HomeMy WebLinkAboutAgenda - 12-06-2004-5hORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: December 6, 2004
Action Agenda
Item No. .5 - 1
SUBJECT: Agreement with UNC Health Link far After Hours Nurse Triage Services for
Primary Care
DEPARTMENT: Health PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
Agreement
INFORMATION CONTACT:
Rosemary Summers, ext 2411
TELEPHONE NUMBERS:
Hillsborough 732-8181
Chapel Hill 968-4501
Durham 688-7331
Mebane 336-227-2031
PURPOSE: To approve an agreement with UNC Health Link for After Hours Nurse Triage
Services far Primary Care Services.
BACKGROUND: The Health Department will begin to provide 'preventive primary care'
services for patients enrolled in the Department's traditional prevention programs (Family
Planning, Well Child services, Maternity) an January 3, 2005 as approved during the 2004-2005
budget discussions. One of the requirements to offer this program is to have after-hours
consultation services available for patients, Attached is an agreement with UNC HealthLink to
provide part of these services, This service is utilized by a number of private practices as well
as all of the UNC medical practices, UNC HealthLink is a nurse triage service that operates
from widely accepted adult and pediatric protocols and will provide guidance and consultation
via telephone to patients with an urgent or emergent condition. The Health Department will
provide information to patients on this after-hours service as part of each patient's first contact
with the Department for service. Depending on the patient's situation, he or she may be
counseled on home treatment, advised to be seen the next day in the Department's office, or
referred to the emergency department for evaluation/treatment, On occasion, the Health
Department back-up, on-call provider (nurse practitioner or physician) may be paged to provide
consultation to the patient,
The cast of the service is $392 per month for asix-month total of $2,352 (January 3, 2004
through June 30, 2004). There will be additional charges if patients call the service on holidays,
Specific charges are detailed in Appendix A to the Agreement.
This service was accounted for in the budgetary estimates of providing this service,
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FINANCIAL IMPACT: The cost of this service was included in the budgetary estimates
presented at the time of budget approval for FY 2004-2005. Annualized, the cost of this service
would be $4,704.
RECOMMENDATION(S): The Manager recommends that the Bcard approve the agreement,
subject to final review by staff and the County Attorney, and authorize the Chair to sign.
HEALTHLINIC PM AGREEMENT
This Agreement made and entered into this 3rd dqy of January, 200.5, by and between
The University ofNorth Carolina at Chapel Hill for its School of Medicine, hereinafter refereed
to as the "University," The University of North Carolina Hospitals, hereinafter referred to as
"UNC Hospitals," and Orange County Health Department, hereinafter referred to as the
"Practice" for and on behalf of itself, its physicians, and mid-level practitioners who provide care
under the supervision of a licensed physician of the Practice.
WHEREAS, HealthLink PM is a service offered by the University and UNC Hospitals
designed to provide after hours call services with nurse-based triage according to practice-
approved guidelines and protocols to patients of pediatricians, family physicians, and internists,
and mid-level practitioners who provide Gaze under the supervision of a licensed physician, in
Chapel Hill and the surrounding area;
WHEREAS, the University and the UNC Hospitals desire to make available the services
of HealthLirk PM to the Practice in consideration for the Practice's payment of the fair market
value of such services; and
WHEREAS, the Practice desires to participate in HealthLink PM under the terms and
conditions set forth in this Agreement.
NOW, THEREFORE, in consideration of the premises and of the following mutual
promises, covenants, and conditions, the parties agree as follows:
1. The University and UNC Hospitals will:
A. Provide after hours call service with nurse-based triage according to Practice-
approved guidelines and protocols to patients of the Practice who call HealthLink PM with their
rnedical problems..
B. Provide the services of HealthL,inlc PM as agreed upon with the Practice. Such
services are available seven (7) days a week, twenty-four (24) hours a day, including weekends
and holidays. The Practice will determine the hours of coverage of HealthLink PM that it desires
for its patients and will notify the University and/or UNC Hospitals of such coverage
determination at the execution of this Agreement. The specifc hours of coverage of HealthLirilc
PM desired by the Practice are set forth in Appendix A hereto, the terms of which are
incorporated herein by reference.
C. Transmit to the Practice by fax each morning a list and description of all of the
transactions with the Practice's patients from the preceding night.
D. Ensure coverage for the nurses who provide triage services through HealthLink
PM under a policy or policies of professional liability insurance or self insurance, including
medical malpractice insurance.
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E. Notify the Practice of any lawsuits or claims filed by a patient of the Practice
against it, its physicians, and its mid-level practitioners, if any, which involve the services of
HealtlrLink PM within five (5) business days of his/her receipt of notice of such a claim having
been filed. The University and/or UNC Hospitals will provide the Practice with any non-
privileged information related to such claim(s) that is reasonably requested by the Practice,
2. The Practice will:
A, Periodically review existing guidelines and provide new guidelines and
protocols applicable to its patients who call HealthLink PM in order to assure that such
guidelines and protocols are consistent with the generally accepted standard of medical practice
in the community in wlrich the practice is located. The parties agree that the Practice will
provide back-up to the nurses who provide the services of HealtlrLink PM.
