Exempla Good Samaritan Radiology RFP
Q&A Bulletin Board
Note:
Address questions to Skip McGinty at
skip@mcgintys.org
510-682-7778. Responses to questions of general interest will be posted
on this site, as received.
1. Is the
medical center coming to this process with an open mind, or is there a group
that has an inside track?
The management at EGSMC is of a completely open mind on
this issue. There is no preconception of who will be the selected
vendor. There is no preferred candidate at this point.
2. Will there be an
opportunity to present our group in person?
Yes, there will formal in-person interviews at the
medical center in January.
3. Are you inviting
national groups to participate, or are all of the groups local?
One national group has been invited; and they have
indicated they plan to participate.
[1/2/2013 update: The one
national group has dropped out.]
4. Who decided which
groups to invite?
EGSMC administration.
5. What are the
backgrounds of the individuals on the review panel?
Dr. John Bakke, John Lee, and Skip McGinty make up the
review panel. Bakke is a former internist, hospitalist, and medical group
executive. Lee is the ex-CEO of a large health care and hospital
system. McGinty is a former managed health care executive. All have
extensive healthcare consulting backgrounds, including specific experience in
evaluating hospital based physician groups. All are from outside of
Colorado, but all are generally familiar with the Denver healthcare
market. All have had previous consulting assignments at all three Exempla
Medical Centers. Brief bios are available on the bottom of this Q&A
list.
6. In the end, who makes
the decision on which group is chosen?
The Quality Committee of the Exempla system board.
7. What is various
payer mix for ER, outpatient (minus Kaiser Permanente) and
inpatient?
There will be a response to this question in the RFP.
8. What
outpatient procedures is Kaiser Permanente not removing from the hospital (e.g.
PET/CT, CT or ultrasound guided biopsies, etc.?)
Kaiser Permanente has not stated plans to duplicate
PET/CT services at their facility. They have stated that they plan to
transfer all other outpatient procedures covered by this contract. It is
possible that Kaiser Permanente will refer overflow volume back to the medical
center.
9. What is emergency and
stat volume between midnight and 8am?
Service volumes will be provided in the RFP.
10. Does Kaiser
Permanente currently operate or is it planning to institute its own Urgent Care
and/or E facility on the campus?
No. KP has stated no plans to operate a separate
urgent care facility at this site.
11. Are the
outpatient imaging procedures at the Community Physician Medical Office
Building covered under this agreement?
No. That contract is managed by the Exempla
Physician Group. The volume of imaging
procedures in this facility are not material.
12. Are there any
problem issues with the current radiologist coverage that specifically need to
be addressed?
Medical center leadership believes that a higher level
of active engagement in service problem solving, a more transparent clinical
quality reporting system, and stronger physician leadership are desirable and
possible. The selection process, however, is more focused on
identifying the group that can best provide an aspirational level of service
and quality, rather than addressing current perceived issues.
13. What is the hierarchical structure
of the institution regarding the Radiology department?
The department manager reports to the Chief Operating
Officer, who reports to the CEO.
14. What is the 2012 budget for new/
upgrade for radiology department imaging equipment?
EGSMC does not make this information available
publicly. The medical center has made ongoing substantial investments in
equipment and support. A detailed listing of rooms, equipment, and
installation dates will be listed in the RFP.
15. Does the imaging
department currently employ per diem techs? If so what areas?
Yes, occasionally, as temporary needs arise in any
area.
16. How long has the
current Imaging Department Director been in their position?
The department manager has recently been promoted into
his position. He was previously the department clinical manager for four
years. The previous director has taken on another position at the medical
center, but continues in an informal adviser and mentoring role.
17. What exactly is a
Senior ED and what is its advantage?
A very good and concise explanation is available in a
recent Colorado Public Radio program about the Senior ED at Exempla
Lutheran. Here is a link to the audio file and transcript: http://www.cpr.org/#load_article|Seniors_Get_Separate_ER
18. What management
role do the Sisters of Charity of Leavenworth have over this institution?
