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HomeMy WebLinkAboutAgenda - 05-16-2006-5fORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: May 16, 2006 Action Age a Item No. SUBJECT: Contract Renewal with UNC Family Medicine and Health Department DEPARTMENT: Health PUBLIC HEARING: (Y/N) No ATTACHMENT(S): Renewal Contract INFORMATION CONTACT: Rosemary Summers, 245-2411 PURPOSE: To renew a contract with UNC Family Medicine and Health Department for Physician Services, BACKGROUND: This contract covers all physician services far the Health Department, including communicable disease consultation, clinic supervision and direct clinical services, mandated oversight of all nurse practitioners, and consultation on protocol development and quality assurance. Back-up services are also included in the contract for vacation and sick coverage, The contract amount is $135,745 for the year, a 4% increase over the previous year. The increase primarily covers an increase in medical malpractice insurance that UNC Family Medicine has experienced. The physicians began providing 24-hour call consultation and supervision for the Health Department's nurse practitioners in January when the Department began providing primary care services, Last year, the Health Department had over 11,000 clinical visits and more than 2,500 home visiting contacts. FINANCIAL IMPACT: The renewal contract for FY 2006-2007 cost includes a 4% increase for a total of $135,745 per year, This represents .70 full time equivalent of a physician's time including medical back-up, These amounts have been included in the department's requested budget for FY 2006-2007. RECOMMENDATION(S): The Manager recommends that the Board approve the contract renewal and authorize the Chair to sign pending approval of the FY 2006-2007 budget and any further review by staff and the County Attorney, STATE OF NORTH CAROLINA COUNTY OF ORANGE HEALTH DEPARTMENT AND THE DEPARTMENT OF FAMILY MEDICINE, UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL AGREEMENT THIS AGREEMENT, made and entered into this first day of July 2006, by and between The University of North Carolina at Chapel Hill, hereinafter referred to as the "University," for its Department of Family Medicine in the School of Medicine, hereinafter referred to as the "Department" and the Orange County Health Department, hereinafter referred to as the "OCHD." WITNESSETH: WHEREAS, the Department desires to provide Medical Director Services, including general consultation and clinical services, and to participate in the provision of medical care for the citizens of the community, and; WHEREAS, OCHD operates a number of "Outpatient Clinics" located at the site of the Orange County Health Department in Chapel Hill and Hillsborough, North Carolina, or other sites that may, from time to time, be provided; NOW, THEREFORE, in consideration of the premises and the following mutual covenants and conditions and any sums to be paid, OCHD and the University agree as follows: 1, The Department will provide "M edical Director Services", including the professional "General Consultation" and "Clinical" services identified below. 2, The Medical Director Services provided by the Department shall include the following General Consultation Services: a. act as the principal advisor to OCHD Health Director and OCHD Personal Health Services Director in matters of medical policy; b. advise OCHD Health Director and OCHD Personal Health Services Director on the medical implications of alternatives in clinical program functioning and management; c. at the request of OCHD Health Director represent OCHD, and negotiate on behalf of OCHD, with respect to interagency relationships that involve medical expertise; d. advise and interpret the regulatory requirements related to medical aspects of OCHD'S functions; e. provide coordination for medical components of the Outpatient Clinics of OCHD; f. advise and assist OCHD staff in epidemiological investigations; OG-07 AGREEMENT Between UNC School o(Medicine And Orange County Health Department Page 2 of 9 3 g. be responsive to community public health concerns directly and in consultation with OCHD Health Director and OCHD Division Directors; h. assist OCHD Health Director and OCHD Personal Health Services Director in establishment of medical pros-educes and quality/quantity control mechanisms; i, assist OCHD staff in data analysis towards identification of public health concerns; j, work with OCHD Health Director and OCHD Division Directors on formulation of responses to public health concerns; k, assist with evaluation of medical programs and services provided by OCHD, including recommendations for constructive change; maintain close contact and availability through on-site visits at OCHD and phone consultation to assist OCHD in the discharge of OCHD responsibilities; m, participate in OCHD Division Head management meetings and OCHD Division level meetings when requested and appropriate; n, attend Orange County Board of Health meetings when requested; o. provide medical direction to school health programs in both school systems in Orange County and medical consultation to both school and OCHD staff working in or with school health programs; p. other miscellaneous duties as provided for in the agreement; q, discharge the above described responsibilities through and with knowledge aforehand of OCHD Health Director. 