Three Purchase Orders At ARMC Total $64.4 Million

(April 26) Upon the recommendation of Patrick Petrie, the director of the county hospital, the board of supervisors this week authorized the expenditure of $64,409,217 to cover  a portion of the upcoming continuing operations as well as the provision of supplies and services at Arrowhead Regional Medical Center.
The county will spend $60 million to purchase pharmaceuticals over the next two years; $2,663,217 for the provision of Nurse Registry Services for the next six months and $1,746,000 for non-emergency medical transportation services over the next three years.
The board approved a master blanket purchase order agreement with Cardinal Health for pharmaceuticals, in the amount of $30 million per year, from May 1, 2013 through April 30, 2015, for a total amount of $60 million over two years. The outlay will come from state Medi-Cal, federal Medicare, and private insurances. According to Petre, the bulk purchase agreement with Cardinal Health will make the county eligible for a rebate of $63,660 during 2013-14.
Since 2008, the county has participated in a group purchasing strategy with University HealthSystem Consortium/Novation to place large volume purchases with various vendors. Under that arrangement, in August 2009 the board of supervisors approved the issuance of a purchase order with Cardinal Health to provide the county hospital, also known as Arrowhead Regional Medical Center, with pharmaceuticals for the period of August 11, 2009 through April 30, 2013 with two one-year options to extend. According to Petre, “The transition to Cardinal Health has resulted in estimated savings of $200,000 per year.”
In 2012, Arrowhead Regional Medical Center established the ArrowCare program to provide comprehensive medical services for low-income county citizens and legal permanent residents who are not eligible for Medi-Cal. The addition of ArrowCare patients and the increase in the uninsured has increased patient volume and need for pharmaceuticals.
The prior amendments extending the agreement with Cardinal Health referenced a “base agreement” which the county later determined it was not a party to. This base agreement is an agreement between Cardinal and University HealthCare System/Novation, the group purchasing organization. This week, Arrowhead Regional Medical Center asked for and received permission to enter into a new agreement with Cardinal Health for two years instead of triggering the extensions to allow the county hospital to continue purchasing pharmaceuticals at a lower rate based on patient volume, resulting in an overall cost savings. The competitive solicitation will be completed through Novation within the scope of the general purchase order.
At Petre’s request, the board authorized the county’s purchasing agent to issue master blanket purchase orders in the aggregate amount of $2,663,217 for the provision of Nurse Registry Services, for the period of January 1, 2013 through September 30, 2013 from  AllStar Staffing;  Certified Nursing Registry, Inc.; Healthcare Pros, Inc.;  HRN Services, Inc.; Juno Healthcare Registry, Inc.; Med-Link Nursing Services, Inc.; MedStaff Healthcare Solutions; Medical Staff Network (MSN); Platinum Healthcare Staffing; PRN Funding, LLC, doing business as Simply the Best Healthcare; Procel Temporary Services; Pro-Tem Personnel; Readylink Healthcare; Star Nursing; and Tempus, LLC, doing business as Emerald Health Services.
The use of registry nurses at the county hospital has long been practiced.
On March 4, 2008, the board approved sixteen countywide agreements for temporary help services, some of which included nurses, for a total not-to-exceed amount of $9 million from March 1, 2008 through February 28, 2011.  In January 2009, the board approved ten nurse registry contracts at a cost of $1,500,000 per year, from January 27, 2009 through June 30, 2012. In March 2009, the board approved eleven additional nurse registry contracts with a $1.5 million expenditure limit, through June 30, 2012. In June 2009, the board approved ten additional nurse registry contracts, again with a $1.5 million expenditure limit through June 30, 2012. In March 2012, the board approved amendments with 8 of the 31 contracts, increasing the not-to-exceed amount by $6,882,041, from $1,500,000 to $8,382,041 through June 30, 2012. In August 2012, the board approved amendments with 14 of the 31 contracts, increasing the not-to-exceed amount by $3,000,000, from $8,382,041 to $11,382,041, and extending the termination date from June 30, 2012 to December 31, 2012.
In October 2012, a request for proposals for temporary help nurse registry services at Arrowhead Regional Medical Center was issued, prompting fourteen proposals from interested vendors. The review process took longer than expected and the existing contracts expired on December 31, 2012. On March 14, 2013, the evaluation committee recommended awards with nine vendors. Three appeals were received. In order to address vendor concerns and ensure the opportunity for all interested vendors to participate, the purchasing department has recommended a new solicitation. In the meantime, the county has expended $259,079 on registry nurse services and will continue paying for these critical services until the new bid for medical temporary help including nurses, therapists and other medical technicians is completed.
Nurse registry services, in particular are vital to maintain nurse-to-patient ratios required by Assembly Bill 394. Ratios in acute care hospitals and psychiatric hospitals reflect the maximum number of patients that may be assigned to a registered nurse during one shift. The purchase order approved Tuesday will ensure nurses are on hand through September 30.
Petre also convinced the board of supervisors to approve agreements with Goodfaith Medical Transportation Company, Inc., GW Transport, Inc., and Premier Medical Transportation, Inc. for non-emergency medical transportation services in the annual aggregate amount of $582,000 for a total aggregate amount of $1,746,000 for the period of April 23, 2013 through April 22, 2016. This will be funded by state Medi-Cal, federal Medicare, and private insurances.
State and federal law mandates specialized healthcare facilities (e.g. skilled nursing care, inpatient rehabilitation therapy, radiation therapy, etc.) accept a patient with higher or specialized level of care needs upon the request of an admitting hospital that is unable to provide the necessary care. Arrowhead is financially responsible for the patient until the patient has been received by the identified facility. In order to facilitate the transfer of the patient, Arrowhead Regional Medical Center contracts with medical transportation companies to ensure a smooth transition of the patient to the identified facility.

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