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COUNTY OF SAN MATEOInter-Departmental Correspondence |
Department of Hospital and Clinics |
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DATE: |
August 8, 2002 |
BOARD MEETING DATE: |
August 20, 2002 |
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TO: |
Honorable Board of Supervisors |
FROM: |
Nancy J. Steiger, Chief Executive Officer |
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SUBJECT: |
Agreements with, Discharge Resource Group (DRG), On-Call Therapists, and Preferred Healthcare Registry, Inc. |
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Recommendation |
Adopt a resolution authorizing the President of the Board to execute agreements with DRG, On-Call Therapists, Inc., and Preferred Healthcare Registry, Inc for Outpatient, Acute and Long Term Care Rehabilitation Services at San Mateo County Health Center. |
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Background |
San Mateo County is responsible for providing necessary medical care to its medically indigent adult population. The Department of Hospital and Clinics is certified to provide general rehabilitation services. Services must cover three distinct areas: Acute hospital patients, long term care residents and ambulatory care. County employees cover physical therapy and occupational therapy. Registry assistance is needed during times of staff absences or high patient census. Speech Therapy and Audiology testing is provided through separate contractual arrangements. Each year the Department of Hospital and Clinics establishes a pool of interested registries that are willing to provide services within prevailing community rates. Very frequently, one registry may not have staff available to respond to our needs because of prior commitments. Having multiple providers broadens the availability of back-up therapists with specific experience required to serve the diverse populations and needs. County patients frequently present more complex problems that often exceed the capacity of one registry provider. |
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Discussion |
In April 2002 Rehabilitation Services issued an RFP to community providers, five companies were contacted, four responded. Of the registries we have used in the past, one did not respond and two others are no longer in business in the Bay Area. (Of the four respondents one has been eliminated due to having the highest rates and not having the equal benefits provision.) The remaining three are best able to provide skilled rehabilitation specialists and willing to provide services at rates at or below the community standards.
Physical therapy and occupational therapy are necessary to assist in increasing patients' functional independence, resulting in earlier discharge from the hospital. Physical therapy services include identification, prevention, remediation, and rehabilitation of acute or prolonged physical dysfunction or pain, with emphasis on ability to perform routine activities. Occupational therapy services include behavior modification training and training in activities of daily living. Besides medical/surgical and intensive care areas of the hospital, occupational therapy also serves the acute psychiatric unit.
These contracts are necessary to maintain the broadest pool of therapy contractors and to provide coverage for mandated therapist positions that can remain vacant for extended periods of time. The registries provide licensed Physical Therapists, certified Physical Therapy Assistants, Registered Occupational Therapists and Occupational Therapy Assistants. The Department of Hospital and Clinics uses rehabilitation therapy registries to provide coverage for temporary absences, vacancies, limited weekend coverage, and fluctuations in patient volume. Regulations and community standards mandate rehabilitation therapy treatment on weekends for those patients whose rehabilitation progress would be diminished by two days of inactivity. Without full coverage, the Department will not meet full clinical standards required to provide care, will lose revenue and may encounter problems with regulatory agencies such as JCAHO and State Department of Health Services Licensing and Certification. The Department then risks losing certification for rehabilitation services, which could result in patients being referred to other facilities at a higher cost to the county.
County Counsel and Risk Management have approved these agreements. |
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Vision Alignment |
This agreement keeps the commitment to Ensure Basic Health and Safety for All and goal number 5: Provide residents access to healthcare and preventive care. These agreements contribute to this commitment and goal by continuing to provide therapy services to county patients. |
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Fiscal Impact |
The terms of the agreements are two years, from July 1, 2002 June 30, 2004. The agreement maximum for all agreements approved collectively under single resolution is $300,000 for two years. The maximum amount for the previous set of agreements was $300,000 for three years. While the County has been able to negotiate the lowest rates possible, the agreement maximum has increased to $150,000 per year to ensure adequate coverage for patient volumes. Funds for these agreements are available in the FY02-03 Hospital and Clinics Approved Budget and will be included in the FY03-04 subsequent budget requests. |