Agenda 03/10/2009 Item #16E 2
EXECUTIVE SUMMARY
,A,oenda ilem r~o. 16E2
" [~3rch '0, 2009
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Recommendation that the Board waive competition and approve an amendment to the
current contract with Vocatus Medical Management Services to renew the contract for
a five year period, incorporate the opening of a North MedCenter location, and
establish fees for Vocatus for the renewal period.
OBJECTIVE: To promote a healthy and productive workforce through the provision of cost-effective
onsite and offsite primary healthcare services to employees enrolled under the Collier County Group
Insurance Plan.
CONSIDERATIONS: In FY 2005, the Board awarded RFP#05-3748R, "Onsite Primary Care Health
Services" to Vocatus Medical Management Services of Naples, Florida. The original RFP was
released in February, 2005 and a Request for Proposals was sent to all participating physicians in the
Community Health Partners physician network. Two proposals were received and both were ultimately
rejected by the Board of Commissioners due to pricing concerns and a lack of responsiveness on the
part of the proposers. A second RFP was released in May, 2005 and one proposal was received from
Vocatus Medical Management Services. The selection committee recommended and the Board
approved Vocatus Medical Management (a/kla Vocatus) to operate the clinic.
The current onsite clinic, known as 'The MedCenter" was opened in December, 2005. Since that time,
usage of the MedCenter has grown and has now reached capacity with approximately twenty patients
per day receiving treatment. The clinic operates on a fixed cost basis rather than a fee for service
basis. Therefore, as the number of patients reaches capacity, the cost per patient encounter is
approximately 20-25% less than a fee for service arrangement. Employees and their eligible
dependents incur a $5 copayment when they use the center for their health care needs.
Due to the maximization of capacity, staff reviewed the potential for expanding the size of the current
clinic and thus, the volume of services at the current site. Due to space limitations, the expansion of
services at the current site is not feasible. As an alternative, Risk Management and Purchasing staff
began discussions with Vocatus about the possibility of creating a North MedCenter at the Vocatus
medical facility located at 4513 Executive Drive, just off Immokalee Road. Vocatus promptly provided
a price proposal to provide these services.
This North MedCenter option provides several advantages. First, there are no capital costs incurred to
build a facility or to purchase equipment. Second, Vocatus will staff the facility with shared staff
including a Physician's Assistant, a Medical Technician, and clerical staff. These staff can be a
dedicated but shared resources, thus the fixed cost to the county is lower. Third, this location will
provide services to employees and dependents who either work or live on the north side of town,
including immokalee, who cannot utilize the current MedCenter site due to the driving distance.
Finally, since this is a dedicated service, employees will receive care promptly and return to work
quickly.
Vocatus has proven to be a loyal partner in the development of the first MedCenter. Employees have
developed a good relationship with the medical staff and utilization of the existing facility has exceeded
its current capacity. Further, Vocatus has worked with the county to develop the Diabetes
Management Program and the Commit to Quit Smoking Cessation Program which are designed to
address two major healthcare cost drivers. Vocatus was the single proposer when this service was
competed in 2005. Nonetheless, the price proposal offered in the Amendment remains competitive.
Vocatus has agreed to m~intCJ.in the current pricing structure for the existing MedCenter for the next
two years.
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The five year pricing schedule for both locations is attached to the Amendment as Exhibit A-2-A.
Therefore, staff recommends that the Board waive competition and approve an amendment to the
current agreement with Vocatus Medical Management Services to extend the term of the agreement
for five (5) years and to incorporate the opening of a North MedCenter location.
LEGAL CONSIDERATIONS: This item is not quasi-judicial, and as such ex parte disclosure is not
required. This item requires majority vote only Pursuant to the Purchasing Policy (section V(A)), the
Board may waive competition when it is in the best interest of the County to do so. This item is legally
sufficient for Board action. - CMG
FISCAL IMPACT: The cost to add the North MedCenter in the first year is $128.941 plus eligible
reimbursable costs per the agreement. It is anticipated that this site will handle approximately 2,000
patient encounters per year. Vocatus has agreed to continue the current pricing for the main campus
MedCenter at a base annual cost of $363,755 plus eligible reimbursable costs for a period of two
years per the agreement. Therefore, the first year base cost of both facilities is $492,696. Staff
recommends that a budget amendment to Fund 517-121640 in the amount of $100,000 be approved
to add the North MedCenter location. Funds would be transferred from reserves.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
item.
