HomeMy WebLinkAboutRESPONSE - FAX QUOTE - 8637 DOT MEDICAL EXAMS (2)Workwell Occupational Medicine, LLC 2017
City of Fort Collins RFQ-8637 DOT Medical Exams Page 1 of 15
City of Fort Collins
RFQ 8637 DOT Medical Exams
Financial Services, Purchasing Division
215 North Mason Street, 2nd Floor
PO Box 580
Fort Collins, CO 80522
970.221.6775
fcgov.com/purchasing
DUE DATE AND TIME: Dec. 15, 2017 by 3pm MST
Workwell Occupational Medicine, LLC
Stephen Pottenger, CEO
steve.pottenger@workwellworks.com
www.workwellworks.com
164 Primrose Ct.
Longmont, CO 80501
303.827.3158
1600 Specht Pt Rd., Ste. 115 3350 Peoria St., Ste. 190 2550 S. Parker Rd., Ste. 150
Fort Collins, CO 80525 Aurora, CO 80010 Aurora, CO 80014
970.672.5100 303.365.4646 720.512.4408
970.672.5105 fax 303.365.4644 fax 720.512.5978 fax
205 S. Main St., Ste. C 1608 Topaz Dr. 1275 58th Ave., Ste. C
Longmont, CO 80501 Loveland, CO 80537 Greeley, CO 80634
303.702.1612 970.593.0125 970.356.9800
303.774.7899 fax 970.593.0127 fax 970.353.3182 fax
Workwell Occupational Medicine, LLC 2017
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TABLE OF CONTENTS
Cover Letter ................................................................................................................................ 3
Qualifications of Firm & Staff ....................................................................................................... 4
DOT Expertise......................................................................................................................... 5
Qualifications of the Staff ......................................................................................................... 6
References .................................................................................................................................... 7
Fee Schedule and Description of Facilities .................................................................................. 7
Vendor Statement ........................................................................................................................ 9
Attachment A – W9 .................................................................................................................. 10
Attachment B - Insurance Certificate ........................................................................................ 11
Attachment C – HIPAA & Privacy Statement ........................................................................... 12
Attachment D – Internal DOT Procedural Algorithm .............................................................. 14
Workwell Occupational Medicine, LLC 2017
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Cover Letter
December 15, 2017
Gerry S. Paul
Director of Purchasing
City of Fort Collins
215 North Mason Street, 2nd Floor
Fort Collins, CO 80522
Dear Gerry and City of Fort Collins:
Thank you for the opportunity to respond to your invitation to bid for DOT Medical Exams for City of
Fort Collins. We are Workwell Occupational Medicine, LLC (“Workwell”), a locally owned and
operated group of workers’ compensation and Occupational Medicine specialists. We deliver services
to companies in every industry, of every size, in a professional manner, providing exceptional
customer service and superior medical care for businesses and their employees throughout Larimer,
Boulder, Denver, Arapahoe, Broomfield and Weld counties. We ONLY focus on occupational medicine
so we can manage schedules efficiently and communicate with clients timely!
Our full facility clinics treat on-the-job injuries and perform drug and alcohol screening, physical
exams, pre- and post-employment functional testing. In addition, we offer employers customized
options such as ergonomic evaluations, safety trainings, and health and wellness services.
Currently, we provide services for a number of municipalities similar to the City of Fort Collins, and
experts within our field, we feel uniquely qualified to provide the services you have outlined in your
request. We hope you feel the same when considering our proposal and trust that you will find our
response more than adequate. It is our desire to not only address your requirements, but also answer
any questions that may arise after review.
Thank you, again, for the opportunity to respond and we look forward to retaining your trust and
your business.
Sincerely,
Stephen Pottenger
Chief Executive Officer
Workwell Occupational Medicine, LLC
Workwell Occupational Medicine, LLC 2017
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Qualifications of Firm & Staff
Workwell is a privately owned and locally operated limited liability corporation serving Colorado businesses
since 1996. Workwell serves thousands of clients, in six distinct markets in Northern Colorado (Loveland,
Longmont, Greeley, Aurora, Denver and Fort Collins). Our organization is based out of Longmont, CO and
employs 80+ people including 11 physicians and 5 physician extenders. We offer a complete array of
occupational medicine and corporate care services and are the only specialist provider of our kind in Northern
Colorado. We are the largest privately held Occupational Medicine provider in Colorado and we serve as a
resource to businesses and insurance companies as experts in our field, regularly lecturing and presenting on a
variety of topics and interests.
