ADOPTED
BOARD OF SUPERVISORS
COUNTY OF LOS ANGELES

18
November 13, 2012

November 13, 2012
SACHI A. HAMAI
EXECUTIVE OFFICER

The Honorable Board of Supervisors
County of Los Angeles
383 Kenneth Hahn Hall of Administration
500 West Temple Street
Los Angeles, California 90012
Dear Supervisors:
AMENDMENT TO MEDICAL SCHOOL AFFILIATION AGREEMENT AND
ONSITE CUSTODIAL INMATE SPECIALTY CARE AGREEMENT BETWEEN
THE COUNTY OF LOS ANGELES AND THE UNIVERSITY OF SOUTHERN
CALIFORNIA
(1st SUPERVISORIAL DISTRICT)
(3 VOTES)
SUBJECT
Request approval to adjust staffing levels and increase the maximum cost
through an amendment to the Medical School Affiliation Agreement with the
University of Southern California, and request delegated authority to execute a
new agreement, to provide onsite specialty care for inmates at certain Sheriff’s
Department facilities.
IT IS RECOMMENDED THAT THE BOARD:
1. Approve and instruct the Chairman to sign the attached Amendment No. 5
(Amendment) to the Medical School Affiliation Agreement No. 75853 (MSAA
Agreement) with the University of Southern California (USC), effective upon
Board approval, to: a) add staff for the clinical oversight of Health Information
Technology (HIT) projects, b) add staff resulting from the implementation of
the State’s Public Safety Realignment Act, c) delete discontinued staff items
and a one-time payment provision for a prior fiscal year,, and d) provide
additional Intra-Operative Monitoring (IOM) technician services at LAC+USC
Medical Center (LAC+USC MC) through June 30, 2013 resulting in a net
increase to the annual maximum obligation from $126,583,896 to $
126,703,786.

The Honorable Board of Supervisors
11/13/2012
Page 2
2. Delegate authority to the Director, or his designee, to amend the MSAA
Agreement to further extend IOM technician services beyond June 30, 2013,
and annually thereafter upon agreement by both parties subject to review and
approval of County Counsel, and notification to the Board and the Chief
Executive Office (CEO).
3. Delegate authority to the Director, or his designee, to execute a new Onsite
Custodial Inmate Specialty Care Agreement (Inmate Care Agreement) for
USC to provide onsite specialty care to inmates at certain Sheriff’s Department
facilities under the terms set forth below for a period of one year effective upon
execution with a one year automatic renewal for full services, or partial
services upon agreement by the parties, and to execute amendments to adjust
staffing levels and cost based on the Sheriff’s Department’s budget and future
need for specialty care within the Sheriff's Department's approved budget as
described below, subject to review and approval by County Counsel, with
notice to the Board and the CEO.
PURPOSE/JUSTIFICATION OF RECOMMENDED ACTION
Approval of first recommendation will adjust the staffing levels and costs based on service needs, as
described below:
Additional Staffing
Chief Medical Information Officer. DHS facilities are implementing HIT projects that are critical to the
successful transformation of DHS’ health care delivery system, which includes a new disease
management registry to improve the quality of care provided to patients with chronic diseases, an econsult system to improve continuity of care through electronic consultations between primary and
specialty care physicians, and an Electronic Health Record system to be implemented enterprisewide. Each facility will have a Chief Medical Information Officer (CMIO) to serve as the clinical
leader to assist in implementing the above projects at their respective facilities. DHS is proposing to
add a physician (0.5 Full Time Equivalent or “FTE”) to perform this function at an annual cost of
$123,524.
Public Safety Realignment Act (Assembly Bill 109). Effective October 1, 2011, State law transferred
responsibility from the California Department of Corrections and Rehabilitation to the County for the
incarceration of individuals convicted of non-violent, non-serious, and non-sex offender, otherwise
known as “N3,” crimes, and the supervision of such individuals from State prisons. As a result, DHS
anticipates an increase in health care utilization at LAC+USC MC, and is requesting approval to add
an Emergency Room Physician (1.0 FTE) at an annual cost of $258,720, and various specialists (1.0
FTE total) at an annual cost of $242,550.
Intra-Operative Monitoring. The current Agreement with USC provides funding for an IOM technician
(1.0 FTE) to monitor the functional integrity of certain neural functions of a patient during surgery.
DHS is proposing to add two additional IOM technicians (2.0 FTE) at a total annual cost of $267,000
to meet the growing demands for such technicians by LAC+USC MC. Such technicians are needed
because the current County class specifications for an Electroencephalography (EEG) Technician do
not meet the industry standards and certification requirements to perform the full array of IOM
services required in the surgical room. Meanwhile, DHS is developing an appropriate class
specification to replace USC’s IOM Technicians, and will start negotiations with USC no later than 9
months after the approval of this Amendment to determine the feasibility and appropriateness of
continuing such services by USC.

