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Approve a first amendment with LocumTenens.com for $1,295,000, for a total cumulative 2 year contract amount of $3,095,000, to provide psychiatric medical services from July 1, 2018 through June 30, 2020; Authorize the County Administrator to execute the amendment; and Approve an Appropriation Transfer Request (ATR) for $204,918 to move appropriations in salary and benefits to contracted direct services (4/5 vote required)
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Published Notice Required? Yes _____ No __X__
Public Hearing Required? Yes _____ No __X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health & Social Services (H&SS) recommends that the Board approve a first amendment with LocumTenens.com for $1,295,000, for a total cumulative 2 year contract amount of $3,095,000, to provide psychiatric medical services from July 1, 2018 through June 30, 2020; Authorize the County Administrator to execute the amendment; and Approve an Appropriations Transfer Request (ATR) in the amount of $204,918 to move appropriations in salary and benefits to contracted direct services (4/5 vote required).
SUMMARY:
LocumTenens.com provides physicians and advanced practice recruitment services in the high-demand medical specialties. Under the existing agreements, LocumTenens.com provides H&SS Behavioral Health Division with temporary professional staffing including psychiatrists, nurse practitioners and/or physician assistants with mental health experience in the Mental Health Integrated Care Clinics. This is an essential aspect of service delivery and contracting with temporary providers is the only way to provide care when there are not enough County psychiatrists to meet the need.
The retirement in July of a long-time child psychiatrist presented with an additional recruitment challenge. As a result, H&SS Behavioral Health needed to replace the child psychiatrist with LocumTenens providers through a combination of onsite and telemedicine.
Currently, there are 5.75 FTE positions vacant in a service system that needs a total of 11.5 FTE for a proper psychiatry staffing to serve adults and children.
FINANCIAL IMPACT:
An ATR in the amount of $204,918 is needed to move appropriations budgeted in salaries and benefits for a child psychiatrist to contracted direct services for the LocumTenens providers. The remaining costs are budgeted in the Department’s FY2019/20 Adopted Budget. Funding for the amendment will primarily come from budgeted federal and State Medi-Cal, County General Fund and 2011 Realignment.
The costs associated with preparing the agenda item are nominal and absorbed by the department’s FY2019/20 Adopted Budget.
DISCUSSION:
The Psychiatrists provide medical oversight, medication support, psychiatric assessments and diagnoses, and clinical leadership to people who have severe and persistent mental illness. Psychiatry services are required by the Department of Health Care Services (DHCS) for the licensing and ongoing operations of Health & Social Services’ mental health clinics.
On a national level, recruitment and placement of psychiatric practitioners remains a challenge as demand continues to outpace supply. On average, psychiatry services are being performed by an older provider population than that found in most other medical specialties. Because of this, retirements are exceeding the quantity of new graduates entering the practice.
The provider shortages have created a competitive market with high compensation scales for psychiatrists which has impeded County employment gains and resulted in a continued shortage of appointment availability for County clients. To operate within the required appropriate appointment levels, H&SS renewed a two-year contract with LocumTenens.com on July 1, 2018. The LocumTenens contracts assists in bridging service needs by placing temporary psychiatrists, nurse practitioners, and/or physician assistants who specialize in psychiatry in the mental health clinics. The anticipated gradual decline in usage of the LocumTenens contracts by Health & Social Services has not been realized as new hires have not kept pace with staff departure and increasing caseloads in the adult clinics.
ALTERNATIVES:
The Board may choose not to approve the contract amendment for LocumTenens.com. This is not recommended as the County is mandated to provide psychiatric services for clients served in the County mental health system. This amendment will ensure delivery of psychiatric services so that severely mentally ill individuals have no disruption in their psychiatric care and medication regimen; if care were to be interrupted it would result in poor client outcomes and higher costs to the County and the community.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved the contract for legal sufficiency.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION