AGREEMENT BETWEEN THE COUNTY OF SAN MATEO AND

GENE BRUCE, M.D.

 

THIS AGREEMENT, entered into this _____ day of _______________ , 2007, by and between the COUNTY OF SAN MATEO, hereinafter called "County," and Gene Bruce, hereinafter called "Contractor";

 

W I T N E S S E T H:

 

WHEREAS, pursuant to Government Code, Section 31000, County may contract with independent contractors for the furnishing of such services to or for County or any Department thereof;

 

WHEREAS, it is necessary and desirable that Contractor be retained for the purpose of providing professional, specialty orthopedic services.

 
 

NOW, THEREFORE, IT IS HEREBY AGREED BY THE PARTIES HERETO AS FOLLOWS:

   

1.

Exhibits and Attachments

The following exhibits and attachments are included hereto and incorporated by reference herein:

Exhibit A—Services

Exhibit B—Payments and rates

Exhibit C—Billing requirements

Attachment I—§504 Compliance

   

2.

Services to be performed by Contractor

In consideration of the payments set forth herein and in Exhibit “B,” Contractor shall perform services for County in accordance with the terms, conditions and specifications set forth herein and in Exhibit “A.”

 

3.

Payments

In consideration of the services provided by Contractor in accordance with all terms, conditions and specifications set forth herein and in Exhibit "A," County shall make payment to Contractor based on the rates and in the manner specified in Exhibit "B." The County reserves the right to withhold payment if the County determines that the quantity or quality of the work performed is unacceptable. In no event shall the County’s total fiscal obligation under this Agreement exceed TWO HUNDRED AND NINETY THREE THOUSAND SIX HUNDRED AND NINETY SEVEN DOLLARS, ($293,697.)

 

4.

Term and Termination

Subject to compliance with all terms and conditions, the term of this Agreement shall be from April 1, 2007 through March 31, 2009.

This Agreement may be terminated by Contractor, the Chief Executive Officer of San Mateo Medical Center (SMMC) or his/her designee at any time without a requirement of good cause upon ninety (90) days’ written notice to the other party.

In the event of termination, all finished or unfinished documents, data, studies, maps, photographs, reports, and materials (hereafter referred to as materials) prepared by Contractor under this Agreement shall become the property of the County and shall be promptly delivered to the County. Upon termination, the Contractor may make and retain a copy of such materials. Subject to availability of funding, Contractor shall be entitled to receive payment for work/services provided prior to termination of the Agreement. Such payment shall be that portion of the full payment which is determined by comparing the work/services completed to the work/services required by the Agreement.

 

5.

Availability of Funds

The County may terminate this Agreement or a portion of the services referenced in the Attachments and Exhibits based upon unavailability of Federal, State, or County funds, by providing written notice to Contractor as soon as is reasonably possible after the county learns of said unavailability of outside funding.

   

6.

Relationship of Parties

Contractor agrees and understands that the work/services performed under this Agreement are performed as an independent Contractor and not as an employee of the County and that Contractor acquires none of the rights, privileges, powers, or advantages of County employees.

 

7.

Hold Harmless

Contractor shall indemnify and save harmless County, its officers, agents, employees, and servants from all claims, suits, or actions of every name, kind, and description, brought for, or on account of: (A) injuries to or death of any person, including Contractor, or (B) damage to any property of any kind whatsoever and to whomsoever belonging, (C) any sanctions, penalties, or claims of damages resulting from Contractor’s failure to comply with the requirements set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and all Federal regulations promulgated thereunder, as amended, or (D) any other loss or cost, including but not limited to that caused by the concurrent active or passive negligence of County, its officers, agents, employees, or servants, resulting from the

performance of any work required of Contractor or payments made pursuant to this Agreement, provided that this shall not apply to injuries or damage for which County has been found in a court of competent jurisdiction to be solely liable by reason of its own negligence or willful misconduct.

 

The duty of Contractor to indemnify and save harmless as set forth herein, shall include the duty to defend as set forth in Section 2778 of the California Civil Code.

   

8.

Assignability and Subcontracting

Contractor shall not assign this Agreement or any portion thereof to a third party or subcontract with a third party to provide services required by contractor under this Agreement without the prior written consent of County. Any such assignment or subcontract without the County’s prior written consent shall give County the right to automatically and immediately terminate this Agreement.