1. Serving Colorado Businesses Since 1996, fully licensed and insured
2. Dedicated to 100% Professional Occupational Medicine
3. Convenient Walk-In Injury and Drug Screen locations & Efficient Full Facility Clinics
4. Experienced Level II Medical Providers
5. Electronic Medical Records and On-line Access for Employers and Insurance Providers
6. Focus on Prompt Communication and timely screenings
7. Se Habla Español – Spanish Speaking Providers and Staff in most facilities
8. Complete Offering of secure, professional employee screens
Workwell provides occupational health related services throughout Northern Colorado that include physicals
such as DOT, HAZMAT, Respirator, pre and post-placement physicals, periodic/annual examinations, hearing,
pulmonary, and/or monitoring services, Impairment Ratings, essential job function testing and more. Due to the
complex nature of today’s employer, all our examination and monitoring services are customized to their
specific need, their specific job or department, and location. We can customize a procedure in a variety of ways
to provide you the service that you need. We can also make these jobs specific, outlined and documented for
future reference.
Workwell Occupational Medicine, LLC has a long and successful history of providing these exams to the City of Fort
Collins. Each year prior to annual exams and following completion, our team meets with representatives from the
City of Fort Collins to discuss ways to improve delivery of services, timeliness of exams and communications, and
overall care to its employees. Not only do we feel qualified to perform the services due to the past success of the
program, but our willingness to improve the process and overall product to the City of Fort Collins demonstrates
the level of commitment Workwell has towards its ongoing success.
Workwell providers specialize in Occupational Medicine services and possess the following credentials:
1. Workwell physicians have many different areas of training and have internal and external resources
that are Board Certified in Occupational Medicine, at American Board of Preventative Medicine.
Board Specialties include Occupational Medicine, Preventative Medicine, Family Medicine, Internal
Medicine, Travel Medicine, and more.
2. All Workwell MD/DOs are Board Certified/Eligible in the area of primary care such as
Occupational Medicine, Preventative Medicine, Family Practice or Internal Medicine.
3. We have considerable talent and experience in the management of treatment of musculoskeletal
disorders, cumulative trauma disorders, and other work-related conditions.
4. Our staff has an excellent understanding of the ergonomic and integrated disability management
programs in workers’ compensation.
5. Our providers and legal team have extensive experience in medical-legal aspects of occupational
medicine.
6. All of our physicians are current with Level II accreditation by the State of Colorado and continuing
education at all times to update knowledge of current workers’ compensation laws in the State of
Colorado.
Workwell Occupational Medicine, LLC 2017
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DOT Expertise
Workwell provides occupational health related services throughout Northern Colorado that include physicals
such as DOT, HAZMAT, Respirator, pre- and post-placement physicals, periodic/annual examinations, hearing,
pulmonary, and/or monitoring services, Impairment Ratings, essential job function testing and more. Workwell
has a long and successful history of providing these exams to municipalities, school districts, and governmental
agencies of all types. Not only do we feel qualified to perform the services due to the past success of our
program, but our willingness to improve the process and overall product delivery demonstrates the level of
commitment Workwell has towards its ongoing success.
1. All medical providers are FMCSA certified and are fully DOT compliant. All Workwell employees
are thoroughly trained to screen, counsel, and follow-up with your employees according to
nationally recognized protocols.
2. Workwell provides more than 4,500 physical exams each year throughout northern Colorado and
has the experience and market coverage necessary to meet the needs of the City of Fort Collins
and its employees.
3. Workwell’s EMR automatically uploads DOT exam results to FMCSA for 100% compliance.
4. DOT Exams results available online thru Workwell’s WWindow™.
5. To reduce variable in testing protocols, Workwell’s DOT Algorithm is provided in Attachment D.
Workwell Occupational Medicine, LLC is experienced in the medical requirements set forth by the Department
of Transportation (DOT) in Section 391.41 and 391.43 including the Federal Motor Carriers Safety
Administration (FMCSA) and the Federal Transit Administration (FTA) and their policies, regulations,
requirements and guidelines. All of Workwell’s medical examiners are a member of the National Registry of
Certified Medical Examiners.
