Updated Questions and Responses.pdf

W81K0025QA115

Amendment 0002

QUESTIONS AND RESPONSES:

Q1. With the understanding that this is a non-personal coverage contract, is 650 the flat billable rate per procedure?

RESPONSE: It is the quantity amount of estimated cases.

Q2. What is the current staffing level on this contract? Incumbents?

RESPONSE: This is a non-labor service requirement. The vendor provides how many people they want to provide for the services. The invoice is per case not hours. There are 6 technicians and 5 Medical Providers providing services.

Q3. Please provide a breakdown by type and number of cases.

RESPONSE: I do not have data showing the exact number of each type. However, the incumbent has stated they have completed 1,877 from June 2021 to May 2025.

Spine – estimated 75% of cases

Modalities include SSEP, Transcranial MEP, EMG, pedicle screw stimulation thresholds.

Rare spine modalities for intradural cases include D-waves, sphincter EMG, direct nerve root stimulation, dorsal column mapping and spinal cord stimulation.

Cranial – estimated 25% of cases

Modalities include SSEP, Transcranial MEP, Phase reversal and direct cortical stimulation for sensorimotor cortex localization, EEG, ECOG, motor cranial nerve recording, brainstem auditory evoked potentials.

Q4. Please provide percentage of cases that fall outside normal business hours.

RESPONSE: I do not have the access to this information. However, the incumbent states there were 1,877 cases completed from June 2021 through May 2025; of those, 208 cases were completed on the weekends and 36 cases scheduled and completed before 0700 and after 1630.

If we assume the no overlap in the number of cases counted in each of those categories, the percentage of cases fall outside normal business hours would be 13%. However, this does not include cases that start during business hours and end after business hours.

If cases that start during business hours and end after business hours are included, approximately 15-30%.

The solicitation’s price schedule outlines quantities and units for IONM services; however, the Performance Work Statement (PWS) references variable shifts, schedule work shifts, hours, and the potential for staff reassignment to similar duties within their scope of practice. To clarify, please provide the following details:

Q5. What are the required total annual hours for IONM services?

RESPONSE: Brooke Army Medical Center does not track the hours associated with provide this non-labor service requirement. Only the cases performed.

Q6. What are the defined tours of duty or shift schedules necessary to support 24/7/365 coverage?

RESPONSE: IOM consisting of the modalities required will be available 24/7/365 to support accredited Level I Trauma care and routine care as scheduled. The service will be provided 24 hours a day, seven days a week depending on surgery requirements. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks

Q7. What is the specific scope of practice for IONM personnel under this contract?

RESPONSE: IONM assists surgeons in performing complex cases and provides real-time feedback on the impact of surgical interventions on the nervous system.

UPDATE VIA AMENDMENT 0002:

The IONM personnel should obtain a history of the patient’s neurological condition to inform neuromonitoring; ensure equipment is well-maintained and functioning properly before the patient arrives in the OR; communicate with the anesthesiologist and surgeon about the IONM modalities and positioning and anesthetic considerations before the patient arrives in the operating room; place electrodes for EMG, SSEP, transcranial MEP, and transcranial EEG; provide sterile probes and electrode arrays necessary in the surgical field for the required modalities; obtain baseline signals and report to the surgeon;

troubleshoot absent/weak baseline signals or technical problems and communicate with the surgeon what is being done to troubleshoot these issues; establish, monitor, and interpret signals for the modalities described in response to Q3; communicate with the off-site neurologist throughout the case; confirm normal/abnormal signals with the off-site neurologist; communicate the off-site neurologists findings and interpretations with the operating surgeon; alert the operating surgeon immediately when there is a change in signals from baseline or any IONM indication of neurological injury or impending injury;

obtain final signals at the conclusion of the surgery and report to the surgeon the status of the final signals; remove electrodes/needles at the conclusion of the case and clean and maintain equipment; observe the post-operative neurological exam (if performed before the patient leaves the operating room) and confirm with the surgeon whether there are any new neurological deficits post-operatively. All of this and more is outlined in the ASET document I previously included, and I am attaching it again to this email to be referenced in the RFQ.