The Honorable Board of Supervisors
11/13/2012
Page 3
Discontinued Staffing and Costs
Senior Pathologist: The initial Agreement provided funding for a Senior Pathologist (1.0 FTE) at an
annual cost of $270,260, which now needs to be removed from the Agreement since this position
has been transferred to the County as authorized by your Board on June 12, 2012.
Psychiatric Outpatient Department Coverage and One-Time Funding. Amendment No. 1 added
psychiatrists (1.5 FTEs) to cover LAC+USC MC’s outpatient department at a total annual cost of
$371,700 until such time that the County Department of Mental Health (DMH) negotiated a separate
agreement with USC to pay for such services. These psychiatric outpatient services were transferred
to DMH in 2009. This same amendment also provided one-time, non-recurring funding of $436,204
to replace County-employed physicians leaving County service. Based on the above, the psychiatric
outpatient services and the one-time attrition funding is no longer required and should be removed
from the Agreement.
Approval of the second recommendation will enable DHS to administratively amend the Agreement
to delete IOM technicians in the event that DHS is able to hire its own technicians.
Approval of the third recommendation will enable DHS to provide cost-effective, onsite specialty care
to inmates at certain Sheriff’s Department facilities rather than the costlier and more cumbersome
process of transporting inmates to LAC+USC MC.
Implementation of Strategic Plan Goals
The recommended actions support Goal 1, Operational Effectiveness, of the County’s Strategic Plan.

FISCAL IMPACT/FINANCING
MSAA Agreement
The maximum annual County obligation for LAC+USC MC under the MSAA Amendment in Fiscal
Year (FY) 2012-13 will be $126,703,786, an increase of $119,890 from the previous fiscal year’s
maximum obligation of $126,583,896. Funding is included in the DHS’ FY 2012-13 Final Budget.
Funding for future years will be requested as necessary.
Inmate Care Agreement
DHS will be fully reimbursed by the Sheriff’s Department for the cost of the inmate care agreement.

FACTS AND PROVISIONS/LEGAL REQUIREMENTS
MSAA Agreement
DHS entered into the current MSAA Agreement with USC effective August 1, 2006 through June 30,
2007, with a one-year automatic extension at the end of each contract year. The term of the current
MSAA Agreement is for a rolling five-year term unless either party serves notice of non-renewal to
the other party, in which case the MSAA Agreement would expire in four years.

