Jump to content
The Wifcon Forums and Blogs
tj2015

What type of contract shall I use (Medical Services)?

Recommended Posts

My agency has a requirement for patients’ health care must be obtained through referrals to community-based providers.  This requirement is national wide service. The solicitation is intend to establish a five (5) year contract with one base year and four (4) options that will provide professional and facility services for both inpatient admissions and outpatient encounters for medical, dental, and some mental health services to include pharmacy within the contractor’s network of care providers.  The agency requires a nationwide health care delivery system to provide health care services for our patients when they are taken outside of the state and local facilities for medical reasons.

 

My question is due to the complexity, which type of contract shall I use is better fit for this service requirement?  We try to avoid Cost-Reimbursement contract.  Thank you.

Share this post


Link to post
Share on other sites

Interesting effort.  

While there may be a nationwide provider of medical services that can accomplish your need I suspect you may be entering into the world of a coordinator of services such as United Health Care, Blue Cross Blue Shield or similar entity.  I note this as many health care provides -hospitals, doctors, dentists, mental health experts, and pharmacies are independent of each other.  Also both DoD and the VA have established multiple award contracts for some needs, mostly in the supply realm and have not established a comprehensive service contract nationwide.  After all generally speaking, either through the auspices of GSA, have the charge to do so on behalf of the Federal government.   All this leads me to the conclusion a single contract approach has been looked at but never successfully accomplished.  The world changes I know and there may be something out there mine is just a narrow view from experience of having worked for and looked at healthcare needs as a acquisition professional for the Indian Health Service and Job Corps (now retired).

With the implied intent to avoid cost-reimbursement squeezing medical care services into the fixed priced box makes my head swim thinking of the CLIN structure even if a requirements or IDIQ type contract.  Makes me wonder why the needs would not be accomplished on a individual need, individual purchase order basis?   But then again I do not know the patients you intend to serve, how comprehensive the medical needs are,  how scattered they anticipated patients are (urban are to rural area) etc. etc.

I will be following this thread with interest to learn as well to see what the years have brought to accomplishing your intended need.

 

Share this post


Link to post
Share on other sites

You are dealing with a touchy, complex, and challenging issue.  As Carl mentioned, this is something DoD and VA continuously deals with. DoD has Tricare which is so complicated, I can’t even begin to explain it here.  VA struggles on an ongoing basis with the notion.  They tried to implement a nationwide program a few years ago with multiple awards based on their regions.  It never made it to award for many reasons, some contract, others program, and still others policy.  The big hurdle they face is providing coverage across the territory covered that ranges from congested metro areas to isolated remote locations.  Within that many patients have long term relationships with doctors that may not get covered by a new contract.  Plus VA doctors have strong preferences with local doctors in making referrals so this is another reason why any single contract may not work.  There are several other reasons I won’t go into. 

As far as contract type, they are set up as IDIQ using CMTs (medical profession codes) and Medicare established rates.  The contracts are based on percentages of those rates.

If your agency proceeds with this, the task can be relatively simple or extremely complex depending on your circumstances.  For example in comparing costs between offerors, how to you deal with a patient with limited mobility in a remote location where one provider has local support while another requires the patient to be transported?  

 My suggestion is sit down and talk with VA people before doing more.

Share this post


Link to post
Share on other sites

I have no idea about pricing other than I agree that it its a tough one, but here is another ossible source for comparison:

In HHS, the Indian Health Services (IHS) does contracting for direct provisioning of health care over a very wide area.  IHS is tiny, so its contracting is a lot easier to understand than, say, the VA.

 

Share this post


Link to post
Share on other sites
4 hours ago, C Culham said:

Interesting effort.  

While there may be a nationwide provider of medical services that can accomplish your need I suspect you may be entering into the world of a coordinator of services such as United Health Care, Blue Cross Blue Shield or similar entity.  I note this as many health care provides -hospitals, doctors, dentists, mental health experts, and pharmacies are independent of each other.  Also both DoD and the VA have established multiple award contracts for some needs, mostly in the supply realm and have not established a comprehensive service contract nationwide.  After all generally speaking, either through the auspices of GSA, have the charge to do so on behalf of the Federal government.   All this leads me to the conclusion a single contract approach has been looked at but never successfully accomplished.  The world changes I know and there may be something out there mine is just a narrow view from experience of having worked for and looked at healthcare needs as a acquisition professional for the Indian Health Service and Job Corps (now retired).

