J A_for_FBO.pdf

J&A #16-10151

JUSTIFICATION AND APPROVAL

FOR OTHER THAN FULL AND OPEN COMPETITION

1. Contracting Activity

This justification is executed by the Naval Medical Logistics Command (NMLC), 693 Neiman Street, Fort Detrick, Maryland 21702 on behalf of the requiring agency, Naval Medical Center San Diego (NMCSD) San Diego, CA.

2. Description of the Action Being Approved

The government intends to award a firm fixed price agency contract to Scripps Green Hospital (Scripps Green), 10666 N Torrey Pines Road, La Jolla, CA 92037, to provide Internal Medicine residents to NMCSD on a rotating basis during the period 24 June 2016 through 22 June 2017 for the services described in Paragraph 3 below.

3. Description of Services

The intent of the resultant contract is to compensate Scripps Green for providing medical care in the inpatient and outpatient settings at NMCSD. The required services are as follows:

Individuals will rotate through both Scripps and NMCSD. The PGY-2 residents will each spend two 4 week rotations (Internal Medicine wards and MICU or Inpatient Cardiology) at NMCSD. The PGY-3 residents will each spend one 4 week rotation (Night Float /ER Consultant) at NMCSD.

The 12 PGY-2 (second year) residents will provide services for a combined total of up to 96 weeks. Additionally, 3 of these residents would also provide outpatient services in the continuity clinic.

The 12 PGY-3 (third year) residents will provide services for a combined total of up to 48 weeks. Additionally, 3 of these residents would also provide outpatient services in the continuity clinic.

Estimated dollar value of the requirement (DHP funding) is anticipated as follows:

PGY-2: $246,330.00

PGY-3: $199,689.12

Total value of this J&A is approximately $446,019.12.

4. Identification of Statutory Authority

10 U.S.C. 2304(c)(1): the services needed by the agency are available from only one responsible source and no other services will satisfy the needs of the agency

5. Rationale Justifying Use of Cited Statutory Authority

With the shortage of military residents, there are currently not enough trainees to support the graduate medical education (GME) programs at NMCSD. Without a solid and robust training program, NMCSD is at risk of losing their accreditation status of the internal medicine residency program.

Only Scripps Green has rotated through NMCSD for the past 1-2 years providing PGY-1 or PGY-2 residents.

Scripps Green’s corporate and system knowledge of the medical center, computer system including three separate electronic medical records, educational policies and requirements, and work hour requirements cannot be duplicated by outside facilities. In addition, the residents providing services at the continuity clinic at NMCSD have undergone a background investigation at considerable cost to the government.

Scripps Green has already established the Accreditation Council for Graduate Medical Education (ACGME) mandated “continuity clinic” panel of patients at NMCSD which requires continuous care for a minimum of 30 months. To interrupt this continuity is detrimental to patient care. Other outside facilities would not meet this

ACGME requirement of providing continuity of care to a panel of patients over the training period.

6. Description of Efforts Made to Solicit Offers from as Many Offerors as Practicable

A sources sought notice was posted to the Federal Business Opportunities (FBO) website on 25 February 2016 with a response date of 4 March 2016. Only one other contractor, Top Docs, Inc., expressed an interest and provided a capability statement in response to the sources sought notice. The capability statement provided by Top Docs, Inc.

indicated their interest and capability of providing locum tenens physicians and made no reference to the required

PGY services at NMCSD or discussed the company’s ability to provide the required services. Therefore, Top Docs

Inc. was not determined to be capable of providing the required services outlined in the notice. Additionally a notice of intent to award to Scripps Green was synopsized on the FBO website on 8 March 2016 with a response date of 24

March 2016. No additional capability statements were submitted for this requirement.

7. Determination of Fair and Reasonable Costs

A thorough market survey has been conducted in the San Diego area to determine the appropriate compensation rates for residents. The contracting officer will make award of a contract using only these pre-determined fair and reasonable prices on a firm fixed price basis.

8. Description of Market Research and Results

Market research has identified numerous other internal medicine residency programs in Southern California;

however, besides Scripps Green, there are only two other hospitals (UC San Diego Health and Scripps Mercy) that are close enough in proximity to NMCSD that would make it logistically feasible for them to rotate through

NMCSD. Given that other facilities have not previously rotated through NMCSD and as a result do not possess the corporate and system knowledge of the medical center, computer system, educational policies and requirements, and work hour requirements, they would not be able to adequately provide the required services.

9. Other Facts Supporting the Use of Other than Full and Open Competition

Not applicable.

10. Sources that Expressed an Interest in the Acquisition

As discussed in paragraph 6 above, only one other source (Top Docs, Inc.) expressed, in writing, interest in the acquisition. However, the capability statement submitted identified the company’s ability to provide locum tenens services and made no reference to NMCSD or PGY resident services. As a result the Government was unable to determine that the company would be able to provide the required services. No additional responses were received in response to the notice of intent to award to Scripps Green that was posted to the FBO website on 8 March 2016.

11. Actions to Remove Barriers to Future Competition

When the current contract was established, NMCSD had identified 18 PGY-1 military trainees that would enable the

MTF to maintain their ACGME accreditation in future years. Based on these trainees it was expected that there would not be a need for contracting future intern/resident requirements. However, while these trainees were able to provide the PGY-1 services as planned, the trainees had one year orders and were not guaranteed consecutive training into the PGY-2 and PGY-3 years. Given that the number of PGY-2 military residents is limited by the total number of training billets in the Navy, there is not an adequate work force from military PGY-2 residents which results in the need for this acquisition.

NMCSD’s Position Management Board has approved the hiring of four civilian hospitalists due to start in July 2017 which will replace the resident services required under this acquisition. These four civilian hospitalist positions have been billeted and their hiring will eliminate the need to contract for these services in the future. The department, working with the NMCSD command suite, has endorsed the permanent end of the Scripps Green contract effective June 2017.

TECHNICAL AND REQUIREMENTS CERTIFICATION REQUIRED BY NAVSUPINST 4200.83H

I certify that the facts and representations under my cognizance which are included in this justification and its supporting acquisition planning documents, except as noted herein are complete and accurate to the best of my knowledge and belief.

Vincent Hill, Program Analyst Code 05 301-619-8019 Date

LEGAL SUFFICIENCY AND CONCURRENCE

I have determined this justification is legally sufficient.

Office of Counsel Code 00L Phone Date

CONTRACTING OFFICER/APPROVING OFFICIAL below $650,000

12. Contracting Officer certification.

I certify that this justification is accurate and complete to the best of my knowledge and belief.

Carrie E. Hickman Code 05 301-619-8594 Date

Contracting Officer

COMPETITION ADVOCATE/APPROVING OFFICIAL $650,000 or above

Upon the basis of the above justification, I hereby approve, as Competition Advocate, the solicitation of the proposed procurements described herein using other than full and open competition, pursuant to the authority of 10

U.S.C. 2304(c)(1)

N/A___________________________________________________________________________

Darin L. Callahan Code 00 301-619-3095 Date

Competition Advocate