REQUEST FOR PROPOSAL (RFP) FOR CRITICAL ACCESS HOSPITAL FINANCIAL AND OPERATIONAL IMPROVEMENT SERVICES TEXAS ORGANIZATION OF RURAL & COMMUNITY HOSPITALS PO BOX 203878 AUSTIN, TX 78720 MAY 13, 2015
I. SUMMARY AND BACKGROUND Purpose of the Request for Proposal: The Texas Organization of Rural & Community Hospitals (TORCH) is inviting proposals for a highly skilled Respondent to provide a set of targeted financial and operational improvement services, interventions, consultation, training and education on key revenue cycle processes, infrastructure, reporting and management for up to 27 Texas Critical Access Hospitals (CAH). Respondent chosen by TORCH must be experienced, with strong references and have an established relationship working with CAHs. The Respondent must be able to provide the services described in this RFP by August 31, 2015. This project is funded by a grant from the Texas State office of Rural Health (SORH), through the Medicare Rural Hospital Flexibility (Flex) Program. About TORCH: TORCH is a non-profit, full-service, member-driven hospital association. Its mission is to be the voice and principal advocate for rural and community hospitals in Texas and to provide leadership and guidance to over 170 rural and community hospitals in addressing the unique needs and issues of these facilities. TORCH s headquarter is located in Austin, Texas. II. PROPOSAL GUIDELINES AND REQUIREMENTS Proposals must be received (hard copies either by mail or electronic copy by email) by TORCH no later than 5:00pm CST, May 21, 2015. Any proposals received after this date and time will not be considered. A duly authorized representative of the Respondent must execute the response submitted to this RFP. An unsigned proposal will not be accepted. Incomplete proposals may be rejected as non-responsive. Disclosure of Proposal Content: TORCH will not consider any Proposal that bears a copyright. If it is necessary for the Respondent to include proprietary or otherwise confidential information in its Proposal or other submitted information, the Respondent must clearly label that proprietary or confidential information. All proposals submitted will be property of TORCH and will not be returned. Proposals must be addressed to: Attn: Carrie Ruiz, P.O. Box 203878, Austin, TX 78720, or by email to cruiz@torchnet.org no later than 5:00pm CST, May 21, 2015. Proposal Selection and Evaluation: Eligible proposals will be considered and evaluated. If additional information, discussions, or negotiations are needed, TORCH will notify the Respondent. Awards are at the discretion of TORCH. The selection decision is anticipated to be announced May 22, 2015. Only the winning Respondent will be notified; non-winning Respondents will not be notified. The successful Respondent s response, this RFP, the Notice of Award, and any amendments will make up the Award Contract. Work is expected to commence upon Contract execution. All required services and deliverables must be completed by August 31, 2015. 1
III. PROPOSAL CONTENT: All proposals must include the following: 1. Organizational Information: Respondent must provide the following information: brief description of company, its mission and philosophy, and description of specialty practice area; formal name, principal place of business and mailing address; name and title of primary contact and contact information for POC; and number of professionals/employees; and a statement of assurances that company is in current, good financial standing and in compliant with state and federal pertaining to ethics. 2. Experience and Qualifications: Respondent must provide a description of its capabilities and expertise, including a description of relevant, representative services it has provided within the last 3 years that demonstrate its ability to successfully execute and complete the required services described in this RFP. Respondent must also describe its technical expertise and experience working with Critical Access Hospitals on financial and operational improvement interventions. 3. Work Plan and Project Schedule: Respondent must provide a detailed work plan outlining how it would plan and execute the required activities described in this RFP. The work plan must include an accompanying narrative that describes method/approach, procedures/work steps, start and compete dates for each required task, and their anticipated corresponding outcomes. The work plan should also include any anticipated risks, dependencies and assumptions. See details under Section IV. Scope of Work: Deliverables, subsections A-C. 4. Budget: Respondent must provide a detailed budget, showing all anticipated costs and expenditures for the successful execution of required activities outlined in this RFP. The budget must demonstrate evidence that financial resources are adequately and appropriately allocated among fee categories in a cost-effective and prudent business manner to accomplish the required scope of work. 5. Project Team: Respondent must provide information about its proposed project team for this project, including description of each person s role, responsibility, expertise and representative accomplishments. Attach CVs/resumes for staff assigned to this project. 6. References: Respondent must provide a list for other projected completed related to the work required in this RFP, along with any accompanying testimonies from past clients for similar type of work. 2
IV. SCOPE OF WORK: DELIVERABLES A. Target Services TORCH is seeking a highly skilled Respondent to deliver a set of targeted financial and operation improvement services, interventions, consultation and education on key revenue cycle processes, infrastructure, reporting and management for up to 27 Texas Critical Access Hospitals (CAH). The financial and operational services should be organized into four (4) intervention options: (1) Chargemaster Review; (2) Pricing Strategy Development; (3) Revenue Cycle Assessments; and (4) Revenue Cycle Team Development Respondent must provide the following key work steps as part of its proposed approach to service delivery: Develop an informational/educational document that describes the four (4) financial and operational assessment options available to the 27 participating hospitals Collect feedback on the selected intervention types for each participating hospitals Issue data request to hospitals as indicated by their selected intervention type Expectation to conduct site visits to participating hospitals, based on geography and hospital availability; all site visits conducted must be completed by August 14 th, 2015 Host one or more hospital-specific webinars to review findings and facilitate the development of performance improvement action plans Issue a final hospital-specific report containing recommendations of opportunities for improvement and applicable best practices Host four (4) statewide webinars, each based on a review of the intervention process and high-level, de-identified findings from the four intervention cohorts Present statewide findings at a TORCH-hosted statewide conference (TBD) Additional required details for each of the four intervention options: Activity Option 1: Chargemaster Review Project work for this option should start with hospital team identification, with the option, by the request of the participating hospital, to initiate with a full-day on-site kick-off meeting. Respondents must describe its proposed methodology for how it will manage and facilitate a focused project for a Chargemaster review with work steps. The Chargemaster review must include a high-level review of CDM contents, identification of department specific issues, provisions of results to revenue-producing departments and the development of a report to include line item CDM review for best practice description, revenue code assignment, duplicates and CPT/HCPCS assignment. Required deliverables under this option include: Conduct a high-level utilization review, 3