3. The Medical Director Services provided by the Department shall include Clinical Services in compliance with State and Federal guidelines and program rules for all Outpatient Clinics conducted by OCHD, including without limitation the following OCHD Outpatient Clinics: family planning (FP), prenatal care (PNC), child health (CH), adolescent health (ADOI), tuberculosis (TB), sexually transmitted disease (STD), general communicable disease control (GEN), adult health preventive services (AH/HP), and Primary Care (PQ. The Clinical Services provided by the Department shall include the following: a. Collaboration with OCHD to develop and approve protocols for Outpatient Clinics. For the mutual benefit of the Department, OCHD, and its prenatal patients, prenatal patients will be managed according to OCHD established hops://owaorangem coorange.nc.us/exchange/GWilder/Inbox/Contrad renewals (or May 76 agenda EML/UNC Family Medicine - Medical Director 2006-07 dodC88EA28C-18C0-4x97-9AF2-036E93DDAF63/UNC Family Medicine-Medical Director 2006- 07 doc?attach =1 06-07 AGREEMENT Between UNC School of Medicine And Orange County FleaOh Department Page 3 of 9 protocols. These protocols will be reviewed annually and be consistent with proton-ols used at UNC Department of OB/CYN and Family Medicine outlying clinics, b, Primary medical supervision of the nurse practitioners who are employees of OCHD to include ongoing monitoring and evaluation of the medical acts performed by the nurse practitioners; Regular individual meetings with the nurse practitioners will occur according to an agreed upon schedule to review records of high-risk or problematic patients; documentation will be recorded in the patient record indicating that a review occurred and noting any recommended changesin the plan of care. c, Co-signing charts of patients seen by new nurse practitioners of OCHD within five (S) working days for at least the first six months of their nurse practitioner' practice, and face-to-face consultation on a weekly basis for the first month of their nurse practitioner practice and at least monthly thereafter for the succeeding five months; d, A review of all OCHD prenatal records at 16, 28 and .36 weeks to assure that appropriate medical care is being provided, with a Maternity Chart Review form completed at each interval. e, Weekly group meetings with clinical staff in each site according to an agreed upon schedule to discuss patient care and clinical operation issues, f. Overall responsibility for medical Residents and medical students working in clinics including orientation, supervision of practice and assurance of compliance with OCHD program and don-umentation requirements. g, Provision of routine medical services during scheduled on-site times at OCHD Outpatient Clinics, including documentation of Clinical Services provided per established OCHD protocols; h, Medical consultation visits to OCHD patients during on-site scheduled times at Outpatient Clinics; medical consultation to OCHD nurse practitioners by telephone when the Medical Director is not on-site at OCHD outpatient clinics, i. Continuing education r-onsultation for OCHD nurse practitioners and other OCHD staff to include regular informal consultation and periodic formal sessions as appropriate; j. After-hours medical consultation for primary care patients of OCHD: UNC Health C'are's HealthLink program provides initial triage of after-hours calls as per the agreement attached hereto and incorporated as exhibit A ("after-hours program"). The Department will provide M edical Director consultation and https://owaorangecocoorangencus/exchange/GWilder/Inbox/Contrad renewals for May 16 agenda.EMUUNC Family Medicine- Medical Director 2006-07.dodC5BEA28G7tIC0-4x97-9AF2-036E93DDAF83/UNC' Family Medicine -Medical Director 2006- 07 doc?attach ® i OG-07 AGREEMENT Between UNC School of Medicine And Orange County Health Department Page 4 of 9 supervision to OCHD clinicians (3 FNPs) that provide after-hours medical consultation (on a rotating basis) for OCHD clients referred by