FINAL Hospital at Home Q A 09-24-2024 .pdf

Hospital @ Home RFI Supplier Questions/UWM Answers

1. Do responses have to be for all services or can contractors bid on select services. My organization provides in-home respiratory care to thousands of patients in 44+ states. Our staffing division provides the other services listed in the table below. Please advise.

Number Service Model 1:

Supplier's staff

Model 2:

Supplier's subcontractors

Model 3:

UW

Medicine

4.1.13 Respiratory care including

oxygen delivery

X

4.1.16 Twice daily Vital Signs X

4.1.17 Twice daily visits by a

Registered Nurse (RN)

X

4.1.20 Durable Medical Equipment

(DME)

X

4.1.22 Social work and Care

Coordination

X

Bidders can provide responses for select services but are encouraged to respond with all the services they provide. It should be noted which services the bidder cannot provide.

2. Is the expectation that the Acute Hospital at Home Care program will be wholly owned by UW Medicine, with Contessa being a vendor in providing the various support service? Or, is UW Medicine planning to establish a joint venture, with split ownership between Contessa / UW Medicine?

The selected vendor would provide support services while UW Medicine will wholly own the AHCAH program.

3. Section 1.3 provides the following in relation to a centralized command center. Is this decision final, or are alternative structures acceptable? Today, Contessa has its own command center that provides 24/7 oversight and support across all our active programs, which is critical to the success of our clinical model.

a. “UW Medicine will direct and oversee clinical care 24x7 using its own clinicians and staff in a centralized medical command center”

UW Medicine prefers to use a model where its practitioners are responsible for the medical management and oversight of AHCAH patients; specifically, UW Medicine Physicians and APPs will direct each episode of care and coordinate with other healthcare professionals.

4. Section 4.2 provides information related to certain standards, process, etc. that must be upheld in the program. In response to this section, is the expectation that vendors will validate that they can comply with each of these items?

Our assumption is that the requirements outlined in Section 4.2 will inform your responses in Sections 4.1 and 4.3. If there are specific items in Section 4.2 where a direct response would help UW Medicine better understand your capabilities or recommendations, you are welcome to provide that information.

5. What is the current status of UW Medicine's CMS waiver application(s), i.e. expected date to receive the waiver? Are you interested in a program to assist you with your preparation and submission?

UW Medicine expects to secure the CMS Waiver by the end of November 2024.

Currently, UW Medicine does not require any assistance with the preparation or submission of the waiver application.

6. Please confirm that UW Medicine is looking for vendor final submission to be formatted as a single large PDF file (rather than as separate PDF files provided in a zip file).

Please submit a single PDF file. Zip files will not be accepted.

7. In regards to the Questionnaire Tables 4.1, 4.2, and 4.3 beginning on page 10, is it acceptable for vendors to put responses to the questions in a new column to the right of the question? If not, can you provide guidance on your preferred format for our responses to the questions in these tables?

The intent is for bidders to place all responses in the PDF. The bidder can copy the questions to their own word document and add a column for their responses, then produce a PDF from the word document. The bidder should not alter the format in the original word document.

8. What is UW Medicine's targeted launch date for this new RPM program?

The targeted launch date is still under consideration although we anticipate that it may take 6-9 months for planning and implementation. We expect to have a clearer timeline in the future.

9. Is UW Medicine targeting any specific patient populations (by condition) with this new RPM program?

Following CMS’s guidance, UW Medicine will assess patients on inpatient status based on the clinical condition of the patient, level of care needed, and other to-be-determined inclusion and exclusion criteria. Patient populations may include: Heart failure patients/exacerbation, COPD/Asthma exacerbation, Infections without severe sepsis eg Kidney/urinary tract infections, PNA, Cellulitis, COVID and respiratory infections, subsets of post surgical patients, etc.

10. Regarding patient device kits and logistics, hospital at home programs normally are designed for device kits to be provisioned to patients in the hospital, before they transition home. Do you plan to provide devices directly to patients on-site at UW Medicine sites?

UW Medicine prefers to have the bidder manage, clean, stock, and maintain the integrity and service of patient device kits regardless of whether kits are delivered directly to the patient’s home or sent to the hospital to provide to the patient before they go home.

11. Is UW Medicine interested in cleaning and re-kitting services for patient device kits?

No, UW Medicine prefers to have the bidder handle the cleaning and re-kitting services for patient device kits.

12. Can you confirm that your Montlake, Northwest, Harborview share a single Epic instance, along with other systems? And that Valley Medical Center has a separate instance of Epic, along with other systems?

Yes, Montlake, Northwest, and Harborview share a single instance of Epic and use the most, if not all, of the other systems that would support Acute Hospital Care at Home patients. Valley Medical Center has a separate instance of Epic with their own interfaced ancillary systems.

13. Are you interested in clinical 24x7x365 support for patient monitoring?

Yes, UW Medicine is interested in clinical patient monitoring 24/7/365 for all patients.

14. Section 1.3: Please define “in process” in reference to CMS Acute Hospital Care at Home waivers being submitted.

Please refer to question #5. UW Medicine expects to secure the CMS Waiver by the end of November 2024.

15. Section 1.3: This section states that primary objectives are increasing inpatient capacity and access. Is this the same primary objective for all 3 hospital locations? Is ED capacity/access also a concern for UW Medicine?

Yes, increasing inpatient capacity and access is the primary objective for all three locations. While ED capacity/access are also concerns for UW Medicine, the primary focus remains on inpatient capacity.

