Metro. METRO SERVICE AREA Downtown. DowntownISan Gabriel Valley West Los Angeles South BayILong Beach San Fernando Valley

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1 Metro Los Angeles County One Gateway Plaza ZI~.~ZZ.ZOO( Metropolitan Transportation Authority Los Angeles, CA rnetro.net EXECUTIVE MANAGEMENT COMMITTEE JANUARY 19,2012 SUBJECT: MEDICAL CLINIC SERVICES ACTION: AWARD SIX CONTRACTS FOR MEDICAL SERVICES RECOMMENDATION Authorize the Chief Executive Officer to award a nine-year firm fixed unit rate contract under RFP No. PS , for medical services including various medical examinations and drug and alcohol collections for employees and job candidates, to the following clinics for a total aggregate not-to-exceed contract value of $5,321,075, inclusive of three two-year options. METRO SERVICE AREA Downtown DowntownISan Gabriel Valley West Los Angeles South BayILong Beach San Fernando Valley PROPOSER Temple Medical Center and Glendale Memorial Occupational Medical Group USHealthworks Commerce USHealthworks Los Angeles CareOnSite USHealthworks Van Nuys Metro conducts physical examinations and drug and alcohol specimen collections for employees and job candidates. These physical examinations and specimen collections are mandated by various funding and regulatory agencies, including the Department of Transportation (DOT), Federal Transit Administration (FTA), California Department of Motor Vehicles (DMV), and Cal-OSHA. DISCUSSION Under Human Resources Fitness for Duty Policy (HR 29), Metro conducts medical examinations to ensure individuals are able to perform the duties of their

2 positions in a safe and competent manner, meet the applicable commercial driver licensing requirements, and are free from the adverse effects of drug abuse and alcohol misuse. Holders of commercial driver licenses are required by law to have periodic physical examinations to recertify their medical cards. The maximum certification period is two years, but drivers with medical conditions such as hypertension or diabetes must recertify annually. Under its own authority, Metro also performs return-to-work physical examinations after leaves of absence of over thirty days for non-occupational illness, as well as in cases when employees experience a medical incident indicating a potential safety risk such as chest pain or dizziness. Clinics are located throughout Los Angeles County. The Human Resources Department assigns pre-employment examinations and corresponding druglalcohol testing to selected clinics in the downtown area. The Human Resources Department also assigns return-to-work examinations and the corresponding drug testing based on expertise and proximity either to Gateway or the employee's home. Divisions assign medical examinations required after medical incidents indicating a safety risk as well as random and incident-based druglalcohol testing to the clinic designated for their divisions or nearest to the site of the incident. Employees choose the clinic they wish for commercial driver license renewal examinations and the corresponding drug test. Basic services will be provided at all locations, while certain specialized services will only be provided at selected locations based upon expertise, location and cost to allow for better monitoring, consistency and cost effectiveness. DETERMINATION OF SAFETY IMPACT The medical clinics provide the capability for Metro to complete fitness for duty examinations, ensuring improved safety for our employees and patrons. FINANCIAL IMPACT The funding of $195,000 for medical clinic services for the last four months of FYI2 is included in cost center 6240, Human Resources Department under project , General Overhead. Since this is a multi-year contract, the cost center manager and Executive Officer will be responsible for budgeting the cost in future years, including any options exercised. Impact to Budget The source of funds for this contract is General Overhead funds, comprised of Federal, State and local funds. These funds are eligible for bus and rail operating costs. Medical Clinic Services

3 Provide the services in-house. This alternative would require establishing a medical services department with qualified specialized staff and equipment that meets the regulatory and certification standards. Currently, Metro does not have the staff with the capability of performing these examinations. A cost benefit analysis completed in 2005 and a survey of other large transit agencies indicated costs associated with establishing and maintaining such services would be greater than contracting for services. This alternative also does not address the need to have multiple, geographically dispersed locations to minimize disruptions and facilitate operational needs. Use mobile service providers to perform drug and alcohol collections. FTA requires random testing to be conducted at all days and hours of operation. Arrival of a mobile vendor could tip off everyone at the division that random testing is occurring, giving employees an opportunity to go out sick to avoid testing. Testing is also conducted with pre-employment physical exams, commercial driver license physical exams and immediately following accidents. In these cases, the employee is going to the clinic for medical services in addition to the drug and alcohol testing, making collections at the clinic more efficient. NEXT STEPS Following execution of the new contracts, the current vendors will continue to provide uninterrupted services. Two new vendors will be oriented to Metro procedures and begin providing services on March 1, Attachment: Procurement Summary Medical Clinic Services Page 3

4 Michelle Lopes ~ald&ll Chief Administrative Services Officer Arthur T. Leahy Chief Executive Officer J Medical Clinic Services Page 4

