INVITATION FOR BIDS
Independent Medical Examinations (IME)
ISSUING OFFICE
Department of Labor and Industry
State Workers’ Insurance Fund
IFB NUMBER
IFB # 6100021235
DATE OF ISSUANCE
February 23, 2012
INTRODUCTION
The State Workers’ Insurance Fund (SWIF) operates within the Pennsylvania Department of Labor and Industry. The purpose of SWIF is to provide a guaranteed workers’ compensation insurance option to Pennsylvania businesses. Pennsylvania law requires that employers carry workers compensation insurance and SWIF is required to provide coverage to any employer requesting coverage regardless of the level of risk involved. Through this Invitation for Bid (IFB), SWIF seeks to establish pools of qualified healthcare providers to perform Independent Medical Examinations (IME) for workers’ compensation cases to determine SWIF’s liability for claims and ongoing claimant physical capacity to work. The Pools established will cover three geographical regions: (1) Philadelphia and the surrounding 4 counties; (2) Pittsburgh, Erie, Johnstown and the surrounding areas; and (3) Scranton, Pottsville, Sunbury, Harrisburg and the surrounding area. There will also be a statewide pool and an out-of-state pool. Each Pool will be composed of healthcare providers expected to perform IME’s and may include: anesthesiologists (pain management), cardiologists, chiropractors, gastroenterologist, general surgeons, infectious disease specialists, occupational medicine specialists, ophthalmologists, oral and maxillofacial surgeons, orthopedist, otolaryngologists, physiatrists, plastic surgeons, podiatrists, primary care physicians, psychiatrists, pulmonologists, neuropsychologists, neurologists, neurosurgeons and urologists. Qualified physicians, healthcare providers and entities providing IME services may apply for one or more geographical region or the entire state.
SWIF is accepting Statements of Qualifications on a rolling basis to join the IME physician and healthcare provider pools. This will be an open/multiple Award IFB through the end of the contract service period, 5/01/2012-4/30/2017. Initial responses shall be opened April 2, 2012, and all Responsive and Responsible submissions shall be awarded contracts.
Following in this IFB, in Section I, is a description of the IME healthcare provider pools and general information for all applicants. Section II outlines Minimum Qualifications applicable to all applicants seeking to qualify for any of the qualified healthcare provider IME pools. Section III provides information regarding the Specific Qualifications that must be addressed, as applicable, for each physician specialty for which the physician or entities providing IME services seeks to be qualified and sets forth the fee structure. Section IV sets forth a healthcare provider’s or entity’s providing IME services requirement to maintain continued compliance with the Minimum Qualifications, and identifies circumstances under which a physician, healthcare provider or entities providing IME services can be removed from a pool. Finally, Section V outlines submission procedures and instructions.
SECTION I
GENERAL INFORMATION
A. IME Physician Pools
SWIF will establish 3 regional IME healthcare provider pools, 1 statewide physician pool and 1 out-of-state healthcare provider pool. Physicians, healthcare providers and entities providing IME services may seek to provide IME services for one or more of the geographical regions or may seek to provide IME services statewide.
· IME physician and Healthcare provider services POOL 1:
Philadelphia and the surrounding 4 counties. Each Pool will also have lists of IME’s by the following physician and healthcare provider specialties: anesthesiologists (pain management), cardiologists, chiropractors, gastroenterologist, general surgeons, infectious disease specialists, occupational medicine specialists, ophthalmologists, oral and maxillofacial surgeons, orthopedist, otolaryngologists, physiatrists, plastic surgeons, podiatrists, primary care physicians, psychiatrists, pulmonologists, neuropsychologists, neurologists, neurosurgeons, urologists and other health care providers as determined by SWIF.
· IME physician and Healthcare provider services POOL 2:
Pittsburgh, Erie, Johnstown and the surrounding areas. Each Pool will also have lists of IME’s by the following physician and healthcare provider specialties: anesthesiologists (pain management), cardiologists, chiropractors, gastroenterologist, general surgeons, infectious disease specialists, occupational medicine specialists, ophthalmologists, oral and maxillofacial surgeons, orthopedist, otolaryngologists, physiatrists, plastic surgeons, podiatrists, primary care physicians, psychiatrists, pulmonologists, neuropsychologists, neurologists, neurosurgeons, urologists and other health care providers as determined by SWIF.
