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 Lakshmi Myneni, MD for Rheumatology Services, for the term of October 1, 2026 through January 31, 2029, in an amount not to exceed $266,159
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Lakshmi Myneni, MD for rheumatology services, for the term of October 1, 2026 through January 31, 2029, in an amount not to exceed $266,159.
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BACKGROUND:
San Mateo Medical Center (SMMC) provides safety net specialty medical services to County patients. Among those specialty services is rheumatology, and Dr. Myneni is one of three providers who meet community needs for that service. Dr. Myneni began providing independently contracted rheumatology services in 2024 on a year-to-year basis. Dr. Myneni is willing to enter into a multi-year agreement from October 1, 2026 through January 31, 2029, to provide ongoing rheumatology services at SMMC.
DISCUSSION:
Dr. Myneni’s previous agreement for the term of October 1, 2025 through September 30, 2026 provided that she would cover 52 four-hour outpatient clinics, 104 ten-hour on-call shifts, and 60 hours of supplemental clinical services as needed to meet patient needs at SMMC. SMMC compensated Dr. Myneni at a rate of $199 per hour for her clinical services and $31 per hour for on-call services. The proposed agreement would increase Dr. Myneni’s outpatient clinic coverage by 52 clinics to 104 four-hour clinics annually and maintain her existing on-call and supplemental clinical availability. The proposed agreement would also continue Dr. Myneni’s compensation at her previously agreed rates through January 31, 2029.
The rates in the new contract 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 less than 5% of Dr. Myneni’s patients who are 18 years of age or older will have an overlapping supply of an opioid and benzodiazepine for 30 or more days in a row.
PERFORMANCE MEASURE:
|
Measure |
FY 2026-27 Estimated |
FY 2027-28 Projected |
|
Percentage of Dr. Myneni’s patients who are 18 years of age or older and have an overlapping supply of an opioid and benzodiazepine for 30 or more days in a row |
< 5% |
< 5% |
COMMUNITY IMPACT:
Dr. Myneni’s continued rheumatology coverage will positively impact equitable health outcomes because delivery of rheumatology services at SMMC, a public safety net hospital, addresses community need. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Between June 1, 2025 and June 30, 2026, half of the patients at SMMC were female and half were male, the largest ethnic cohort was Hispanic or Latino (57%), and a plurality primarily spoke Spanish (47%). 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. Myneni 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 October 1, 2026 through January 31, 2029. The amount of the agreement is not to exceed $266,159 for the two-year, four-month term. Funds in the amount of $114,068 are included in the SMMC FY 2026-27 Adopted Budget. Funds in the amount of $114,068 are included in the SMMC FY 2027-28 Recommended Budget. Similar arrangements will be made for future years.
The level of service in this contract differs from that of the previous contract due to the doubling of the number of annual 4-hour clinics to be covered by Dr. Myneni (from 52 to 104), which accounts for the entire 23% increase in annual cost. As noted above, Dr. Myneni’s compensation rates will remain the same as in her previous agreement through January 31, 2029.
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.