The Honorable Board of Supervisors
11/13/2012
Page 4
In November 2008, DHS processed Amendment No. 1 to the MSAA Agreement to increase the
volume of physician services to accommodate the Replacement Facility for the LAC+USC MC and to
provide additional compensation to retain current physician staffing. The MSAA Agreement was
subsequently amended to memorialize LAC+USC MC’s and USC’s responsibilities relative to
undergraduate and medical school education for USC’s accrediting agency, add additional services
for radiology and emergency room services, and add purchased services and funding to ensure full
compliance with accreditation standards.
The recommended Amendment No. 5 identifies the changes in staffing and costs for FY 2012-13 as
previously described hereinabove.
Inmate Care Agreement
On June 28, 2012, DHS informed the Board about its work with the County Sheriff's Department’s
Medical Services Bureau (MSB) to assess options for improving specialty care for individuals
incarcerated in Los Angeles County jails. This report also included a proposed plan for how DHS
could further collaborate with MSB to improve services by providing on-site specialty care to jailed
patients. The Board subsequently passed a motion that the funds will be annually identified within
the Sheriff's Department’s budget not to exceed $5.2 million annually. The motion also directed the
Chief Executive Officer and the Sheriff's Department to ensure that all cost-savings will be used to
expand the scope of specialty care
The Inmate Care Agreement will include provisions substantially similar to those in the MSAA
Agreement with respect to indemnification, insurance and the County's standard terms and
conditions. Additional provisions include an automatic one year renewal unless either party serves
upon the other a notice of non-renewal. Unless the parties agree to the contrary, such renewal shall
continue for the full services provided during the previous one year period. Either party may
terminate this Agreement for convenience upon one hundred twenty days written notice.
DHS is seeking delegated authority to enter into an Inmate care Agreement with USC to provide
these on-site custodial specialty care services.
County Counsel has advised that the portion of the MSAA Agreement related to academic and
patient care services and the Inmate Care Agreement, which is for a one-year period, are not subject
to the provisions of County Code Chapter 2.121, Contracting with Private Business (Proposition A).
County Counsel has reviewed and approved Exhibit I as to form.

CONTRACTING PROCESS
Not applicable.

IMPACT ON CURRENT SERVICES (OR PROJECTS)
The MSAA Agreement will continue the provision of certain clinical and academic services at the
LAC+USC MC.

The Honorable Board of Supervisors
11/13/2012
Page 5
It is anticipated that the Inmate Care Agreement will improve inmate care by reducing the number
and volume of inmates who have to be transported to LAC+USC MC to receive specialty care.

Respectfully submitted,

Mitchell H. Katz, M.D.
Director
MHK:ck
Enclosures
c:

Chief Executive Office
County Counsel
Executive Office, Board of Supervisors
Sheriff’s Department

USC ADDENDUM A-4
Purchased Services
Contract Year Ending June 30, 2013
A.1

General. Payment for Purchased Services will be made by County to University in the
amounts set forth in Section A.3 below. Payment for Purchased Services shall be made
in quarterly installments, each payable on the first business day of each Contract Year
quarter. In addition, if County requests increases in the volume of any Purchased
Services identified in this Addendum A, County will pay for such services in advance on
a quarterly basis. University is not obligated to provide such supplemental services until
University receives payment from County for those services. Except with regard to
additional Purchased Services provided by University pursuant to Section A.2.4.3
Attrition of County-Employed Physicians, any new services which the Parties agree to
commence during the Contract Year, of a nature not set forth in this Addendum A, will be
provided pursuant to an amendment or separate agreement between the Parties,
subject to the approval of the Governing Board; such new services will be taken into
account in revising Addendum A for the next Contract Year. Any such revisions to this
Addendum A shall not take effect without a properly executed amendment.

A.2

Purchased Services. University shall provide the following Purchased Services during
the Contract Year beginning July 1, 2012 and ending June 30, 2013 . The type and
volume of Purchased Services provided during the Contract Year shall continue at the
same overall level, on an annualized University Personnel FTE basis, as provided by
University Personnel during the prior Contract Year.
A.2.1

Clinical Services. Except for those services which may be provided by
persons other than University Personnel, University shall provide those clinical
services sufficient to address the goals and responsibilities set forth in §5.4.

A.2.2

Non-Clinical Academic and Administrative Services. Except as provided by
persons other than University Personnel, University shall provide academic and
management services sufficient to address the goals and responsibilities set forth
in §§ 5.3 and 5.5, respectively.

A.2.3

Research. The Parties understand and agree that no funds paid under this
Agreement shall be used to pay for non-clinical research. If it is determined that
any funds are used to pay for non-clinical research, University shall reimburse
County such amount.

