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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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September 30, 2008
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BOARD MEETING DATE:
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November 4, 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, M.D., Chief Executive Officer
San Mateo Medical Center
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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:
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A.
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Authorizing the President of the Board to execute an Agreement with Associated Medical Specialists (AMS) to provide internal medicine, subspecialty and hospitalist services for the term October 1, 2008 through September 30, 2011, in an amount not to exceed $14,407,765
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B.
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Authorizing the Chief Executive Officer of San Mateo Medical Center (SMMC) or designee to execute contract amendments which modify the County’s maximum fiscal obligation by no more than $25,000, 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
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VISION ALIGNMENT:
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Commitment: To Ensure Basic Health and Safety for All.
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Goal 5: Residents have access to healthcare and preventive care.
The Agreement contributes to this commitment and goal by providing comprehensive internal medicine services to County patients.
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Performance Measure(s):
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Measure
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FY 2008-09
RVU Budget
Projected
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FY 2009-10
RVU Budget
Projected
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FY 2010-11
RVU Budget
Projected
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Meet medical service volume targets as measured by Relative Value Units (RVUs)
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44,500
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45,584
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45,584
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BACKGROUND:
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AMS has provided high quality, inpatient and outpatient internal medicine services, both general and subspecialty, since 1975. In prior contracts, payment was based on volume and productivity, as measured by Relative Value Units (RVU’s), with a target of 34,850 RVU’s per year. At this level of service, wait times for access to specialty care have been excessive. In response to this problem, the medical center is engaged in a Health Redesign process to increase efficiency and access in several outpatient specialty services.
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DISCUSSION:
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The current contract contains several changes over the prior contract to enable us to successfully implement specialty care redesign. 1) Consistent with the Health Redesign direction, it replaces productivity-based compensation with an FTE-based model, using regional benchmarks. The FTE-based model permits a greater flexibility in work assignment needed for system redesign. 2) The Agreement adds a hospitalist to enable specialists to focus on providing specialty services. 3) It calls for substantially increased RVU’s over the prior contract. 4) It redresses a historical underpayment compared to regional benchmarks for some specialties, as well as for over-night and weekend coverage.
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The increase in cost over the prior contract includes a first year one-time increase of $633,302, or 15.9%, to reflect the cost of the four above goals. The second and third years include a 3% cost-of-living adjustment.
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The Health System Redesign Initiative Team, County Counsel, and Risk Management have reviewed and approved this Agreement.
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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.
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FISCAL IMPACT:
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The term of this Agreement is October 1, 2008 through September 30, 2011. The maximum amount payable is $14,407,765. This is an increase over the previous Agreement amount of $633,302 in year one, $809,132 in year two, and $990,236 in year three, or $2,432,670 over the life of the Agreement. Funds are included in SMMC’s FY 2008-09 Adopted Budget and will be included in future fiscal year recommended budgets.
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