Q--New short-term contract Funding for services 8/1/12 to 9/30/12

This is a sources sought notice only; it is not a request for quotations or offers. The VISN 9 Network Contracting Office (NOC 9) is conducting market research for the Tennessee Valley Healthcare System (TVHS) in Nashville, Tennessee to identify potential sources for a contract within the service area (Stewart County, TN) to provide veteran beneficiaries the services of board eligible/certified orthopedic surgeons to provide orthopedic surgery care. It is the Department of Veterans Affairs (VA) intention to solicit proposals in accordance with all terms, conditions, provisions, specifications, and schedules of this solicitation and award a contract under the authority of 38 U.S.C. 8153. TERM OF CONTRACT: The contract is projected to be effective with a base period commencing sometime in 2012 through one year with four, one-year renewal options to be exercised at the discretion of the Government. DESCRIPTION/SPECIFICATIONS/PERFORMANCE WORK STATEMENT (PWS) The requirement is for Community-Based Outpatient Clinics (CBOCs) for providing Primary Care Services in a private hospital, office or clinic environment to veterans primarily residing in Stewart County and the surrounding counties in Tennessee. The Parent Facility for this CBOC is the VA Tennessee Valley Healthcare System (TVHS) in Nashville, Tennessee. Unless otherwise noted, hereafter within this document, singular terms such as “CBOC?, “clinic? or “Contractor’s facility? shall refer to the Stewart County CBOC. The Contractor shall provide a community-based outpatient clinic solely dedicated to veterans in one location. Primary Care services will provide a continuum of care from prevention to diagnosis and treatment, to appropriate referral and follow-up. Those patients needing specialty or follow-up care shall be referred to VA TVHS. The CBOC must have the necessary professional medical staff, diagnostic testing and treatment capability, and referral arrangements needed to ensure continuity of health care. Primary Care services include longitudinal outpatient medical care for the purposes of prevention and detection of disease and subsequent management of medical conditions, for veterans deemed eligible. The care will be provided by primary care providers who may be general practitioners or general internists or their authorized designees. The proposed CBOC, at a minimum, shall provide one standard of care that must be consistent, safe and of high quality. Additionally, the proposed CBOC is expected to comply with all relevant VA policies and procedures, including those related to quality, patient safety and performance. The CBOC must be poised to respond quickly to VA policy and procedure changes. If requested or required by either the government or the Contractor, the Contractor will work closely with the Contracting Officer and COTR to modify the contract expeditiously, in order to limit the impact on the clinic’s veterans and ensure consistency with the care provided by the VA’s other Primary Care Clinics. This care will include: (1) Scheduled initial or follow-up visits to primary care providers at the CBOC site. A complete history and physical examination which includes cervical cancer screening for women (including one of the following Current Procedural Terminology (CPT) codes: 99203-99205; 99213-99215; 99243-99245; 99385-99387; or 99395-99397.) must be performed on the first visit other than in exceptional circumstances. This is a Vesting CPT Code visit. Exceptional circumstances means the Veteran is seen for his first visit as an emergency for a shorter duration visit. In this case, a complete history and physical examination must be completed within 72 hours. The complete history and physical examination will be performed with documentation of Veteran problems via the on-line Problem List option in the Veterans Health Information Systems and Technology Architecture (VISTA)/Computerized Patient Record System (CPRS) computer system which will be updated as needed on each subsequent visit. The Problem List is to be updated by the third visit and all subsequent visits, and include all significant diagnoses, procedures, drug allergies, and medications. Within twelve (12) months of the last visit, the Veteran must receive a visit which justifies any of the Vesting CPT Codes. (2) Point of Care Testing (POC): The CBOC will provide POC Testing for the following conditions: (a) Conditions requiring chronic anticoagulation with warfarin. All CBOCs will perform POC INR (International Normalized Ratio) testing to allow for real-time adjustment of warfarin dosing. (b) Glycosylated Hemoglobin (HbA1C) testing for patients with diabetes. Several VA Mission Critical performance targets are based on HbA1C levels in diabetics, including yearly monitoring of HbA1C levels. This POC testing should be performed at least yearly. (3) Office visits to other health care providers including nurses, physician extenders, or dietitians for the purposes of monitoring or preventing disease and providing patients with information and/or skills so they can participate in decision-making and self-care. (4) Diagnostic tests ordered by primary care provider or his/her designee as indicated in paragraph 1.b. below. (5) Phone contacts with patients and primary care providers or their designee. b. Examples of primary care services include, but are not limited to, the following CPT codes: (The Contractor shall adhere to the most current CPT coding standards.) CPT CODES SERVICES 90801 Diagnostic Consultation 90804, 90806, 90808, 90847, 90853 Individual Psychotherapy 90805, 90807 Medication Management and psychotherapy 90847, 90847 Group/Family Psychotherapy 90862 Medication Management 99201-99215 Office or Other Outpatient Services 99241-99245 Consultations 99354-99355 Prolonged Services Face to Face 99441-99443 Telephone Calls to Patient or Other Health Care Professionals 99381-99397 Preventive Medicine Service 99401-99429 Counseling and or Risk Factor Reduction Intervention 36410, 36415 Venipuncture for collection of specimens Included in CPT codes listed elsewhere in this table. Female: Women's health services, including but not limited to, pelvic/breast exams; pap smears, contraception counseling and management; management of osteoporosis, menopause, pelvic pain, abnormal uterine bleeding, and sexually transmitted diseases; in addition to screening for breast and cervical cancer or, a history of sexual trauma. Referral for pregnancy, mammography and recognition of ectopic pregnancy. GYN abnormalities should be referred through a Gynecology consult to the Parent facility. 