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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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July 28, 2008
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BOARD MEETING DATE:
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August 12, 2008
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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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Sang-ick Chang, MD, Chief Executive Officer,
San Mateo Medical Center
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SUBJECT:
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Amendment to the Agreement with San Mateo Health Commission, dba Health Plan of San Mateo
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RECOMMENDATION:
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Adopt a resolution authorizing the execution of an Amendment to the CareAdvantage Agreement with San Mateo Health Commission for the provision of Medicare services for Health Plan of San Mateo clients for the term January 1, 2008 to December 31, 2008, increasing the inpatient per diem rate by $275.57 from $760 to $1,035.57 effective July 1, 2008
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VISION ALIGNMENT:
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Commitment: Ensure Basic Health and Safety for All.
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Goal 5: Provide residents access to healthcare and preventive care.
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The Agreement contributes to this commitment and goal by providing a mechanism to pay for additional Medicare reimbursable hospital and medical services provided to San Mateo County Medicare recipients at San Mateo Medical Center (SMMC).
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Performance Measure(s):
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Measure
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FY 2006-07
Actual
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FY 2007-08
Projected
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FY 2008-09
Projected
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Number of Medicare recipients treated at SMMC
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14,500
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14,000 – 15,000
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14,280 – 15,300
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The number of projected Medicare recipients for FY 2008-09 is consistent with the work of the Health Systems Re-Design Team.
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BACKGROUND:
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SMMC has contracted with HPSM since November 1987. SMMC has contracted for CareAdvantage since 2005. The CareAdvantage Agreement provides for the care of inpatient, outpatient and emergency services patients who are eligible to receive CareAdvantage Benefits. HPSM reimburses SMMC for providing such care.
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DISCUSSION:
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In 2007, the County Board of Supervisors approved an implementation plan aimed at the healthcare delivery configuration in San Mateo County. The implementation plan recognized that the increasing costs of health care and the deficits and tight financing facing local governments require all partners to work together to develop a health care delivery system that sustains and improves access for our most vulnerable populations. There were several work groups established. One of these was the Psychiatry and Long Term Care Workgroup which was charged with reducing the number of administrative days on the inpatient psychiatric and medical-surgical units at SMMC and improving the appropriateness of care on both units. This workgroup has revised the Memorandum of Understanding (MOU) between SMMC and County Mental Health to align financial incentives and it names all partners which include the Health Plan of San Mateo. The revised MOU sets the inpatient per diem rate at the Short Doyle Medi-Cal maximum allowance (SMA) for these services established by the State Department of Mental Health unless the SMMC cost report establishes a per unit cost for these services that is less than the SMA. The MOU further states that HPSM will revise its contract with SMMC to also pay at this same rate. This amendment changes the current rate of $760/per diem to the new rate of $1,035.57/per diem effective July 1, 2008.
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 has reviewed and approved this amendment.
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FISCAL IMPACT:
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The term of the Agreement remains the same at January 1, 2008 to December 31, 2008. However, this amendment is effective July 1, 2008. The anticipated revenue from this amendment is approximately $ 217,000 based on 2007 days and is included in the San Mateo Medical Center’s FY2008-09 Recommended Budget.
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