Health Services Coalition
Hospital Services
Request for Proposal
April 15, 2010
Health Services Coalition
Request for Hospital Service Proposals
Contents
1.
2.
Introduction ............................................................................................................................. 1
1.1.
Health Services Coalition Background and Mission ....................................................... 1
1.2.
Request for Proposal Approach – We Want Us to be Better ........................................... 1
1.3.
Proposers’ Conference ..................................................................................................... 2
1.4.
RFP Evaluation by the HSC ............................................................................................. 2
1.5.
RFP Deadline ................................................................................................................... 3
Hospital Patient Care Quality ................................................................................................. 3
2.1.
CMS Quality Indicators ................................................................................................... 4
2.1.1.
Historical Statistics ................................................................................................... 4
2.1.2.
2012 Quality Goals – CMS Quality Indicators ......................................................... 7
2.2.
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ....... 8
2.2.1.
Historical Statistics ................................................................................................... 8
2.2.2.
2012 Quality Goal - HCAHPS................................................................................ 10
2.3.
Hospital Acquired Infections ......................................................................................... 11
2.3.1.
Historical Statistics ................................................................................................. 11
2.3.2.
2012 Quality Goal – Hospital Acquired Infections ................................................ 12
2.4.
Readmission Rates ......................................................................................................... 13
2.4.1.
Historical Statistics ................................................................................................. 13
2.4.2.
2012 Quality Goals - Readmissions........................................................................ 14
2.5.
Births and Deliveries ...................................................................................................... 15
2.5.1.
Historical Statistics ................................................................................................. 16
2.5.2.
2012 Quality Goals – Births and Deliveries ........................................................... 16
2.6.
CMS Hospital-Acquired Conditions and NQF Serious Reportable Adverse Events .... 17
2.6.1.
Historical Statistics ................................................................................................. 17
2.6.2. 2012 Quality Goals – Hospital-Acquired Conditions and Serious Reportable
Adverse Events ..................................................................................................................... 18
3.
Alternative Service Delivery Model Proposals..................................................................... 19
4.
Rate Proposal ........................................................................................................................ 19
Health Services Coalition
Request for Hospital Service Proposals
1. Introduction
Current hospital contracts with the Health Services Coalition (HSC) expire December 31,
2010. In issuing this request for proposal (RFP), the HSC is attempting to start a multi-year,
broad based process of realigning economic and other incentives to improve the quality and
value of health care for our constituents in the Las Vegas area. In short, the HSC wants us,
including its hospitals to be better.
This first section provides some background information regarding the Health Services
Coalition and the motivations to issue this request for proposal.
1.1. Health Services Coalition Background and Mission
The Health Services Coalition (HSC) was formed in 1989 as the Health Services
Purchasing Coalition. Currently, there are 24 groups representing employer and union
sponsored benefit plans. Those organizations commit to the Coalition’s goals of quality,
affordable and accessible health care. The HSC also has taken an active role in
supporting legislative initiatives that would improve the quality of health care in our
community.
A total of 260,000 members are enrolled in self-funded plans offered to them. For the
twelve-months ending September 30, 2009, Coalition members spent over $831 million
for all medical and pharmacy services, of which $242.8 million was with Las Vegas area
hospitals.
1.2. Request for Proposal Approach – We Want Us to be Better
There is widespread agreement that there are significant opportunities to better the
quality and reduce the cost of hospital care, both nationally and in Nevada. A variety of
projects across the country have shown that dramatic reductions can be achieved in
hospital-acquired infections and complications, readmissions and overused procedures
such as Cesarean sections, etc. These projects have shown that changes in the way care
is delivered can achieve better outcomes for patients as well as reduce costs for payers.
The data available in Nevada suggest that there are many opportunities here to achieve
these kinds of benefits, and make us all better.
There also is widespread national agreement that current methods of paying for hospital
care and other healthcare services can present barriers to implementing these desirable
changes in care delivery. Today, both hospitals and physicians are paid primarily based
on how many patients they see and how many services they deliver, not on the quality of
services or their effectiveness in improving a patient’s health. Moreover, under current
payment systems, both hospitals and physicians may actually be financially penalized
for providing better quality services and/or reducing unnecessary utilization of services.
Rather than continuing with the current flawed payment methods and simply negotiating
with hospitals regarding the rates of reimbursement, the Health Services Coalition is
willing to make significant changes in payment methods for those hospitals which are
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willing to take effective, aggressive steps to achieve better quality and value of the care
they deliver.
