REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE COUNTY OF SAN BERNARDINO
AND RECORD OF ACTION
October 27, 2020
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Authorization to Accept Residents from Desert Regional Medical Center’s Neurosurgery Residency Program into Arrowhead Regional Medical Center’s Neurosurgery Residency Program
End
RECOMMENDATION(S)
Recommendation
1. Authorize Arrowhead Regional Medical Center to accept the neurosurgery residents being displaced by the closure of Desert Regional Medical Center’s Neurosurgery Residency Program.
2. Designate the Director of Arrowhead Regional Medical Center (ARMC) as the authorized official for the County of San Bernardino (County), on behalf of ARMC, for all necessary letters, forms, and documentation needed to complete the acceptance of all neurosurgery residents effected by the closure of the Desert Regional Medical Center’s Neurosurgery Residency Program, including any non-standard County terms, to the extent authorized by County policy, associated with such documents, subject to review and approval by County Counsel.
3. Direct the Director of ARMC to transmit all binding documentation signed in regards to the Neurosurgery Residency Program to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: William L. Gilbert, Director, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies.
FINANCIAL IMPACT
Approval of the recommendations will not result in the use of Discretionary General Funding (Net County Cost) as full reimbursement is expected through submission of the CMS cost report annually. Adequate appropriation and revenue will be included in the Arrowhead Regional Medical Center (ARMC) 2021-22 budget and future budgets as appropriate.
BACKGROUND INFORMATION
This item will allow the County of San Bernardino (County), along with Arrowhead Regional Medical Center (ARMC), to support the future of healthcare. Currently, there are fourteen residents enrolled in the Desert Regional Medical Center (DRMC) Neurosurgery Residency Program (NSRP), sponsored by the American Osteopathic Association (AOA). The NSRP is a seven-year program that DRMC has determined it can no longer support after June 30, 2021. ARMC Administration has reviewed the AOA-sponsored NSRP and determined that it is in the best interest of the residents of the County to accept the transfer of the program, beginning July 1, 2021, by accepting the neurosurgery residents from DRMC into ARMC’s Neurosurgery Residency Program.
In order to move forward, DRMC must provide AOA with a letter of closure, and ARMC must provide AOA with a letter of acceptance. Once, these letters are submitted and accepted, ARMC must submit additional information, along with specific data to the Centers for Medicare and Medicaid Services (CMS) to allow the continuation of the program at ARMC. Once this is approved, CMS will allow ARMC to accept the transfer of the neurosurgery residents, along with their residency funds.
ARMC will request that County Human Resources provide an additional fourteen contract residency positions so that ARMC may provide each transferred resident with a Master Resident Contract for the year. Along with the documentation for moving the program, ARMC will need to enter into a Program Letter of Agreement (PLA) with additional hospitals and medical centers within Southern California for the usage and training of the NSRP participants. The PLA will provide revenue to ARMC to assist in the training and compensation for the program.
The NSRP will not result in any additional costs to ARMC. This action is expected to provide multiple benefits to the County and ARMC from the relocation of the DRMC AOA-accredited NSRP. Upon acceptance of the DRMC neurosurgery residency, ARMC will also have the indirect benefit of receiving the core faculty who are currently based in Palm Springs. This faculty transfer will occur without any net cost to ARMC, and will result in recruiting several additional neurosurgeons to ARMC. In addition, DRMC has indicated that they will voluntarily transfer to ARMC those CMS positions associated with their NSRP, allowing for funding of the expenses associated with this residency transfer. The Chief Financial Officer of ARMC has reviewed the costs and expenses associated with the transfer of the program and determined that it will be budget neutral over the life of the program.
The presence of the DRMC Neurosurgery residents at ARMC will also significantly expand the overall scholarly activity at ARMC. Some of the DRMC neurosurgery residents are expected to continue to rotate at Redlands Community Hospital and Kaiser Anaheim, strengthening ARMC’s academic relations. In addition, Dr. Javed Siddiqi, ARMC Chief of Neurosurgery, and Chair of Surgery at California University of Science & Medicine, will continue to be the Residency Program Director after the DRMC Program is relocated to ARMC, providing significant stability and reassurance for the residents and the AOA of the highest standards. Dr. Siddiqi is currently President-Elect of the California Association of Neurological Surgeons, the largest State neurosurgical society in the USA, which is to the benefit of ARMC and our residency training assets.
Overall, relocating the DRMC NSRP to ARMC is the first step in a plan for ARMC Neurosciences. It is expected to be the most robust clinical and academic Neuroscience programs, with associated residency programs, in the region. Over the next few years, the ARMC Neuroscience Program will support ARMC’s ambitions of achieving Level 1 Trauma designation, Neurointerventional program development, Comprehensive Stroke Center accreditation, and various Neuro Centers of Excellence (eg. Spine, NeuroTrauma, NeuroICU, NeuroEndovascular, NeuroOncology, Epilepsy, and Pain)-these developments would take ARMC towards its goal of being a world-class medical center, with significant and self-evident benefits for our community.
Approval of Recommendation Nos. 1 and 2 will authorize ARMC to pursue the transfer process with CMS and to designate the Hospital Director at ARMC as the authorized official for the County to submit and sign all necessary letters and documentation, including any non-standard County terms, to the extent authorized by County policy, required for the process to occur, subject to review and approval by County Counsel. The Master Resident Contracts with the 14 neurosurgery residents from DRMC will be presented to the Board for approval at a later date.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on October 1, 2020; Finance (Amanda Trussell, Principal Administrative Analyst, 387-5423) on October 5, 2020; and County Finance and Administration (Matthew Erickson, County Chief Financial Officer, 387-5423) on October 9, 2020.