A.2.4

Volume of Purchased Services. Until measures are developed to more
accurately define the volume of Purchased Services, the Parties agree that the
volume of all services will be measured on the basis of full time equivalents
(FTEs) for physicians and other University Personnel.
A.2.4.1

Intentionally omitted.

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FTE COUNT
Physician and
Dentist FTEs**
Base Contract as of
Contract Year 2012
New Contract Year 2013
Total

NonPhysician
FTEs

Total
FTEs

594.75

79.75

674.50

1.0

2.0

3.0

595.75

81.75

677.50

** The number of FTEs includes a fraction of the effort of 73 direct County-paid physicians
who receive a stipend from University (to be verified by the Hospital).

A.3

A.2.4.2

Allocation of FTEs. The allocation of University Personnel FTEs
among Departments may be changed upon written agreement of
the Chief Medical Officer, CEO and University Representative that
such reallocation optimizes the use of personnel in the performance
of this Agreement.

A.2.4.3

Attrition of County-Employed Physicians. Upon attrition of a Countyemployed physician in Primary County Facilities, Director may (1) hire a
replacement or (2) direct University, for the remainder of the Contract
Year to provide the services previously provided by such County
physician through University-employed physicians, which shall
constitute additional Purchased Services under this Agreement for
which University shall be compensated during the Contract Year in
addition to the contract maximum amount set forth in this Addendum A.

A.2.4.4

Intentionally omitted.

Payment for Purchased Services. County shall compensate University as set forth
below.
Contract
Year
2012
(annualized)
Contract Maximum Amount (from MSOA Addendum A-3)

/
/
/
/
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126,583,896*

Additional Funding Needed for Current Services:
ADDITIONAL FTEs
1.

Chief Medical Information Officer (0.5 FTE)

123,524

2.

Emergency Medicine Physician (1.0 FTE)

258,720

3.

Various Specialists (1.0 FTE total)

242,550

4.

Intra-Operative Monitoring Technician (2.0 FTE)

Subtotal (4.5 FTE)

303,000*

927,794

DELETED FTEs and ONE-TIME COSTS**
1.

Psychiatric Outpatient Department Coverage (1.5 FTEs)

(371,700)

2.

One-Time Costs (Attrition for County Employees - CY 2008)

(436,204)

Subtotal (1.5 FTEs)

(807,904)

Contract Maximum Amount

126,703,786***

* Notwithstanding the provisions of Section 4.2 of this Agreement, Intra-Operative Monitoring Technician
services shall expire after June 30, 2013, unless otherwise mutually agreed to by the parties, and ratified
via an administrative amendment to the Agreement.
** The Senior Pathologist (1.0 FTE) and its funding shall be deleted from this Agreement contingent upon
the transfer of this position to the County.
***Contract Amount does not include revision necessary to reflect implementation of the County’s
Physician Pay Plan in accordance with Section A.10 below.

A.4

Volume of Purchased Services.
A.4.1. Academic Purchased Services. During the term of this Agreement, Academic
Purchased Services will be performed by Faculty in accordance with the
requirements of this Agreement. The parties agree during the Contract Year
to work together to develop a new methodology for determining payments for
the provision of Academic Purchased Services under this Agreement.
A.4.2. Academic and Clinical Administrative Purchased Services. During the term of
this Agreement, University shall provide Academic and Clinical Administrative
Purchased Services as needed to support the Training Programs in
accordance with the requirements of this Agreement. The Parties agree during
the Contract Year to work together to develop a new methodology for
determining payments for the provision of University Academic and Clinical
Administrative Purchased Services under this Agreement.
A.4.3. Mission Support. County is committed to promoting medical education in its
community, as reflected through County’s affiliation with University and
County’s participation in graduate medical education training programs
accredited by the Accreditation Council for Graduate Medical Education. The

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Parties agree during Contract Year 2009 to work together to develop a
methodology for providing mission support to University.
A.5

