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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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October 24, 2005
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BOARD MEETING DATE:
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November 8, 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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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 Agreement with Associated Medical Specialists (AMS) to provide internal medicine, cardiology, and hospitalist services, for the period October 1, 2005 through September 30, 2008.
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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 Agreement contributes to this commitment and goal by providing comprehensive internal medicine services to County patients. Contractor performance is measured by adherence to the quality improvement plan for internal medicine and cardiology standards with specific benchmarking indicators based on:
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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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1. Internal Customer Satisfaction: Percentage of physician surveys of internal medicine and hospitalist services assessing communication, timeliness, and overall quality rated at levels 4 or 5 on a 5 point scale.
2. External Customer Satisfaction: Percentage of patient satisfaction with clinic services survey assessing communication, respect and overall quality rated at levels 4 or 5 on a 5 point scale.
3. Reduce the risk of healthcare-associated infections and adhere to infection control standards as defined by Joint Commission, Title 22, and other applicable standards.
4. Increase overall RVU productivity for internal medicine, cardiology, and hospitalist services
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>80%
>80%
100%
32,400
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>80%
>80%
100%
36,000
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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. Over the past year, 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 have negotiated a reimbursement model based on Relative Based Resource Value Work Units (Work RVUs) to capture productivity levels of the two distinct functions. The first step was to identify the actual cost of providing services to ensure they are within reasonable market parameters. The next step was to value the cost of the operational structure we provide to an internal group. The final step was to identify what our projected needs for internal medicine would be under the new model and determine the appropriate cost for such services.
This streamlining process resulted in an original savings to the County of 9%. We were then able to reinvest the 9% savings to increase the contract by 1.5 FTEs to boost expected productivity and respond to patient safety issues. SMMC will also expect the increase in Work RVUs by each individual doctor to enhance revenue generation projections for the hospital. The overall reimbursement amount of the new contract is a flat increase from the previous contract.
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 this Agreement is October 1, 2005 to September 30, 2008. The maximum amount County shall be obligated to pay Contractor is $11,080,524.59. SMMC expects the increase in productivity under this contract to result in a proportionate increase in revenue generation for the hospital. Funds are included in the San Mateo Medical Center’s FY2005-06 Adopted Budget and will be included in future Recommended Budgets.
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