Consequently, as part of this RFP, the HSC invites hospitals to propose:
 Changes in the ways the hospital will deliver services to its patients that will achieve
better outcomes for patients and reduce overall healthcare costs for THE HSC.
 Any changes in the way THE HSC pays the hospital and, if appropriate, physicians
and other healthcare providers, that the hospital believes are necessary for it to
implement the proposed service changes in a financially viable manner.
The HSC recognizes that moving to a value based health delivery system will require a
significant transition period for both purchases and providers. While some programs
may already be underway at various hospital facilities and the rewards will be realized in
the near-term, others have not yet begun. Hospitals are encouraged to propose solutions
regardless of their time horizon. The HSC is interested in initiatives that will deliver
short term gains, as well as initiatives that are more transformational over the long term.
We expect that as local purchasers and as providers we have the mutual goal of assuring
the best and most affordable care for the patients in our communities over many years to
come. The goal is to look at what positive changes can be pursued through the RFP and
contract negotiation process.
1.3. Proposers’ Conference
A pre-bid conference will be held on May 5, 2010 at 10:00 a.m. Interested parties will
be able to ask questions regarding the RFP at that meeting. A conference number will
also be available for those wishing to attend telephonically.
Health Services Coalition Office
2300 W. Sahara Ave, Suite 800
Las Vegas, NV 89102
Conference Number: 866-642-1665
Passcode: 354177
The HSC will make every effort to post questions and answers to its website for
potential proposers to access. The HSC website is www.lvhsc.org.
1.4. RFP Evaluation by the HSC
Hospitals are not obligated to include quality improvement proposals as part of their
response to the RFP. However, the HSC intends to develop and implement methods of
encouraging and incenting its members to use hospitals which deliver better value care,
so those hospitals which submit successful proposals can expect to receive a greater
share of hospital spending from THE HSC, and those hospitals which do not submit such
proposals can expect to receive a smaller share.
The HSC reserves the right to reject any proposal if it believes it will not make
sufficiently large improvements in both the quality and cost of care for patients, or if the
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hospital has not presented an adequate business case explaining the need for the
proposed payment changes, or if the payment changes are not technically feasible during
the current contract cycle.
In addition, if THE HSC receives multiple proposals for care changes needing payment
changes, it reserves the right to select only the subset that it believes will deliver the best
value.
1.5. RFP Deadline
Responses to this RFP are due no later than Wednesday June 2, 2010. Electronic
submissions are encouraged. Please send proposals to Leslie Johnstone, HSC Executive
Director at ljohnstone@lvhsc.org. If sending hard copies, please include six sets to:
Health Services Coalition
Attn: Leslie Johnstone, Executive Director
2300 W. Sahara Ave., Suite 800
Las Vegas, NV 89102
2. Hospital Patient Care Quality
While there are innumerable statistics and methodologies by which hospital patient care
quality can be analyzed, this RFP focuses on six main areas1.






CMS Quality Indicators
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
Infection Control
Readmission Rates
Births and Deliveries
CMS Hospital-Acquired Conditions and NQF Serious Reportable Adverse Events
Some indicators are publically reported while others are not. In all cases, efforts have been
made to ask only for data that the hospitals are responsible for reporting to regulatory bodies.
For those items that are not publically reported, that information will be held confidential by
the HSC.
Proposers are asked to provide three year historical data for each quality measure. In
addition, 2012 goals are requested along with process improvement plans for meeting those
goals. For facilities that are part of a multi-hospital organization, data for each Las Vegas
area hospital is requested along with composite values for all hospitals within that
organization.
In all of these quality areas there are usually several contributing factors to the results. One
area of concern for hospitals is physician related. However, it is important to note that
hospitals credential and re-credential providers and have the responsibility and authority to
monitor their performance and take the appropriate action when deemed necessary in order to
1
Other quality indicators may be included in proposals or may be included in upcoming contract negotiations.
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provide for patient safety and quality of care. In addition, discharge planning is the
responsibility of the hospitals. Thus, any unsafe or inappropriate discharge should be
identified by the discharge planner prior to discharge in order to intervene in a timely and
appropriate manner.
2.1. CMS Quality Indicators
2.1.1. Historical Statistics
The Centers for Medicare and Medicaid (CMS) publically reports hospital quality
using 25 different indicators involving heart attack, heart failure, pneumonia and
surgical infection prevention. This data is reported on a rolling twelve-month
basis with an approximate nine month lag. For each measure the denominator is
the number of eligible cases, and the numerator is the number of eligible cases
where the recommended care was provided. The overall success (performance)
rate for each hospital is calculated by summing the numerators and denominators
for all measures reported.