Community-Based Health Services Planning. University agrees to participate in the
County’s community based planning efforts. These planning efforts include but are not
limited to: resizing the breadth and depth of primary and specialty care programs to
meet local community needs, disease burden and public health initiatives; resizing the
breadth and depth of tertiary and quaternary services to fit effectively within systemwide DHS clinical programs; expansion of outpatient diagnostic and therapeutic
programs at Hospital and other community–based sites; sizing ACGME, ADA and
other allied health programs in concert with service delivery planning; and developing,
implementing and reporting evaluation metrics for the quality and efficiency of the
service delivery program.

A.6

Replacement Hospital Transition Planning. County agrees to participate with the
University to maximize collaborative planning for the transition to the Hospital
replacement facility during the term of this Addendum. Through such planning,
County agrees to provide adequate office space, on-call rooms, and other support
space for University administration, clinical service, and teaching in the Hospital
replacement facility.
County also agrees to make best efforts to ensure the continuing viability of
University Training Programs in the Hospital replacement facility. Pursuant to
section 2.6.1 of this Agreement, University will notify County of any matters within
the control of County in transitioning to the Hospital replacement facility that to the
University’s knowledge may compromise accreditation of any University Training
Program. In the event County receives such notice, County will cooperate with
University to make all reasonable efforts to retain accreditation. The parties
understand and acknowledge that County has a continuing obligation to provide
adequate non-physician staffing support pursuant to section. 3.3.4 of the Agreement.

A.7

Faculty Teaching Incentive Fund. Facility JPO Committee will establish annual awards
for excellence in teaching to be awarded to Faculty. Faculty awardees and the amount of
the awards will be determined by the Facility JPO based on written criteria to be jointly
developed by University and County. In developing written criteria, University and
County shall include resident and medical student participation as necessary criteria.
Parties agree to equally finance this Incentive Fund, with each party contributing $25,000
annually.

A. 8

Primary County Facilities. Those facilities listed in Exhibit 2 shall constitute the Primary
County Facilities where Purchased Services may be performed.

A.9

Information Physician Workload and Productivity. The Parties shall work
collaboratively to achieve both the clinical and operational goals as identified in the
Hospital's mission and strategic plan. These include both short and long range
goals, which will be refined and updated on an annual basis as part any revisions to
this Addendum. To address a long range goal of improving information on
attending staff workload and productivity, the parties agree to implement an initial
two part solution:
A.9.1

AmIOn Physician Scheduling. The Hospital shall provide the AmIOn electronic
attending staff scheduling program for use by University. Within six months of
providing the University access to AmIOn, or within six months of the execution
of this Addendum, whichever is later, and in accordance with a timetable
established by University and accepted by County, the University shall install

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and operate the AmIOn electronic attending staff scheduling program in a
manner that identifies physicians in all clinical departments providing
Purchased Services at Hospital each day (the "Hospital Schedules"). Hospital
will have online access to the Hospital Schedules through Am IOn.
A .9.1.1 The University shall be responsible for the input, security and access of
all data into AmIOn. To ensure accuracy, the University shall update
physician scheduling data into AmIOn on not less than a daily basis and
will periodically validate Hospital Schedules.
A.9.1.2

A.9.2

Upon request of the County, the University shall verify the accuracy
of physician schedules in AmIOn as compared to actual physicians
who have worked and the amount of hours worked by such
physicians. The above verification may include one, several or all
departments/services in the Hospital.

