COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

DATE:

July 1, 2008

BOARD MEETING DATE:

July 22, 2008

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Sang-ick Chang, M.D., Chief Executive Officer,
San Mateo Medical Center

SUBJECT:

Agreement with California Emergency Physicians Medical Group

Recommendation

Adopt a Resolution:

1.

Authorizing the execution of an Agreement with California Emergency Physicians Medical Group to provide Emergency Medical Services and Correctional Health Services for the term July 1, 2008 to June 30, 2010, in an amount payable not to exceed $7,530,110

2.

Authorizing the Chief Executive Officer (CEO) of San Mateo Medical Center or the CEO’s designee to execute contract amendments which modify the County’s maximum fiscal obligation by no more than $25,000 (in aggregate), and/or modify the contract term and/or services so long as the modified term or services is/are within the current or revised fiscal provisions

Vision Alignment

Commitment: To Ensure Basic Health and Safety for All.

Goal 5: Residents have access to healthcare and preventive care.

The Agreement contributes to this commitment and goal by providing twenty-four hour coverage of Emergency Room services at SMMC.

Performance Measures:

Measure

FY2007-08

Actual

FY2008-09

Projected

Number of patients seen in emergency room annually

33,781

32,120

Time to antibiotics for pneumonia

<150 min (mean)

<150 min (mean)

Blood culture before first antibiotics for pneumonia

>90%

>90%

Aspirin at arrival for acute myocardial infarction

>95%

>95%

Beta blocker at arrival

>95%

>95%

Thrombolytic agent received within 30 minutes of hospital arrival

>95%

>95%

BACKGROUND:

California Emergency Physicians Medical Group (CEP) has provided the physician and physician assistant staff for the Emergency Department (ED) at the San Mateo Medical Center (SMMC) for the last several years and provides Emergency Department coverage at 22 other Northern California hospitals. Their group offers the hospital the benefits of a large practice with diverse specialization and administrative support.

DISCUSSION:

CEP will continue to provide Board Certified emergency room physicians twenty four hours a day, seven days a week. They will also provide coverage for correctional health and have increased overall emergency room coverage by maintaining the number of shifts for physicians and physician assistants during the week and increasing annual physician time by 449 hours (a 4% increase) and physician assistant annual hours by 621 hours (a 7% increase) to provide adequate coverage for weekends. This is necessary to accommodate the increase in patient flow on weekends, which has now reached a level equal to the flow during the week. In addition, they will continue to provide medical supervision for Psychiatric Emergency Services (PES) residents and restraint authority for PES patients in the absence of on-site psychiatry attending staff.

The level of staffing is determined by a staffing model. The previous contract was not adequately funded to sustain ED coverage based on the 2005 model. As the number of patients and patient wait times increased on weekends, CEP increased the physician and physician assistant hours and staffing to accommodate the patient demand. CEP subsidized the prior contract to cover the additional hours and staffing by cutting the salaries of the ED doctors working at SMMC.

This item was reviewed by the Health System Redesign Initiative Team and aligns with the first-year implementation plan approved by the Board of Supervisors on March 25, 2008.
County Counsel and Risk Management have reviewed and approved this Agreement.

The contractor has assured compliance with the County’s Contractor Employee Jury Service Ordinance, as well as all other contract provisions that are required by County ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination and equal benefits.

FISCAL IMPACT:

The term of the Agreement is July 1, 2008 through June 30, 2010. The maximum amount of the Agreement is $7,530,110. This is a 5% increase over the previous agreement for January 1, 2007 to June 30, 2008, due to increased physician and physician assistant coverage. Funds are included in the SMMC’s FY2008-09 Recommended Budget and will be included in future year budget requests.