 

9.

Insurance

The Contractor shall not commence work or be required to commence work under this Agreement unless and until all insurance required under this paragraph has been obtained and such insurance has been approved by Risk Management, and Contractor shall use diligence to obtain such insurance and to obtain such approval. The Contractor shall furnish the Department/Division with certificates of insurance evidencing the required coverage, and there shall be a specific contractual liability endorsement extending the Contractor's coverage to include the contractual liability assumed by the Contractor pursuant to this Agreement. These certificates shall specify or be endorsed to provide that thirty (30) days' notice must be given, in writing, to the Department/Division of any pending change in the limits of liability or of any cancellation or modification of the policy.

 

(1)

Worker's Compensation and Employer's Liability Insurance: The Contractor shall have in effect during the entire life of this Agreement Workers' Compensation and Employer's Liability Insurance providing full statutory coverage. In signing this Agreement, the Contractor certifies, as required by Section 1861 of the California Labor Code, that it is aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions of the Code, and I will comply with such provisions before commencing the performance of the work of this Agreement.

 

(2)

Liability Insurance The Contractor shall take out and maintain during the life of this Agreement such Bodily Injury Liability and Property Damage Liability Insurance as shall protect him/her while performing work covered by this Agreement from any and all claims for damages for bodily injury, including accidental death, as well as any and all claims for property damage which may arise from contractors operations under this Agreement, whether such operations be by himself/herself or by any sub-contractor or by anyone directly or indirectly employed by either of them. Such insurance shall be combined single limit bodily injury and property damage for each occurrence and shall be not less than the amount specified below.

   
 

Such insurance shall include:

 

(a)

Comprehensive General Liability . . . . . . . . . . . . . . . . . .

NONE

 

(b)

Motor Vehicle Liability Insurance . . . . . . . . . . . . . . . . . .

NONE

 

(c)

Professional Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$1,000,000/ $3,000,000

       

County and its officers, agents, employees and servants shall be named as additional insured on any such policies of insurance, which shall also contain a provision that the insurance afforded thereby to the County, its officers, agents, employees and servants shall be primary insurance to the full limits of liability of the policy, and that if the County or its officers and employees have other insurance against the loss covered by such a policy, such other insurance shall be excess insurance only.

 

In the event of the breach of any provision of this section, or in the event any notice is received which indicates any required insurance coverage will be diminished or canceled, the County of San Mateo at its option, may, notwithstanding any other provision of this Agreement to the contrary, immediately declare a material breach of this Agreement and suspend all further work pursuant to this Agreement.

 

10.

Compliance with laws; payment of Permits/Licenses

All services to be performed by Contractor pursuant to this Agreement shall be performed in accordance with all applicable Federal, State, County, and municipal laws, including, but not limited to, Health Insurance Portability and Accountability Act of 1996 (HIPAA) and all Federal regulations promulgated thereunder, as amended, and the Americans with Disabilities Act of 1990, as amended, and Section 504 of the Rehabilitation Act of 1973, as amended and attached hereto and incorporated by reference herein as Attachment “I,” which prohibits discrimination on the basis of handicap in programs and activities receiving any Federal or County financial assistance. Such services shall also be performed in accordance with all applicable ordinances and regulations, including, but not limited to, appropriate licensure, certification regulations, provisions pertaining to confidentiality of records, and applicable quality assurance regulations.

In the event of a conflict between the terms of this agreement and State, Federal, County, or municipal law or regulations, the requirements of the applicable law will take precedence over the requirements set forth in this Agreement.

Contractor will timely and accurately complete, sign, and submit all necessary documentation of compliance.

 

11.

Non-Discrimination and Other Requirements

   

A.

Section 504 applies only to a Contractor who is providing services to members of the public. Contractor shall comply with § 504 of the Rehabilitation Act of 1973, which provides that no otherwise qualified handicapped individual shall, solely by reason of a disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination in the performance of this Agreement.

B.

