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
Michael del Rosario, Director, Correctional Health Services
Subject: Agreement with CEP America - California, a California General Partnership dba Vituity for Emergency and Correctional Health Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with CEP America - California, a California General Partnership dba Vituity to provide emergency and correctional health services, for the term of May 1, 2026 through April 30, 2029, in an amount not to exceed $8,712,408.
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BACKGROUND:
CEP America - California, a California General Partnership dba Vituity (Vituity) provides physicians, advanced practice practitioners (also commonly known as “midlevel practitioners”), and scribes to San Mateo Medical Center’s (SMMC’s) Emergency Department (ED) and the Correctional Health Services Division (CHS) in the County’s jail.
SMMC has one of the busiest EDs in San Mateo County. In 2025, SMMC’s ED cared for 38,459 patients. The County also provided medical care to 2,472 individuals in custody of the Sheriff’s Office Corrections Division. ED coverage is legally required for SMMC to maintain supplemental basic emergency services under Cal. Code Regs §§ 70413, 70415 and to facilitate compliance with the Emergency Medical Treatment and Active Labor Act. CHS helps prevent avoidable inmate transfers to SMMC’s ED. It is therefore necessary for the County to enter into an arrangement for ED and CHS medical services coverage.
SMMC recognizes Vituity’s commitment to SMMC and San Mateo County, which includes the organization’s history of providing high quality services that helped the County navigate a public health crisis during the COVID-19 pandemic, along with continuously improving and maintaining high quality of care within the ED. Many of Vituity’s physicians reside in San Mateo County and reflect the group’s sustained commitment to caring for the County’s vulnerable patient populations. Vendor performance is constantly monitored by SMMC and CHS leadership and this contractual relationship has been reevaluated every three years to ensure the group is meeting the terms of the agreement aligned with SMMC and CHS goals and that rates are consistent with market rates. Vituity continues to meet or exceed all established goals, and it is SMMC’s assessment that this group remains the best market option for San Mateo County, SMMC, and CHS. Therefore, SMMC and CHS request authorization of this new three-year contract.
DISCUSSION:
The scope of Vituity’s medical coverage services at SMMC’s ED and CHS remains largely unchanged from the County’s prior contract. SMMC’s ED will remain staffed 24 hours per day, with physicians responding to provide correctional health services. Administrative and medical support services will also be provided with the same consistency, amount of service, and quality. A minor addition in service scope compared to the County’s previous contract in 2023 is the dedication of Epic “SuperUser” services, whereby Vituity will provide Medical Director and advanced practice practitioner support for assisted practitioner troubleshooting regarding order entry, workflow, and documentation within the County’s electronic health record system. Over time this service was added by amendment to the 2023 coverage agreement and will be maintained going forward. On-call consultation to Cordilleras Mental Health Center is discontinued due to the County’s reassignment of psychiatric resources through the County’s Behavioral Health and Recovery Services division to handle “5150” order entry workflows.
The rates in the new contract are, as required by law, 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 less than 2% of patients who arrive at the SMMC ED will leave before being seen by a provider each quarter of each year.
PERFORMANCE MEASURE:
|
Measure |
FY 2026-27 Projected |
FY 2027-28 Projected |
|
Percentage of patients who arrive at the SMMC ED and leave before being seen by a provider each quarter of each year |
<2% |
<2% |
COMMUNITY IMPACT:
Vituity’s ED and CHS coverage will positively impact equitable health outcomes because delivery of services at SMMC, a public safety net hospital, and within the County’s jail addresses community need and the needs of individuals within the Sheriff’s Office’s custody. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Since November 1, 2024, SMMC has provided specialty care to approximately the same number of men and women, the largest ethnic cohort being Hispanic or Latino (58%) and primarily Spanish-speaking (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 Vituity to meet with SMMC, discuss patient feedback to improve patient satisfaction, and remove potential barriers to care.
FISCAL IMPACT:
The term of the agreement is May 1, 2026 through April 30, 2029. The amount of the agreement is not to exceed $8,712,408 for the three-year term. Funds in the amount of $395,790 and $88,232 are included in the SMMC and CHS FY 2025-26 Adopted Budgets, respectively. Funds in the amount of $2,904,136 and $529,393 are included in the SMMC FY 2026-27 and CHS Adopted Budgets, respectively. Similar arrangements will be made for future years.
The total value of the new contract represents a 3% increase in base physician, advance practice practitioner, medical director, and scribe coverage cost compared to the previous three-year agreement. Adding Epic SuperUser support services and budgeting for unrealized (yet possible) extra staffing expenses caused by the contract’s “surge pricing” formula adds an additional 3% increase in cost over the three-year term. In sum, the contract yields an expected 6% total increase in cost.
One hundred percent of CHS’ funds are Net County Cost.
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.