To be completed by proposer (Tables I – V): For each clinical area reported to
CMS, the following table reports the overall performance rate2 for Las Vegas
hospitals annually (July 2006 - June 2007 and July 2008 – July 2009). Each
proposing hospital is asked to:




Provide the applicable data for the July 2007 – June 2008 time period.
Provide the applicable data for the most recent six month period (July
2009 – Dec 2009). It is understood that the information provided by each
proposing facility for the most recent six month period will be held
confidential by the HSC.
Populate the applicable historical data reported to CMS organization-wide
if multiple facilities are owned (in the row labeled “Composite for All
Hospitals within Organization”).
Proposing hospitals from outside the Las Vegas area should submit data
for all time periods (please provide data for each individual hospital by
name).
Table I
AMI (Heart Attack) Performance Rate
Facility
2
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
St. Rose – De Lima
96%
100%
St. Rose – San Martin
90%
96%
St. Rose – Siena
98%
98%
Mountainview
94%
99%
Percent of patients receiving recommended care across each set of disease-specific indicators
July 2009 –
Dec 2009
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Table I
AMI (Heart Attack) Performance Rate
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
Southern Hills
89%
93%
Sunrise
91%
98%
North Vista
88%
95%
Boulder City
100%
n/a
Centennial Hills
n/a
95%
Desert Springs
92%
97%
Spring Valley
93%
98%
Summerlin
89%
94%
Valley
90%
98%
Univ Medical Center
94%
98%
July 2009 –
Dec 2009
Other - Name
Composite for All
Hospitals within
Organization
Table II
Heart Failure Performance Rate
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
St. Rose – De Lima
93%
98%
St. Rose – San Martin
81%
96%
St. Rose – Siena
90%
97%
Mountainview
85%
92%
Southern Hills
83%
96%
Sunrise
73%
91%
North Vista
85%
98%
Boulder City
56%
85%
Centennial Hills
n/a
79%
Desert Springs
79%
94%
Spring Valley
100%
100%
Summerlin
69%
90%
Valley
77%
95%
Univ Medical Center
91%
81%
Other - Name
July 2009 –
Dec 2010
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Table II
Heart Failure Performance Rate
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
Dec 2010
July 2008 –
June 2009
July 2009 –
Dec 2009
Composite for All
Hospitals within
Organization
Table III
Pneumonia Performance Rate
Facility
July 2006 –
June 2007
July 2007 –
June 2008
St. Rose – De Lima
93%
97%
St. Rose – San Martin
83%
94%
St. Rose – Siena
93%
97%
Mountainview
85%
96%
Southern Hills
84%
97%
Sunrise
85%
97%
North Vista
90%
95%
Boulder City
72%
81%
Centennial Hills
n/a
92%
Desert Springs
81%
87%
Spring Valley
84%
89%
Summerlin
78%
90%
Valley
75%
85%
Univ Medical Center
85%
85%
Other - Name
Composite for All
Hospitals within
Organization
Table IV
SCIP (Surgical Infection) Performance Rate
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
St. Rose – De Lima
78%
98%
St. Rose – San Martin
69%
96%
St. Rose – Siena
77%
95%
July 2009 –
Dec 2009
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Table IV
SCIP (Surgical Infection) Performance Rate
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
Mountainview
78%
97%
Southern Hills
65%
96%
Sunrise
83%
97%
North Vista
69%
95%
Boulder City
n/a
84%
Centennial Hills
n/a
93%
Desert Springs
72%
93%
Spring Valley
83%
93%
Summerlin
75%
94%
Valley
81%
91%
Univ Medical Center
78%
89%
July 2009 –
Dec 2009
Other - Name
Composite for All
Hospitals within
Organization
HealthInsight is an organization which, using publically reported data, ranks
hospital performance on this overall rate and then convert the ranks to percentiles.
Their analysis uses all performance measures included in the database and does
not exclude any hospitals or measures based on the number of cases in the
denominator. The HSC has access to Health Insight’s reporting for the prior three
annual reporting periods for hospitals located in Nevada. Proposing hospitals
from outside Nevada should submit data for all time periods using the following
format:
Table V
National Ranking (percentile)
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
Other - Name
2.1.2. 2012 Quality Goals – CMS Quality Indicators
The HSC assumes that each facility has internal goals for each CMS quality
indicator. In addition, process improvements may be planned or already
underway to effect more efficient achievement of those goals.