General non-discrimination. No person shall, on the grounds of race, color, religion, ancestry, gender, age (over 40), national origin, medical condition (cancer), physical or mental disability, sexual orientation, pregnancy, childbirth or related medical condition, marital status, or political affiliation be denied any benefits or subject to discrimination under this Agreement.

C.

Equal employment opportunity. Contractor shall ensure equal employment opportunity based on objective standards of recruitment, classification, selection, promotion, compensation, performance evaluation, and management relations for all employees under this Agreement. Contractor’s equal employment policies shall be made available to County of San Mateo upon request.

D.

Violation of Non-discrimination provisions. Violation of the non-discrimination provisions of this Agreement shall be considered a breach of this Agreement and subject the Contractor to penalties, to be determined by the County Manager, including but not limited to

 

i)

termination of this Agreement;

 

ii)

disqualification of the Contractor from bidding on or being awarded a County contract for a period of up to 3 years;

 

iii)

liquidated damages of $2,500 per violation;

 

iv)

imposition of other appropriate contractual and civil remedies and sanctions, as determined by the County Manager.

     

To effectuate the provisions of this section, the County Manager shall have the authority to examine Contractor’s employment records with respect to compliance with this paragraph and/or to set off all or any portion of the amount described in this paragraph against amounts due to Contractor under the Contract or any other Contract between Contractor and County.

     

Contractor shall report to the County Manager the filing by any person in any court of any complaint of discrimination or the filing by any person of any and all charges with the Equal Employment Opportunity Commission, the Fair Employment and Housing Commission or any other entity charged with the investigation of allegations within 30 days of such filing, provided that within such 30 days such entity has not notified Contractor that such charges are dismissed or otherwise unfounded. Such notification shall include the name of the complainant, a copy of such complaint, and a description of the circumstance. Contractor shall provide County with a copy of their response to the Complaint when filed.

 

E.

Compliance with Equal Benefits Ordinance: With respect to the provision of employee benefits, Contractor shall comply with the County Ordinance which prohibits contractors from discriminating in the provision of employee benefits between an employee with a domestic partner and an employee with a spouse.

F.

The Contractor shall comply fully with the non-discrimination requirements required by 41 CFR 60-741.5(a), which is incorporated herein as if fully set forth.

   

12.

Compliance with Contractor Employee Jury Service Ordinance

Contractor shall comply with the County Ordinance with respect to provision of jury duty pay to employees and have and adhere to a written policy that provides that its employees shall receive from the contractor, on an annual basis, no less than five days of regular pay for actual jury service in San Mateo County. The policy may provide that employees deposit any fees received for such jury service with the contractor or that the contractor deduct from the employees’ regular pay the fees received for jury service.

   

13.

Retention of Records, Right to Monitor and Audit

(a) CONTRACTOR shall maintain all required records for three (3) years after the COUNTY makes final payment and all other pending matters are closed, and shall be subject to the examination and/or audit of the County, a Federal grantor agency, and the State of California.

(b) Reporting and Record Keeping: CONTRACTOR shall comply with all program and fiscal reporting requirements set forth by appropriate Federal, State and local agencies, and as required by the COUNTY.

(c) CONTRACTOR agrees to provide to COUNTY, to any Federal or State department having monitoring or review authority, to COUNTY's authorized representatives, and/or their appropriate audit agencies upon reasonable notice, access to and the right to examine all records and documents necessary to determine compliance with relevant Federal, State, and local statutes, rules and regulations, and this Agreement, and to evaluate the quality, appropriateness and timeliness of services performed.

 

14.

Merger Clause

This Agreement, including the Exhibits attached hereto and incorporated herein by reference, constitutes the sole Agreement of the parties hereto and correctly states the rights, duties, and obligations of each party as of this document's date. In the event that any term, condition, provision, requirement or specification set forth in this body of the agreement conflicts with or is inconsistent with any term, condition, provision, requirement or specification in any exhibit and/or attachment to this agreement, the provisions of this body of the agreement shall prevail. Any prior agreement, promises, negotiations, or representations between the parties not expressly stated in this document are not binding. All subsequent modifications shall be in writing and signed by the parties.

   

15.

Controlling Law

The validity of this Agreement and of its terms or provisions, as well as the rights and duties of the parties hereunder, the interpretation, and performance of this Agreement shall be governed by the laws of the State of California.

