REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 27, 2023
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Amendments to the Medical Coding and Clinical Documentation Improvement Services Contracts for Temporary Staff
End
RECOMMENDATION(S)
Recommendation
Approve the following Amendments to Contracts for temporary staff for the provision of medical coding and clinical documentation improvement services, increasing the not-to-exceed contract amounts as indicated below, from amounts not-to-exceed $2,000,000 each, and extending the term by three months, for a total term of July 1, 2019 through September 30, 2023:
1. Amendment No. 3 to Contract No. 19-412 with AE & Associates, LLC., increasing the not-to-exceed contract amount by $100,000 to a total amount not-to-exceed $2,100,000.
2. Amendment No. 3 to Contract No. 19-413 with Himagine Solutions, Inc., increasing the not-to-exceed contract amount by $300,000 to a total amount not-to-exceed $2,300,000.
3. Amendment No. 5 to Contract No. 19-414 with AMN Workforce Solutions, LLC, increasing the not-to-exceed contract amount by $412,000 to a total amount not-to-exceed $2,412,000.
(Presenter: William L. Gilbert, Director, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The cost of $100,000 for AE & Associates, LLC (AE), $300,000 for Himagine Solutions, Inc. (Himagine), and $412,000 for AMN Workforce Solutions, LLC (AMN), is funded by State Medi-Cal, Federal Medicare, private insurances, and other departmental revenue. Funding sources may change in the future pending any legislative activity related to the repeal and/or replacement of the Affordable Care Act. Adequate appropriation and revenue have been included in the Arrowhead Regional Medical Center (ARMC) 2022-23 budget and will be included in the ARMC 2023-24 recommended budget.
BACKGROUND INFORMATION
ARMC has used temporary staff from AE, Himagine, and AMN to assist ARMC Coding and Clinical Documentation Integrity teams with reviewing and assigning accurate diagnostic codes for health care services rendered by the hospital. The services provided by temporary staff were needed longer than ARMC anticipated to allow for the completion of a Request for Proposals for new contracts and a smooth transition between incumbent and newly awarded contractors, and provide the needed time to onboard new staff.
As ARMC implemented a new electronic health record system in February 2022, tasks were delegated to the Health Information Management, which required contracted temporary help. The unanticipated delegation of the tasks required the onboarding of three full-time and two part-time temporary coders to assist with the completion of the tasks, which lasted approximately two months. As a result, the additional costs incurred will exceed the anticipated amount originally allocated to the contracts. The recommendation for the extension is to allow for staff to transition to the newly awarded contracts, based on the Request for Proposal (RFP) No. ARMC122-ARMC-4561 process.
As a result of evaluations of the proposals received, contracts are recommended to be awarded to three new vendors on June 27, 2023. Approval of these new contracts for Health Information Management Consulting Contracts will be presented to the Board of Supervisors at the same meeting on June 27, 2023. ARMC will need to extend the current contracts for three months and increase contract amounts to allow for transitioning between the current vendor staff and the new vendor staff.
On June 25, 2019 (Item No. 12), the Board of Supervisors (Board) approved Contract No. 19-412 with AE, Contract No. 19-413 with Himagine, and Contract No. 19-414 with Peak Health Solutions, LLC (Peak) for medical coding and clinical documentation improvement services on a fee-for-service basis, for a total aggregate amount of $2,400,000, for the three-year period of July 1, 2019 through June 30, 2022.
On January 7, 2020 (Item No. 14), the Board approved Amendment No. 1 to Contract No. 19-414 with Peak to assign Contract No. 19-414 to AMN as a result of a corporate merger, effective July 1, 2019, with no other changes to the contract terms.
On October 6, 2020 (Item No. 8), the Board approved Amendment No. 2 to Contract No. 19-414 with AMN to add clinical documentation improvement leadership services and a related hourly rate, with no other change to the contract terms.
On March 23, 2021 (Item No. 8), the Board approved Amendment No. 1 to Contract No. 19-412 with AE, Amendment No. 1 to Contract No. 19-413 with Himagine, and Amendment No. 3 to Contract No. 19-414 with AMN to change and increase the contract amounts such that they were increased by $500,000 each, for a not-to-exceed amount of $1,300,000 each, with no change to the contract term of July 1, 2019 through June 30, 2022.
On June 28, 2022 (Item No. 20), the Board approved Amendment No. 2 to Contract No. 19-412 with AE, Amendment No. 2 to Contract No. 19-413 with Himagine, and Amendment No. 4 to Contract No. 19-414 to increase the not-to-exceed contract amount by $700,000 each, from a not-to-exceed amount of $1,300,000 each to a not-to-exceed amount of $2,000,000 each, and to extend the term of the contracts for one year, for a total term of July 1, 2019 through June 30, 2023.
ARMC recommends approval of this Amendment for continued use of temporary staff to assist Coding and Clinical Documentation Integrity teams with reviewing and assigning accurate diagnostic codes for health care services rendered by the hospital.
PROCUREMENT
The amendments are a continuation of a competitive procurement based on RFP No. ARMC119-ARMC-3287 which was approved for release by the County Administrative Office on February 26, 2019. The contracts were approved by the Board on June 25, 2019 (Item No. 12). The Purchasing Department continues to support the competitive nature of this procurement.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on June 1, 2023; Purchasing (Ariel Gill, Buyer III, 777-0722) on June 2, 2023; ARMC Finance (Chen Wu, Finance Budget Officer, 580-3165) on June 5, 2023; Finance (Jenny Yang, Administrative Analyst, 387-4884) on June 8, 2023; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on June 9, 2023