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To be completed by proposer (Table VI): For each quality area, please describe
your internal goal for 2012. Also describe any process improvements that are
required to improve the results. This should include a high level action plan with
timeframes. For hospitals who are proposing services from multiple facilities,
please provide a separate response for each facility.
Table VI
2012 Quality Goals
Hospital Name: to be completed by proposer
Clinical Area
Internal
Goal
Process Improvements /
Timeframe
AMI (Heart Attack)
Performance Rate
Heart Failure Performance
Rate
Pneumonia Performance
Rate
SCIP (Surgical Infection)
Performance Rate
2.2. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
HCAHPS is a national, standardized survey of patients’ perspectives of hospital care.
The survey asks a random sample of discharged patients 27 questions about their recent
hospital stay. For each participating hospital results on 10 measures (six summary
measures, two individual survey items and two global ratings) are publically reported on
the Hospital Compare website.
2.2.1. Historical Statistics
The Centers for Medicare and Medicaid (CMS) publically reports HCAHPS data
on a rolling twelve-month basis with an approximately nine month lag.
To be completed by proposer (Tables VII - VIII): The following table reports
the mean most favorable response rate as reported by HealthInsight3 for Las
Vegas hospitals for the periods October 2007 - June 2008 and July 2008 – June
2009. Each proposing hospital is asked to:

3
Provide the applicable data for the most recent six month period (July
2009 – December 2009). It is understood that the information provided by
The national rankings presented here are based on the percentage of survey respondents who give the most
favorable response for each of these measures. For each hospital these 10 response rates are averaged to get the
mean most favorable response rate, hospitals are ranked based on this mean and then the ranks are converted to
percentiles.
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

each proposing facility for the most recent nine-month period will be held
confidential by the HSC.
Populate the applicable average historical results for all facilities within a
multi-hospital organization (in the row labeled “Composite for All
Hospitals within Organization”).
Proposing hospitals from outside the Las Vegas area should submit data
for all time periods (please provide data for each individual hospital by
name).
Table VII
HCAHPS Mean Most Favorable Response Rate
Oct 2007 –
June 2008
July 2008 –
June 2009
St. Rose – De Lima
63%
65%
St. Rose – San Martin
69%
70%
St. Rose – Siena
69%
71%
Mountainview
59%
59%
Southern Hills
61%
61%
Sunrise
54%
55%
North Vista
56%
58%
Boulder City
n/a
n/a
Centennial Hills
n/a
58%
Desert Springs
47%
53%
Spring Valley
50%
58%
Summerlin
50%
57%
Valley
47%
54%
Univ Medical Center
51%
53%
Facility
Other - Name
Average for All
Hospitals within
Organization
July 2009 –
Dec 2009
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HealthInsight is an organization which, using publically reported data, ranks
hospital performance on this overall rate and then convert the ranks to percentiles.
The HSC has access to Health Insight’s reporting for the prior two reporting
periods for hospitals located in Nevada. Proposing hospitals from outside Nevada
should submit data for each time period using the following format:
Table VIII
HCAHPS National Ranking (percentile)
Oct 2007 –
June 2008
Facility
July 2008 –
June 2009
Other - Name
2.2.2. 2012 Quality Goal - HCAHPS
The HSC assumes that each facility has internal goals for HCAHPS results. In
addition, process improvements may be planned or already underway to effect
more efficient achievement of those goals.
To be completed by proposer (Table IX): Please describe your internal
HCAHPS goal for 2012. This information should be in relation to Mean Most
Favorable Response Rates as measured in the previous table. Also describe any
process improvements that are expected to improve the results. This should
include a high level action plan with timeframes. For hospitals who are proposing
services from multiple facilities, please provide a separate response for each
facility. In addition, please submit a copy of your HCAHPS Quality Assurance
Plan (QAP) that is due to be submitted to the CMS HCAPHS Project Team by
April 16, 2010.
Table IX
2012 HCAHPS Overall Mean Most Favorable Response Goal
Hospital Name: to be completed by proposer
Internal Goal
Process Improvements /
Timeframe
Mean Most Favorable
Response Rate
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2.3. Hospital Acquired Infections
Hospital acquired infections (HAIs) impose significant economic consequences on the
nation’s healthcare system. HAIs impact length of stay, cost, and patient outcomes.
Although hospitals monitor and implement performance improvement measures to
reduce the rate of occurrences, HAIs continue to be a key driver in cost and negatively
impact healthcare quality, with an estimated 4.5 HAIs for every 100 hospital admissions.