16. Section 1.3: Is UW Medicine considering this program as a Medicare Fee-for-Service only initiative or inclusive of other payers? If other payers are being considered, would this include Washington State’s Medicaid program?

UW Medicine anticipates that the program will launch as a Medicare Fee-for-Service only initiative. Contracting with other payers will evolve over time.

17. Section 1.3: Will UW Medicine require a Certificate of Need or other similar permission from the state of Washington to operate an Acute Hospital Care at Home program?

UW Medicine does not need a Certificate of Need. However, UW Medicine will need to notify and file the necessary documentation with the State of Washington.

18. Section 2.4.1: What is the preferred format for the PDF attachment report (i.e., Word document converted to PDF, PowerPoint slides converted to PDF, etc.)

A Word document converted to PDF is preferred. It is recommended to use a Word document for most of the content, while PowerPoint or Visio can be used for diagrams or visuals. However, there is no strong preference as long as the answers are clear and comprehensive. Please refer to question #6. Once all documents are complete, submit a single PDF file; zip files will not be accepted.

19. Section 4.1.03: What patient conditions (DRGs) are focused targets for your program at launch?

See response to Question #9.

20. Section 4.1.06: Are there known specific services that may be insourced at a future date in the first 2 years of program operation?

At this time, it is unknown what services, if any, will be insourced within the first two years aside from the medical command center which will be staffed with UW Medicine practitioner from the outset of the program.

21. Section 4.2.01: Does UW currently have or planning to have in FY25, any internal labor resources to staff the newly developed Acute Hospital at Home Care program (other than the identified insourcing of specimen processing and resulting, and radiology and echo reads and interpretation?

Yes, UW Medicine will have internal labor resources to support select services required by the Acute Hospital Care at Home Care program.

22. Section 4.2.03: Does a command or virtual care center exist today, or would this function be created specifically for the Acute Hospital at Home Care program?

No, a UW Medicine command or virtual care center does not exist today. This function would be newly established specifically for the Acute Hospital Care at Home program.

23. Section 4.2.04: Is there an existing preferred vendor or virtual solution for home-based telemedical visits?

UW Medicine prefers zoom and Epic for telemedicine visits.

24. Section 4.2.06: Does a preferred 3rd party virtual interpreter service already exist for UW

Medicine? If yes, which service is used?

UW Medicine’s preferred video vendor (that also provides audio-only/phone services) is called AMN and used across UW Medicine. We also have three telephonic vendors that are used at different entities. They are: Certified Languages International, Language Line, and Propio.

25. Section 4.2.0: What is the preferred transmission method for billed services?

The process for submitting invoices and payment will be communicated at time of contracting.

26. Section 4.2.11: What is the expected distance (in miles) from each hospital that patient admissions would extend to given local traffic patterns and infrastructure?

Up to 25 miles or approximately 30 minutes from the referring UWM hospital.

27. Section 4.2.12: Will management and troubleshooting of the in-home devices be the responsibility of the Supplier or UW Medicine?

The responsibility will be the supplier’s.

28. Section 4.3.01: What prior data analysis was completed to establish the beds and annual admit goals in this section? Can a copy of this analysis be shared?

UW Medicine completed a pro forma analysis based on conservative assumptions, indicating that referrals would generate an average daily census of 12 during the first year with plans for future growth. Unfortunately, a copy of the analysis is not available for sharing.

29. Section 4.3.04: Are there existing “command center systems” and software currently being used?

For existing software, UW Medicine uses Epic as the electronic health record (EHR) system provider. For the command center of the Acute Hospital Care at Home (AHCAH) program, Epic’s IP and Hospital at Home functionalities will be utilized. However, UW

Medicine will depend on the vendor’s solution for logistics and service deployment.

30. Section 4.3.07: What is the expected timing for insourcing services? Which services are top priorities for insourcing?

Refer to question #21. The timing for insourcing services is currently unknown and will depend on multiple factors. UW Medicine anticipates that the vendor will supply all services at launch, except for those already specified in the RFI.

31. Section 4.3.09: Was Valley Medical Center included in the established bed and annual admit data in Section 4.3.01?

Initially, UW Medicine anticipates an average daily census of 12. This estimate includes

Valley Medical Center.

32. Based on the review of RFI 3773 section 1.3 , it appears that UW intends/desires to manage and oversee clinical care 24/7 using their own in-person and virtual clinicians and staff through a centralized medical command center. Please confirm if this is a requirement for the program or if UW would be open to a proposal in which the patient Identification and admission/activation are managed by UW (with consultation/expertise from vendor) but the majority of clinical care delivery is provided via a Professional Services Arrangement (PSA) by the vendor?

UW Medicine intends to use our own in-person and virtual clinicians and staff in a centralized medical command center for patient Identification and admission/activation;

however, we are open to a proposal in which in-home clinical care delivery is provided via a Professional Services Arrangement (PSA) by the vendor.

33. For the UW insourced radiology, echo reads, and interpretation will any of it be done in the home? If not, would UW be open to the vendor using its owned in-home mobile imaging service when appropriate? (this question relates specifically to section 4.1.15).

Yes, UW Medicine is open to a vendor using its owned in-home mobile imaging services.

The images would still need to be sent to UW Medicine to be read by our radiologists and incorporated into Epic.

34. As part of the partnership, will the vendor also be involved with helping UW acquire the CMS AHCH waiver? If not, has UW already applied for the waiver and if so, what date was the application submitted? If so, when do you anticipate wanting to submit the application?

Please refer to question #5. No, UW Medicine will not require the vendor's assistance in acquiring the CMS waiver. UW Medicine expects to secure the CMS Waiver by the end of

November 2024.