HealthLink. The Medical Director shall also provide after-hours medical consultation for HealthLink referred OCHD clients (on a rotating basis) such that each of the 4 clinicians shall provide such after-hours medical consultation 1 week/month, k. Discharge the above described responsibilities through and with knowledge aforehand of OCHD Health Director, 4, OCHD Outpatient Clinics are operational during the normal business hours of 8:00 a,m. to 5:00 p.m., Monday through Friday. However, one day per site of the Outpatient Clinics (Tuesday -Hillsborough; Thursday -Chapel Hill) operates on a flexible evening schedule (i,e. 9:.30 AM - 6:30 PM) to provide greater access to care. Outpatient Clinics may run beyond their scheduled time. In addition to the above-described activities during the after-hours program, the Department is responsible for medical activities conduc-ted in the Outpatient Clinics in accordance with this agreement during the entirety of the hours specified in this paragraph, 5, The Department shall provide, at a minimum, the equivalent of .70 Full Time Equivalent (FTE) personnel to carry out the Medical Director Services described in this agreement, including the General Consultation and Clinical Services identified above. Said services will be provided primarily by the "M edical Director", or "back-up Department physician". The M edical Director shall be board certified in Family Medicine or an equivalent certification, The Medical Director will report activities and services performed for OCHD as requested by OCHD Health Director, 6, The Chair of the Department shall, concurrent with the execution of this agreement, designate the name of the Medical Director, and the names of four Department physicians who will rotate as back-up Department physicians, to be "available" to provide the General Consultation and Clinical Services identified in this agreement. a. The Department and OCHD shall indicate their mutual agreement to the designation of the Medical Director and designated back-up Department physicians available to be scheduled in the absence of the Medical Director by signing the "Designation of Medical Director" attachment to this contract. Any changes in these designations will be mutually agreed to by the Chair of the Department and OCHD Health Director. In the event that the Medic-a) Director or any designated back-up Department physician becomes unwilling or unable to perform the duties required by this agreement, the Department and OCHD shall attempt to mutually agree upon replacement(s). If such mutual agreement is not ac-hieved, then this agreement shall terminate and any payment due as of the date of termination shall be paid as provided for in paragraph 18 of this agreement- b, Substitutions in the scheduling of the Medical Director or designated bark-up Department physician will be the responsibility of the Department in consultation with OCHD Health Director, Vacation leave, continuing hops://owaorangecoco orangenc us/exchange/GWilder/Inbox/Contrac[ renewals for May 16 agenda.EMUUNC Family Medicine- Medical Director 2006-07 dodC56EA26C-iBC0-4a97-9Af2-036E93DDAF63/UNC Family Medicine -Medical Director 2006- 07 doc?attach ® 7 06-07 AGREEMENT Between UNC School of Medicine And Orange County Health Department Page 5 0( 9 education, and other assignments requiring temporary back-up coverage will be mutually agreed upon by the Chair of the Department and OCHD Health Director. 7. The Medical Director or designated back-up Department physician shall provide a total of 20 hours per week of the foregoing Clinical Services on-site at OCHD Outpatient Clinics or other sites as provided therefor. Days and times and the identity of the person or persons scheduled to be on-site to provide this coverage on behalf of the Department will be mutually agreed to by the Department and OCHD. Although the Department is not required to provide the attendance of a Medical Director or back-up Department physician on the premises of OCHD outpatient facilities or other sites provided therefor at other times, access should be made available during other days and times as stipulated in this agreement. Substitute coverage by a back-up Department physician is expected during vacations and other anticipated absences of the Medical Director orback-up Department physician originally scheduled to be available. The Medical Director or designated back-up Department physician shall be responsible for notifying OCHD of schedule changes, If attendance as scheduled of the Medical Director or designated back-up Department physician is impossible due to unremediable circumstances, phone coverage of a designated back-up Department physician must be provided and nurse practitioner charts will be signed by the appropriate designated Department physician or back up Department physician on call within five (5) working days. In addition to the foregoing described days and hours, at the request of OCHD Health Director, the Medical Director or designated back-up Department physician will provide on-site medical supervision at OCHD Outpatient Clinics or other sites provided therefor, as necessary, during communicable disease incidents or other public health-related emergencies. 