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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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April 29, 2005
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BOARD MEETING DATE:
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May 17, 2005
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SPECIAL NOTICE/HEARING:
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None
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VOTE REQUIRED:
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Majority
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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 Associated Medical Specialists
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RECOMMENDATION:
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Adopt a resolution authorizing the President of the Board to execute an Amendment to the Agreement with Associated Medical Specialists (AMS) to provide internal medicine and hospitalist services for six months and increasing the maximum Agreement obligation by $1,570,002 from $9,913,512 to $11,483,514.
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VISION ALIGNMENT:
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Commitment: To Ensure Basic Health and Safety for All.
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Goal(s): Provide residents access to healthcare and preventive care.
The Amendment contributes to this commitment and goal by continuing to provide internal medicine services, including cardiology and mental health, to county patients.
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Performance Measure(s):
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Measure
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FY 2004-05
Actual
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FY 2005-06
Projected
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Number of clinic visits and admissions for internal medicine.
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6,870
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7500
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BACKGROUND:
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San Mateo County is responsible for providing necessary basic medical care to its medically indigent population. This care includes internal medicine services. Since 1975, Associated Medical Specialists (AMS) has provided these internal medicine services, including cardiology, oncology, gastroenterology, rheumatology, endocrinology, pulmonology, and critical care, as well as the management and supervision of those services. For the past three years, AMS has expanded their role to include conducting history and physicals for mental health patients and provision of on-call coverage for the Burlingame Long Term Care facility.
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DISCUSSION:
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The San Mateo Medical Center has operated under a hybrid model of internal medicine that includes both hospitalist and subspecialty services. In an effort to address the growing demand for inpatient and outpatient clinic services, we are negotiating to separate the current model into two distinct functions and adjust our admissions procedures. The first step is to identify the actual cost of providing services to ensure they are within reasonable market parameters. The next step is to value the cost of the operational structure we provide to an internal group. The final step is to identify what our projected needs for internal medicine will be under the new model and determine the appropriate cost for such services. Our anticipation is that this streamlining process will result in increased revenue generation for the hospital at an overall net savings to the County.
The original Agreement budget of $9,913,512 was based on a three year contractual period and included performance incentives. The Amendment period is for a six month period to extend the same basic hospital coverage. A new contract with an October 2005 effective date is currently being negotiated based on the above process. The timing reflects an advance ramp up period to put in place a new program specifically addressing separation of the internal medicine and subspecialty services, and including the establishment of more defined quality performance indicators and reporting requirements. If SMMC cannot reach an agreement with the current internal medicine group in a reasonable period of time we will seek to bid out for the service through an RFP.
Internal Medicine services are provided under the general direction of the Chief Executive Officer for the San Mateo Medical Center. Monitoring and evaluation of the quality of services provided by contractor are accomplished through peer review by the Quality Assurance Committee and the Executive Committee of the medical staff.
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FISCAL IMPACT:
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The term of the previous Agreement is being amended to extend the contract by six months through September 30, 2005. The maximum amount the County shall be obligated to pay Contractor is increased by $1,570,002 from $9,913,512 to $11,483,514. Funds are included in the San Mateo Medical Center’s FY2004-05 Adopted Budget and will be included in the FY2005-06 Recommended Budget.
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