Workwell utilizes the most current, technologically advanced, occupational health specific Electronic Medical Record
available today. All documentation is currently available for distribution from our offices via email or fax and can
easily be customized upon the employer’s request. WWindow™ also allows an employer or their insurance carrier
to access reports, clinic information, visit notes, physical reports, etc. via an encrypted and HIPAA compliant
electronic portal.
Once the patient has been scheduled, the service has been completed, and the required documentation is
recorded in our EMR, we coordinate the dissemination to various people identified by the City of Fort Collins.
Our company policy is to provide any and all written results to the employer by the end of each business day
and within 24 hours or sooner of receiving completed results. As requested, Workwell will furnish one copy of
the results to the person who was examined and a complete Medical Examiner’s Certificate. The DOT Medical
Exam long form and Medical Card will be emailed to the City of Fort Collins, DOT Compliance Specialist by the
end of each business day that exams are conducted.
Workwell also provides the benefit of having multiple locations all along the front range to provide your
organization and your employees the flexibility of obtaining services wherever the need may be. Our facilities
are fully HIPAA compliant, secure, and provide a private area for all collection services in each of our Colorado
locations. Your organization has the ability to tour any of these sites at your convenience to ensure that
Workwell complies with your organizations commitment to privacy and security.
Workwell Occupational Medicine, LLC is willing and able to provide all the services listed in the Scope of
Services within this RFQ to the City of Fort Collins and its employees. Our organization fully understands, and
accepts, all requirements of the City of Fort Collins to participate in this RFQ and to provide these services in
the future to you and your employees.
Workwell Occupational Medicine, LLC 2017
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Qualifications of the Staff
Name: Neal Tah, MD
Years of employment with your organization: 1 year
Years of experience in industry: 1 year
Years of experience performing work relevant to Service Proposed: 1 year
Licenses, professional designations and/or degrees earned: Board Certified in Family
Medicine. Level I (Level II Exam in April 2018)
Name: Kevin Keefe, DO
Years of employment with your organization: 3 Years
Years of experience in industry: 4 Years
Years of experience performing work relevant to Service Proposed: 30 Years
Licenses, professional designations and/or degrees earned: Board Certified Internal
Medicine and Level II.
Name: Beth Otto, NP
Years of employment with your organization: 2 years
Years of experience in industry: 2 years
Years of experience performing work relevant to Service Proposed: 30 Years
Licenses, professional designations and/or degrees earned: Nurse Practitioner Award
from University of Alabama.
Name: Paul Ogden, MD, CMO
Years of employment with your organization: 4 Years
Years of experience in industry: 7 Years
Years of experience performing work relevant to Service Proposed: 20 Years
Licenses, professional designations and/or degrees earned: Board Certified, Level II,
Name Jolynn Diesing, Clinic Manager
Years of employment with your organization: 4 Years
Years of experience in industry: 10 Years
Years of experience performing work relevant to Service Proposed: 10 Years
Licenses, professional designations and/or degrees earned: Certified DOT Collector,
Certified Breath Alcohol Technician
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References
City of Longmont
Doug Spight, Risk Management Director
303.651.8763
doug.spight@ci.longmont.co.us
Larimer County
Jeffrey Green, Director of Risk Management
970.498.5962
jlgreen@larimer.org
JBS Carriers
Kate Silvas, Operations and Safety Officer
970.506.6899
kate.silvas@jbssa.com
Poudre Valley School District
Kristin Bennett, Risk Manager
970.490.3141
kbennett@psdschools.org
Fee Schedule
DOT Physicals (PHYDOT)……………………………………………………….…………$70
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General Description of Facilities and Locations
WORKWELL Occupational Medicine Clinic
1600 Specht Point Road, Ste. 115
Fort Collins, CO 80525
Phone: 970-672-5100
Fax: 970-672-5105
Hours: 8am-5pm Monday-Friday
WORKWELL Occupational Medicine Clinic
2550 S. Parker Rd. Ste. 150