The Sisters of Charity of Leavenworth system has a
substantial management role in the governance of EGSMC. The medical
center CEO, for example, reports to the President of Exempla, who is also the
principal system hospital executive for SCL.
19. How much
influence does Kaiser Permanente have in determining the choice of
the Radiologist Group?
Kaiser Permanente will have no formal role in selecting
the radiology group. The Colorado Permanente Medical group will be an
important customer of this service; and Permanente physicians have been part of
the broad stakeholder group interviewed to develop the RFP document.
There are Permanente physicians on the Medical Staff Executive Committee which
will review the recommendation. There are no Kaiser or Permanente
representatives on the Quality Committee of the Exempla Governing Body, which
will make the final decision.
20.
When we will
know the exact time and date of our
interview?
Interviews can be
scheduled for either January 16th or the morning of January 17th through Lynda
Wenk at EGSMC. She can be reached
at: 303-689-5243/ Lynda.Wenk@exempla.org.
21. Appendix C of the RFP provides a table of
imaging volumes by modality. Can you
provide a more detailed breakdown?
See below:
|
Total YTD Volume (10/31/12)
|
Total Volume 2012 Annualized
|
2012 Annualized w/ KP Outpatient Volume Removed
|
||
|
CAT SCAN
|
23,329
|
27,995
|
18,477
|
|
|
DEXA SCAN
|
3,271
|
3,925
|
981
|
|
|
DIAGNOSTIC IMAGING
|
41,183
|
49,420
|
35,582
|
|
|
MAMMOGRAPHY
|
16,130
|
19,356
|
5,807
|
|
|
MRI
|
10,695
|
12,834
|
4,749
|
|
|
NUC MED
|
4,299
|
5,159
|
2,734
|
|
|
ULTRASOUND
|
14,908
|
17,890
|
10,555
|
|
|
Total
|
113,815
|
136,578
|
80,581
|
Note: The above table reflects billed exams.
The first column is an exact count.
The next two columns are estimates, based on medical imaging department
data. The comparable estimates from the
finance department are approximately 3% higher.
None of these estimates reflect current or projected growth trends.
22. What is the
expectation about after-hours reading of plain film x-rays?
The current practice
is that plain films are generally read the following morning, after a preliminary
read by the ED physician, in-house hospitalist, etc. If the ED or in-house physician has a
real-time concern about a specific film they would call the radiologist who is
covering. This approach appears to be
satisfactory.
23.
In Appendix E, the payer mix for ED Services is provided, including
Kaiser Permanente. What is the estimated
payer mix after 7/1/2012?
The medical center
does not anticipate that the ED volume for Kaiser patients will materially decrease
after 7/1/2012. KP will not be providing
separate emergent or urgent care services in the immediate service area. The group selected through this process will
provide the professional radiology services for all ED patients. The combination of Kaiser Permanente
membership growth and the availability of two new KP plan hospitals to the
north is anticipated to have a net 2% decrease in emergency department and
inpatient KP use at EGSMC.
24.
Will there be time for, and may we make, a formal presentation at the
interview?
The interviews will be
90 minutes long. There would be time for
a short presentation, but our preference is that you use the great majority of
your time for discussion with us. You
can assume that the members of the review panel will have read the proposals
carefully. If there is material you want
to share that is best presented live you are welcome do so.
25.
Please explain the central line placement included in the scope of
service statement?
The reference to
central line replacement on page 2 of the RFP is an error. Peripheral Intravenous Central Catheters are
placed by a PICC team at the hospital. The difficult PICC lines are placed in
Interventional Radiology. Routine
central line placement is an exclusion from that contract, but it is not part of
the services covered by this RFP.
26.
On which medical staff and hospital committees does EGSMC expect us to participate? What is the anticipated time commitment for
each?
The required
committees are listed below:
1.
Medical Executive Committee- Once a
month, 2 hours. Radiology representation
rotates annually with Pathology
2.
Peer Review Committee- Once a month,
2 hours Participation is ad hoc,
depending on agenda.
3.
Dept. of Pathology & Radiology
Committee- semi-annually. 2
hours
4.
