Area-Wide_Ortho_SOW_Base_4.docx

INDIAN HEALTH SERVICE

STATEMENT OF OBJECTIVES

For

ORTHOPEDIC SERVICES

TABLE OF CONTENTS

I. BACKGROUND

II. PROJECT OBJECTIVES AND PROCESS REQUIREMENTS

III. PERFORMANCE MEASURES AND POTENTIAL DEDUCTIONS

IV. PROJECT PROPOSAL REQUIREMENTS

V. DELIVERABLES

VI. EVALUATION CRITERIA

VII. CONSTRAINTS

Indian Health Service’s (IHS) Statement of Objectives (SOO) for Orthopedic Services

I. BACKGROUND

Indian Health Service (IHS) wants to improve current accessibility and financial position when purchasing orthopedic services. The demand for this care exceeds the budget of the Purchased/Referred Care (PRC) program. This Orthopedic Project (OP) shall increase accessibility for patients, decrease wait times for orthopedic services to be obtained by patients, while assuring that services received are best value. Patient outcomes shall be optimized which aligns with the mission of IHS.

II. PROJECT OBJECTIVES AND PROCESS REQUIREMENTS

The Contractor shall provide an all-encompassing Orthopedic Service, within the Oklahoma City city limits and the city of Tulsa, or closely surrounding area, and an orthopedic surgeon(s) (excluding orthopedic specialty services such as: orthopedic oncology, podiatry and/or surgical podiatry services, any spine treatment, joint replacement surgeries, or carpal tunnel surgeries) with associated support staff to include, but not limited to: nursing, scheduling, medical support assistants, coding and billing services; office space, equipment and supplies, facility or facilities, and any/all other ancillary services. One treatment location must be available to see patients upon contract award, either Tulsa area or Oklahoma City. Second/alternate city location may be granted a sixty day extension to begin providing care, if warranted.

1) Perform at least monthly treatment requirements of fifty new patients and thirty surgeries. Urgent referrals must be scheduled and not returned, unless the patient is not able to be reached, in this instance referral must be returned immediately.

2) One Orthopedic must be available to treat IHS patients at each location to ensure services are received timely, back-up Orthopedic surgeons are authorized for this scope of care, as long as appropriate credentialing information has been proactively submitted and vetted by IHS.

3) Ensure all urgent patient conditions can be scheduled within forty-eight business hours. Non-urgent referrals shall be scheduled within fifteen business days, or returned to Indian Health Services if it is a non-urgent referral and volume of care required by the contract exceeds the ability to provide timely treatment. When medically appropriate, patient can be scheduled into the future up to, but not to exceed a two month period. Urgent patient conditions are defined as: displaced and/or angulated fractures, Achilles tendon rupture, distal biceps tendon rupture, flexor tendon rupture/lacerations, extensor tendon laceration, scaphoid fractures, long head of biceps tendon rupture and/or ligament ruptures surrounding elbow and thumb.

4) Associated charges/cost for patient treatment shall be paid separately by IHS. Such as, ASC surgery center, medically required DME, anesthesiology, and EMG/NCS services. To ensure the Government pays best value for these services, the IHS shall provide input on the selection of the entities providing this care. These contractors will be paid for approved associated charges, upon receipt of required reporting information, at or less than Medicare-like/PRC rates, after exhausting all third party payors, as described in the Payor of Last Resort Regulation 42 CFR 136.61.

5) A credentialing packet for each recommended provider shall be submitted with the initial project plan. If there is a change/addition in key personnel, the Contracting Officer shall be immediately informed, and new credentialing packet is submitted, when applicable.

6) Provide required monthly reports of all contract financial activities. The minimal monthly reports required are: a) invoicing for payment process b) excel format of two month future schedule of IHS patient appointments, by each treating physician, c) excel formatted report list of total appointments provided with details on type of appointment (new or returning) and numbers of surgeries to include description of body part/treatment/codes provided, d) excel formatted monthly accruement report of all third party payment amounts received by each treating orthopedic’s location.

7) Provider to demonstrate competent/effective oral and written communication. Care shall be appropriately documented in medical records, utilizing computer software/program for entering and signing medical orders, in accordance with standard commercial practice and Centers for Disease Control and Prevention (CDC) health record requirements.

8) The quality of medical practice shall meet or exceed standards of care. The Government shall evaluate the performance and may also conduct inspections under the Inspection/Acceptance clause at FAR 52.212-4.

9) The provider performs emergent after-duty hour home care advice via telephone to patients, when appropriate.

10) The contractor and/or designee shall be accessible for physician-to-physician consultation.