The overall annual direct medical costs of HAI’s to U.S. hospitals range from $35.7
billion to $45 billion (after adjusting to 2007 dollars using the CPI for inpatient hospital
services). After adjusting for the range of effectiveness of possible infection control
interventions, the benefits of prevention range from a low of $5.7 to $6.8 billion (20
percent of infections preventable, CPI for all urban consumers) to a high of $25.0 to
$31.5 billion (70 percent of infections preventable, CPI for inpatient hospital services).
In addition, there is an indirect cost associated with HAIs. These include lower patient
satisfaction and fewer referrals.
The HSC has selected two major areas to be included in this RFP4.
 Central line associated bloodstream infection (CLABSI) for intensive care units
(ICU) - CLABSI is an important cause of morbidity and excess cost of care for
hospitalized patients. Studies of CLABSI that control for the underlying severity of
illness suggest that the attributable mortality rate is 4% to 20%. It is estimated that
CLABSI accounts for 15% of all HAIs. Some recent estimates put the average added
cost when an ICU patient gets a central line infection at $42,000 per patient.
 Ventilator acquired pneumonia (VAP) - The incidence of VAP is 22.8% in
patients receiving mechanical ventilation. Patients receiving ventilator support
account for 86% of the cases of hospital acquired pneumonia. Furthermore, the risk
for pneumonia increases 3 to 10 fold in patients receiving mechanical ventilation.
VAP is also associated with increases in morbidity and mortality and hospital length
of stay. The mortality rate attributable to VAP is 27% and has been as high as 43%
when the causative agent was antibiotic resistant. Length of stay in ICU is increased
by 5 to 7 days and 2 to 3 fold in patients with VAP. It is estimated to cost $1.03
billion to $1.5 billion a year in the US.
2.3.1. Historical Statistics
To be completed by proposer (Tables X – XI): Each proposing hospital is
asked to populate the applicable data reported to CMS, Joint Commission, CDC
and the NHSN (National Healthcare Safety Network) for the prior three twelvemonth periods and for the most recent six-month period. For facilities that are
part of a multi-hospital organization, comparisons to each Las Vegas area hospital
4
It is understood that the information provided in this section will be held confidential by the HSC.
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are requested along with composite values for all hospitals within that
organization.
Table X
Central Line Associated Bloodstream Infection (CLABSI) ICU (Rate per 1,000 central line days)
Facility / Composite
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
Dec 2009
Composite for All
Hospitals within
Organization
Table XI
Ventilator Acquired Pneumonia (VAP) (Rate per 1,000 ventilator days)
Facility / Composite
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
Composite for All
Hospitals within
Organization
2.3.2. 2012 Quality Goal – Hospital Acquired Infections
The HSC assumes that each facility has internal goals for hospital acquired
infection rates. In addition, process improvements may be planned or already
underway to effect more efficient achievement of those goals.
To be completed by proposer (Table XII): Please describe your internal 2012
goal for each hospital acquired infection category. These goals should be in
relation to the same measures as in the previous two tables. Also describe any
process improvements that are expected to improve the results. This should
include a high level action plan with timeframes. For hospitals who are proposing
services from multiple facilities, please provide a separate response for each
facility.
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Table XII
2012 Hospital Acquired Infection Goals
Hospital Name: to be completed by proposer
Internal Goal
Process Improvements /
Timeframe
Central line associated
bloodstream infection
(CLABSI) for ICU
Ventilator acquired
pneumonia
2.4. Readmission Rates
Readmission rates for heart failure, pneumonia and myocardial infarction (MI) are
tracked by CMS using claims data created from hospital billing records. CMS uses the
National Quality Forum (NQF) endorsed definition of all cause readmissions within 30
days. It is measured using the hospital-specific risk-standardized readmission rate
(RSRR) to develop a readmission metric. The hospital-specific risk-standardized
readmission rate is calculated as the ratio of predicted to expected readmissions,
multiplied by the national unadjusted rate. The "numerator" of the ratio component is the
predicted number of readmissions for each hospital within 30 days given the hospital's
performance with its observed case mix. This methodology is similar to the 30 day
mortality rate used to develop a readmission metric. The count begins on the discharge
date and CMS only counts readmission to an acute care facility.
2.4.1. Historical Statistics
To be completed by proposer (Tables XIII – XV): Each proposing hospital is
asked to populate the data for all applicable readmissions based upon NQF
endorsed definitions for the prior three twelve-month periods and for the most
recent six-month period. For facilities that are part of a multi-hospital
organization, comparisons to each Las Vegas area hospital are requested along
with composite values for all hospitals within that organization.
