San Mateo County Logo
Share to Facebook Share to Twitter Bookmark and Share
File #: 19-759    Version: 1 Name:
Type: Resolution Status: Passed
File created: 6/10/2019 Departments: HEALTH
On agenda: 7/23/2019 Final action: 7/23/2019
Title: Adopt a resolution authorizing an agreement with Ronald Greenwald, MD to provide neurosurgery services for the term of July 1, 2019 through June 30, 2022, for an amount not to exceed $1,425,000.
Attachments: 1. 20190723_r_Ronald Greenwald, MD, 2. 20190723_a_Ronald Greenwald, MD

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 Ronald Greenwald, MD to Provide Neurosurgery Services




Adopt a resolution authorizing an agreement with Ronald Greenwald, MD to provide neurosurgery services for the term of July 1, 2019 through June 30, 2022, for an amount not to exceed $1,425,000.




Neurosurgery services are provided under the general direction of the Chief of Surgery at San Mateo Medical Center (SMMC). Such care includes the evaluation and treatment of brain, spinal cord, and peripheral nervous system disease. Dr. Greenwald has provided professional neurosurgery services at SMMC since 1991.



Dr. Greenwald will continue to provide neurosurgery services at SMMC. He will perform surgeries and provide a half-day clinic every week for 48 weeks each year.


County Administrative Memorandum B-1 provides that contracts for physicians are exempt from the Request for Proposals process.


The agreement and resolution have been reviewed and approved by County Counsel as to form. This agreement is coming to your Board late due to prolonged negotiations.


The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).

The agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing patients access to the evaluation and treatment of diseases requiring neurosurgery. As a safety net hospital, SMMC is acutely aware of the importance of controlling hospital-borne infections, especially in the surgical setting. Failure to control infection results in higher costs to the County for additional care of those patients who become victims of a preventable infection, and for which the County is not reimbursed. It is anticipated that the rate of readmission due to surgical site infection will be less than three percent.




FY 2018-19 Actual

FY 2019-20 Estimated

Rate of readmission due to surgical site infection

< 5%

< 3%



The term of the agreement is July 1, 2019 through June 30, 2022. The amount of the agreement is not to exceed $1,425,000 for the three-year term. Funds in the amount of $475,000 are included in the SMMC FY 2019-20 Recommended Budget. Similar arrangements will be made for future years.


This contract’s payment provisions differ from that of the previous contract. Specifically, there is a 12% increase over the three-year term. Of that increase, 8% is due to increased rates published in the 2018 Medical Group Management Association Provider Compensation and Production Report, a tool SMMC uses to benchmark physician contract compensation. The other 4% is primarily due to the on-call coverage rates increasing to market level, and this agreement being three years in duration instead of two. 


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.