11) The contract coordinator(s) shall be accessible for Administrative training and subsequent communications from PRC programs/Area Office Administration.

12) Maintain familiarity and comply with all Federal and State regulations and requirements to include, but not limited to, constraints referenced in section VII.

13) The provider shall maintain continuing medical education (CME), licensing, registration, and certification.

14) The Contractor shall provide a safe work environment and ensure employee safe work habits inclusive of complying with Occupational Safety and Health Administration (OSHA) standards and requirements.

15) Contractor and staff shall ensure IHS patients receive optimum culturally sensitive customer service by all contractors, and staff during every IHS patient’s experience for the patient’s entire scope of care.

16) Contractor and all staff shall maintain patient privacy/confidentiality to include, but not limited to, constraints referenced in section VII.

17) Contractor shall advise Federal PRC program by fax cover sheet the patient’s appointment date and time. If unable coordinate services, please use the provided fax cover sheet to coordinate next best steps for optimal patient outcomes. Specific details on process:

a) Referrals that may be lacking: information, appropriate diagnostics, correct contact information, or that are not applicable for scope of contract shall be communicated back to the referring PRC program by the forthcoming developed by IHS fax cover sheet. If no response from IHS on requested information, within five business days, note this information on the fax cover sheet as a second request, resend a copy of fax to the PRC program and a copy of fax to the Oklahoma City Area Office, for Administrative oversite, Attention: Randi Schoeppel, Fax number (405) 951-3920.

b) Referrals for patients unable to be reached or unable to be scheduled timely (non-urgent) shall be returned to the referring PRC program, utilizing the IHS developed fax cover sheet, and actions completed within fifteen business days.

c) PRC programs may contact individual physician locations for referral status inquiries and may refer PRC patients to contact individual physician locations for referral status inquiries.

d) PRC programs shall ensure patient is referred for a specifically described body part. Referral may include multiple body parts (as applicable to the contract) but only if IHS also provides appropriate work-up/diagnostics for each body part that requires treatment.

e) Contractor to receive all orthopedic referrals at one designated fax number but can be multiple fax numbers for alternate city locations. Contractor to provide fax number and monthly report of referral status in excel format. Report shall include which orthopedic physician shall be treating the patient.

18) Contractor to provide an all-inclusive list to IHS detailing treating physicians within the project. List must be updated and resubmitted as/if changes occur. List must include the following details: location, phone and fax number, name and number of contact person for project (and phone number, if different).

19) Medical records shall be available upon request for urgent review or audit purposes.

20) Patient treatment reports shall be mailed within ten business days to the IHS patient’s primary care physician location.

III. PERFORMANCE MEASURES AND POTENTIAL REDUCTIONS

5. Minimal monthly treatment requirement for contractor is fifty new patients and thirty surgeries.

100% compliance required

IV. PROJECT PROPOSAL REQUIREMENTS

1) The offeror shall submit project plan with the proposal that shall be inclusive of processes, provide a credentialing packet for each recommended provider, and proposed monthly process/reports of financial activities.

2) The offeror shall also submit a quality assurance plan with this proposal.

3) A final project plan shall be delivered within 15 calendar days after review of the proposed comments by IHS.

V. DELIVERABLES

Contractor shall send all deliverables referenced in the table below to the Contracting Officer at 701 Market Drive, Oklahoma City, OK 73114.

VI. EVALUATION CRITERIA

The award shall be based upon best value and quality. Evaluation factors are Personnel Qualification (PQ) and Experience, Price, Past Performance, and Technical Approach. Evaluation factors, when combined, are more important than price.

1) Personnel Qualifications (PQ) and Experience. The provider shall have a minimum of 5 years of experience performing orthopedic surgeries.

2) Price shall be evaluated based upon realism and reasonableness, reflecting a clear understanding of the objectives.

3) Past Performance- Offerors shall be evaluated as to the areas of quality, timeliness, customer satisfaction and business practices. Successful past performance of similar services, to include but not limited to timeliness of performance, customer satisfaction, and outcomes.

4) Technical Approach- Offerors project plan shall be evaluated.

VII. CONSTRAINTS

The contractor’s solution shall comply with all applicable government regulations referenced in this SOO, which include but are not limited to the following:

Government Performance and Results Act (PL 103-62), Federal Records Act (36 CFR 1220), Freedom of Information Act (5 USC 552), Electronic FOIA Amendment of 1996 Privacy Act (5 USC 552A), Computer Security Act (PL 100-235) Health Information Portability and Accountability Act (HIPAA) Health Information Technology for Economic and Clinical Health Act (HITECH Act) and Patient Safety and Quality Improvement Act (PSQIA).