ADDENDUM NO. 1
THE UNIVERSITY OF NEW MEXICO HOSPITAL
PURCHASING DEPARTMENT
933 Bradbury Dr. SE, Ste. 3165
ALBUQUERQUE, NM 87106
Date:
March 25, 2015
Request For Proposal:
RFP P318-15 UNM Health System Surgical Services Consulting
Services
Name of buyer:
Florencio Gallegos
This Addendum becomes a part of the Original document and Modifies, as noted below, the original
Price Request Proposal:

Q.
Questions and Answers (in red) Received as of March 20, 2015
Is there an existing perioperative team or committee, consisting of physicians,
managers, and staff already in place to promote and execute improvement initiatives either
by site or across your system? If so, what is the role of this team and/or other internal key
stakeholders with regard to project initiation, project planning, education delivery, and
facilitation of workshops (i.e., Kaizen or other improvement team Events)?
A.
We have an OR Executive Committee at UNM Hospital that is a committee charged
by the Medical Executive Committee (MEC). Neither group leads project, but many
projects are approved by this group. SRMC has an OR Committee of surgeons,
anesthesiologists and nursing.
Q.
How familiar with Lean concepts and tools are Surgical Services leadership,
physicians, and staff? Has any LEAN training already been completed by members of the
UNMH and SRMC teams (leadership, physicians, internal performance improvement staff,
other staff)?
A.
Many leaders are familiar and have been trained and many have not. SRMC has
done initial RIE (Rapid Improvement Events) in the operating room. SRMC has done
initial 5s-ing for materials management. SRMC is in the process of deploying Lean
Management throughout the organization.
Q.
What peri-operative performance data is available for all four sites, and at the
surgeon level: On time OR Starts, Block and OR utilization, room turnover times, close to
cut times, etc.
A.
This data exists in SurgiNet but has been challenging to produce into useful reports
at the individual surgeon level. SRMC has a monthly OR dashboard, daily internal
surgical volume counts, weekly dashboard for all operations, including OR activity. We
also have a surgeon level data on OR utilization, but not other metrics.
Q.
Are there standardized pre- and post- anesthesia guidelines in place at the
procedural level?
A.
Yes, there are pre and post anesthesia guidelines for all patients. Certain
procedural based guidelines exist for certain procedures.
Q.
Is there currently a nursing shared governance model?
A.
Yes
Q.
Do surgical service line peer review or medical staff leadership teams already exist?
Specifically, how is medical staff peer review broken up for the surgical population?
A.
Yes, organized through medical staff at department level. We have established
medical staff leadership both through the Chief of Staff and the organized medical staff
and through the service chiefs (department chairs). We conduct both focused and ongoing
peer reviews as indicated by ongoing quality monitoring and investigation of events. These
are primarily conducted by peers within a medical staff member’s department and/or
division.
Q.
Given the 95% occupancy rate noted in the Background section, are there any
initiatives, in parallel to peri-operative improvement efforts, to improve inpatient
throughput, and/or increase inpatient bed capacity?
A.
Yes
Q.
Does your PACU hold ICU overflow patients?
A.
Yes.
Q.
What electronic medical record system is utilized in Surgical Services, and is
surgical documentation integrated into post-op documentation?
A.
SurgiNet
Q.
Does Anesthesia document electronically?
A.
Yes
Q.
Given the level of growth in neurosciences and surgical oncology patients, is there
interest in creating centers of excellence for either?
A.
Yes
Q.
Does the organization participate in NSQIP, STS, or any other surgical based
registry?
A.
The organization participates in TQIP (Trauma), STS for about a year and is in the
process of hiring an abstractor and signing a contract to begin NSQIP.
Q.
EHR Vendor and current release:
Cerner PowerChart/SurgiNet 2012.1.33
Q.
Could you please indicate what information systems are being used to support the
following functions in Peri-operative Services:
Q.
Patient Scheduling
A.
SurgiNet
Q.
Patient Registration Admission Transfer and Discharge
A.
Cerner
Q.
Block Utilization and Case Scheduling System
A.
SurgiNet
Q.
Preoperative Clinical Documentation and Order Management
A.
SurgiNet
Q.
Intra-operative Clinical Documentation and Order Management
A.
SurgiNet
Q.
Post-operative Clinical Documentation and Order Management
A.
SurgiNet
Q.