B. Notify its patients of the availability and hours of operation of HealtlrLink
PM's services, and encourage them to make use of such services,
C. Authorize the University and/or UNC Hospitals to use the Practice's name in
connection with the marketing of and promotional activities for HealthLink PM,
D. Be responsible for the provider-patient relationship and for the health care
provided to each of its patients. Physicians and mid-level practitioners who provide service
under this agreement shall: be responsible for responding to pages in a timely manner; ensure
that the pager is operational; and call patients directly if deerned a second level triage by
HealthLink PM charge nurse.
E. Provide appropriate physician supervision of mid-level practitioners who
provide health care services to patients of the Practice.
F, Obtain and maintain professional liability insurance, including medical
malpractice insurance, at its expense, in amounts of at least $1 million for each occurrence, and
$3 million annual aggregate to ensure the Practice, its physicians, and its mid-level practitioners,
if' any. At no time during the term of this Agreement will the Practice cause the insurance
coverage required to be reduced below the minimum amounts stated herein. The Practice will
notify the University and UNC Hospitals at least thirty (.30) business days prior to the
termination, cancellation, or lapse of such insurance. In the event that the Practice procures and
maintains a "claims made" policy as distinguished from an "occurrence" policy, the Practice will
obtain and maintain prior to the termination of this Agreement, "Tail" coverage to continue and
extend coverage complying with this Agreement after the end of the terms of the claims made
policy.
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G. Notify the University and/or UNC Hospitals of any lawsuits or claims filed by
a patient of the Practice against it, its physicians, and its mid-level practitioners, if any, which
involve the services of HealthLink PM within five (5) business days of his/her receipt of notice
of such a claim having been filed.. The Practice will provide the University and/or UNC
Hospitals with any non-privileged information related to such claim(s) that is reasonably
requested by the University and/or UNC Hospitals„
H. Ensure that each physician and mid-level practitioner in the Practice maintains
current, unrestricted licenses to practice medicine in the State of North Carolina.
3. The parties agree HealthLink PM will be provided to the Practice at the fees described
in Appendix A hereto. The University, UNC Hospitals, or its designated agent will send the
Practice a monthly invoice for the fees incurred, payable within thirty (30) days of the invoice
date. All fees for the services of HealthLink PM will be determined by the University and/or
UNC Hospitals, and maybe adjusted from time to time. The University, UNC Hospitals, or its
designated agent will notify the Practice of any such adjustments at least thirty (.30) days prior to
their effective date.
4. General Terms
A, This Agreement will continue in effect for one (1) year(s) from its effective
date, This Agreement will be automatically renewed each year for an additional year, unless
written notice of an intent not to renew is given thirty (.30) days prior to the annual anniversary
date,
B. Any of the parties may terminate this Agreement For the material breach by the
other of its obligations under this Agreement, provided that written notice of such material
breach and any intent to terminate this Agreement has been given to the breaching party and such
breach has not been cured to the satisfaction of the non-breaching party within thirty (.30) days of
such notice. In addition, any of the parties may terminate this Agreement without cause with
ninety (90) days written notice, termination becoming effective as of the first day of any month
following the ninety (90) days prior notice.
C. This Agreement also maybe terminated immediately by any of the parties upon
the occurrence of any one of the following events:
(1) The failure of the University and/or UNC Hospitals, or the Practice, its
physicians, and its mid-level practitioners, if any, to maintain professional liability insurance,
including medical malpractice insurance as provided above; or
(2) The failure of the Practice to pay a monthly invoice for the services of
HealthLink PM within sixty (60) days of the invoice date; or
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(.3) Should any of the parties, including physicians, improperly file a
Medicare or Medicaid claim as described in the Medicare & Medicaid Patient Program
Protection Act of 1987 [42 U.S.C, section 1:320a-7a], and/or the Ethics in Patient Referral Act of
1989, as amended [42 U.S.C. sections 1395nn and 1.3951(q)], and all existing and fuhire
implementing regulations; or
(4) Upon the good faith deternrination by any of the parties that the health
and/or' welfare of the Practice's patients is jeopardized by the continuation of this Agreement.
D. The Practice may terminate this Agreement by providing written notice to the
University and UNC Hospitals in the manner specified in Subparagraph O within thirty (30) days
of his/her notification from the University, UNC Hospitals, or its designated agent of an
adjustment in the fees for the services of HealthLink PM.
E. To the extent that any law, rule, or regulation of any authority having
jurisdiction over the parties will raise a question as to the legality, enforceability, or
appropriateness of this Agreement or any provision hereof, the pazties agree to negotiate
promptly regarding modification as maybe required to bring this Agreement into compliance
with applicable law, rule, or regulation.. Should the parties be unable to agree upon such
modification within a period of thirty (30) days fiom the date that a party will give notice of such
changes in law, rule, or regulation, this Agreement will be deemed terminated.