5 ATTACHMENT A PROCUREMENT SUMMARY Medical Clinic Services Contract Number: PS Recommended Vendors: Temple Medical Center, Glendale Memorial Occupational Medical Group, USHealthworks - Commerce, USHealthworks - Los Angeles, CareOnSite, USHealthworks - Van Nuys, and alternate Glendale Adventist Occupational Medical Center Type of Procurement (check one) : IFB [XI RFP RFP - A&E Non-Competitive Modification Task Order Procurement Dates: A. Issued: August 18,2011 B. AdvertisedIPublicized: August 24 and 25, 2011 C. Pre-proposal1Pre-Bid Conference: August 29, 2011 D. ProposalslBids Due: September 26, 2011 E. Pre-Qualification Completed: November 2, 2011 F. Conflict of Interest Form Submitted to Ethics: December 14, 2011 G. Protest Period End Date: January 24, 2012 Solicitations Picked BidsIProposals Received: 10 up1downloaded: Contract Administrator: Maria Lechuga Project Manager: Carol Holben Telephone Number: (2 1 3) Telephone Number: (2 1 3) A. Procurement Background This Request for Proposal is a competitively negotiated procurement using explicit evaluation factors issued to support the Human Resources medical examination and drug and alcohol-testing programs for Metro employees. The RFP was issued in accordance with Metro's Acquisition Policy and the contract type is firm fixed unit rate. No amendments were issued during the solicitation phase of the RFP, but answers were provided to six questions to clarify requirements in communications issued on September 1, 201 1, September 12,201 1 and September 20, Medical Clinic Services Page 5

6 A total of ten proposals from eight medical groups were received on September 26, The three proposals from USHealthworks were packaged together and logged as one at receipt. B. Evaluation of ProposalslBids A Source Selection Committee consisting of two staff members from Transit Operations and one from Human Resources was convened and conducted a comprehensive technical evaluation of the proposals received. The proposals were evaluated based on minimum technical qualifications with passlfail criteria and weighted supplemental evaluation criteria consisting of: Supplemental Criteria 50 percent Cost Proposal 50 percent The evaluation criteria are consistent with criteria developed for similar services procurements. Primary concern was assuring that each clinic and its staff met the minimum technical qualifications and that a contracted clinic would be geographically accessible to all operating divisions. It was also necessary to assure sufficient availability for drug/alcohol testing twenty-four hours a day and 365 days a year. The minimum technical requirements were in compliance with state and federal regulations. Medical clinics were required to meet minimum technical qualifications prior to being evaluated on added factors designed to identify those firms best able to meet Metro's specific medical and customer service needs. The intent was to select a panel of six qualified occupational medical clinics among which the work would be divided based primarily on geography. Seven of the ten medical clinics met the minimum qualifications and three clinics did not. They were eliminated from further competition. The remaining seven medical clinics continued in the evaluation process using the weighted evaluation criteria described above. The Source Selection Committee also conducted site visits of all clinics meeting the minimum technical requirements to confirm they had all the required equipment and facilities that were clean, well-designed and accessible by public transit. The supplemental criteria focused on (1) the expertise of the primary physician in providing specialized clinical services and (2) expanded hours of availability for drug and alcohol testing and conducting commercial driver's license physical examinations. While all clinics meeting the minimum technical requirements would be qualified to perform services, the supplemental criteria provided a means of differentiating between clinics as to which would best meet Metro's needs. Of the ten proposals received, seven demonstrated they met the minimum technical requirements. These seven proposers are listed below by geographic area to be served. Medical Clinic Services Page 6

7 SERVICE AREA Downtown Downtown ISan Gabriel Valley West Los Angeles South BayILong Beach San Fernando Valley PROPOSER Temple Medical Center and Glendale Memorial Occupational Medical Group Glendale Adventist Occupational Medical Center (Contingent) USHealthworks Commerce USHealthworks Los Angeles CareOnSite USHealthworks Van Nuys The Selection Committee is recommending immediate contracts be awarded to all of these clinics except Glendale Adventist because of its close geographic proximity (1.I3 miles) to another clinic that received a higher score. However, it is recommending that Glendale Adventist be approved as a contingency to allow for formal contracting should another contract be terminated or needs change based on service expansion such as the Gold Line extension. This need did arise during the current contract period and required a whole separate solicitation. Qualifications of the Medical Clinics Temple Medical Center (TMC): TMC is a privately owned medical practice located at 124 N. Vignes Street in Los Angeles and has been in business since The practice is devoted to occupational medicine, (injuries, fitness exams and drug and alcohol testing). The center has been contracted with Metro since 2005, providing satisfactory services and has also had contracts with Metro in the past. In addition to Metro, it provides similar services to Greyhound Lines, Veolia Transportation and MV Transit. Glendale Memorial Occupational Medical Group (GMOMG): GMOMG is a privately owned medical group established in It is located adjacent to Glendale Memorial Hospital at 222 W. Eulalia St., Suite 101 in Glendale. Services at the facility are split between 90% occupational medicine and 10% urgent care. While GMOMG has not had a contract with Metro, the medical group provides services for the City of Pasadena and the Los Angeles Unified School District Transportation Division. Glendale Adventist Occupational Medical Center (GAOMC): GAOMC is a licensed outpatient center of Glendale Adventist Medical Center and has more than 20 years experience. The practice is located at 600 S. Glendale Ave. in Glendale and is totally devoted to occupational health. While GAOMC has not had a contract with Metro, they provide services for the County of Los Angeles, Metropolitan Water District and the City of Glendale. Medical Clinic Services Page 7

