COUNTY OF SAN MATEO Inter-Departmental Correspondence
San Mateo Medical Center
DATE:				July 28, 2008
BOARD MEETING DATE:				September 16, 2008
SPECIAL NOTICE/HEARING:				None
VOTE REQUIRED:				Majority
TO:		Honorable Board of Supervisors
FROM:		Sang-ick Chang, MD, Chief Executive Officer, San Mateo Medical Center
SUBJECT:		Amendment to the Agreement with James Meier, MD and Scott Oesterling, MD
RECOMMENDATION:
Adopt a resolution:
A.	Authorizing the execution of an Amendment to the Agreement with James Meier, MD and Scott Oesterling, MD to provide obstetrics and gynecology services extending the term by six months to December 31, 2008, and increasing the maximum amount payable thereunder by $1,045,296, from $4,667,673.60 to $5,712,969.60
B.	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: Ensure Basic Health and Safety for All.
Goal 5: Provide residents access to healthcare and preventive care.
The Amendment to the Agreement contributes to this commitment and goal by providing comprehensive obstetrics and gynecology services.
Performance Measure(s):
Measure			2007 Actual		2008 Projected
Number of vaginal, operative, and cesarean deliveries			1222		1136
Meet agreed-upon mean cycle time (registration to discharge) targets			< 80%		< 80%
SIPS: timeliness and appropriateness of antibiotics for hysterectomy			< 80%		< 80%
Intensive care nursery admission rates			< 10%		< 10%
Rates of Apgar score <7 less than 15%			< 15%		< 15%
Rates of chorioamnionitis infection during labor			< 15%		< 15%
Rates of preterm delivery < 15%			< 15%		< 15%
BACKGROUND/DISCUSSION:
The group represented by Doctors James Meier and Scott Oesterling has a long history of providing obstetrics and gynecology services to SMMC. In particular, these disciplines serve as the basis for routine evaluation and treatment of pre-, intra-, and post-partum care (obstetrics) and the evaluation, diagnosis, treatment, and monitoring of uterine, ovarian, endometrial, and vaginal disease (gynecology). SMMC has a continuous need for obstetrics and gynecology services, and Doctors Meier and Oesterling offer the hospital the benefits of experienced practitioners familiar with the complex nature of the County’s patient base.
At this time, all SMMC obstetrics (OB) patients are delivered at Lucille Packard Children’s Hospital at Stanford. Through the leadership of the County Manager’s Office, staff at the Health Department, Health Plan of San Mateo, and the SMMC are involved in planning to redistribute these deliveries to other hospital and physician providers in the County. This will improve the quality of care by enabling women to deliver their children closer to home, and at the same time will involve other community providers in the OB system of care for the underserved. This effort is an important part of planning to implement the Blue Ribbon Task Force recommendations and the Community Health Network for the Underserved.
Because of these ongoing negotiations, this Amendment represents an extension of the existing terms with Doctors Meier and Oesterling for a period of six (6) months, through December 31, 2008. By that time, there will be clarity about the participation of Doctor Meier’s and Oesterling’s group in the community system of OB care, and SMMC will be able to execute a contract with them reflecting that participation. Dr. Oesterling is actively involved in the planning process, and has assumed primary administrative director responsibilities for the entire line of service.
The terms and conditions in Exhibit A from the Agreement dated August 15, 2006 remain the same except the list of providers has been updated. The terms and conditions in Exhibit B from the Agreement dated August 15, 2006 have been updated to include the period July 1, 2008 to December 31, 2008 and to increase the maximum amount payable under the Agreement by $1,045,296 to $5,712,969.60.
The Health System Redesign Initiative Team and County Counsel have reviewed and approved this Amendment. 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.
TERM AND FISCAL IMPACT:
The term of the Agreement is July 1, 2006 through December 31, 2008. The maximum amount payable is $5,712,969.60. Funds are included in SMMC’s FY2008-09 Recommended Budget.