· IME physician AND Healthcare provider services POOL 3:
Scranton, Pottsville, Sunbury, Harrisburg and the surrounding area. Each Pool will also have lists of IME’s by the following physician and healthcare provider specialties: anesthesiologists (pain management), cardiologists, chiropractors, gastroenterologist, general surgeons, infectious disease specialists, occupational medicine specialists, ophthalmologists, oral and maxillofacial surgeons, orthopedist, otolaryngologists, physiatrists, plastic surgeons, podiatrists, primary care physicians, psychiatrists, pulmonologists, neuropsychologists, neurologists, neurosurgeons, urologists and other health care providers as determined by SWIF.
· IME physician and Healthcare provider services POOL 4:
Statewide pool. Each Pool will also have lists of IME’s by the physician and healthcare provider specialties following: anesthesiologists (pain management), cardiologists, chiropractors, gastroenterologist, general surgeons, infectious disease specialists, occupational medicine specialists, ophthalmologists, oral and maxillofacial surgeons, orthopedist, otolaryngologists, physiatrists, plastic surgeons, podiatrists, primary care physicians, psychiatrists, pulmonologists, neuropsychologists, neurologists, neurosurgeons, urologists and other health care providers as determined by SWIF.
· IME PHYSICIAN AND Healthcare provider services POOL 5:
Out-of -state pool. Each Pool will also have lists of IME’s by the following healthcare provider specialties: anesthesiologists (pain management), cardiologists, chiropractors, gastroenterologist, general surgeons, infectious disease specialists, occupational medicine specialists, ophthalmologists, oral and maxillofacial surgeons, orthopedist, otolaryngologists, physiatrists, plastic surgeons, podiatrists, primary care physicians, psychiatrists, pulmonologists, neuropsychologists, neurologists, neurosurgeons, urologists and other health care providers as determined by SWIF.
B. General Information for Applicants
The purpose of this IFB is to invite physicians, healthcare providers and entities providing IME services to submit Statements of Qualifications, in the form and manner described herein, for any or all of the above-described IME pools for which they believe the qualifications are met by the physician, healthcare provider or the entity providing IME services. As described in Section II and Section III that follow, Minimum Qualifications have been established for all applicants and Specific Qualifications have been established for each specialty. Physician, healthcare providers and entities providing IME services submissions in response to this IFB document will be reviewed to determine whether the Minimum Qualifications have been satisfied. Thereafter, submissions that have met the Minimum Qualifications will be evaluated, as appropriate, for each of the IME pools to determine whether the Specific Qualifications for each specialty have been met. Inclusion in each IME pool commences on the date the first PO for services is executed by SWIF. The Commonwealth’s Standard Terms and Conditions are attached as Appendix A. Please note, however, that inclusion in any or all of the IME pools does not provide assurance that a physician, healthcare provider or entity providing IME services will receive an appointment to any evaluation. Any physician, healthcare provider and entities providing IME services selected for inclusion in any IME physician pool may, at any time, be selected to provide specific services to SWIF based on specific need, capacity, qualification or such other circumstances as SWIF shall determine. Nothing herein shall in any way be deemed to limit the discretion of SWIF to make IME assignments to serve the needs of the SWIF as deemed appropriate. The pools will remain in effect at the discretion of the SWIF. SWIF may determine, at any time, to dissolve any or all of the pools or to realign the composition of any pool. SWIF further retains the right to amend, modify, or discontinue this IFB and the process described herein at any time. SWIF does not currently have a limit on the number of physicians, healthcare provider or entities providing IME services in a given IME physician and healthcare provider service pool. It is currently expected that physicians and healthcare providers for each specific evaluation will be selected from the applicable pool; however, the manner in which SWIF makes IME assignment may change at any time, without notice.
SWIF reserves the right to make IME physician and/or healthcare provider assignments as it may deem necessary or desirable, in the sole judgment of SWIF, for all aspects of, or roles within, a workers’ compensation case.
C. Work Statement and Assignment Procedure
A work statement with timing of appointments and report completion deadlines is attached to this IFB as Appendix B.
SECTION II
MINIMUM QUALIFICATIONS FOR ALL APPLICANTS
In order to qualify for inclusion in any of the five IME healthcare provider service pools, a physician, healthcare provider or entity providing IME services’ Statement of Qualifications must demonstrate the applicant’s ability to meet each of the Minimum Qualifications or equivalent qualifications outlined below. Responses must be provided addressing each Minimum Qualification in the order set forth. Each individual physician and healthcare provider must satisfy the Minimum Qualifications. An entity providing IME services must prepare a response for each physician and/or healthcare provider who will be providing services to SWIF. A response template is provided as Appendix C. A response to this IFB requires at a minimum the following information, acknowledgements and agreements:
1. Each applicant must list the name used by each physician and/or health care provider and any other names used professionally by each physician and/or health care provider within the last 10 years. For each physician and/or health care provider the name of each medical school he/she attended and the medical school or professional school, he/she received a diploma from and the year the degree was granted must also be provided.