RECOMMENDATION: It is recommended that the Board waives competition and approves an
amendment to the agreement with Vocatus Medical Management Services to renew the Agreement
for a five (5) year period and to incorporate the opening of a North MedCenter location and authorize
the Chairman to sign the Amendment.
PREPARED BY: Jeff Walker, CPCU, ARM, Director, Risk Management
Item Number:
Item Summary:
Meeting Date:
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COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
16E2
Recommendation tr.althe Board waive competition and approves an amendment to the
current contract with Vocatus Medical Management Services to open a r~orth MedCenter
location, and establish fees for Vocatus for the ren8vval period
3/10/20099:00:00/"M
Prepared By
Jeffrey A. Walker, CPCU,
ARM
Administrative Services
Risk Man;;:gcrncnt Director
Date
Risk Management
2,'19/2009 11 :15:03 AM
A pprond By
William Mountford
County Attorney
Assistant County Attorney
Date
County Atlomt'y Office
2t19!2009 11 :24 AM
Apprond By
Lyn Wood
Administrative Services
Purchasing Agent
Date
Purchasing
2/201200911:2.7 AM
Appro\'Cd By
Jeffrey A. Walker, CPCU,
ARM
Administralive Services
Risk Management Dire~tor
Date
Risk Man2qement
2:20-'2909 ~1:35/\M
Approved By
Steve Carnoll
Administrative Services
Purchasing/General Sv:s Director
Date
Purchasing
2/23/20093:04 PM
Approved By
Len Golden Price
Administrative Services
Administ,ative Services Administrator
Dale
Administrative Services Admin.
2/24/2009 10:49 AM
i\ppro\'ed By
Scott R. Teach
County Attorney
Assistant County Attorney
Date
County Attorney OHice
2/26/2009 2: i 0 PM
Approved By
OMB Coordinator
County Manager's OfficB
OMS Coordinator
Date
Office of Management &- Budget
2'27/20098:40 AM
Approved By
Laura Davisson
County Manager's Office
Management & Budget Analyst
Date
Office of Management e. Budget
2/27/20093:05 PM
A pprond By
James V. Mudd
Board of County
Commissioners
County Manager
Dete
County Manager's Office
3!3/20094 1i PM
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EXHIBIT A-t Contract Amendment #1
"On-Site Primary Care Health Services"
This amendment, dated , 2009 to the referenced agreement shall be by and
between the parties to the original A6'1'eement, Vocatus Medical Management Services of Naples (to be
referred to as "Provider") and Co]lier County, Florida, (to he referred to as "Owner").
Statement of Understanding
RE: Contract #05-3748R - "On-Site Primary Care Health Services"
In order to continue the services provided for in the original Contract document referenced above, the
Provider agrees to amend the above referenced Contract as per the Supplemental Authorization Exhibit
"AI-A" attached to this Amendment and incorporated herein by reference. This Amcndment shall extend
the Agreement through November ]4, 2014.
The following sections are amended as follows:
2. ST ATE'lE:\'T OF WORK. is amended to include Providcr's proposal to establish a second
MedCenter at 4153 Executive Drive, Naples, Florida, dated January 26, 2009, attached hereto as
Exhibit A-]-A, and made an integral part of the Agreement. The Provider shall establish the
additional service facility located at 45] 3 Executive Drivc, Naples, Florida, as expeditiously as
possible, and shall begin service at the additional facility after Jive (5) business days written notice to
the County.