The parties acknowledge that the Hospital and University have completed
three Memoranda of Understanding to measure performance and
productivity of Purchased Services for the Harris-Rodde Specialty Clinics
Coverage, Echocardiography and Radiation Oncology, anticipated to be
executed by the parties within one month of execution of this Addendum.
Hospital and University mutually agree to work together to develop additional
Memoranda to measure performance and productivity for other major clinical
Purchased Services as agreed by the Parties. The Parties shall use good
faith efforts to complete and execute such Memoranda within twelve months
of execution of this Addendum.
The Parties shall develop a mutually agreed upon system to track
compliance with the performance and productivity goals identified in each
Memorandum of Understanding (the “Tracking System”). When Hospital
has reasonably determined that the performance and productivity goals
under one (or more) Memorandum have not been met by University based
on the data from the Tracking System, the Hospital shall notify the
University in writing within twenty (20) days of such determination (the
“Notice”). The Notice shall be delivered to the Office of the Dean of the
Keck School of Medicine, with a copy to the Office of the General Counsel.
The Notice shall identify the specific performance and productivity goal by
type and amount of unmet services, as compared to the performance and
productivity goal(s) under the applicable Memorandum as well as Hospital’s
efforts to correct any Hospital issues related to the performance and
productivity goal(s) at issue.
Within thirty (30) business days of receiving the Notice from the Hospital, the
University shall submit a corrective action plan to the Hospital which sets forth
the specific action(s) to be taken to meet the performance and productivity
goal(s) and time period for completion of the corrective action plan. The
Parties will work together to modify the corrective action plan to address each
Party’s concerns.
Disputes about each Party’s compliance with the corrective action plan will be
reviewed by an independent arbitrator selected by the Parties. The arbitrator’s
fees will be equally borne by the Parties. If the arbitrator determines that, solely
due to the acts or omissions of University, University has not implemented in
good faith the material elements of the corrective action plan within the time
period specified in the corrective action plan agreed to by the Parties, the
Hospital may deduct from payment to be made to the University the Hospital’s

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actual and reasonable additional cost to provide the unmet services that directly
result from such failure to meet the performance and productivity goals (except
with respect to any goal established for new patients or new visits) through an
alternative arrangement.
To the extent that the Parties desire University to provide services in excess of
those established by the performance and productivity goals, they may
increase those goals and provide for additional payment related to such
services to University through an administrative amendment signed by both
Parties, provided that such additional payment does not exceed the Contract
Maximum Amount provided in Section A.3 of Addendum A. To the extent that
payment for such additional services would cause total payments due under
this Addendum to exceed the Contract Maximum Amount, the Parties
acknowledge that compensation may only be made for such additional
services after the Governing Board approves a formal amendment to this
Addendum A authorizing such supplemental services.
A.9.3. Medical Record Documentation Performance Goals. The parties acknowledge
the importance of accurate and timely documentation of patient medical
information to facilitate patient treatment, care and services, particularly in the
postgraduate physician teaching environment of the Hospital. Such proper
documentation is reflected in policies and standards applicable to the
University, including, without limitation, the standards set forth by the Joint
Commission (formerly defined as "JCAHO"), and policies issued by the
County Department of Health Services. In addition to other compliance
obligations, the parties seek to emphasize compliance with the following:
A.9.3.1 Joint Commission. The Parties agree to work together to maintain a
medical record delinquency rate at or better than the full compliance
threshold set forth by Joint Commission (IM 6.10; EP 11 “The medical
record delinquency rate averaged from the last four quarterly
measurements is not greater than 50% of the average monthly
discharge (AMD) rate and no quarterly measurement is greater than
the AMD rate.”). To that end, the University agrees to work with County
toward compliance by ensuring that physicians meet this compliance
threshold with respect to the physician components of the medical
record. For purposes of this section, a delinquent medical record is
defined as a medical record available to the Physician for review and is
further defined by Hospital Medical Staff Rules and Regulations.
A.9.3.2 DHS Policy. The University agrees to work toward a 90% threshold
compliance rate for the following components of DHS Policy 310.2,
Supervision of Residents, or as subsequently amended by DHS, by
ensuring that physicians meet this compliance threshold regarding the
physician components of the medical records and activities which are
set forth below. References to the specific provision of DHS Policy
310.2 are in parentheses.
(4.1)
(4.2)

An attending physician shall see and evaluate each patient prior
to any operative procedure or delivery and shall document this
evaluation in the medical record.
An attending physician is responsible to assure the execution of
an appropriate informed consent for procedures and deliveries
with consent form and progress note documenting the consent
discussion in the medical record.