Computerized Physician Order Management and Ordersets
A.
SurgiNet/PowerChart
Q.
Anesthesia Intra-Operative Documentation and Order Management
A.
SurgiNet
Q.
Bedside Medical Device Interface Documentation Capture
A.
SurgiNet
Q.
Automated Medication Dispense Systems Pre-Op, Intra-Op, Post Op
A.
Pyxis
Q.
Hospital Billing
A.
Siemens Invision, we are currently implementing Siemens Soarian.
Q.
Professional Billing
A.
GE IDX
Q.
Patient Education and Discharge Instructions
A.
SurgiNet/Cerner
Q.
Implant Tracking
A.
IPM
Q.
Patient Acuity Nursing/Staffing system
A.
None
Q.
Laboratory Information System
A.
Sunquest
Q.
Radiology and Imaging system and which modalities are supported
A.
Isite is the PACS system. There are multiple other Radiology systems.
Q.
Interventional Radiology
A.
Isite/Surginet
Q.
Cardiovascular Catheterization Lab
A.
Lumedex
Q.
Endoscopy
A.
EndoWorks
Q.
Instrument and Preference card Tracking and management
A.
SurgiNet/Censistrac
Q.
OR Supply and materials management systems
A.
Lawson
Q.
Are the facilities in scope the following?
A.
UNM Hospitals Yes
A.
UNM Children’s Hospital Yes (a part of UNM Hospital)
A.
UNM Sandoval Regional Medical Center Yes
A.
Outpatient Surgery and Imaging Center (OSIS) Yes (a part of UNM Hospital)
Q.
How many surgical suites are in scope?
A.
UNM Hospital Main OR 16 rooms
A.
UNM Children’s Hospital 6 rooms
A.
UNM Sandoval Regional Medical Center 6 rooms plus GI suite and Interventional
Radiology Suite
A.
Outpatient Surgery and Imaging Center (OSIS) 9 (6 regular plus 3 smaller
procedure rooms [Satellite])
Q.
Within each surgical suite, how many operating rooms exist are functioning and
what is annual number of surgical caseloads?
A.
UNM Hospital Main OR 16 rooms – 9655 cases
A.
UNM Children’s Hospital 6 rooms – 3639 cases
A.
UNM Sandoval Regional Medical Center 6 rooms – 3512 cases
A.
Outpatient Surgery and Imaging Center (OSIS) 9 (6 regular – 4714 cases) plus 3
smaller procedure rooms [Satellite] – 1480 cases)
A.
UNMH Anesthesia Mobiles 3761 cases
(Case volume calculated from July 2013 through June 2014)
Q.
What are your most pressing concerns that led to the RFP being issued?
A.
Essentially it is creating a more cost-efficient, high-quality, customer-friendly
surgical enterprise that will be sustainable into the future, creating a fully efficient
operating platform
Q.
Has Surgical Services employed consultants within the last five years and if so what
were the summary recommendations or output?
A.
Approximately 5 years ago. We changed the way we distributed block time,
including leaving flow rooms for urgent/emergent add-ons. We also restructured an OR
Executive Committee. SRMC opened in July of 2012 and has not utilized any consultants to
look at operations.
Q.
Describe the current Governance model for Surgical Services
A.
UNMH has an OR Executive Committee that is chartered by the Medical Executive
Committee (MEC). It makes decisions on Block Time allocations and authorizes our “Rules
of the Road.’ The Departmental Chairs are the clinical service chiefs and work for the
Dean via the School of Medicine. Surgical Services are departments of the Hospitals and
report to the CNO/CEO of each Hospital. All of these ultimately are under the authority
of the Chancellor of the Health Sciences Center. SRMC has an OR Committee. surgeons,
anesthesiologists, nursing/CMO/CNO.
Q.
Describe UNM’s strategic growth plan that will impact Surgical Service in the
future.
A.
We have a strategic plan for our entire enterprise. Surgical services has an expected
annual growth.
Q.
Help us understand how this project fits into UNM corporate performance
improvement initiatives.
A.
We have been attempting to become a LEAN organization and to become a more
user-friendly organization for our providers. We also want to grow to meet the health care
needs of all New Mexicans.
Q.
Who are the stakeholders and ultimate Executive Sponsor and purchaser of the
consulting services?
A.
