REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 28, 2022
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Amendments to the Medical Coding and Clinical Documentation Improvement Services Agreements
End
RECOMMENDATION(S)
Recommendation
Approve the following Amendments to the Medical Coding and Clinical Documentation Services contracts to increase the not-to-exceed contract amounts by $700,000 each, from amounts not-to-exceed $1,300,000 each, to amounts not-to-exceed $2,000,000 each, and extend the term of the contracts for one year, for a total term of July 1, 2019 through June 30, 2023:
1. Amendment No. 2 to Contract No. 19-412 with AE & Associates, LLC
2. Amendment No. 2 to Contract No. 19-413 with Himagine Solutions, Inc.
3. Amendment No. 4 to Contract No. 19-414 with AMN Workforce Solutions, LLC
(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) as the additional not-to-exceed cost of $700,000 for each of the three contracts 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 are included in Arrowhead Regional Medical Center’s (ARMC) 2021-2022 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
Approval of these agreements will allow ARMC to increase the not-to-exceed contract amounts and continue receiving medical coding and clinical documentation improvement specialist services while a competitive bid process is utilized to implement new contracts. As ARMC expands to provide new services, the number of patients utilizing ARMC facilities is increasing. The increase in patient volume has led to a greater need for medical coding and clinical documentation improvement services staff to assist ARMC staff coders with coding medical records. ARMC and Human Resources are working in conjunction on the recruitment and identification of qualified candidates for open positions. ARMC and Human Resources are revisiting the impacted classifications and the minimum qualifications to develop recommendations to ensure positions are competitive and transition to regular positions for classifications such as Coding and Clinical Documentation Improvement Specialists, Supervisor, and the Assistant Director. ARMC will request Public Service Employees (PSEs) as a pathway to Health Information Management Assistant (HIMA) I and II, and have an open recruitment for the Supervising HIMA. Recruitment efforts include the posting of paid ads.
ARMC is expanding the roles of the Coding and Clinical Documentation Improvement programs provided by the contractors by continuing the expansion to outpatient services, handling the new electronic health record system (Epic) workflows, and assisting with conversion of the legacy system into Epic. There is a need to onboard staff quickly to recover costs of this service line and to continue to bring the hospital in compliance with industry standards of 48-hour turnaround for billing and coding. The increased coding support services usage rate resulted in a need to increase the contract amounts to ensure timely and accurate coding of patient medical records. ARMC has traditionally used coding support services to assist with staffing leaves of absences.
On June 25, 2019 (Item No. 12), the Board of Supervisors (Board) approved Contract No. 19-412 with AE & Associates, LLC (AE), Contract No. 19-413 with Himagine Solutions, Inc. (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 the contract to AMN Workforce Solutions (AMN) as a result of a corporate merger, effective July 1, 2019, with no 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 update hourly rates for CDI Leadership Services, with no other change to the total cost of the agreement, or the contract term.
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 increase the not-to-exceed contract amount by $500,000 each, from $800,000 to $1,300,000, and to update hourly rates, with no change to the contract term.
PROCUREMENT
Contracts were awarded to these vendors as the result of a competitive solicitation, Request for Proposal (RFP) ARMC119-ARMC-3287. Purchasing continues to support the competitive nature of this procurement. A new RFP for the competitive solicitation is being developed for a July 1, 2023 contract effective date.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on June 3, 2022; Purchasing Department (Ariel Gill, Buyer, 777-0722) on April 14, 2022; Human Resources (Gina King, Deputy Director, 387-5571) on June 2, 2022; ARMC Finance (Chen Wu, Finance Budget Officer, 580-3165) on June 6, 2022; Finance (Jenny Yang, Administrative Analyst, 387-4884) on June 10, 2022; and County Finance and Administration (Diana Atkeson, Deputy Executive Officer, 387-5423) on June 10, 2022.