8, The Medical Director or designated back-up Department physician shall be available at least 4 hours per week for phone consultation during business hours and after-hours program coverage, and emergency phone consultation shall be available as needed during non-business hours through a pager system. Phone coverage will also be provided by the Medical Director or designated back-up Department physician for consultation and direction for communicable disease/epidemic control. 9. The Medical Director or designated back-up Department physician shall be available at least 4 hours per week for direct administrative and/or consultative services as outlined in General Consultation Services (Paragraph 2). 10. The Department will maintain current registration and licensure of the Medical Director and designated back-up Department physicians and shall provide copies to OCHD as appendices to the Designation of Medical Director attachment to this contract. 11. The Department will assure that the Medical Director and designated bark-up Department physicians are in, and maintain, compliance with OSHA guidelines regarding bloodborne pathogens including Hepatitis B and TB status as well as documentation of immunization against measles, mumps, rubella and varicella. In the event of a bloodborne pathogen exposure, the Department will be responsible htlps://owa orangeco co orange.nc.us/exchange/GWilder/Inbox/Contrad renewals (or May 16 agenda.EMVUNC Family Medicine - Medical Director 2006-07.dodC58EA28C-i8C0-4x97-9Af2-036E93DDAF83/UNC Family Medicine -Medical Director 2006- 07 doc?attach =1 OG-07 AGREEMENT Between UNC School o(Medicine And Orange County Health Department Page 6 0( 9 for providing follow-up according to its policies and procedures governing exposure incidents. 12. The University will be responsible for the negligence of its employees and agents to the extent of the North Carolina Tort Claims Act. Further, the University will provide adequate professional liability insurance for the University and its personnel who provide the services described in the agreement. The insurance limits will be stated in a Confirmation of Insurance submitted at the time the contract is commenced. 13. The Department will offer medical consultation in accordance with the appropriate medical standards and accepted methods and procedures. 14. OCHD agrees to pay the Department in return for the above services equal monthly installments of ELEVEN THOUSAND AND THREE HUNDRED TWELVE DOLLARS ($11,312) for a total of $1.35,745, 15, The University shall bill OCHD on a monthly basis with the first bill being dated July 1, 2006 and OCHD shall pay the University within thirty (.30) days of receipt of the University's bill. Any adjustments to the billing shall be taken into acr_ount in the next succeeding bill or as soon thereafter as reasonably practicable, 16 OCHD agrees to furnish all supplies, equipment, office space and a computer as needed by the Medical Director; to include the Medical Director in all appropriate conferences, meetings, correspondenr_e and publications necessary to appropriately discharge the Medical Director's duties within budgetary constraints. 17, This agreement shall run for a period of TWELVE (12) months, from the 1st day of July, 2006, to the .30th day of )une, 2007, and shall be renewable annually thereafter upon written notice executed by both parties. 18. This agreement or its renewals may be terminated at any time without penalty by either party provided that the agreement is terminated either: a. upon failure of the parties to agree on a replacement Medical Director or replacement designated back-up Department physician pursuant to paragraph 6 of this agreement; or b, upon delivery of written notice of termination furnished to the other party at least ninety (90) days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination. 