Approve fifth amendment to Agreement No. PO 4385 with LocumTenens.com to add funding in the amount of $56,755 for 2023-24, for a new contract maximum of $1,526,755, for the period of July 1, 2022 through June 30, 2025, for the provision of adult psychiatric staffing services. (No general fund impact) (Sullivan)

Approve fifth amendment to Agreement No. PO 4385 with LocumTenens.com to add funding in the amount of $56,755 for 2023-24, for a new contract maximum of $1,526,755, for the period of July 1, 2022 through June 30, 2025, for the provision of adult psychiatric staffing services. 

On or about June 22, 2022, the County entered into Agreement Legacy PO No. 4385 (the Agreement) with LocumTenens.com for the provision of adult psychiatric services for eligible Yolo County clients including County residents conserved under the Lanterman-Petris-Short (LPS) Act. County Behavioral Health programs rely on short-term contracted psychiatric providers to augment their county staffing as recruitment and retention of such staff (i.e., psychiatrists and psychiatric nurse practitioners) is very difficult in this field. Contracting with LocumTenens.com provides professional staffing augmentation, recruitment, presentation, and management, which is the best option as this is a challenging process for the County.

On or about February 21, 2023, the parties amended the Agreement via the first amendment (Agreement No. 23-48) to add funding in the amount of $295,000 for 2022-23 to account for the ongoing inability to recruit and retain psychiatry staff who wish to fill a vacant County position.

On or about May 9, 2023, the parties amended the Agreement via the second amendment (Agreement No. 23-86) to add funding in the amount of $200,000 for 2023-24 and $215,000 for 2024-25 to account for the continued ongoing inability to recruit and retain psychiatry staff who wish to fill a vacant County position.

On or about July 25, 2023, the parties amended the Agreement to add funding to account for the continued ongoing inability to recruit and retain psychiatry staff. In FY23/24, HHSA had three consistent locum tenens staff that covered vacancies and helped meet the current need. The second amendment also increased the maximum hourly rate for Psychiatry/Telepsychiatry effective July 1, 2023.

On or about June 4, 2024, the parties amended the agreement to add funding to account for the continued ongoing inability to recruit and retain psychiatry staff and fill vacant County positions.

This fifth amendment adds additional funding needed to cover remaining 2023-24 invoices. LocumTenens.com providers continue to be used at a higher level than planned at the start of the fiscal year due to ongoing prescriber employee vacancies and the recent retirement of a half-time prescriber staff member. Now that HHSA has a Medical Director of Psychiatry, HHSA will be revisiting the need for this increased use of contracted psychiatric providers.

Performance Measures included in this Agreement are as follows:
Performance Measures are not associated with this Agreement. As HHSA does not directly supervise Locum Tenens psychiatric providers and each provider’s contract is secured in three-month increments, the development of an RBA for this contract has not yet occurred. Additionally, the contracted staff schedules vary widely as they may provide temporary and/or fill-in services when HHSA loses an HHSA staff prescriber. Each quarter, a rudimentary prescriber capacity versus need comparison is undertaken to inform ongoing contracted provider arrangements.

County Counsel has approved this Agreement as to form.
Department of General Services, Procurement Division

On April 26, 2022, the then acting Yolo County Procurement Manager or designee approved a sole/single source procurement for these services.

Procurement reviewed HHSA’s request and determined that it was in the best interest of the County to renew the agreement, based on satisfactory service/reasonable prices and to avoid the interruption of County business. Without sole source approval and renewal of the agreement with the vendor, the County would lose the staffing of two psychiatrists and one nurse practitioner, resulting in devastating impacts to the County’s ability to provide mandated psychiatric care for County mental health clients. Factors considered, included but were not limited to:

1) the County’s ongoing difficulty in recruiting psychiatrists and nurse practitioners (prescribers) due to statewide staffing shortages; 2) satisfactory vendor performance–the vendor has been a County vendor for over five years providing competitive rates and documented successful performance in recruiting high quality locum tenens providers; 3) competitive pricing/cost savings; and 4) loss of three locum tenens providers from the vendor, who are actively on the HHSA clinic psychiatric staff contingent, carrying a combined case load of hundreds of County mental health clients. Without renewal of the agreement, these placements would be terminated leaving the County without outpatient psychiatric care providers for its mental health clients, severely disrupting the quality & continuity of care for these vulnerable clients.