COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Department of Hospital and Clinics

DATE:

March 13, 2003

BOARD MEETING DATE:

April 8, 2003

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer

SUBJECT:

Resolution Authorizing the Controller to Pay Non-Contract Medical Service Providers

Recommendation

Adopt a resolution authorizing the Controller to pay non-contract medical service providers for services to medically indigent adult (MIA) patients.

Background

San Mateo County is responsible for providing necessary medical care to its medically indigent (MIA) population. If an MIA patient needs services or procedures not offered at San Mateo Medical Center (SMMC), the patient is referred to another facility and the expenses must be paid by the County. Examples of these services are invasive/non-invasive cardiac procedures and radiation therapy.

Since 1990, your Board has authorized the Controller to pay non-contract medical providers who provide medical services at other facilities to our MIA patients.

On June 4, 2002, your Board approved Resolution No. 65310 allowing the Controller to pay non-contract providers for services provided at the prevailing Medicare participating fee schedule for all Part "B" services that can be reimbursed per Health Care Financing Administration (HCFA) guidelines or the Medicare Labor Adjusted Ambulatory Surgery Classification (ASC); and 40% of billed charges for all services not found on the Part "B" Medicare Fee Schedule or the ASC. The maximum amount allowed under this Resolution is $250,000 for the term March 1, 2002 through February 28, 2003.

Discussion

San Mateo Medical Center has seven patients during the current contract term who are requiring outside services for serious illness requiring costly treatments. Two patients have been diagnosed with osteosarcoma (cancer), one patient with acute leukemia, one pediatric patient with autoimmune hepatitis, and two patients requiring ICU beds that could not be accommodated at SMMC. The high cost treatments for just these patients totaled approximately $250,000.

Increased patient activity necessitating these high cost treatments has depleted the $250,000 approved by Resolution No. 065310. Due to the unpredictability of expensive diagnostic procedures that patients require and the increase in clinic utilization, the cost for these services has averaged approximately $56,250 per month.

An extension of four months is being requested to enable San Mateo Medical Center to budget for this expense on fiscal year basis. An increase of $650,000 is being requested to allow San Mateo Medical Center to pay pending invoices and future invoices incurred during the four additional months.

All referrals to non-contract providers must be authorized by Hospital Administration, and utilization review is concurrently provided by the Case Management Department at the hospital. Continuing efforts are being made to reduce expenses for outside providers and perform services within San Mateo Medical Center.

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. The agreement contributes to this commitment and goal by continuing to provide healthcare services to county patients.

Fiscal Impact

This resolution increases the maximum amount by $650,000, from $250,000 to $900,000. It also extends the term by four months, making the new term March 1, 2002 to June 30, 2003. Previously the monthly amount was anticipated to be $20,833, under the new terms the monthly amount increases to $56,250.

Funds for these services have been budgeted in the San Mateo Medical Center FY2002-03 Approved Budget.