Table XIII
Readmission Rates – Heart Failure (RSRR)
Facility Name
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
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Table XIII
Readmission Rates – Heart Failure (RSRR)
Facility Name
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
Composite for All
Hospitals within
Organization
Table XIV
Readmission Rates - Pneumonia (RSRR)
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
Composite for All
Hospitals within
Organization
Table XV
Readmission Rates - Myocardial Infarction (RSRR)
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
Composite for All
Hospitals within
Organization
2.4.2. 2012 Quality Goals - Readmissions
The HSC assumes that each facility has internal goals for readmission rates. In
addition, process improvements may be planned or already underway to effect
more efficient achievement of those goals.
To be completed by proposer (Table XVI): Please describe your internal 2012
goal for each measure. These goals should be in relation to the same measures as
in the previous three tables. Also describe any process improvements that are
expected to improve the results. This should include a high level action plan with
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timeframes. For hospitals who are proposing services from multiple facilities,
please provide a separate response for each facility.
Table XVI
2012 Readmission Rate Goals
Hospital Name: to be completed by proposer
Internal Goal
Process Improvements /
Timeframe
Readmission Rates – Heart
Failure
Readmission Rates – Pneumonia
Readmission Rates – Myocardial
Infarction
2.5. Births and Deliveries
Cesareans - Over 31% of U.S. births are now by cesarean section, although a 5% to
10% rate is best for mothers and babies. The extra cost is well over $2.5 billion per year.
According to the U.S. Department of Health and Human Services, the rate of cesarean
section increased for the 11th consecutive year in 2007 in the U.S. The rise in the total
cesarean delivery rate in the recent years has been shown to result from higher rates of
both first and repeat cesareans. In addition, babies born by cesarean section, even when
they are full term, need to go to the NICU due to respiratory difficulty more frequently
than babies who were born vaginally.
Elective Inductions Before 39 Weeks - The delivery of infants between 37 and 38
weeks of gestation has increased over the past decade and now accounts for
approximately 17.5% of live births in the United States. A retrospective analysis of
179,701 births showed that the incidence of severe respiratory distress syndrome was
22.5 times higher for infants born at 37 weeks gestation and 7.5 times higher for infants
born at 38 weeks of gestation compared with those born at 39 – 41weeks gestation.
Transient Tachypnea of the Newborn (TTN), persistent pulmonary hypertension,
admissions to neonatal intensive care units, prolonged hospital stays beyond five days
and other morbidities are significantly increased in those early term elective deliveries.
The American Congress of Obstetricians and Gynecologists (ACOG) recommendations
say the gestational age of the fetus should be determined to be at least 39 weeks or that
the fetal lung maturity must be established before induction. According to ACOG, there
are a number of health conditions that may warrant inducing labor, but physicians should
take into account maternal and infant conditions, cervical status, gestational age, and
other factors.
Health Services Coalition
Hospital Services Request for Proposal
Page 16
2.5.1. Historical Statistics
To be completed by proposer (Tables XVII – XVIII): Each proposing hospital
is asked to populate the applicable data reported for the prior three twelve-month
periods and for the most recent six-month period. For facilities that are part of a
multi-hospital organization, comparisons to each Las Vegas area hospital are
requested along with composite values for all hospitals within that organization.
Table XVII
Cesarean Section (all) - % of all Deliveries
Facility Name
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
Composite for All
Hospitals within
Organization
Table XVIII
Elective Induction Prior to 39 Weeks - % of all Deliveries
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
Composite for All
Hospitals within
Organization
2.5.2. 2012 Quality Goals – Births and Deliveries
The HSC assumes that each facility has internal goals for cesarean and elective
induction rates. In addition, process improvements may be planned or already
underway to effect more efficient achievement of those goals.
To be completed by proposer (Table XIX): Please describe your internal 2012
for each measure. These goals should be in relation to the same measures as in
the previous two tables. Also describe any process improvements that are
expected to improve the results. This should include a high level action plan with
timeframes. For hospitals who are proposing services from multiple facilities,
please provide a separate response for each facility.
Health Services Coalition
Hospital Services Request for Proposal
Page 17
Table XIX
2012 Cesarean and Elective Induction Rates
Hospital Name: to be completed by proposer
Internal Goal
Process Improvements /
Timeframe
Cesarean rate (all)
Elective Induction Prior to 39
weeks rate
2.6. CMS Hospital-Acquired Conditions and NQF Serious Reportable Adverse Events
In addition to the quality measures presented in previous sections, the HSC is committed
to the same quality considerations employed by CMS and NQF. In reviewing their
respective “Hospital-Acquired Condition” and “Serious Reportable Adverse Events”
criteria, the following measures have been included in this RFP for consideration. Each
measure is tracked by both organizations.