65205 Eye: Superficial removal of foreign bodies. 69000-69200 69210 Ear: Simple procedures (e.g., drainage ext. ear abscess, removal foreign body). 70010TC-76499TC Diagnostic Radiology and Diagnostic Imaging shall be performed with the exclusion of invasive procedures, MRI, CT, and ultra sound. 81002, 81025, 82272QW, 82075, 82948, 83036QW, 85610QW Laboratory Services as follows: Urinalysis (non-automated w/o microscopic), pregnancy testing (visual color comparison), occult blood feces 1-3 tests, whole blood glucose, Hemoglobin (A1C), and prothrombin time/INR. Note: These (waived) laboratory tests can be typically done in physicians' offices. All other laboratory services should be referred to VA TVHS. 90700-90749 Immunization Injections as recommended by CDC, or other recognized medical groups/academies. 93000, 93005, 93010, 93040, 93041, 93042 Cardiography Services are limited to ECG performance and interpretation. Note: The Contractor must utilize MUSE-compatible EKGs. 94010, 94060, 94640, 94760 Performance and interpretation of pulse oximetry for oxygen saturation. Other pulmonary procedures are excluded. c. Examples of workload that can be appropriately managed in primary care are: Simple to Moderately Complex: Hypertension Depression Ischemic Heart Disease Anxiety Hypercholesterolemia Degenerative Arthritis Congestive Heart Failure Respiratory Infection Cerebral Vascular Disease Chronic Obstructive Pulmonary Disease (COPD) Peripheral Vascular Disease Urinary Tract Infection Diabetes Mellitus Common Dermatological Conditions Chronic Pain Acute Wound Management Gastric Disease Skin Ulcers (Stasis and Dermal) Anemia Male Genitourinary (GU) Issues Stable Chronic Hepatic Insufficiency Cervical Cancer screening Constipation Osteoporosis Common otic and optic conditions Basic diagnostic evaluation and tests for infertility Preventive Medicine Screening and Procedures Cervical Cancer Screening Breast Cancer Screening Pharmacology in Pregnancy & Lactation Evaluation & Treatment of Vaginitis Amenorrhea/Menstrual Disorders Evaluation of Abnormal Uterine Bleeding Menopause Symptom Management Diagnosis of pregnancy and initial screening tests Evaluation and management of Acute and Chronic Pelvic Pain Recognition and management of Postpartum Depression and Postpartum Blues Evaluation and management of Breast Symptoms (Mass, Fibrocystic Breast Disease, Mastalgia, Nipple Discharge Mastitis, Galactorrhea, Mastodynia) Crisis Intervention; Evaluate psychosocial well being and risks including issues regarding abuse Violence in women & Intimate Partner Violence Screening -Personal and physical abuse -Verbal/Psychological abuse Preconception Counseling Assessment of abnormal cervical pathology QUALIFICATIONS: a. Offers will be considered only from offerors who are regularly established in the business called for and who, in the judgment of the Contracting Officer, are financially responsible and able to show evidence of their responsibility, ability, experience, equipment, facilities, and personnel directly employed or supervised by them to render prompt and satisfactory service in the volume required for all items under this contract. By the signing of this offer, offeror is certifying that he/she shall meet all requirements of Federal, State, or local laws, codes, and/or regulations and all applicable standards in the most current version of The Joint Commission Accreditation Manual for Hospitals regarding the operation of this type of service. b. VA TVHS will inspect and investigate the establishment, facilities, business reputation, and other qualifications of the offeror and reserves the right to reject any offer, irrespective of price, that shall be administratively determined by the Contracting Officer to be lacking in any of the essentials judged necessary to assure acceptable standards of performance. c. VA TVHS prefers that the Contractor’s facility be located within the county limits of Stewart County, Tennessee. All proposed site locations which can effectively serve the complete county areas will be considered, however, county sites that aren’t within the city limits as described will be considered, but with less favor. d. All contract employees must be United States citizens or permanent residents. Personnel assigned by the Contractor to perform the services covered by this contract shall be licensed in a State, Territory, or Commonwealth of the United States or the District of Columbia. All licenses held by the personnel working on this contract shall be current, full and unrestricted licenses. No physician or physician extender assigned by the Contractor shall have ever had a medical license suspended, revoked or limited by a State, Territory, Commonwealth or the District of Columbia. The qualifications of such personnel shall also be subject to review by the Chief of Staff and approval by the VA Facility Director. e. Must certify that any individual providing clinical services under this contract: (1) Has no physical/mental limitations or other conditions that may adversely affect his/her ability to perform as required by this contract; (2) Has not had a loss, reduction, restriction, or revocation of his/her clinical privileges at any institution; (3) Has revealed any pending or prior litigation for medical malpractice; (4) Is a member in good standing or has not had a loss of medical staff membership at or from any institution; and (5) Has not, or does not currently have any felony criminal charges against him/her. f. Physicians (including subcontractors) providing primary care services under this contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. VA TVHS prefers that the primary care physicians performing under this contract are board certified by the