnic cohort was Hispanic or Latino (58%), and a plurality spoke primarily Spanish (48%). 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. Lui and his team of nephrologists 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 November 1, 2026 through October 31, 2029. The amount of the agreement is not to exceed $1,221,913 for the three-year term. There are staggered increases in hourly physician compensation each year, resulting in a 16% increase in total contract cost over the three-year period compared to the previous agreement if all bonus metrics are met regarding timely documentation and response to consultations each month of each year. Without any bonus payments, the core increase in cost is 13%. Funds in the amount of $388,107 are included in the SMMC FY 2026-27 Adopted Budget. The following fiscal year funds in the amount of $406,949 will be included in SMMC’s FY 2027-28-Recommended Budget. Finally, funds in the amount of $426,858 will be included in SMMC’s FY 2028-29 Recommended Budget.
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.