2. Each applicant must confirm that each physician and/or health care provided possesses an active license with the Pennsylvania State Board of Medicine, State Board of Chiropractic, State Board of Dentistry, State Board of Psychology or State Board of Podiatry. For each physician and/or health care provider the applicant must include date of issuance each current license and date of expiration of each current state license along with current state license numbers.
For Pool 5 (out-of-state healthcare provider pool) the physician, healthcare provider or entity providing IME services must assure SWIF that the individual physician or health care provider possesses and maintains in good standing the appropriate licensure for the state in which the IME is being performed. The physician or entity providing IME services shall provide verification of licensure upon SWIF’s request.
3. Each applicant must list for each physician and/or health care provided all current addresses at which he/she practices medicine and/or provides health care services.
4. Each applicant must state for each physician and/or healthcare provider his/her number of years in practice in each specialty
5. Each physician must describe his/her experience in being deposed and testifying in workers’ compensation litigation.
6. For each specialty the following certification is required for each physician and/or health care provider. In addition the physician or healthcare provider’s certification number, certification issuance and expiration dates must be provided on the template:
a. Anesthesiology (Pain Management). A physician performing IME’s for this specialty must possess an active certification from the American Board of Anesthesiology in pain medicine. Osteopathic physicians must possess an active certification American Osteopathic Board of Anesthesiology in pain management or the equivalent.
b. Cardiologists. A physician performing IME’s for this specialty must possess an active certification from the American Board of Internal Medicine in Cardiovascular Disease. Osteopathic physicians must possess an active certification from the American Osteopathic Board of Internal Medicine with a subspecialty certification in cardiology.
c. Chiropractors. Current Pennsylvania license is sufficient for Pools 1-4. For Out-of-State Pool 5, licensure in state where Chiropractors is performing the IME is required.
d. Gastroenterologists. A physician performing IME’s for this specialty must possess an active certification from the American Board of Internal Medicine in Gastroenterology. Osteopathic physicians must possess an active certification from the American Osteopathic Board of Internal Medicine with subspecialty certification in gastroenterology.
e. General Surgeons. A physician performing IME’s for this specialty must possess an active certification from the American Board of Board of Surgery certified in general surgery. Osteopathic physicians must possess an active certification from American Osteopathic Board of Surgery in general surgery.
f. Infectious Disease Specialists. A physician performing IME’s for this specialty must possess an active certification from the American Board of Internal Medicine in infectious disease. Osteopathic physicians must possess an active certification from the American Osteopathic Board of Internal Medicine with subspecialty certification in infectious disease.
g. Occupational Medicine Specialists. A physician performing IME’s for this specialty must possess an active certification from the American Board of Preventative Medicine in occupational medicine or the equivalent.
h. Ophthalmologists. A physician performing IME’s for this specialty must possess an active certification from the American Board of Ophthalmology. Osteopathic physicians must possess an active certification in ophthalmology from the American Osteopathic Boards of Ophthalmology and Otolaryngology-Head and Neck Surgery in ophthalmology.
i. Oral and Maxillofacial Surgeons. A dentist performing IME’s for this specialty must possess an active certification from the American Board of Oral and Maxillofacial Surgery.
j. Orthopedists. A physician performing IME’s for this must possess an active certification from the American Board of Orthopedic Surgery. Osteopathic physicians must possess an active certification from the American Osteopathic Board of Orthopedic Surgery.
k. Otolaryngologists. A physician performing IME’s for this specialty must possess an active certification from the American Board of Otolaryngology. Osteopathic physicians must possess an active certification from the American Osteopathic Boards of Ophthalmology and Otolaryngology-Head and Neck Surgery in otolaryngology.
l. Physiatrists. A physician performing IME’s for this specialty must possess an active certification from the American Board of Physical Medicine and Rehabilitation. Osteopathic physicians must possess an active certification from the American Osteopathic Board of Physical Medicine and Rehabilitation.
m. Plastic Surgeons. A physician performing IME’s for this specialty must possess an active certification from the American Board of Plastic Surgery. Osteopathic physicians must possess an active certification from the American Osteopathic Boards of Ophthalmology and Otolaryngology-Head and Neck Surgery in otolaryngology/facial plastic surgery.