Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Agreement with Melissa Selner, DPM to Provide Podiatry Services
RECOMMENDATION:
title
Adopt a resolution authorizing an agreement with Melissa Selner, DPM to provide podiatry services for the term of November 1, 2023, through October 31, 2026, in an amount not to exceed $478,800.
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BACKGROUND:
San Mateo County is responsible for providing necessary medical care to its medically indigent population. Since 2008, Dr. Selner has provided podiatry services for San Mateo Medical Center (SMMC). SMMC’s patient population has a high need for podiatry services, which treats foot and lower leg injuries as well as ongoing health issues like diabetes that can affect lower extremities.
Historically, Dr. Selner’s contract did not require review and approval by the Board of Supervisors in accordance with County Administrative Memorandum B-1. On May 3, 2022, the Board, for the first time, reviewed and approved an amendment to Dr. Selner’s contract expanding her patient care services by approximately 400 hours annually. Specifically, SMMC increased Dr. Selner’s coverage moving from 0.14 to 0.34 “full time equivalent” (FTE) coverage using 2,000 hours per year as an FTE, reflecting the increase in her clinic coverage from 72 four-hour clinics per year to 168 four-hour clinics per year. The expansion of Dr. Selner’s coverage increased the “not to exceed” amount under the agreement by $125,000 to an amount not to exceed $225,000 with no change in the contract term as of May 3, 2022. The implied hourly rate for Dr. Selner’s coverage under the prior contract was $164.70 per hour.
DISCUSSION:
The proposed agreement would renew Dr. Selner’s contract for three years beginning November 1, 2023, through October 31, 2026, at an hourly rate of $166.25 per hour for general podiatry services, or $665 per 4-hour clinic. This contract would increase the amount of coverage Dr. Selner provides from 168 clinics under her prior contract to 240 clinics annually.
SMMC attempted to recruit two podiatrists within the past two years to avoid concentrating the work on a limited number of providers. Of the recruits, only one podiatrist agreed to provide coverage. The latter podiatrist ceased providing services, leaving the County increasingly reliant upon Dr. Selner’s to bridge coverage needs.
County Attorney has reviewed and approved the resolution and agreement as to form. Dr. Selner’s hourly rate of compensation is only slightly higher than the rate under her previous contract, and appears to be both commercially reasonable and within fair market value given the departure of the other podiatrist, community need, and because her compensation was negotiated at arm’s length without any intent or requirement to direct patient referrals between the parties.
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 85% of patients who complete the Patient Satisfaction Survey would recommend Dr. Selner as a provider.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Percentage of patients who complete the Patient Satisfaction Survey that recommend Dr. Selner as a provider |
85% |
85% |
FISCAL IMPACT:
The term of the agreement is November 1, 2023, through October 31, 2026. The amount of the agreement is not to exceed $478,800 for the three-year term. Funds in the amount of $119,700 are included in the SMMC FY 2023-24 Adopted Budget. Funds in the amount of $159,600 are included in the SMMC FY 2024-25 Recommended Budget. Similar arrangements will be made for future years.
The payment provisions and levels of services in this contract differ from that of the previous contract, due to an increase in the number of 4-hour clinics covered by Dr. Selner and a 1.1% increase in Dr. Selner’s hourly rate of compensation.
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.