 Stage 3 or 4 pressure ulcers after admission
 Death/disability associated with a fall within facility
2.6.1. Historical Statistics
To be completed by proposer (Tables XX – XXI): Each proposing hospital is
asked to populate the applicable data reported for the prior three twelve-month
periods and for the most recent six-month period. For facilities that are part of a
multi-hospital organization, comparisons to each Las Vegas area hospital are
requested along with composite values for all hospitals within that organization.
Table XX
Stage 3 or 4 Pressure Ulcers after Admission - # of Occurrences
Facility
Total for All
Hospitals within
Organization
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
Health Services Coalition
Hospital Services Request for Proposal
Page 18
Table XXI
Death/Disability Associated with a Fall Within Facility - # of Occurrences
Facility
July 2006 –
June 2007
July 2007 –
June 2008
July 2008 –
June 2009
July 2009 –
December 2009
Total for All
Hospitals within
Organization
2.6.2. 2012 Quality Goals – Hospital-Acquired Conditions and Serious Reportable
Adverse Events
The HSC assumes that each facility has internal goals for all CMS hospitalacquired conditions and NQF serious reportable adverse events. In addition,
process improvements may be planned or already underway to effect more
efficient achievement of those goals.
To be completed by proposer (Table XXII): Please describe your internal 2012
goal for each quality measure. These goals should be in relation to the same
measures as in the previous two tables. Also describe any process improvements
that are expected to improve the results. This should include a high level action
plan with timeframes. For hospitals who are proposing services from multiple
facilities, please provide a separate response for each facility.
Table XXII
2012 Hospital-Acquired Conditions and Serious Reportable Adverse Event Occurrences
Hospital Name: to be completed by proposer
Internal Goal
Process Improvements /
Timeframe
Stage 3 or 4 pressure
ulcers after admission
Death/disability
associated with a fall
within facility
Health Services Coalition
Hospital Services Request for Proposal
Page 19
3. Alternative Service Delivery Model Proposals
Proposing organizations are invited to include alternative service delivery models in this
section of the response. These alternatives may include, but are not limited to, one or more
of the following:
 Global pricing for specific service areas like open heart surgery, knee and hip
replacements, or other appropriate services that would be all inclusive costs for facility,
physician and any other ancillary services or implants.
 Shifting services within your hospital system where economies of scale could be
achieved, such as all cardiac services offered at one facility or orthopedic services only
offer at another facility, whereby the facility portion and the physician portion could be
offer at a reduced rate for the increased volume.
 Changes in services within a single facility, across a system of hospitals, or across the
entire HSC participant community.
 Ideas that would require participant incentives to utilize proposed services, limitations in
the current HSC hospital network, expansion of the current HSC hospital network, or
changes in physician relationships.
 Establishment of one or more ‘centers of excellence’.
 Any other creative pricing solutions that could generate savings to your organization
which could be shared with the HSC.
For each alternative service delivery model proposed, please use the format shown in
Attachment A to include a thorough description of the model, resources required to
implement the model (direct and indirect costs) and implementation timeframe. Expected
benefits should be described in terms of the impact on specific quality measures (those
detailed in this document or others), customer service or cost reductions. Also indicate
whether the proposal is specific to participants represented by the HSC or are planned for
implementation regardless of the contract status with the HSC.
To assist in developing proposals, Attachment C reflects the HSC member counts by zip
code as of December 2009.
4. Rate Proposal
Consistent with the purpose of this RFP, organizations are asked to focus on alternative rate
schedules5 that are directly or indirectly linked to achieving better quality measures. Our
initial ideas are centered around risk/reward scenarios. For example, a certain percentage of a
facility’s inpatient rate structure would be subject to achieving outlined goals or quality
measures. If those goals are met or exceeded, then there would be an increase in the rate and
if they are not met then there would be a corresponding decrease in the rate structure. Other
quality derived rate proposals would be directly related to specific services (e.g. no charge
for the treatment of hospital acquired infection). Again, the HSC is anticipating some
For hospitals that currently contract with the HSC, the term “alternate rate schedule” refers any change in
reimbursement structure compared to the existing contract. For hospitals not currently contracted with the HSC,
please submit a rate schedule for all services proposed.
5
Health Services Coalition
Hospital Services Request for Proposal
Page 20
creativity on the part of our facility partners to strive for an improved quality outcome in the
community.