American Board of Medical Specialties (ABMS) in Internal Medicine and/or Family Practice or the Bureau of Osteopathic Specialists (BOS) in Internal Medicine and/or Family Practice. If physician(s) who are not board certified or not eligible for board certification are proposed by the Contractor to provide services under this contract, the VA Chief of Staff and Director will make a determination that these physicians are well qualified and fully capable of providing high quality care for veteran patients based on the verification of their credentials related to education, training, professional experience and competency. If VA TVHS rejects a proposed physician, the Contractor is required to propose substitute acceptable personnel within five (5) calendar days. VA TVHS determination is conclusive and not subject to further review through disputes resolution procedures. g. Physicians and personnel providing services under this contract must speak and write English proficiently. h. Any dietitian services must be provided by a Registered and Licensed Dietitian. i. The social worker providing services under this contract must have a degree in Social Work from a school accredited by The Council on Social Work Education (CSWE) and be licensed in a State, Territory, or Commonwealth of the United States or the District of Columbia. The CSWE website is http://www.cswe.org/. The VA prefers that the social worker have some experience providing mental health services. j. Certified Nurse Practitioners (CNPs) must have a MSN from a National League for Nursing (NLN) accredited nursing program and have American Nurses Association (ANA) Certification as a Nurse Practitioner in either Adult Health or Family Practice. Authorization for prescriptive authority is required. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. k. Physician Assistants must meet one of the three following educational criteria: a) A bachelor’s degree from a Physician Assistant (PA) training program which is certified by the Committee on Allied Health Education and Accreditation (CAHEA); or b) Graduation from a Physician Assistant training program of at least twelve (12) months duration, which is certified by the CAHEA and a bachelor’s degree in a health care occupation or health related science; or c) graduation from a Physician Assistant training program of at least twelve (12) months duration which is certified by the CAHEA and a period of progressively responsible health care experience such as independent duty medical corpsman, licensed practical nurse, registered nurse, medical technologist, or medical technician. The duration of approved academic training and health care experience must total at least five (5) years. Authorization for prescriptive authority is required. Physician Assistants must be certified by the National Commission on Certification of Physician Assistants. l. Any subcontractor utilized by the Contractor for the provision of services required under this contract must meet the same qualifications specified herein for the Contractor, as appropriate to the work being performed. The Contractor must obtain approval from the Contracting Officer for subcontractor(s) utilized. In an effort to achieve socioeconomic small business goals, depending on the evaluation factors included in the solicitation, VA TVHS shall evaluate offerors based on their service-disabled veteran-owned or veteran-owned small business status and their proposed use of eligible service-disabled veteran-owned small businesses and veteran-owned small businesses as subcontractors. The offeror agrees, if awarded a contract, to use the service-disabled veteran-owned small businesses or veteran-owned small businesses proposed as subcontractors in accordance with 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, or to substitute one or more service-disabled veteran-owned small businesses or veteran-owned small businesses for subcontract work of the same or similar value. m. Thirty (30) days prior to the contract expiration date, the Contractor will certify in writing to the Contracting Officer that all licenses and registrations of personnel employed under this contract are valid and current and will be renewed as necessary during the option period. Failure to provide this certification may result in a determination not to exercise the VA's renewal option. Updated copies of all licenses and registrations will be provided to the Contracting Officer annually no later than the contract anniversary date. B3.3. WORKLOAD PROJECTIONS: a. Estimates: (1) The following is a listing of estimated numbers of veterans residing in Henry, Houston and Stewart counties, and the estimated number which have been seen in catchment area for this CBOC. County Veterans County Veterans Seen Henry, TN 3095 Henry, TN 1129 Houston, TN 843 Houston, TN 350 Stewart, TN 2040 Stewart, TN 796 Grand Total 5,978 Grand Total 2,275 All these veterans are not actually “enrolled? at VA TVHS or CBOC’s but have been seen. Current enrollment at the existing CBOC is 750. Interested parties should respond to the Contracting Officer, Christina B. Smith by e-mail at contact@example.gov no later than 27 July 2012 at 4:00 P.M. Central Time. This sources sought notice is to assist the Tennessee Valley Healthcare System (TVHS) in Nashville, Tennessee in identifying an appropriate acquisition strategy only. Written communication received will be considered solely for the purpose of determining current market capabilities for the services identified within this notice. A solicitation is not currently available. If a solicitation is issued, it will be announced and posted on this website at a later date, and interested parties must respond to the solicitation to be considered for award. This notice does not commit the government to contract for any supply or service. The government will not pay for any information or administrative cost incurred in response to this Sources Sought Notice. Do not contact medical center staff in regards to this requirement, as they are not authorized to discuss matters related to this procurement action. All questions should be submitted in writing for this procurement to the Contracting Officer.