With the implied intent to avoid cost-reimbursement squeezing medical care services into the fixed priced box makes my head swim thinking of the CLIN structure even if a requirements or IDIQ type contract.  Makes me wonder why the needs would not be accomplished on a individual need, individual purchase order basis?   But then again I do not know the patients you intend to serve, how comprehensive the medical needs are,  how scattered they anticipated patients are (urban are to rural area) etc. etc.

I will be following this thread with interest to learn as well to see what the years have brought to accomplishing your intended need.

 

 

2 hours ago, formerfed said:

You are dealing with a touchy, complex, and challenging issue.  As Carl mentioned, this is something DoD and VA continuously deals with. DoD has Tricare which is so complicated, I can’t even begin to explain it here.  VA struggles on an ongoing basis with the notion.  They tried to implement a nationwide program a few years ago with multiple awards based on their regions.  It never made it to award for many reasons, some contract, others program, and still others policy.  The big hurdle they face is providing coverage across the territory covered that ranges from congested metro areas to isolated remote locations.  Within that many patients have long term relationships with doctors that may not get covered by a new contract.  Plus VA doctors have strong preferences with local doctors in making referrals so this is another reason why any single contract may not work.  There are several other reasons I won’t go into. 

As far as contract type, they are set up as IDIQ using CMTs (medical profession codes) and Medicare established rates.  The contracts are based on percentages of those rates.

If your agency proceeds with this, the task can be relatively simple or extremely complex depending on your circumstances.  For example in comparing costs between offerors, how to you deal with a patient with limited mobility in a remote location where one provider has local support while another requires the patient to be transported?  

 My suggestion is sit down and talk with VA people before doing more.

Thank you.  CMT or CPT?

Share this post


Link to post
Share on other sites

Here’s some info on the most recent awards.  Hopefully you can find someone to talk with you about the most recent strategy.

https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5175

I’m not sure what the new contracts looked like but in the past, the strategy was list all needed CPTs and offerors were free to propose percentage increases or decreases to current Medicare rates.  So the actual contract rates were calculated using another list of prices and adjusted by percentages in the contract.  

There were several national medical and dental networks interested and numerous regional and locals.  One of the challenges was letting offerors know how much work to expect.  Originally the intent was make the contracts mandatory and allow existing agreements to slowly expire. But many providers, VA program and doctors, and veteran groups objected.  They all felt existing patient relationship should be maintained, VA doctors should be able to refer patients to whomever they felt best, and veterans wanted a say.  So the mandatory nature went away.

Share this post


Link to post
Share on other sites

Yeah, if you're VA you are going to want to sit down with the people at the VISN or central office or the medical sharing office and figure out how to move forward, especially if this is a national contract. VA has a process for authorizations, referrals and payments for what you're describing.

As pointed out above, I have historically seen these as IDIQs that list the medical code and the medicare rate for each, and the proposals are a percentage above/below that rate. It's been a while since i've worked there, but see if you can find the Patient-Centered Community Care (PC3) contract or solicitation. I'm sure it's been replaced with something new or a different program since i've left, but that contract had a process that was similar to what I think you're describing through referrals. It might give you an idea of what internal VA processes look like, and since i don't work there and have lack of available intranet resources, i can't offer much more.

 

 

Share this post


Link to post
Share on other sites
On ‎9‎/‎9‎/‎2019 at 11:35 PM, formerfed said:

Here’s some info on the most recent awards.  Hopefully you can find someone to talk with you about the most recent strategy.

https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5175

I’m not sure what the new contracts looked like but in the past, the strategy was list all needed CPTs and offerors were free to propose percentage increases or decreases to current Medicare rates.  So the actual contract rates were calculated using another list of prices and adjusted by percentages in the contract.  

There were several national medical and dental networks interested and numerous regional and locals.  One of the challenges was letting offerors know how much work to expect.  Originally the intent was make the contracts mandatory and allow existing agreements to slowly expire. But many providers, VA program and doctors, and veteran groups objected.  They all felt existing patient relationship should be maintained, VA doctors should be able to refer patients to whomever they felt best, and veterans wanted a say.  So the mandatory nature went away.

Thank you. That's very helpful info. Will make phone calls to VA.  The requirement is estimated at about 150+/- locations nation wide. The patients may range from 10-200 in one location.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...