COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health System

DATE:

January 31, 2011

BOARD MEETING DATE:

March 15, 2011

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Jean S. Fraser, Chief, Health System
Susan Ehrlich, MD, MPP, Chief Executive Officer
San Mateo Medical Center

SUBJECT:

Resolution Authorizing the Controller to Pay Non-Contract Physicians for Services at San Mateo Medical Center

RECOMMENDATION:

Adopt a Resolution authorizing the Controller to pay non-contract physicians for emergency, emergent and non-contracted services at San Mateo Medical Center and physicians at non-contracted hospital facilities in an amount not to exceed $150,000 for the term July 1, 2011 through June 30, 2013.

BACKGROUND:

On occasion, there is insufficient specialty care coverage at San Mateo Medical Center (SMMC). Examples of areas in which shortages have occurred include pediatric on-call coverage, gastroenterology, neurosurgery and cardiac catherization. For that reason, it is sometimes necessary to augment the physicians with whom the County contracts. Non-contract physicians provide emergency backup services to our patients when no other contracted medical coverage or SMMC staff physician is available.

This Resolution would also cover payments for physician services for patients referred to other facilities (i.e., Stanford Hospital). Specifically, in the cases where SMMC does not offer the service or surgical procedure in question, the Resolution authorizes payment of the non-contracted physician who performs the necessary procedure or surgery. Since 2005 the Board has authorized the Controller to pay non-contract physicians who provide medical services to SMMC patients.

DISCUSSION:

In July 2007 your Board adopted a Resolution authorizing the Controller to pay non-contract physicians for services provided at the Medicare participating fee schedule rate for San Mateo County Part “B” and on the Medicare Labor Adjusted Ambulatory Surgery Classification (ASC). All other services not found on the Part “B: Medicare Fee Schedule or the ASC are paid at the Ambulatory Payment Classification (APC) rate. All additional procedures are paid at 50% of the Medicare Allowable Reimbursement Rate.

All patient referrals to non-contract physicians for specialty care services must be authorized in advance and in writing by SMMC Administration, and utilization review will be concurrently provided by the Case Management Department at SMMC.

County Counsel has reviewed and approved the Resolution as to form.

This Resolution contributes to the Shared Vision 2025 outcome of a Healthy Community by addressing the need for highly specialized medical services to County patients. It is anticipated that less than one percent (<1.0%) of County patients will be referred to non-contract physicians for specialty care services.

Performance Measure:

Measure

FY 2009-10
Actual

FY 2010-11
Projected

Percentage of patients referred to non-contract physicians for specialty care services

<1.0%

<1.0%

FISCAL IMPACT:

The term of the Resolution is July 1, 2011 through June 30, 2013. The maximum total fiscal obligation is $150,000. Funds in the amount of $75,000 are included in the SMMC FY 2011-12 Recommended Budget. Funds in the amount of $75,000 will be included in the SMMC FY 2012-13 Recommended Budget.

Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care are covered by the County’s General Fund contribution to SMMC.