Other rate proposals may be related to alternative delivery systems described in Section 3
above. In recognition of the complexities involved to implement different proposals, each
year may be presented independent of the prior years. Obviously some logical progression
toward improved quality and/or improved cost effectiveness would be evaluated favorably.
In all cases of change from current conditions, an explanation regarding how the cost
proposal was derived should be included.
Quality rate proposals should be presented in the format shown in Attachment B. Complete
one table for each alternate rate proposal.
Attachment A
Health Services Coalition
Alternative Service Delivery Models
Alternative Service Delivery #1
Title:
Related Quality Measure:
Impact on Measure
Direct
describe
Indirect
describe
Description:
Scope of Change:
HSC Member Plan
Incentives Required:
Impact on Current HSC
Hospital Network:
Impact on HSC Physician
Relationships:
Impact on HSC Participants
and Dependents:
Direct Start-up Costs (if
any) related to HSC
population
Three-year Direct
Cost/Savings Related to
HSC Population
Other Information or
Explanation:
Individual
Facility
Hospital System
Community-wide
Attachment B
Health Services Coalition
Quality Rate Proposal(s)
Rate Alternative #1
Title:
Related Quality Measure:
Impact on Measure
Related Alternative
Delivery System:
Year 1 Reimbursement
Structure:
Year 2 Reimbursement
Structure:
Year 3 Rate Reimbursement
Structure:
Other Information or
Explanation:
Direct
describe
Indirect
describe
Attachment C
Health Services Coalition
Member Count by Zip Code
Zip Code
84713
84720
84752
84757
84765
84783
84790
86305
86401
86406
86409
86413
86426
88062
89001
89002
89003
89005
89006
89007
89008
89009
89011
89012
89014
89015
89016
89017
89018
89020
89021
89024
89025
89027
As of 12/31/2009
Primary
Total
Participants
Members
5
9
30
108
1
3
7
20
6
15
7
37
24
78
5
9
20
53
9
27
8
21
6
13
13
32
1
6
50
155
1,079
2,655
10
31
483
1,143
55
107
22
93
24
60
53
105
638
1,375
1,049
2,258
1,756
3,845
2,292
5,447
26
47
5
13
103
239
18
52
154
532
58
158
37
119
195
582
Attachment C
Health Services Coalition
Member Count by Zip Code
Zip Code
89029
89030
89031
89032
89036
89040
89041
89042
89043
89044
89046
89048
89049
89052
89053
89060
89061
89074
89077
89081
89084
89085
89086
89101
89102
89103
89104
89105
89106
89107
89108
89109
89110
89111
As of 12/31/2009
Primary
Total
Participants
Members
19
50
2,893
7,274
3,446
8,675
2,388
5,819
117
248
99
290
130
260
23
67
66
135
507
979
9
15
354
837
88
232
1,554
3,373
30
60
177
395
99
240
2,009
4,241
23
50
1,274
3,379
827
2,068
113
293
201
565
2,018
4,887
1,853
3,908
3,648
7,001
3,051
6,807
78
143
1,396
3,102
2,058
4,697
3,500
7,837
648
1,161
5,013
12,547
22
61
Attachment C
Health Services Coalition
Member Count by Zip Code
Zip Code
89112
89113
89114
89115
89116
89117
89118
89119
89120
89121
89122
89123
89124
89125
89126
89128
89129
89130
89131
89133
89134
89135
89136
89138
89139
89140
89141
89142
89143
89144
89145
89146
89147
89148
As of 12/31/2009
Primary
Total
Participants
Members
108
219
1,756
3,614
131
225
2,465
6,434
78
165
2,883
5,888
1,517
2,963
2,745
5,469
1,507
3,184
3,860
8,194
2,908
6,638
3,728
8,004
57
112
59
92
105
215
1,707
3,674
2,456
5,598
1,588
3,689
2,019
5,158
75
149
582
1,173
793
1,641
45
88
434
1,014
2,392
5,207
56
98
1,327
2,956
2,625
6,436
565
1,525
609
1,356
1,265
2,545
1,006
2,090
4,018
8,560
2,645
5,765
Attachment C
Health Services Coalition
Member Count by Zip Code
Zip Code
89149
89156
89157
89160
89161
89162
89166
89169
89170
89173
89178
89179
89180
89183
89193
89815
Out of Area
and All Other
Total
As of 12/31/2009
Primary
Total
Participants
Members
1,360
3,132
1,414
3,450
61
139
24
38
9
17
64
134
310
704
1,069
2,162
135
220
102
187
1,834
3,880
227
508
84
146
1,605
3,480
89
162
9
21
11,134
20,181
117,624
259,842