EXHIBIT B

PAYMENTS

Correctional Health and Emergency Department (ED) Services

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

I.

Correctional Health

A.

For the period July 1, 2008 through June 30, 2009, Contractor shall invoice the County on a monthly basis at the rate of SEVENTEEN THOUSAND, SEVEN HUNDRED AND THIRTY-EIGHT DOLLARS ($17,738) per month, not to exceed TWO HUNDRED AND TWELVE THOUSAND, EIGHT HUNDRED AND FIFTY- SIX DOLLARS ($212,856) for year one (1) of this Agreement for jail clinics and after-hours telephone management of jail patients.

B.

For the period July 1, 2009 through June 30, 2010, contractor shall invoice the county on a monthly basis at the rate of EIGHTEEN THOUSAND, TWO HUNDRED AND SEVENTY DOLLARS ($18,270) per month, not to exceed TWO HUNDRED AND NINETEEN THOUSAND, TWO HUNDRED AND FORTY DOLLARS ($219,240).

C.

The Correctional Health Services Manager shall approve invoices for payment. The jail physician shall be on site three (3) days per week and on call until 9:00 p.m., Monday through Friday. At other times the SMMC ED physician on duty will, by telephone or by telemedicine imaging, manage the jail patients or direct the transfer of patients to the SMMC ED for further evaluation.

II.

Emergency Department Services

A.

For the period July 1, 2008 through June 30, 2009, Contractor shall invoice the County on a monthly basis for direct clinical ED services at the equivalent of $160.00 per physician hour, and $55.91 per physician assistant hour. There will be a minimum of one physician on duty in the ED at all times, 24 hours a day, 365 days a year. Services include the recitals in EXHIBIT A, including telephone and telemedicine backup for the jail, and evaluation and management of critical laboratory values after hours for the County primary care physicians and such support as may be needed. This budget is based on 32,120 patient visits per year.

Clinical ED services shall be paid at TWO HUNDRED AND NINETY-FIVE THOUSAND, SEVEN HUNDRED AND FIFTY DOLLARS ($295,750) per month, not to exceed THREE MILLION, FIVE HUNDRED AND FORTY-NINE THOUSAND, AND SEVEN DOLLARS ($3,549,007) for the period from July 1, 2008 through June 30, 2009. ED management services are included in the total annual cost of emergency services of $3,549,007. See ATTACHMENT I for a breakdown of costs by line item.

B.

For the period July 1, 2009 through December 31, 2009, Contractor shall invoice the County on a monthly basis for direct Clinical ED services at the equivalent of $160.00 per physician hour and $55.91 per physician assistant hour. Contractor will bill these hours as a component of the monthly total emergency services billing at SMMC of TWO HUNDRED AND NINETY-FIVE THOUSAND, SEVEN HUNDRED AND FIFTY DOLLARS ($295,750) on the monthly invoice. There will be a minimum of one physician on duty in the ED at all times, 24 hours a day, 365 days a year. Services include the recitals in EXHIBIT A, including telephone and telemedicine backup for the jail and evaluation and management of critical laboratory values after hours for the County primary care physicians and such support as may be needed.

C.

For the period January 1, 2010 through January 31, 2010, contractor shall invoice the County on a monthly basis for direct Clinical ED services at the entire equivalent of $210 per physician hour for six (6) hours per night and six (6) nights per week, in addition to the amount set forth in Paragraph B, above.

D.

For the period February 1, 2010 through June 30, 2010, for each day that patient visits to the SMMC ED exceed 100 patients, Contractor may invoice six physician hours per day at a rate of $210 per hour.

E..

Surge staffing services will be triggered by SMMC Administration in the event of emergency coverage of other departments; i.e., inpatient psychiatry on night shifts or other difficult to fill shifts when there is a shortage of staff or contract physicians. This would be a last option when every use of other staff alternatives has failed. The other use of funds to be triggered by SMMC Administration would be for events such as a pandemic flu or a multiple victim injury catastrophic event that would require additional staff. Surge funding will not be paid without prior authorization of SMMC Administration. Surge reimbursement will be for medical services staff only; no management fees will be paid in relation to surge funds. Surge funds for the term of the Agreement from July 1, 2008 through June 30, 2010 have not been budgeted.

III.

Productivity-Based Reimbursement Model

A.

Both County and Contractor acknowledge the need for a productivity reimbursement model based on mutually acceptable units of measurement. This contract was established on the model in ATTACHMENT 1 to this Agreement. The metrics used are as follows:

1.

Patients per day: 88

Patients per doctor hour: 2.8

Patients per clinical hour: 1.5

2.

Physician hours per day: 32

Physician Assistant hours per day: 27.5

3.

Physician FTE’s: 7.5

Physician Assistant FTE’s: 5.6

B.

In full consideration of Contractor’s performance of the services described in EXHIBIT A, the amount that County shall be obligated to pay for services rendered under this Agreement shall not exceed SEVEN MILLION, SEVEN HUNDRED NINTEEN THOUSAND, THREE HUNDRED SIXTY DOLLARS ($7,719,360) for the Agreement term July 1, 2008 through June 30, 2010.