Q8. What are the hours required to be on station working before the start of the operative surgery and after the operative surgery, providing direct patient care?

RESPONSE: 2 Hours prior to the start of Surgery. The IONM technologist should be on station in time to ensure all equipment is ready and functioning properly and to discuss specific case requirement prior to the patient’s arrival in the operating room. The IONM technologist is expected to remain on station until the conclusion of the surgery or until released by the operating surgeon.

For first-start cases (07:30), the IONM technologist is expected to be in the operating room for Team STEPPS, which occurs at 06:55.

Q9. If hours and shift work are required, please add the Line Item/CLIN in the Price Schedule for the base year and all option years.

RESPONSE: The contract is for a specific number of operative cases and not for specific hours/shifts.

UPDATE VIA AMENDMENT 0002:

The Performance Work Statement has been updated.

Q10. Could you provide the location(s) for the reassigned duties outside of the operating room?

RESPONSE: The IONM technicians will not have assigned duty locations outside of the OR.

The Performance Work Statement has been updated.

Q11. What are the duties outside of the operating room?

RESPONSE: The IONM technicians will not have any specific duties outside the OR. A company that tracks quality data is preferred. Accurate data about the IONM quality requires information about patients’ neurological function after fully awake from anesthesia, and this usually does not occur until the patient has moved from the OR to recovery. Thus, to have accurate data, the company would need to have a method for obtaining information about patient’s neurological function after they have left the OR.

Q12. The Scope of Practice is not included in the current solicitation. Can the Government please provide the expected scope of practice for all staff providing IONM services?

RESPONSE: See the attached National Competency Skill Standards for Performing Intraoperative Neurophysiologic Monitoring published by the American Society of Electro neurodiagnostic Technologists. This provides an outline of what is expected for IONM services, including details on each monitoring modality.

Q13. Under the Continuation of Supplies or Services and Prices/Costs for the solicitation I'm assuming that 001 is year one, Option Line Item 1001 is for an optional year 2, 2001 for an optional year 3, and so on.

RESPONSE: 0001 is the Base Year (year 1) 1001 is Option period 1 (year 2)

2001 is Option period 2 (year 3) 3001 is Option period 3 (year 4)

Q14: Pages throughout. The RFQ is titled Interoperative Neuromonitoring, and much of the text refers to the work as Interoperative Neuromonitoring, but the PWS refers to Intraoperative Neuromonitoring. The latter (Intraoperative) is a much more commonly used term and refers to monitoring patients’ neurological conditions during surgery, whereas the former refers to monitoring neurological conditions between surgeries. Please clarify that you are requesting services for Intraoperative Neuromonitoring.

RESPONSE: The terms "Interoperative Neuromonitoring" and "Intraoperative Neuromonitoring" are essentially the same and refer to the practice of monitoring the nervous system during surgery to minimize the risk of nerve damage. Both terms are used to describe the process of using neurophysiological techniques to assess the functional integrity of neural structures while a patient is undergoing surgery. "Interoperative" and "Intraoperative" are often used interchangeably in this context, and the core goal is to provide real-time feedback to the surgical team to prevent or minimize potential nerve injury.

The Performance Work Statement has been updated to reflect Intraoperative Neuromonitoring.

Q15: Page 28, Addendum to Evaluation: Subfactor 1B. Standardized Patient Screening Process.

When first looking at this requirement we assumed this referred to having a standard Patient Screening Process; in other words, a standard process for screening patients’ neurological conditions. However, the acceptable rating information states “ACCEPTABLE: To receive an acceptable rating the proposal shall clearly demonstrate that the offeror fully understands and is capable of performing the requirements of the Performance Work Statement and provides an adequate screening process for vetting Standardized Patients.” This does not make sense in the context of the requested work, as Standardized Patients are used in a learning setting. Please re-word the rating information to conform to the work being requested.

RESPONSE: Addendum to Evaluation - Commercial Product and Commercial Services has been rewritten.