Review hospitals current chargemaster and charge capture process, identify of opportunities for improvement, and recommend actionable changes that lead to improvements; Provide best practices Chargemaster/Revenue Capture Process training; Education/presentations on ensuring departmental accountability and ownership and best practice Chargemaster/Revenue Capture Processes; and A report for each participating hospital with actionable recommendations and identification of ongoing performance metrics. Activity Option 2: Pricing Strategy Development Respondents must describe how it will manage and facilitate a focused project related to the development of a defensible pricing strategy with work steps that review department-specific prices and utilization, provide an analysis of current pricing strategy, and develop and implement pricing policies for procedures, supplies and pharmaceuticals. This activity option will also need to identify potential revenue capture issues and discuss with individual departments, review process for provision of patient quotes, and meet with Revenue Steering Committee to discuss pricing impacts on patients and payors. Deliverable for this activity options include: Review and documentation of department-specific prices and utilization, pricing strategy, and pricing policies and procedures; Education/presentations on developing a patient centered customer service platform and developing a defensible pricing strategy; and A report for each participating hospital in this activity with actionable recommendations and identification of ongoing performance metrics. Activity Option 3: Revenue Cycle Assessments Respondents must describe how it will manage and facilitate a focused project related to Revenue Cycle Assessment with work steps, including identification of issues and opportunities with hospital revenue cycle leadership, interviews with business office, coding and identified department managers and up to three (3) departments reviewed. For each targeted department, Respondent will identify and document opportunities for improvement and best practices to address issues and prevent them in the future and to provide a high-level review of business office functionality. The business office review will focus on policies and procedures for contractual adjustments, bad debt, self-pay collections and customer service. Deliverables for this activity option include: Interviews with business office, coding and department managers for up to three departments; High-level review of business office functionality, focusing on policies and procedures; Documentation and education/presentations on opportunities for improvement and best practices; and A report for each participating hospital with actionable recommendations and identification of ongoing performance metrics. Activity Option 4: Revenue Cycle Team Development 4
Respondents must describe how it will manage and facilitate a focused project related to Revenue Cycle Team Development with work steps, including identification of revenue cycle mission, creation of meeting agenda and strategic topics, and identification of team members. In addition, the project must include a review of available data components, development of audit process, and review of payment cycle pertaining to areas such as denials, self-pay, bad debt and customer service. Deliverables for this activity option include: Identification and development of a revenue cycle team, mission, meeting agenda, audit process, and review criteria for payment cycle for various areas, such as denials, selfpay, bad debt and customer services; Education/presentations on opportunities for improvement and best practices, including how to instill departmental ownership and accountability, and how to incorporate best practice revenue cycle teams; and A report for each participating hospital with actionable recommendations and identification of ongoing performance metrics. B. Education and Training Services Critical to the targeted intervention options described above is the need to provide focused, evidence-based educational training for those corresponding activities. Respondents must describe how it will plan, design and implement at least one virtual or in-person educational training activity for CAHs participating in those activities, as well as similar education that will be adapted and made available online for broader use among other interested CAHs. The educational training activity should be designed especially to complement and reinforce the intervention options. The selected Respondent will deliver these education webinars to hospitals in each activity cohort and to all hospitals in the project. C. Reporting Requirements Selected Respondent is required to submit to TORCH a monthly progress report of activities status, progress, and accomplishments, including any challenges and planned resolutions for addressing those challenges. Selected Respondent is required to final written document to provide comprehensive results of all efforts, services, deliverables and outcomes as part of this project. The final report must include all relevant data, charts, visualizations, and work products generated as part of this project. Finally, the final narrative report should include any relevant insights, observations, analysis, and best practices or use cases as a result of this project. V. BUDGET Respondents must provide a detailed budget along with a budget narrative that shows all anticipated costs and fees for the successful execution of required activities outlined in this RFP. The budget must demonstrate evidence that financial resources are adequately and appropriately allocated among fee categories in a cost-effective and prudent business manner to accomplish the required scope of work. If the organization submitting a proposal must outsource or contract any work to meet the requirements contained herein, this must be clearly stated in the proposal. Additionally, all costs included in proposals must be all-inclusive to include any outsourced or contracted work. 5
Any proposals which call for outsourcing or contracting work must include a name and description of the organizations being contracted. Contract terms and conditions will be negotiated upon selection of the winning Respondent for this RFP. VI. PROJECT TIMELINE Respondents are required to submit a detailed project timeline for the successful execution of all required activities. Services are expected to commence upon execution of the contract, which is anticipated to be on or around May 22, 2015. All required deliverables (activities, services, education, and reporting) must be completed by August 31, 2015. VII. QUESTIONS All questions regarding this proposal should be submitted in written via email to Carrie Ruiz at cruiz@torchnet.org and copied Quang Ngo at quang@torchnet.org. We will respond to questions as soon as possible upon their receipt. Proposals must be addressed to: Attn: Carrie Ruiz, P.O. Box 203878, Austin, TX 78720, or by email to cruiz@torchnet.org no later than 5:00pm CST, May 21, 2015. Proposals submitted after this deadline will not be considered. 6