Tumor Conference- Three times a
month, 1 hour
5.
Trauma Committee- Once a month, 1 hour
6.
Performance Excellence Committee-
Once a month, 2 hours
The medical center
wishes to select a group that generally has the interest and ability to
actively participate in the life of the medical center.
27.
What is the mechanism for report generation? Is there a voice recognition system embedded
in the PACS?
Reports are generated
via speech recognition software: Speech
Q. Once the user is logged on to the speech
recognition application, the application is linked and launched through
PACS. The reports may be self-edited or
sent to a transcriptionist for editing. Reports are posted to patients’ electronic
medical record or faxed electronically to physician offices.
28.
The December
10th deadline is only for references. Is that correct? Do they need to be sent in any special
format?
Yes, Monday, December
10th is the deadline for receiving references. They can be send by email or letter. Receipt will be confirmed by email.
29.
What are the
existing QA and risk management programs at EGSMC?
Existing peer review,
benchmarking, quality assessment and quality improvement activities are all current requirements at EGSMC and will continue to be required of the successful group. QA requirements include written annual reviews at both the group and individual physician
level. The group maintains written
copies of their QA, QI, and peer review processes and written descriptions of
their policies for disruptive or impaired physicians on file with the medical
center. The group is to refer individual
physicians who fail to meet benchmark standards or about whom there are
individual complaints to the medical staff peer review process. There are currently also specific quality and service metrics
which are jointly determined by the group and EGSMC administration. Included in the service measurements are
patient, client physician, and EGSMC staff satisfaction measurements.
Risk management responsibilities include
participation in root cause analysis and performance improvement initiatives as
specific issues and opportunities arise.
Again, EGSMC is looking for a group that is
highly motivated to provide, and be held accountable for, benchmark levels of service and quality, as
well as helping the medical center as a whole continually improve clinical
quality, service quality, and patient safety.
Strong proposals will focus on this area and provide specific details on
current and proposed efforts.
29.
Item #42
asks about any ‘operation support’ that we would provide to EGSMC at the
hospital. Can you clarify what that
would be?
“Operational support”
in this question refers to administrative support to the group’s operation
at the medical center, rather than to EGSMC.
Typically, this is a coding/ billing operation.
30. What is the current on-site radiologist
coverage?
Weekday coverage is 7am to 5pm with two general
radiologists present 5 days a week plus a dedicated mammographer 4 days a
week. Week-end coverage is a single
radiologist 7am to “3:30pm ish”.
31.
Is there a
different expectation about mammography coverage once the Kaiser population
leaves?
As noted above, there is currently onsite mammography
coverage 4 days a week. Hospital
administration believes that, in order to grow the service, five day coverage
is needed. The surgeons also have strong
desire for early morning breast biopsy coverage each week day.
32. Is
it possible to get a full CPT code file of procedures currently being provided
so that we could see a more detailed breakdown of procedures and payors?
Yes. The
medical center will prepare an Excel file with 2012 projected based on year to
date actual, with the assumed Kaiser Permanente non-ED outpatient volume removed. Contact Skip McGinty if you want a copy of
the file.
33. Are
neuro interventional procedures covered under the current exclusive IR
agreement. If not, would there be the
desire on the part of the medical center to have our group provide this service
as part of the contract?
Neuro interventional radiology is not currently
provided at EGSMC. The medical center believes
that these procedures are not included in the current IR exclusive contract;
and they would welcome their inclusion in your proposal.
34. Is it acceptable to add additional references
after 12/10? Is there an upper limit on
the number of references we may provide.
Yes, you may submit additional references after the
deadline, as long as you met the deadline with the minimum number. No, there is no upper limit on the number of
references you can submit. The review
group, however, may not contact all of your references if you submit a large
number or if they are submitted within a week of the interviews.
35. Would
it will be necessary for the mammographer responsible for screening and
diagnostic work (including breast needle localization and sentinel node
studies) to sit somewhere other than the main reading room in the department?