   

16.

Notices

 

Any notice, request, demand, or other communication required or permitted hereunder shall be deemed to be properly given when deposited in the United State mail, postage prepaid, or when deposited with a public telegraph company for transmittal, charges prepaid, addressed to:

    In the case of County, to:

    Sang-ick Chang M.D., Interim Chief Executive Officer

    San Mateo Medical Center

    222 West 39th Avenue

    San Mateo, CA 94403

    In the case of Contractor, to:

Gene Bruce, M.D.

100 South Ellsworth Avenue, Suite 607

Redwood City, CA 94401

IN WITNESS WHEREOF, the parties hereto, by their duly authorized representatives, have affixed their hands.

COUNTY OF SAN MATEO

By:

President, Board of Supervisors, San Mateo County

Date:

ATTEST:

By:

Clerk of Said Board

Gene Bruce, M.D.

Contractor’s Signature

Date:

Long Form Agreement/Non Business Associate v 6/28/06

Exhibit “A”

In consideration of the payments set forth in Exhibit “B”, Contractor shall provide the following services:

    1. Contractor shall provide orthopedic specialty services in the Division of Medical Specialty, Department of Medicine, including inpatient, outpatient, and emergency care.

    2. Contractor shall participate in such scheduled coverage of service as is mutually arranged and agreed upon by members of the Department of Surgery under the supervision of the Chief of Surgery.

    3. Contractor is to hold one (1), half day clinic per week and rotate one (1) half day surgery per week.

    4. Contractor shall develop a schedule for "On Call," and/or "Emergency Call" status during all other times on Monday through Friday and for twenty-four (24) hours each Saturday, Sunday, or holiday. "On Call" and "Emergency Call" are defined as being available by telephone or pager to the hospital medical staff, nursing supervisor, and administrator on-call as needed. In addition, Contractor must adhere to the guidelines of the San Mateo County Trauma System by being immediately available by phone and must make every reasonable effort to be present at the hospital at the time of the patient's arrival.

    5. It is expressly understood that Contractor and subcontractors for Medical Specialty services, are subject to these conditions, that all will accept equal scheduling for "On Call" status and that each will be responsible for his/her portion of "On Call" time. All physicians who take calls for Medical Specialty must have SMMC hospital privileges

    6. Scheduled surgery hours shall be Monday through Friday, 0730 through 1500 hours. Add-on cases during the afternoon, nights, and weekends should be truly urgent or emergent. Any elective add-on cases need prior administrative approval.

    7. Contractor shall participate in such teaching and/or training programs as are, or may be, established by the medical staff at San Mateo County General Hospital. Each individual's participation in continuing education is documented and considered at the time of reappointment to the medical staff and/or renewal or revision of individual clinical privileges.

    8. Contractor shall fulfill those requirements for active staff membership set forth in Articles 3 and 4.2 of the SMMC Medical Staff Bylaws, and maintain such active staff status as a condition of the Agreement.

    9. Contractor shall attend regularly and serve without additional compensation on committees responsible for Peer Review activities, Quality Assurance, Utilization Review as outlined in the Medical Staff Bylaws, Rules and Regulations.

    10. Contractor shall provide Medical Staff administrative support to hospital and nursing in meeting surgical and anesthesia standards as defined by Joint Commission, Title 22, and other applicable standards.

Exhibit “B”

In consideration of the services provided by Contractor in Exhibit “A”, County shall pay Contractor based on the following fee schedule:

    1. Contractor shall be paid at the rates set forth below, to include the complete professional component associated with orthopedic services.

    2. The source of orthopedic base units is the current Medicare Resource-Based Relative Value Scale (RBRVS) Relative Value Work Units (RVUs.)

    3. Contractor compensation for orthopedists by the County will be based on an RVU base work unit value of $49.16 in year one (I) and $50.88 in year two (II).

