COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

 

DATE:

July 12, 2004

BOARD MEETING DATE:

July 27, 2004

 

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer, San Mateo Medical Center

 

SUBJECT:

Second Amendment to the Agreement with MedQuist Transcriptions, Ltd.

 

Recommendation

Adopt a resolution authorizing the President of the Board to execute an Amendment to the Agreement with MedQuist Transcriptions, Ltd. to increase the maximum amount of the Agreement by $1,200,000 and to allow a three month Mitigation Period.

 

Background

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 was May 1, 2001 to April 30, 2004 with a maximum amount of $1,439,622. On August 12, 2003, your Board approved an amendment to the agreement with MedQuist extending the term of the agreement by one year, from May 1, 2001 through April 30, 2005 and increasing the maximum amount of the agreement by $1,215,000, from $1,439,622 to $2,654,622. With this Amendment 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 negotiated with MedQuist.

MedQuist 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.

 

Discussion

Transcribed reports 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 trend for the last six months has transcription costs averaging $95,000.00 with a $103,000 invoice for April 2004. The increase in transcription costs stems from a series of events occurring within the medical center during the past year. Transcription services are now also being provided to Burlingame Long Term Care, a 281-bed long-term care facility as well as to three new clinics: Ron Robinson Senior Center, Fair Oaks Pediatric Clinic and the Infusion Clinic. For this reason, it is critical to increase the current contract by $1,200,000 for the remainder of the contract period.

Currently SMMC is working on going live on a new transcription platform. For the first 90 days of the new platform, MedQuist has presented a period of implementation (Mitigation Period) wherein the system will be switched from DOS to Windows. The difference in the two systems causes characters, such as the tab key and the indent key to be counted differently. The calculation of symbols between the two systems also tabulate differently. During this period of implementation, MedQuist will be billing San Mateo Medical Center on a per report basis rather than a per line basis for a period of approximately three months. Implementation will begin on or about August 1, 2004. San Mateo Medical Center anticipates a slight savings during the Mitigation Period.

The Medical Records Department has aggressively considered 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.

The Medical Records Department will continue to explore methods to decrease transcription cost without having a negative outcome on availability of patient health information maintaining compliance with state and federal governmental regulatory agencies.

County Counsel and Risk Management have both reviewed and approved this Amendment.

 

Vision Alignment

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.

 

Fiscal Impact

This Amendment increases the maximum amount of the agreement by $1,200,000, from $2,654,622 to $3,854,622. The term of the agreement, May 1, 2001 through April 30, 2005, remains the same. Funds are included in San Mateo Medical Center’s FY2003-04 Approved Budget and FY2004-05 Recommended Budget.