It would not be necessary for the radiologist to be
physically be located in the mammography department. The availability of the
radiologist to speak to patients, technologists and or perform exams is the
only concern. The physical location of the mammography department is 100 ft
from the main reading room.
36. Has
Radisphere dropped out of the process?
Yes. [See item
3.]
37. Is
it possible for us to know who all the
participants in our interview will be?
Yes. Beth Forsyth, the VP for clinical and support
services at EGSMC will host the interview session. We anticipate others from the medical center
who will attend include: Robert Billerbeck the CMO, George Payan the
imaging department manager, and Chris Lee, the director of business development
[and former imaging department manager].
They will primarily observe and be available to respond to questions. Bios for Beth Winter and Dr. Billerbeck are
available at: http://www.exempla.org/body.cfm?id=735
.
The interview questions will generally come from the three members of the external review
panel: John Bakke, John Lee and Skip McGinty.
Those bios are available below.
Review Group Bios:
John
Bakke, MD MBA:
Dr. Bakke began private practice in rural Maine in the late 1970s. He
subsequently became the director of an internal medicine residency program at a
large community hospital in Portland, Oregon. He then joined Kaiser
Permanente and, in addition to practicing medicine, filled a number of medical
group administrative positions in Ohio and Oregon including Department Chief,
Primary Care Medical Director and assistant Regional Medical Director. He
spent the last 5 years of his clinical career as a hospitalist. After retiring from Kaiser in 2007, he has
taught graduate level courses in healthcare delivery system policy and design;
and has been an organizational consultant to hospitals and medical
organizations throughout the United States. His clinical training
included an internal medicine residency at the University of Chicago and a
clinical fellowship year in infectious disease at Harvard. His M.D. is
from the University of Pennsylvania. He has an M.B.A. from the University
of Portland and an undergraduate degree from Haverford College. In his
spare time, he pursues an interest in genealogy; and has published a number of articles
concerning early American family history. He and his family currently
make their home in Oregon. John has
served on several other selection panels for hospital based physician services.
John
Lee:
Mr. Lee is a private healthcare consultant in Portland, Oregon and an experienced
hospital and healthcare system executive. Prior to retirement, he was the CEO
of the Providence Health System in Oregon, which included a seven hospital
system, a 250 physician medical group, a 300,000 member HMO, and a large
PPO. The California and Alaska operations and the shared services
function of the Providence Health System also reported to John as part of his
system executive role. He is a Fellow of both the American College of
Healthcare Executives and the American Hospital Financial Management
Association. Lee served on several local and national health care and
education boards of directors. He is currently an advisor to the
Oregon Health Leadership Council. His education includes BS and MBA
degrees from the University of Portland and an MPH from UCLA. He was a US
Air Force officer for four years. John has participated a number of
selection panels for hospital based physicians; and has prior experience as a
consultant for the Exempla system. Lee,
McGinty and Bakke have worked together on several different projects..
Skip
McGinty: Skip
is an independent health care consultant based in Olympia, Washington. He
works primarily in the areas of healthcare strategy, alliances, negotiations, network
development, litigation support, and physician group evaluation &
selection. He has worked with clients in Washington, Oregon, Montana,
California, Texas, Maine, Indiana, Colorado, Florida, and New Zealand.
Prior to retirement, he worked for Kaiser Permanente for over 20 years in a
variety of health plan, medical group and hospital management functions. He
also spent two years as an executive for the 1984 Los Angeles Olympic
Organizing Committee, and five years directing the Peace Corps program in Oman
and managing Peace Corps recruiting activities in the northeastern U.S.
He was a Peace Corps Volunteer and trainer in Sierra Leone. McGinty
teaches courses in healthcare delivery, economics, policy, and government
relations. He has an undergraduate degree from Occidental College and an MBA
from Stanford University. McGinty has provided consulting services to the
Exempla system on a variety of projects for over 10 years. He has
coordinated numerous physician group evaluation and selection processes,
including several for the Exempla system.
McGinty
Associates, LLC
6233 Elizan
Drive NW
Olympia,
Washington 98502
510-682-7778
skip@mcgintys.org