8 USHealthworks - Commerce (USHW-C): USHW-C is part of a national corporation headquartered in Valencia, CA, that was founded in The Commerce Clinic is located at 3430 S. Garfield Ave. in Commerce, and services are divided between 95% occupational (injuries, fitness exams and drug and alcohol testing) and 5% urgent care. A contract with this site was initiated in March 201 1, to fill an essential service gap and services have been satisfactory. The clinic also provides services to the Los Angeles County Sheriff's Department. USHealthworks - Los Angeles (USHW-LA): USHW-LA is part of a national corporation headquartered in Valencia, CA that was founded in The Los Angeles Clinic is located at W. Eighth Street, Suite 100 just west of downtown Los Angeles and services are divided between 95% occupational (injuries, fitness exams and drug and alcohol testing) and 5% urgent care. This site has been contracted with Metro since 2005 and has been providing satisfactory services. The clinic also provides services to multiple local employers, including United Parcel Service and the Los Angeles County Sheriff's Department. CareOnSite (COS): COS, formerly known as Long Beach Medical Clinic, is a physician-owned medical corporation with the primary clinic located at 1250 Pacific Avenue in Long Beach and a satellite facility at 455 E. Carson Plaza Dr. in Carson. COS has been providing occupational medical services for 32 years. It has had multiple contracts with Metro in the past providing satisfactory services. COS also provides occupational health services for Long Beach Transit and multiple oil refineries. USHealthworks - Van Nuys (USHW-VN): USHW-VN is a part of a national corporation headquartered in Valencia, CA, that was founded in The Van Nuys Clinic is located at Roscoe Blvd., Van Nuys, and services are divided between 95% occupational (injuries, fitness exams and drug and alcohol testing) and 5% urgent care. This site has been contracted with Metro since 1996 and has been providing satisfactory services. The clinic also provides services to multiple local employers, including Pepsi-Cola. Medical Clinic Services Page 8

9 C. CostlPrice Analvsis Explanation of Variances The recommended total Contract Not-To-Exceed amount is made up of a firm fixed unit rate for each regular and special service anticipated to be performed by the clinics. In order to evaluate the pricing of proposals, the RFP pricing sheets included an annual estimated number of services to be performed by individual clinics. These annual estimated numbers were formulated by using the figures from the prior year across the projected number of clinics. Primary evaluation was based on a total of six clinics and on Tier I services provided by all clinics. Tier 1 services include commercial driver license medical examinations, clearance after medical incidents indicating a safety risk, and all types of drug and alcohol testing. In addition to the Tier I services, some clinics are being designated to provide the specialized Tier II and Tier Ill services on the basis of geography, expertise and prior experience in performing these types of examinations. Tier II services include return-to-work examinations after leaves of absence and other focused fitness examinations. Tier Ill services include pre-employment examinations and specialized testing such as for lead and asbestos. Pricing for these anticipated services will be added into the total contract amount. The recommended contract amounts for each clinic are best estimates. The actual numbers of services any one clinic provides may vary both because employees may choose which clinic they use for medical card renewal examinations and because of variation in the number of new hires and persons returning from medical leave. As with the last procurement, a contingency has been added of 5%. All payments will be on a fee basis. Metro, however, makes no commitment or guarantee of any specific volume of business that will be received by any given clinic. The recommended price has been determined to be fair and reasonable based upon adequate competition and comparison to the Independent Cost Estimate ("ICE"). The proposed total NTE for recommended awardees compares favorably to the ICE of $5,450,000 for the entire nine year term, inclusive of three two-year options. Medical Clinic Services Page 9

10 SUBTOTAL $5,067,690 CONTINGENCY 5% $ 253,385 TOTAL $5,321,075 D. Small Business Participation The Diversity and Economic Opportunity Department (DEOD) established a 5% Disadvantaged Business Enterprise (DBE) Anticipated Level of Participation (DALP) for this solicitation. The selected vendors did not list any DBE subcontractors nor commit to any DBE participation. Meeting the DALP is neither a condition of award nor an issue of responsiveness. Some of the reasons given by Medical Clinics for not utilizing DBEs are as follows: Unable to identify a DBE certified vendor andlor supplier that could provide relevant and cost-effective services for Metro's medical clinic services project. Medical Clinic Services Page 10

11 The medical clinic is a comprehensive and an all inclusive facility and thus able to do all related examination and testing by trained staff and medical providers. Unable to find DBE firms to fit their business needs at this time. Historically found that maintaining oversight and control of staff and services ensures the level of patient safety, efficiency, confidentiality, and convenience that cannot be achieved through the utilization of outside vendors. Medical Clinic Services Page 11

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