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 and Tulsa, Oklahoma, and an orthopedic surgeon(s) (excluding orthopedic specialty services such as: orthopedic oncology, podiatry and/or surgical podiatry services, any spine treatment, or most joint replacement surgeries, unless prior authorization is received by the Oklahoma City Area Office) 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 applicable ancillary services.

1) Perform at least monthly treatment requirements of fifty new patients and thirty surgeries. Services shall not exceed the available authorized funding as defined by the order for supplies or services, provided by Acquisitions.

2) Contractor shall pay all associated costs (surgery facility, medically required DME, anesthesiology, and EMG services) with input from IHS to ensure the Government pays best value for these services. The IHS shall pay contractor for approved associated charges upon receipt of required reporting at Medicare-like, or less, rates, after exhausting all third party resources. If alternate resources pay first, IHS will pay the lessor of the patient’s responsibility or applicable Medicare-Like rate.

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

4) 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, d) excel formatted monthly accruement report of all third party payment amounts received by each treating physician (orthopedic and anesthesiology).

5) 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.

6) 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.

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

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

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

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

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

12) 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.

13) 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.

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

15) Contractor shall advise Federal PRC program by fax cover sheet the patient’s appointment date and time. Urgent referrals as described in Attachment 1, shall be scheduled within forty-eight business hours after receipt of fax, or provide a fax update if contractor’s designee(s) are unable to contact the patient. Non-urgent referrals shall be scheduled within fifteen business days or returned to IHS via fax with appropriately annotated required fax cover sheet. When medically appropriate, referrals can be scheduled into future dates up to, but not to exceed, two-month period.

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 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. Contractor to provide fax number and weekly report of referral status in excel format. Report shall include which orthopedic physician shall be treating the patient.

16) Contractor to provide an all-inclusive list to IHS detailing treating physicians within the project. Include the following details: location, phone and fax number, name and number of contact person for project (and phone number, if different).

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

18) 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. Perform at least monthly treatment requirements of fifty new patients and thirty surgeries. Services shall not exceed the available authorized funding as defined by the order for supplies or services, provided by Acquisitions.

Non-Performance Reductions IHS may reduce payments not to exceed ten percent of monthly payment for non-compliance of performance measures.

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. 20%

2) Price shall be evaluated based upon realism and reasonableness, reflecting a clear understanding of the objectives. 40%

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. 20%

4) Technical Approach- Offerors project plan shall be evaluated. 20%

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).