REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 8, 2023
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Amendment to Physician Service Agreement with CEP America - California
End
RECOMMENDATION(S)
Recommendation
Approve Amendment No. 2 to Physician Service Agreement No. 20-1199 with CEP America - California, to add a physician and physician assistant for street medicine, and a Designated Institutional Officer, increasing the total contract amount by $318,198, from $49,626,312 to $49,944,510 plus variable costs, with no change to the contract term of January 1, 2021 through December 31, 2023.
(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.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The agreement includes fixed costs, as well as variable costs that are dependent on the number of medical students that participate in rotations at ARMC, the volume of utilization of services for disaster response, and the number of hours of services provided by the street medicine physician and physician assistant. Costs for services are funded by State Medi-Cal, Federal Medicare, and private insurances, and, in some cases, reimbursed by County departments. Funding sources may change in the future pending any legislative activity related to the repeal and/or replacement of the Affordable Care Act. Adequate appropriation and revenue have been included in Arrowhead Regional Medical Center’s (ARMC) 2023-24 budget.
BACKGROUND INFORMATION
Approval of this amendment will add a physician and physician assistant for street medicine, along with the duties and responsibilities of a Designated Institutional Officer (DIO). The Accreditation Council for Graduate Medical Education (ACGME), which is ARMC’s graduate medical education program’s accrediting agency, requires ARMC to have a qualified DIO on staff. The previously contracted DIO resigned unexpectedly in June 2023, so a qualified replacement is needed as expeditiously as possible to meet ACGME requirements. As the DIO will only be in place a few months before the contract expires, it is expected that the DIO position will be included in any future physician services contract negotiations with the recommended physicians group. The additional street medicine physician and physician assistant will be instrumental in supporting a new medical street medicine initiative to go out into the community and provide medical care to the homeless within their place of shelter.
On December 15, 2020 (Item No. 18), the Board of Supervisors (Board) approved Physician Service Agreement No. 20-1199 with CEP America - California (CEP) to provide administrative, educational, and emergency medical services at ARMC and its affiliated Family Health Clinics, Sheriff/Coroner/Public Administrator Detention Facilities, San Bernardino Probation Department, Department of Behavioral Health (DBH), and San Bernardino County Fire Protection District.
On November 16, 2021 (Item No. 18), the Board approved Amendment No. 1 to Agreement No. 20-119 to update the existing duties and responsibilities and provide incremental increases for psychiatrists associated with the DBH - Alcohol and Drug Services, with no overall increase of the total contract amount and no change to the contract term of January 1, 2021 through December 31, 2023.
ARMC recommends approval of Amendment No. 2 to Physician Service Agreement No. 20-1199 to provide for the safety, health and social service needs of County residents by providing healthcare to the homeless, and education to future healthcare physicians.
PROCUREMENT
Although the Government Code (GC) does not make an explicit exception to competitive bidding for professional physician services, Section 31000 provides the Board with the authority to contract with and employ any persons for the furnishing of “special services”. Section 31000 authorizes a county to contract for medical services without the necessity of advertising for bids.
It is in the best interest of ARMC patients to allow them to continue with the existing physicians within this contracted physician group for continuity of care.
The Purchasing Department recognizes the specialized credentials and supports the non-competitive procurement for these services, allowing for continuity of care for patients in these specialty areas, such as emergency and family medicine.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on July 11, 2023; Purchasing (Ariel Gill, Buyer, 777-0722) on July 17, 2023; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on July 17, 2023; Finance (Jenny Yang, Administrative Analyst, 387-5423) on July 18, 2023; and County Finance and Administration (Valerie Clay, Deputy Executive Officer 387-5423) on July 19, 2023.