    4. Contract shall be paid monthly. Such payments will be 1/3 of the quarterly floor, and shall be paid no later than the 30th day of the following month. Quarterly and pro-rated quarterly payments will be made no later than the 30th day of the month following the close of the quarter

    5. Contractor’s quarterly compensation will be no less than a minimum amount specified below:

    Year I (Monthly = $9,979)

    April 1, 2007 through June 30, 2007: $29,938

    July1, 2007 through September 30, 2007: $29,938

    October 1, 2007 through December 31, 2007: $29,938

    January 1, 2008 through March 31, 2008: $29,938

    Year II (Monthly = $10,329)

    April 1, 2008 through June 30, 2008: $30,986

    July1, 2008 through September 30, 2008: $30,986

    October 1, 2008 through December 31, 2008: $30,986

    January 1, 2009 through March 31, 2009: $30,986

    6. In year one (I),if the quarterly total of RVU’s performed multiplied by the unit value of $49.16 for any quarter result in an amount greater than the quarterly floor amount for that quarter, the County will pay Contractor the difference.

    7. In year two (II),If the quarterly total of RVU’s performed multiplied by the unit value of $50.88 for any quarter result in an amount greater than the quarterly floor amount for that quarter, the County will pay Contractor the difference.

    8. If total units performed for any quarter result in an amount less than an average of 183 units per month, which is 10% below minimum, Contractor agrees to meet with the Medical Director, or his designee, to determine the source of low productivity no later than 30 days from the end of the preceding quarter.

    9. Compensation for partial quarters shall be on a pro-rata basis, using the same methodology as set forth in this Agreement.

    10. Contractor shall submit the quarterly invoice no later than the 5th day of the month, following the close of the quarter. County shall generate and provide to contractor a verification report for RVU unit reconciliation on the 10th of every month. Any discrepancies between Contractor quarterly invoice and County verification report(s) should be resolved by the 15th of the month, following the close of the quarter. Contractor will make best effort to reconcile encounters monthly. County will reimburse Contractor for all RVU units supported by encounter forms submitted up to and including the 10th of the month, following the close of the quarter. Any outstanding RVU unit encounter forms submitted after the 10th of the month following the close of the quarter will be reimbursed at the following quarter's settlement.

    11. Total payment for services under this agreement will not exceed TWO HUNDRED AND NINETY THREE THOUSAND SIX HUNDRED AND NINETY SEVEN DOLLARS, ($293,697.)

 

Exhibit “C”

Billing and Invoicing Requirements

All Contractors shall be obligated to comply with the following billing and invoicing provisions:

A. OUTPATIENT

Contractor shall submit to County complete, accurate and timely encounter forms here to support invoicing for services rendered. Invoices should be submitted no later than the 10th of the following month:

    Complete” shall mean:

    -- All procedure and diagnosis codes shall be present on form in CPT format

    -- Contractor’s signature, date and title is present on form and accompanying invoice

    -- Referral Authorization Form (RAF) is completed by Contractor as required by

    MediCal or HPSM regulations

    “Accurate” shall mean:

    -- E & M CPT codes must be consistent with level of care

    -- Other procedures codes must be consistent with diagnosis

    -- Procedures must be consistent with Medicare and MediCal guidelines for medical necessity

    -- All Contractor services must be supported by documentation in inpatient Chart

    “Timely” shall mean:

    -- Submission of encounter forms to County within three calendar days from date of service

 

The SMMC will provide physician encounter forms appropriate to specialties covered under this agreement. The SMMC will also provide, at time of service, encounter forms will be embossed or have a sticker applied with the following information:

    -- Medical Record number

    -- Patient Name

    -- Date of Birth

    -- Date of Service

    -- Patient Number

    -- Financial Class

SMMC will attach a RAF with encounter form where appropriate

B. INPATIENT (includes Same Day Surgery and Observation)

Submission to SMMC of complete, accurate and timely charge slips and additional documentation needed for billing and invoicing:

    “Complete” shall mean:

    Charge slips shall include:

      Date of Service

      Appropriate CPT code

      Physician signature and title on slip and accompanying invoice

      Patient name

      Medical Record number

    “Timely” shall mean:

    Contractor charge slips are submitted to the SMMC within three calendar days of date of service.

    “Additional documentation” shall mean:

      Discharge summary is completed in the time and manner specified in the Medical Staff Bylaws

      Operative notes are complete in the time and manner specified in the

      Medical Staff Bylaws

      History and Physical is complete in patient chart

      Short Stay/Admission form completed with CPT for all surgeries