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(4.5)

(5.1)
(5.2)
(7.1)

(7.2)

(7.3)

(8.1)

(8.2)

(8.3)

(4.4.1) If the attending is present for the operative or invasive
procedure or delivery, he/she must document in the
medical record that he/she has evaluated the patient and
authorizes the procedure.
(4.4.2) If the attending physician is not present for the operative
or invasive procedure or delivery, the supervisory resident
shall document in the medical record that he/she has
discussed the case with the attending and the attending
authorizes the resident to proceed.
An attending physician must assure an operative or procedure
note is written or dictated within 24 hours of the procedure and
shall sign the record of operation ("green sheet") in all
situations for which direct attending physician supervision is
required.
An attending physician is responsible for supervision of the
resident and appropriate evaluation of the patient for each
emergency department visit.
An attending physician or supervisory resident shall review
and sign the patient's record prior to disposition.
An attending physician shall see and evaluate each inpatient
within 24 hours of admission and shall co-sign the resident's
admission note or record his/her own admission note within 24
hours.
An attending physician shall see and evaluate the patient at
least every 48 hours and shall ensure that the resident includes
in the progress note that he/she has discussed the case with the
attending or the attending physician shall record his/her own
note at least every 48 hours.
An attending physician shall discuss the discharge planning with
the resident. The resident shall document in the medical record
the discussion of the discharge plan and the attending physician
concurrence with the discharge plan prior to the patient's
discharge, or the attending shall record his/her own note.
An attending physician or supervisory resident shall discuss
every new patient with the resident physician within 4 hours of
admission of each such patient to the Intensive Care Unit. The
resident shall document this discussion with the attending
physician.
An attending physician shall see and evaluate the patient within
24 hours after admission to the Intensive Care Unit, discuss this
evaluation with the resident and document this evaluation and
discussion in the medical record.
An attending physician shall see and evaluate all admitted
patients at least daily following admission and discuss this
evaluation with the resident. The attending physician shall ensure
that the resident includes in the progress note that he/she has
discussed the case with the attending, or the attending physician
shall record his/her own note to that effect.

The parties acknowledge that resident compliance of DHS policy requires that
each party satisfy their respective obligations, with the Hospital employing
residents, and the University employing the Faculty responsible for the
oversight/teaching of residents. To that end, the responsibilities of the
University under this Agreement shall include proper teaching/instruction of the
requirements of DHS policy as set forth in this section and appropriate

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incorporation of the requirements of this section with resident competency
evaluation.
A.9.3.3 Monitoring and Corrective Action Regarding Compliance with DHS
Policy. Monitoring and corrective action to determine and maintain
compliance with Performance Goals set forth above shall be performed
through the Hospital's existing quality assurance/quality improvement
structure and committees, or as modified in accordance with Hospital
bylaws, and rules and regulations.
In addition, within six months of the execution of this Addendum, the
Hospital shall work with the University to establish a process for the
University to monitor compliance with the Performance Goals set forth
above.
A.9.4