F. If this Agreement is terminated, its provisions will remain in effect for the
resolution of all matters unresolved at the time, including but not limited to, the Practice's
payment of all outstanding invoices for HealthLink PM services as provided in Paragraph .3
above, through the effective date of termination of this Agreement.
G. All medical information obtained from and medical records of patients who
call HealthLink PM will be treated as confidential so as to comply with all state and federal laws
and regulations regarding the confidentiality ofinedical information and medical records. The
parties' confidentiality obligations under this Agreement will continue after termination.
Notwithstanding termination, the parties will continue to have access to medical records for five
(5) years from last date that services are furnished to patients under the terms of this Agreement,
or for such length of time as required by applicable law, as necessary to fulfill the terms of this
Agreement or other obligations of any of the parties.
H. The parties acknowledge that the payment of consideration, whether direct or
indirect, to induce a refer'al of any patient for services or equipment reimbursement under the
Medicare and Medicaid programs is unlawful, and agree that no benefit incurred hereunder by
any party will be conditioned upon, nor granted in consideration of; the referral of any patient to
any party.
h The parties will cooperate to resolve any dispute which may arise between them
regarding this Agreement or the services provided hereunder.
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1. This Agreement constitutes all of the terms and conditions agreed upon by the
parties hereto regarding the subject matter of this Agrreement. Any prior agreements, promises,
negotiations, or representations of or between the parties, either oral or written, relating to the
subject matter of this Agreement which were not expressly set forth in the Agreement are null
and void and of no further force or effect.
K, The parties acknowledge that they may wish to amend this Agreement from
time to time. Any such amendment must be in writing and signed by each party..
L. No assignment of'the rights, duties, or obligations of this Agreement will be
made without the written consent of each party.
M. This Agreement will be governed by the laws of the State of North Carolina,
N. The parties to this Agreement intend that this Agreement will create a
relationship of independent contractors between them.. Nothing in this Agreement will be
construed as, or be deemed to create a relationship of employer and employee, principal and
agent, or any relationship other than that of independent parties contracting with each other solely
for the purpose of cazrying out the provisions of this Agreement. Neither UNC Hospitals, the
University, nor the Practice as independent contractors, nor any of their respective employees
will be liable or responsible for any acts and omissions on the part of the other.
O, All notices under this Agreement will be in writing and mailed by certified or
return receipt request mail. All notices to the Practice will be mailed to the addresses set forth
below his/her signature line.. All notices to the University and UNC Hospitals will be mailed to:
Suzanne Herman, Director, Regional Services, UNC Hospitals, 6003 East Wing, 101 Manning
Drive, Chapel Hill, N.C. 27514.
P. This Agreement is not intended and will not be construed to be an agreement
for the benefit of any third party.
Q. In the event that any provision of this Agreement is held to be invalid or
unenforceable, the remainder of the provisions of this Agreement will remain in full force and
effect.
R. Force Majeure. Failure of HealthLink to perfornr any of the provisions of this
Agreement by reason of any of the following shall not constitute an event of default of breach of
this Agreement: fires, floods, snow/ice, accidents, war, revolution, riots, insurrections, acts of
God, acts of government (including without limitation any agency or department of the United
States of America), or other causes which are reasonably beyond HealthLink's control..
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IN WITNESS WHEREOF, the undersigned have executed this Agreement as of the date
and year written above.
THE UNIVERSITY OF NORTH THE UNIVERSITY OF NORTH
CAROLINA AT CHAPEL HILL CAROLINA HOSPITALS
Nancy D. Suttenfield Gary Park
Vice-Chancellor for Finance President/CEO
and Administration
Date:
"PRACTICE"
Orange County Health Department
Rosemary L. Summers
Health Director
Address
Date:
Barry Tacobs, Chair Date
Orange County Board of Commissioners
"This instrument has been pre-audited in the manner required by the Local Government Budget
and Fiscal Control Act."
ICen Chavious, Finance Director Date
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APPENDIX A
HealthLink PM Fees effective .July 1, 2004
$00..50 per Contracted Hour of Coverage.
# of Physicians (and mid-level practitioners who provide care under the supervision of a licensed
physician, if any) in the Practice: Charged, for 1..5 providers
Designated Hours of Coverage per Week: IZI hours per Weelc
Effective Start Date of Coverage: January .3, 100.5
Monthly Fee for HealthLink PM services = (Contracted hours per week X # of providers) X 52
(Weeks per year) / 12 (months/year) X $00.50 (cost per hour of coverage per provider).
Ill hours per week X 1..5 providers X .52 weeks per,year / Il months per,year X $00..50 =
$.392.OOhnonth
Optional Holiday coverage for non-contracted hours is available at a rate of $20.00/patient call
on the following Holidays only: New Year's Day, Memorial Day, Independence Day, Labor
Day, Thanksgiving Day, Christmas Day
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