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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
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San Mateo Medical Center
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DATE:
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July 25, 2003
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BOARD MEETING DATE:
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August 12, 2003
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TO:
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Honorable Board of Supervisors
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FROM:
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Nancy J. Steiger, Chief Executive Officer
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SUBJECT:
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Amendment to the Agreement with MedQuist Transcriptions, Ltd.
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Recommendation
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Adopt a resolution authorizing the President of the Board to 1) waive the Equal Benefits Compliance for MedQuist Transcriptions, Inc. and 2) execute an Amendment to the Agreement with MedQuist Transcriptions, Ltd.
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Background
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State and Federal regulatory agencies, including the Joint Commission Accreditation of Healthcare Organizations (JCAHO) and the Licensing and Certification Division of the State Department of Health Services (DHS) are continually increasing standards for health information documentation. With recent emphasis on patient safety, health information becomes more critical. The Medical Executive Committee has a plan around dictated reports that increases health information available for patient care. This includes using dictation and transcription of all hospital inpatient stays, same day surgeries, outpatient clinic visits including the satellite clinics, emergency department visits, and ancillary tests through a contractor. Excluded from this service is pathology and radiology dictation, which are under separate contract with The Electric Company. The contractor includes the equipment needed for dictating and equipment maintenance services. The division does not incur the cost for purchasing and maintaining equipment.
In January 2001, San Mateo Medical Center conducted a Request for Proposal (RFP) process. The RFP was sent to 12 vendors. Selection criteria included turnaround time, performance parameters, training, technical support and quality assurance. MedQuist was selected from five transcription service providers who responded to the RFP because they were the lowest bidder, and had the best qualification.
On June 19, 2001, your Board approved an agreement with MedQuist. The term of the agreement is May 1, 2001 to April 30, 2004 with a maximum amount of $1,439,622. MediQuist has been providing San Mateo Medical Center with good service with respect to turnaround time, quality of work performed and response to service needs since 1997.
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Discussion
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The trend for the last six months has transcription costs averaging $72,000 per month with an $80,000 invoice for March 2003. The contract began with a monthly transcription average of $50,000. With multiple clinics and treatment centers, transcribed reports also allow the availability of health information throughout San Mateo Medical Center for continuation and quality of patient care. A health care provider can call up transcribed reports from anywhere in the Medical Center. Patients coming to the San Mateo Medical Center emergency room can have the benefit of their prior health information available for emergency treatment.
The Emergency Room currently dictates 95% of all patients. Emergency Room visits had an increase this year of 25%. This, among other factors, has contributed considerably to the increase of transcription cost for San Mateo Medical Center.
The Medical Records Department is aggressively considering other options to decrease the cost of transcription and the processing of the transcribed documents including, voice recognition; building templates specific for physicians disciplines and electronic signature which will enable physicians to authenticate (sign) documents at their computer terminals.
At this time it is critical to increase the current contract by $1,215,000 for the remainder of the contract period. The San Mateo Medical Center negotiated a 10% decrease in the rate per line in the current agreement for an additional year in the term of the agreement. This savings is in addition to the already very competitive rates the SMMC has negotiated with MedQuist.
The Medical Records Department will continue to explore methods to decrease transcription cost without having a negative outcome on availability of patient health information and maintaining compliance with state and federal governmental regulatory agencies.
Equal Benefits and Health Insurance Portability and Accountability Act (HIPAA) language have been incorporated into this amendment. County Counsel and Risk Management have reviewed and approved this amendment.
SMMC is requesting a waiver of the Equal Benefits Compliance for MedQuist because MedQuist’s benefits do not extend to domestic partners. This Vendor has no staff in Northern California.
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Vision Alignment
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This Contract keeps the commitment to Responsive, effective and collaborative government and goal number 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain. The agreement contributes to this commitment by providing mandated transcription services and timely transcribed reports thereby making available accurate procedure reports for physicians and improving the availability of health information through San Mateo Medical Center.
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Fiscal Impact
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This Amendment extends the term of the agreement by one year, making the new term May 1, 2001 through April 30, 2005. The maximum amount of the contract is increased by $1,215,000, from $1,439,622 to $2,654,622. Funds are included in San Mateo Medical Center’s FY2003-04 Approved Budget and FY2004-05 Recommended Budget.
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