19. OCHD hereby agrees with the University that, in their educational and/or employment practices, OCHD and the University will comply with such non- discrimination laws as may be applicable to it in the performance of this agreement. The Department shall abide by pertinent rules and regulations of OCHD, Orange County, and the North Carolina Department of Health and Human Services in the conduct of service. The University, the Department and OCHD shall comply with such confidentiality laws as may be applicable in the performance of this agreement and acknowledge that in receiving, storing, processing or otherwise dealing with any confidential information, they will safeguard and not further disclose the information except as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended, and the provisions of hops://owaorangecom orange.nc us/exchange/GWilder/Inbox/Conlrad renewals (or May 7G agenda EMUUNC Family Medicine - Medical Director 2006-07 dodC68EA28C-78C0-4a97-9AF2-03GE93DDAF83/UNC Family Medicine -Medical Director 2006- 07 doc7altach ~ 1 06-07 AGREEMENT Between UNC School o(Medicine T And Orange County Health Department ~l Page 7 of 9 the Business Associate Agreement which is attached hereto and incorporated herein by reference. 20, No provision of this agreement shall be construed or interpreted as creating a pledge of the faith and credit of the County of Orange or OCHD within the meaning of any constitutional debt limitation. No provision of this agreement shall be construed or interpreted as creating a delegation of governmental powers nor as a donation by or a lending of the credit of the County of Orange or OCHD within the meaning of the Constitution of the State of North Carolina. This agreement shall and does not directly or indices-tly or contingently obligate the County of Orange or OCHD to make any payments beyond those appropriated in the sole discretion of the County of Orange or OCHD for any fiscal year in which this agreement shall be in effect, No deficiency judgment may be rendered against the County of Orange or OCHD in any action for breach of a contractual obligation under this agreement and the taxing power of the County of Orange is not and may not be pledged directly or indirectly or contingently to secure any moneys due under this agreement, 21. This agreement supersedes any previous agreements between the parties concerning the matters agreed to herein. This agreement contains the entire understanding of the parties and shall not be altered, amended or modified, except by an agreement in writing executed by the duly authorized officials of both parties. 22. The laws of North Carolina shall govern the validity and interpretation of the provisions, terms, and conditions of this agreement. blips://owa orangeco coorange nc us/exchange/GWilder/Inbox/Contnct renewals for May 1G agenda.EMVUNC Family Medicine - Medical Director 2006-07 dodC58EA28C-18C0-4x97-9AF2-036E93DDAF63/UNC Family Medicine -Medical Director 2006- 07 doc7attach ~ 1 06-07 AGREEMENT Between UNC School of Medicine And Orange County Health Department Page 8 of 9 IN WITNESS WHEREOF, the parties have hereunto signed this agreement in their official capacities of the day and year listed below. FOR AND ON BEHALF OF FOR AND ON BEHALF OF ORANGE COUNTY HEALTH DEPARTMENT THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL Rosemary L. Summers, MPH, DrPH Nancy Suttenfield Health Director Vice-Chancellor for Finance and Administration DATE: DATE: Warren P. Newton, MD Chair, Family Medicine DATE: FOR AND ON BEHALF OF THE COUNTY OF ORANGE Barry Jacobs, Chair Orange County Board of Commissioners DATE: ORANGE COUNTY FINANCE DIRECTOR: "This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act." Ken Chavious Finance Director DATE: hops://owa.orangeco co orange nc us/exchange/GWilder/Inbox/Contracl renewals (or May 16 agenda.EMUUNC Family Medicine - Medical Director 2006-07.doc1C58EA28C-1 BCO-4a97-9AF2-036E93DDAF63/UNC Family Medicine -Medical Director 2006- 07 doc7attach ®1 06-07 AGREEMENT between UNC School of Medicine And Orange County Nealgi Department ' O Page 9 of 9 Designation of Medical Director Attachment to Contract between the Department of Family Medicine, University of North Carolina, School of Medicine and the Orange County Health Department for July 1, 2006 through June 30, 2007. The following physicians are designated by the Department of Family Medicine to fulfill the terms of the attached contract: Michael Fisher, MD Lauren Lingley, MD Clark Dennison MD Andrew Hannioel, MD Margaret Nusbaum, DO Medical Director Physician Physician Physician Physician Copies of current registration and licensure for these physicians are attached. Signed: Warren Newton, Chair Department of Family Medicine Date Agreed: Rosemary Summers, Health Director Orange County Health Department Date hops://owa. orangeco coorange. nc. us/exchange/G W ilder/Inbox/Contract renewals for May 7 6 agenda EM VUNC Family Medicine - Medical Director 2006-07 dodC5BEA28C-78C0-M1a97-9AF2-03GE93DDAF83/UNC Family Medicine -Medical Director 2006- 07.doc?attach ~ i