3. THE CONTRACT SUM. The contract sum for each of the next five (5) years, beginning November
15, 2009, is set forth in the Price Proposal Summary. attached hereto as Exhibit A-2-A. The sum for
the additional service facility located at 45 I 3 Executive Drive. Naples, Florida, prior to November] 5,
2009, shall be based on a monthly proration of one hundred twenty-eight thousand nine hundred forty-
onc dollars ($] 28,94]) fee set forth for Year 1 for that location in the Price Proposal Summary.
The follmving sections are added to the AbTfeement:
18. l\lMIGRATlO" LAW COMPLIANCE. By cxecuting and entering into this agreement, the
Provider is fonnally acknowledging without exception or stipulation that it is fully responsible for
complying with the provisions of thc Immi6'1'ation Refonn and Control Aet of 1986 as located at 8
U.S.c. ] 324, et seg. and regulations relating thereto, as either may be amended. Failure by the
Providerr to comply with the laws referenced hercin shall constitute a breach of this agreement and
the Owner shall have the discretion to unilaterally tcnninate this agreement immediately.
19. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise
unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in efIect.
20. ADDITlOC'iAL ITEMS/SERVICES. Additional items and/or services may be added to this
contract upon satisfactory negotiation of price by the Owner and Provider.
21. DISPUTE RESOLCTION. Prior to the initiation of any action Of piOcccding permitted by this
A6'1'eement to resolve disputes between the parties, the parties shall make a good faith effort to
resolve any such disputes by negotiation. The negotiation shall be attended by representatives of
Provider with full decision-making authority and hy Owner's staff person who would make the
presentation of any settlement reached during negotiations to Owner for approval. Failing
resolution, and prior to the commencement of depositions in any litigation between the parties
arising out of this ^bTfCement the parties shall attempt to resolve the dispute through Mediation
before an agreed-upon Circuit Court .MedialOr ceniflcd hy the State of Florida. The mediation shall
;;genda Item ND. : 6E2
March 10. 2009
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be attended by representatives of Provider with full decision-making authority and by Owner's staff
person who would make the presentation of any settlement reached at mediation to Owner's board
for approval. Should either party fail to submit to mediation as required hereunder, the other party
may obtain a court order requiring mediation under section 44.102, Fla. Stat.
22. VENUE: Any suit or action brought by either party to this Agreement against tile other party
relating to or arising out of this Agreement must be brought in the appropriate federal or state courts
in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters.
23. KEY PERSONNEL/PROJECT STAFFING: The proposer's personnel and management to be
utilized for tilis project shall be knowledgeable in their areas of expertise. The County reserves the
right to perform investigations as may be deemed necessary to insure that competent persons \"i11
be utilized in the perfonnance of the contract. Firm shall not change Key Personnel unless the
following conditions are met: (I) Proposed replacements have substantially the same or better
qualifications and/or experience. (2) that the County is notified in writing as far in advance as
possible. Firm shall make commercially reasonable efforts to notify Collier County within seven (7)
days of the change. The County retains final approval of proposed replacement personnel.
All other terms and conditions of the agreement shall remain in force.
IN WITNESS WHEREOF, the Provider and the County have each, respectively, by an authorized
person or agent, hereunder set their hands and seals on the date(s) indicated below.
Accepted:
,2009
Vocatus Medical Management Services
By:
Richard D. Otto, M.D.
ATTEST:
OWNER:
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
Dwight E. Brock, Clerk
By:
Donna Fiala, Chainnan
Approved as to fonll and
Legal sufficiency:
Assistant County Attorney
By:
/.\genca item f\lo. 16E2
March 10. 2009
Page 6 of 13
Jeff Walker, Project Manager/Department
Director
DIVISION ADMINISTRATOR
By:
Len Golden Price
CONTRACT SPECIALIST
By
Lyn M. Wood
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EXfiIRIT .~-l-A
PROPOSAL SUBMISSION BY:
VOCATUS MEDICAL MANAGEMENT SERVICES
Addition to:
RFP#OS-3748R
PRIMARY CARE SERVICES
Submitted December 17, 2008
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f\.1arch 1 D. 2009
F'age 8 of 13
INTRODUCTION
Vocatus Medical Management Services has been asked to submit a proposal for revision
to the original RFP for the provision of primary medical services. Specifically we have been
asked to submit a proposai for an offsite primary care clinic to supplement the current on site
clinic. The directions given for this proposal were flexible. Therefore the proposal as submitted
is an effort to provide an effective, efficient and cost effective service.
