Backup Documents 03/10/2009 Item #16E 2
MEMORANDUM
DATE:
March 12, 2009
TO:
Lyn Wood, Contract Specialist
Purchasing Department
FROM:
Teresa Polaski, Deputy Clerk
Minutes and Records Department
RE:
Contract #05-3748R: "On-site Primary Care Health
Services"
Contractor: V ocatus Medical Management Services of
Naples
Enclosed, please find an original, referenced above (Agenda Item #16E2)
approved by the Board of County Commissioners on Tuesday, March 10,
2009.
An original Agreement is being held in the Minutes and Records
Department in the Official Records of the Board's
If you should have any questions, you may contact me at 252-8411.
Thank you,
Enclosures
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REQUEST FOR LEGAL SERVICE~ c.J t;~..s -J----
March 10, 2009 {L. R I ; ~ .,.)I . j?J
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Lyn M. Wood, C.P,M. 4? "yf) ~'Ij
Contract Specialist ~ v vO ,.., 11
252-2667 <J ~OJl' I
Contract: Amendment #1 for Contract #OS-3748R "On-Site Primary Care /1...) J/ } P q
Health Services" ./
Contractor: Vocatus Medical Management Services of Naples
FILE NO.:
ROUTED TO:
Date:
From:
Re:
BACKGROUND OF REQUEST:
This agreement was approved by the Board of County Commissioners on March
10,2009, Agenda Item l6.E.2
This item has not been previously submitted.
ACTION REQUESTED:
Contract amendment review and approvaL
OTHER COMMENTS:
Please forward to the Board of County Commissioners for signature after
approvaL If there are any questions concerning the document, please contact me.
Thank you.
C: Jeff Walker, Risk Management
EXHIBIT A-I Contract Amendment #1
"On-Site Primary Care Health Services"
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This amendment, dated 'f1a.r~ 10 ,2009 to the referenced agreement shall be by and
between the parties to the original Agreement, V ocatus Medical Management Services of Naples (to be
referred to as "Provider") and Collier County, Florida, (to be referred to as "Owner").
Statement of Understanding
RE: Contract #05-3748R - "On-Site Primary Care Health Services"
[n 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
"Al-A" attached to this Amendment and incorporated herein by reference. This Amendment shall
extend the Agreement through November 14,2014.
The following sections are amended as follows:
2, STATEMENT OF WORK, is amended to include Provider's proposal to establish a second
MedCenter at 4513 Executive Drive, Naples, Florida, dated January 26, 2009, attached hereto as
Exhibit A-I-A, and made an integral part of the Agreement. The Provider shall establish the
additional service facility located at 4513 Executive Drive, Naples, Florida, as expeditiously as
possible, and shall begin service at the additional facility after five (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 4513 Executive Drive, Naples, Florida, prior to November 15,
2009, shall be based on a monthly proration of one hundred twenty-eight thousand nine hundred forty-
one dollars ($128,941) fee set forth for Year I for that location in the Price Proposal Summary.
The following sections are added to the Agreement:
18. IMMIGRATION LAW COMPLIANCE. By executing 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 the Immigration Refonn and Control Act of 1986 as located at 8
U.S.c, 1324, et seq. and regulations relating thereto, as either may be amended, Failure by the
Providerr to comply with the laws referenced herein shall constitute a breach of this agreement and
the Owner shall have the discretion to unilaterally terminate this agreement immediately.
19. AGREEMENT TERMS. [I' 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 effect.
20. ADDITIONAL 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 RESOLUTION. Prior to the initiation of any action or proceeding permitted by this
Agreement 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 by 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 Agreement, the parties shall attempt to resolve the dispute through Mediation
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before an agreed-upon Circuit Court Mediator certified by the State of Florida, The mediation
shall 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 the 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 PERSONNEUPROJECT STAFFING: The proposer's personnel and management to be
utilized for this 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 will
be utilized in the performance of the contract. Finn shall not change Key Personnel unless the
following conditions are met: (1) 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 ofthe 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:
fYI a....-c.h 10
,2009
V ocatus Medical Management Services
By: ~.,~
Richacl'.' ttO, ..
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OWNER:
BOARD OF COUNTY COMMISSIONERS
COLLIER CO Y, FLORIDA
By:
Donna
Item #
110 b-62...
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Agooda
Date
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Deputy Clerk
, Project Manager/Department
DNISION ADMINISTRATOR
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By: y<CLfL~C'if!d.;:J1 /':'U.~L
Len Golde' Price
CONTRACT SPECIALIST ,
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By ~..'IY- '>>7 It)d, /
Lyn Nt od
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EXHIBIT A-I-A
PROPOSAL SUBMISSION BY:
VOCATUS MEDICAL MANAGEMENT SERVICES
Addition to:
RFP#OS-3748R
PRIMARY CARE SERVICES
Submitted December 17, 2008
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 proposal 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 ofthis 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 if there
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
T ota I 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
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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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ADMINISTRATIVE COSTS
Annually
Personnel management
EM R 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
CONCLUSION
The proposal submitted is intended to allow the expansion of services for the county primary
care clinic without adding significant costs. V ocatus Medical Management Services has made
every effort to use its current infrastructure to lessen the expense to the county. The current
positioning of the Vocatus clinic on lmmokalee road will allow an alternative location for county
employees who live and work in that area. By utilizing existing staff V ocatus will be able to
implement this program within a short time frame probably not exceeding two months 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 patient care.
As stated previously we believe in the concept of this clinic and fully embrace its intent to
provide for the long term health of county employees. We have every confidence that this
service will be successful in these goals while also being cost effective, We hope to continue
with our excellent partnership with the county and would happily respond to any further
questions.
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Jan 26 09 08:01 a
VOCATUS PHYSICIAN GROUP
2395989384
p.8 16 E 2
Exhibit A-2-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