Aurora, CO 80014
Phone: 720-512-4408
Fax: 720-512-5978
Hours: 8am-5pm Monday-Friday
WORKWELL Occupational Medicine Clinic
3350 Peoria Ave. Ste. 190
Aurora, CO 80011
Phone: 303-365-4646
Fax: 303-365-4644
Hours: 8am-5pm Monday-Friday
WORKWELL Occupational Medicine Clinic
2528 West 16th Street
Greeley, CO 80634
Phone: 970-356-9800
Fax: 970-353-3182
Hours: 8am-5pm Monday-Friday
WORKWELL Occupational Medicine Clinic
205 S. Main Street, Ste C
Longmont, CO 80501
Phone: 303-702-1612
Fax: 303-774-7899
Hours: 8am-5pm M, W, F; 7am-5pm T, Th
WORKWELL Occupational Medicine Clinic
1608 Topaz Drive
Loveland, CO 80537
Phone: 970-593-0125
Fax: 970-593-0127
Hours: 8am-5pm Monday-Friday
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Vendor Statement
Vendor hereby acknowledges receipt of the City of Fort Collins Request for Quote and acknowledges
that it has read and agrees to be fully bound by all of the terms, conditions and other provisions set
forth in the RFQ. Additionally, Vendor hereby makes the following representations to City:
a. All of the statements and representations made in this submittal are true to the best of the
Vendor’s knowledge and belief.
b. Vendor commits that it is able to meet the terms provided in this quote.
c. This quote is a firm and binding offer, for a period of 90 days from the date hereof.
d. Vendor further agrees that the method of award is acceptable.
e. Vendor also agrees to complete the proposed Agreement with the City of Fort Collins within 30 days
of notice of award.
f. If contract is not completed and signed within 30 days, City reserves the right to cancel and award to
the next lowest quote.
g. Vendor acknowledge receipt of ____ addenda.
Firm Name: Workwell Occupational Medicine, LLC
Physical Address: 1600 Specht Point Road, Suite 150, Fort Collins, CO 80525
Remit to Address: 164 Primrose Ct, Longmont, CO 80501
Phone: (303) 827-3158
Authorized Agent of Firm Name: Stephen Pottenger
Signature of Authorized Agent:
Primary Contact for Project: Jolynn Diesing
Title: Clinic Manager Email Address: jolynn.diesing@workwellworks.com
Phone: (970) 672-5100 Cell Phone: (720) 438-9452
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Attachment A – W9
Workwell Occupational Medicine, LLC 2017
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Attachment B - Insurance Certificate
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Attachment C – HIPAA & Privacy Statement
WORKWELL OCCUPATIONAL MEDICINE, LLC NOTICE OF PRIVACY PRACTICES GUARDING
PROTECTED HEALTH INFORMATION
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Workwell, through its subsidiaries and affiliates, provides injury care services and related services. These subsidiaries
and affiliates providing such services are hereinafter referred to as "Workwell," "we," "our," or "us." Due to the
nature of these services, we are required by law to maintain the privacy of certain confidential health care
information, known as Protected Health Information (PHI), and to provide you with a notice of our legal duties and
privacy practices with respect to your PHI. We are also required to abide by the terms of the version of this Notice
currently in effect.
Uses and Disclosures of PHI: We may use PHI for the purposes of treatment, payment and health care
operations, in most cases without your written permission. Examples of our use of your PHI:
For Treatment. This includes such things as obtaining verbal and written information about your medical
condition and treatment from you as well as from others, such as doctors and nurses who give orders to allow
us to provide treatment to you. We may give your PHI to other health care providers involved in your
treatment, and may transfer your PHI via fax or telephone to the hospital or other provider specialists.
For Payment. This includes any activities we must undertake in order to get reimbursed for the services we
provide to you, including such things as submitting bills to insurance companies, making medical necessity
determinations and collecting outstanding accounts.
For Health Care Operations. This includes quality assurance activities, licensing and training programs to ensure
that our personnel meet our standards of care and follow established policies and procedures, as well as certain
other management functions.
Reminders for Scheduled Appointments and Information on Other Services. We may also contact you with a
reminder of any scheduled appointments for non-emergency service, or to inform you about other services we
provide.