Operative Procedures for Residents. The University shall ensure that each
department develops within 60 days of execution of this Addendum, and
updates as needed to reflect any changes, or on an annual basis, whichever is
more, the following:
1. a list of residents designated as supervisory residents.
2. a list of operative procedures that may be conducted by a supervisory
resident to be approved by the Medical Executive Committee and
Network Executive Committee.
A.9.4.1 Clinical Core Measures. The Parties agree that quality patient care is
critical to the missions of the University and the County. To that end, the
University shall use best efforts to achieve 90% compliance with the
following clinical core measures:
1.
Heart Failure-3:ACEI or ARB for LVSD
2.
Heart Failure-2: Evaluation of LVS function
3.
Pneumonia 3b: Blood cultures performed in the Emergency
Department prior to initial antibiotic received in the Hospital.
4.
Pneumonia 6b: Initial antibiotic selection for community acquired
pneumonia in immunocompetent patients – non ICU patients.
5.
Pneumonia 6a: Initial antibiotic selection for community acquired
pneumonia in immunocompentent patients – ICU patients
6.
Acute MI - 1: Aspirin on arrival.
7.
Acute MI - 2: Aspirin prescribed at discharge.
8
Acute MI - 3: ACEI or ARB for LVSD.
9.
Acute MI - 5: Beta blocker prescribed at discharge.
10.
Acute MI - 6: Beta blocker on arrival.
11.
Acute MI - 8a: Median time to primary PCI received within 90 minutes
of hospital arrival.
12.
SCIP 1a: Prophylactic antibiotic received within one hour prior to
surgical incision, overall rate.
13.
SCIP 2a: Prophylactic antibiotic selection for surgical patients, overall
rate.
14.
SCIP 3a: Prophylactic antibiotics discontinued within 48 hours after
surgery end time, overall rate.
A.9.4.2 Monitoring and Corrective Action Regarding Compliance with Clinical
Core Measures. Monitoring and corrective action to determine and
maintain compliance with Performance Goals set forth in Paragraph
A.9.4.1 above shall be performed through the Hospital's existing quality

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assurance/quality improvement structure and committees, or as
modified in accordance with Hospital bylaws, and rules and regulations.
A.10

COUNTY'S PHYSICIAN PAY PLAN. The parties acknowledge that the County has
recently approved a new physician pay plan, and will be approving a new rate
structure for physician employees represented by a collective bargaining group, for
reimbursement of County-employed physicians and dentists. In order to implement the
foregoing, the parties agree to the following terms subject to the approval by the
County physicians' collective bargaining group.
1.

Faculty who are County employees, who receive funds derived from this
Agreement and who are tenured Faculty as of the date of execution of this
Addendum shall maintain their dual employment status at the County and the
University.

2.

All other Faculty who are County employees and who receive funds derived
from this Agreement shall have the following options:
a.

Resign from County employment and receive all compensation from the
University for all services to be provided at Primary County Facilities. The
County shall pay to the University the annual base salary paid to the
physician by County at the time such option is selected. University
agrees to accept such employee and pay to him or her the base salary
amount provided by the County. Nothing in this Agreement shall be
construed to restrict any County employee from resigning from County
service at any time upon his or her determination.

b.

Cease receiving any compensation by the University of funds derived
from this Agreement for all services to be provided at Primary County
Facilities and receive compensation from the County under the County's
new pay plan, except as set forth below. The University agrees to
provide to County the total of compensation of funds derived from this
Agreement and paid by University to such Faculty for the most recent
Contract Year. Further, the County shall reduce this compensation
amount on a pro rata basis from the payments made by the County to
the University under this Agreement. The University acknowledges that
County employees are prohibited under County policy from working for
more than 24 hours per week outside of County employment.
Notwithstanding the foregoing, to the extent permitted by County outside
employment, and other applicable, rules and policies, a County physician
may provide services to the County through the University. In addition, a
County physician may be eligible to receive funds distributed from the
Management Performance Plan.
Replacement (due to attrition) of physicians who choose option b shall be in
accordance with section A.2.4.3 above.

c.

If the physician does not choose option a. or b., the physician shall
continue to receive compensation from the County, under the old pay plan,
and compensation from the University.

The parties agree to work collaboratively to implement these provisions within a time
frame agreed to by the Parties. The parties contemplate holding a joint meeting with
each Faculty who is eligible to select between option a. or b. above to discuss the pay

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plan and other related matters such as reimbursement and benefits provided by the
County and the University.
Nothing in this Agreement shall be construed to restrict the existing right of a County
employee to resign from County employment at any time at his or her discretion.
Subject to section 2.1.2.2, the University is solely responsible for setting the
compensation paid by the University to County employees in connection with
services performed under this Agreement.

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