There were several potential options in the structure of this service including types of
providers, locations and intensity. At this time the most logical structure would be to add a 0.5
HE physician extender with appropriate physician supervision. This emulates the current
structure which has worked well for the county at a reasonable cost. At a later date ifthere
should be a need the half time FTE could easily be expanded. By this incremental increase
there will be less expense to the county. There is also significant flexibility in the arrangement
allowing for fairly immediate expansion at a later date if needed.
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FINANCIAL ANALYSIS
STAFFING COSTS
Below is the staffing cost analysis. The cost structure is similar to the original proposal. Due to
the economy of scale cost efficiency is utilized to allow for cost to the county less than
expected. The following is a detailed breakdown of the staffing costs. The amounts listed are
for a full time individual then multiplied by a factor taking into account utilization efficiencies.
Of note there has been no price escalation from the original proposal from 2005. In many areas
there has been price reduction.
PA/NP Medical Asst Receptionist
Salary 80,000 40,000 25,000
Malpractice Insurance 20,000
Pension 0 0 0
CME 2,000
Health Ins. 6,000 6,000 6,000
Taxes 7,000 3,500 2,000
Workman's Comp 900 450 250
Total: 115,900 49,950 33,250
Multiple 0.5 0.5 0.125
Total costs 57,950 24,974 4,155
Physician extender
Medical assistant
Clerical support
Medical Director
Administration
Rent and CAM
Total fixed cost
Profit margin 8%
Total cost
57,950
24,974
4,155
12,000
10,286
10,260
119,625
9,570
129,195
PRICE PROPOSAL
For 0.5 FTE
For 0.5 FTE
For 0.125 FTE
Covers physician oversight of PA or NP
See next page for breakdown
380 sq ft of medical space at $20jft, $7 CAM
annually
Reimbursable costs will be as per the original agreement that is now in place.
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/l.gen.ja Item [-Jo. 16E2
lv1arch 10,2009
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ADMINISTRATIVE COSTS
Annually
Personnel management
EMR and medical records
Data entry and coding
Report generation
Communications
Physician oversight
Misc.
1,200 Mostly time hiring and managing provider
5,000 Mostly for EMR hardware and software for Provider
2,886 Covers 3 hours per week at $20jhour
o
1,200 One phone and fax line for provider
o
o
Total
10,286
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CONCLUSION
The proposal submitted is intended to allow the expansion of services for the county primary
care clinic without adding significant costs. V oculus Medical Managclncnt Services has made
every cffi.Jrt to use its current infrastructure to lessen the expensc to the county. The current
positioning ofthc Vocatus clinic on Immokalec road will allow an alternative location for county
employees who live and work in that area. 13y utilizing existing stuffVocatus will be able to
implcmcnt this program \Nithin a short time framc probably not exceeding two montbs and
possibly within one month. The major limitations to a timely start date would be the hiring of
the provider who will directly provide the paticnt curc.
As stated previously we believe in the concept of this clinic and fully embrace its intent to
provide for the long term hcalth of county employees. Wc hale every confidcncc that this
service will be successful in these goals while also being cost effectivc. We hope to continuc
with our excellent partnership with the county and would happily respond to any funhcr
questions.
Jan 26 09 08:01a
VOCATUS PHYSICIAN GROUP
2395989384
Agenda Item No. 16E2
1'~'';aicI110, 2009
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Exhibit A-?-A
PRICE PROPOSAL SUMMARY
Year 1 Year 2 Year 3 Year 4 Year 5
Proposed contract $363,755 $363,755 $382,095 $382,095 $384,485
Extension
North Campus $128,941 $134,071 $142,438 $142,780 $143,132
Total $492,696 $497,826 $524,533 $524,875 $527,617
Monthly $41,058 $41,485 $43,711 $43,740 $43,968
Plus reimbursable expenses per contract