Use and Disclosure of PHI Without Your Authorization. We are permitted to use PHI without your written
authorization, or opportunity to object, in certain situations, and unless prohibited by a more stringent state law,
including:
For the treatment, payment or health care operations activities of another health care provider who treats you;
For health care and legal compliance activities;
To a family member, other relative, or close personal friend or other individual involved in your care if we
obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you
do not raise an objection, and in certain other circumstances where we are unable to obtain your agreement
and believe the disclosure is in your best interests;
To a public health authority in certain situations as required by law (such as to report abuse, neglect or domestic
violence);
For health oversight activities including audits or government investigations, inspections, disciplinary proceedings,
and other administrative or judicial actions undertaken by the government (or their contractors) by law to
oversee the health care system;
For judicial and administrative proceedings as required by a court or administrative order, or in some cases in
response to a subpoena or other legal process;
For law enforcement activities in limited situations, such as when responding to a warrant;
For military, national defense and security and other special government functions;
To avert a serious threat to the health and safety of a person or the public at large;
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For workers’ compensation purposes, and in compliance with workers’ compensation laws;
To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of
death, or carrying on their duties as authorized by law;
If you are an organ donor, we may release health information to organizations that handle organ procurement
or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation
and transplantation;
For research projects, but this will be subject to strict oversight and approvals;
Use or disclose health information about you in a way that does not personally identify you or reveal who you
are.
Any other use or disclosure of PHI, other than those listed above will only be made with your written authorization.
You may revoke your authorization at any time, in writing, except to the extent that we have already used or
disclosed medical information in reliance on that authorization.
Patient Rights: As a patient, you have a number of rights with respect to your PHI, including:
The right to access, copy or inspect your PHI. This means you may inspect and copy most of the medical
information about you that we maintain. We will normally provide you with access to this information within 30
days of your request. We may also charge you a reasonable fee, as state law permits, to provide a copy of any
medical information you have the right to access. In limited circumstances, we may deny you access to your
medical information, and you may appeal certain types of denials. We have forms available to request access to
your PHI and we will provide a written response if we deny you access and let you know your appeal rights. You
also have the right to receive confidential communications of your PHI. If you wish to inspect or obtain a copy of
your medical information, you should contact our local privacy representative.
The Right to Amend Your PHI. You have the right to ask us to amend written medical information we may have
about you. We will generally amend your information within 60 days of your request and will notify you when
we have amended the information. We are permitted by law to deny your request to amend your medical
information only in certain circumstances, like when we believe the information you have asked us to amend is
correct. If you wish to request an amendment of the medical information we have about you, please contact our
local privacy representative to obtain an amendment request form.
The Right to Request an Accounting. You may request an accounting from us of certain disclosures of your
medical information we have made in the six years prior to the date of your request. However, your requests
for an accounting of disclosures cannot precede the implementation date of HIPAA April 14, 2003. We are not
required to give you an accounting of information we have used or disclosed for purposes of treatment, payment
or health care operations, or when we share your health information with our business associates, such as our
billing company or a medical facility from/to which we have transported you. We are also not required to give
you an accounting of our uses of PHI for which you have already given us written authorization
The Right to Request That We Restrict the Uses and Disclosures of Your PHI. You have the right to request
that we restrict how we use and disclose your medical information we have about you. We are not required to
agree to any restrictions you request, but any restrictions agreed to by us in writing are binding on us.
Internet and the Right to Obtain a Paper Copy of the Notice on Request. If you would like a paper copy of this
Notice, you may print this off your computer by choosing that option, or you may contact us at the address
listed below and we will provide you a paper copy of the Notice upon request.
Revisions to the Notice: We reserve the right to change the terms of this Notice at any time, and the changes will
be effective immediately and will apply to all PHI we maintain. Any material changes to the Notice will be promptly
posted in our facilities and posted to our web site, if we maintain one. You can get a copy of the latest version of this
Notice by contacting our offices.
Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of the United
States Department of Health and Human Services if you believe your privacy rights have been violated. You will not
be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions,
comments or complaints you may direct all inquiries to our offices.
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Attachment D – Internal DOT Procedural Algorithm
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