This initiative is supported by our Chancellor, the Executive Physician-in-Chief of
UNM Health System, the CEO’s, CMO’s and CNO of our Hospitals, the Surgical and
Anesthesia Chairs, the Executive Director of Surgical Services at UNMH and the Director
of Surgical Services at SRMC. The Executive Physician for Health System Surgical
Services, the Executive Director of Surgical Services at UNMH and the Director of Surgical
Services at SRMC will be the points of contact directing this effort locally.
Q.
Describe UNM’s current internal Project Management and/or Lean capabilities.
A.
Under the auspices of the UNM Medical Group, we have a Clinical Practice
Excellence team that has been leading our LEAN journey and should be available to help
with project management.
Q.
Does UNM have the capacity to provide assistance from internal consulting /
project management resources?
A.
As noted above, we have a Clinical Practice Excellence team that has been leading
our LEAN journey and should be available to help with project management. However, the
Executive Physician for Health System Surgical Services and the Executive Director for
Surgical Services at UNM Hospital are the owners of the surgical services value stream in
our LEAN structure.
Q.
Due to the overlap of anesthesia coverage requirements and potential impact upon
the OR, should an analysis be performed on the NORA locations; Endoscopy, IR, Cath
Lab, etc.
A.
Yes. 3761 annual anesthesia mobile cases covering these areas and more.
Q.
Are all locations on the same EMR/EHR and define the operation system for each
A.
Yes. Cerner SurgiNet/PowerChart
Q.
What is the business intelligence application for the enterprise and what
company/version
A.
Siemens Invision Decision Support
Q.
Does the OR have a business manager?
A.
There is a business manager for UNMH surgical services. SRMC does not have an
OR business manager.
Q.
What is the general ledger application for the enterprise? i.e. Lawson, People Soft,
etc.
A.
Lawson
Q.
Indemnification. Consideration of mutual indemnification.
A.
No
Q.
Patent and Copyright Indemnity. Consideration of mutual indemnification.
A.
No
Q.
Offerors Public Liability Insurance. Consideration of industry norm of $1M/$3M
A.
Yes
Q.
Meals and incidentals. Is there an option for M&IE other than per diem? The
current GSA per diem rate of $46 is the maximum allotted, correct?
A.
Please reference Section IX Attachment A. As of Wednesday March 24, 2015, GSA
per diem rate is $46.
Q.
You have requested that the final report address “improved flow through the
hospital.” Is there an expectation that the assessment will include a review of inpatient
capacity and throughput? Is this specific to patients coming from or going to the OR?
A.
Specific to the patients coming to and from the OR.
Q.
You request “estimates of UNM Hospitals and UNM Sandoval Regional Medical
Center Surgical Services ability to realize growth targets.” Can you provide information on
anticipated growth? Is this request specific to surgical services only, or to the overall
hospitals’ capacity?
A.
Currently under review. Surgical Services
Q.
Section VII A (6) on page 21: You request that the final report “identify and
recommend cost saving and control measures for areas such as equipment, length of
stay, etc.” By “length of stay” do you mean PACU length of stay? Inpatient LOS for
surgical patients? Please clarify.
A.
For PACU only
Q.
Section VII A (12) on page 21: You request that the final report “provide
recommended staffing levels for optimal performance for each staffing position within the
Surgical Services environment to include nursing and anesthesia staff.” Does anesthesia
staff refer to both Anesthesiologists as well as CRNAs? Does this request also include
ancillary staff such as housekeeping and transport, or only direct care staff?
A.
Yes. All anesthesia providers are through the Department of Anesthesiology.
Anesthesia Assistants (AAs) are also utilized as mid-level providers. Yes
Q.
You have requested references in both section VI E 8 (page 20), and Section VII I
(page 23). Are more than four references required? Are these intended to be separate
references?
A.
Only four references are required.
ALL OTHER TERMS AND CONDITIONS WILL REMAIN THE SAME.
(End of Addendum)
This addendum becomes a part of the request Documents and modifies, as noted above, the
original Pricing Request Proposal documents identified. All other provisions of the pricing
document shall remain unchanged. This addendum is hereby made a part of the Request for
Pricing Documents to the same extent as those provisions contained in the original documents
and all itemized listing thereof.
Acknowledge receipt of this Addendum in the space provided on the Pricing Request Proposal
Form. Failure to do so may cause your proposal to be considered non-responsive and your
response rejected.