SERVICES AGREEMENT
This Agreement is effective this __1st___ day of _____July___________, 1996,
(the "Effective Date") between -Disease State Management, Inc., 00 Xxxxxx
Xxxxxx, Xxxxxxxxx, Xxx Xxxx 00000 ("Vendor") and American Homepatient. Vendor
agrees to provide services to American Homepatient under the terms set forth
below.
A. SERVICES
Vendor will provide the product(s) or service(s) set forth, and to the
specifications set forth in the proposal incorporated herein as Attachment
A.
The product and all elements as set forth on Attachment A are subject to
prior approval by American Homepatient such approval not to be unreasonably
withheld.
B. COMPENSATION
American Homepatient will pay Vendor according to the terms or payment
schedule set forth in Attachment A hereto.
In the event that American Homepatient shall request any changes in the
concept, specifications or scope of the product(s) or service(s) described
on Attachment A hereto, Vendor will notify American Homepatient of the cost
of such revisions and will not proceed without prior written approval.
If the compensation provision on Attachment A hereto is other than a flat
fee amount per element or for the entire project, Vendor will provide such
documentation in support of all xxxxxxxx as American Homepatient may
reasonably require.
C. CONFIDENTIALITY
Vendor shall treat as confidential and secret any and all American
Homepatient Confidential Information. "American Homepatient Confidential
Information" shall include, but not be limited to, information relating to
American Homepatient past, present and future marketing and research and
development activities that may be disclosed to Vendor by American
Homepatient and/or American Homepatient's parent, subsidiary or affiliate
companies and which are identified in writing by American Homepatient as
confidential. American Homepatient Confidential information shall not
include (i) information known by Vendor prior to disclosure from American
Homepatient. (ii) information which is or becomes publicly known through no
wrongful act of Vendor, (iii) information that is independently developed
by Vendor, without use of information that otherwise constitutes American
Homepatient Confidential Information, or (iv) information disclosed
pursuant to law, rule, regulation or pursuant to a court order, provided
that American Homepatient is given 10 days prior notice of such disclosure.
Vendor expressly agrees that any information it discovers or develops under
this Agreement for the benefit of American Homepatient shall not be used
by Vendor or disclosed by Vendor to any third party, nor shall Vendor show
this Agreement or disclose the existence, nature or subject matter of this
Agreement to any third party without the prior written consent of American
Homepatient. Vendors obligations not to disclose American Homepatient
Confidential Information to third parties and not to otherwise use American
Homepatient Confidential Information shall survive the termination of this
Agreement for a period of five years. Vendor shall not duplicate any
material containing American Homepatient Confidential Information, except
in the direct performance of its services under this Agreement. Vendor
shall return all copies of materials containing American Homepatient
Confidential Information upon Vendor's completion of services under this
Agreement or upon any earlier termination of this Agreement for any reason
whatsoever.
American Homepatient shall treat as confidential and secret any and all
Vendor Confidential Information. Vendor Confidential Information" shall
include, but not be limited to, information relating to Vendor's past,
present and future systems development activities that may be disclosed to
Homepatient and/or American Homepatient's parent, subsidiary or affiliate
companies and which are identified in writing by Vendor as confidential,
except that in no event shall Vendor Confidential Information include
information related to Vendor deliverables under this agreement. Vendor
Confidential information shall not include (i) information known by
American Homepatient prior to disclosure from Vendor, (ii) information
which is or becomes publicly known through no wrongful act of American
Homepatient, (iii) information that is independently developed by American
Homepatient without use of information that otherwise constitutes Vendor
Confidential Information, or (iv) information disclosed pursuant to law,
rule, regulation or pursuant to a court order, provided that Vendor is
given 10 days prior notice of such disclosure. American Homepatient
expressly agrees that any Confidential Information it discovers under this
Agreement shall not be disclosed by American Homepatient to any third party
without the prior written consent of Vendor. American Homepatient
obligations not to disclose Vendor Confidential Information shall survive
the termination of this Agreement for a period of five years.
D. INDEMNIFICATION
Each party shall indemnify and hold the other party harmless from and
against all liability, damages, penalties, losses, costs or expenses,
including attorneys' fees, arising from or in any way related to its
willful or negligent actions or omissions in performing the
responsibilities as described in this Agreement, or for any willful or
negligent breach of this Agreement.
E. PROFESSIONAL STANDARDS
Vendor represents that it has facilities, personnel, experience and
expertise sufficient in quality and quality to perform all such assignments
and projects given it by American Homepatient hereunder and agrees that it
will perform all such assignments and projects in a manner commensurate
with professional standards generally applicable to its industry.
F. OWNERSHIP OF MATERIALS
Any and all reports, information, data or other works created by Vendor for
American Homepatient in connection with this Agreement (with the exception
of customization of the Vendor's basic software and systems for American
Homepatient as well as the Vendor's basic software and systems themselves)
shall be the sole and exclusive property of American Homepatient. American
Homepatient may use such work wherever and whenever it chooses. This
Agreement shall be deemed a transfer of copyright and any copyrightable
subject matter created by Vendor in such works. Vendor shall execute any
and all documents necessary to demonstrate or perfect such transfer.
Vendor shall not at any time in any manner during or after this Agreement,
under any circumstances, be entitled to or claim any right, title or
interest herein or any commission, fee or other direct or indirect benefit
from American Homepatient or American Homepatient's parent, subsidiary or
affiliate companies, in respect of such reports, data, information or other
works created by Vendor hereunder. Vendor agrees to execute or cause its
agents and/or employees to execute any documents necessary or desirable to
secure or perfect American Homepatient's legal rights and worldwide
ownership in such works, including, but not limited to documents relating
to patent, trademark and copyright applications. American Homepatient
hereby grants Vendor a worldwide perpetual royalty free license to the data
and information created by Vendor in connection with this agreement for
purposes of making marketing presentations to other potential customers and
for the development and sale of additional products based upon this data
and information.
G. RELEASES
Any materials furnished hereunder which have not been created for American
Homepatient and are subject to the rights of third parties shall be
specifically identified to American Homepatient in writing. Vendor shall
obtain (and deliver upon request to American Homepatient) releases for all
names, photographs, illustrations, testimonials, and any and all other
materials used in works which Vendor prepares or uses. All such releases
shall run to American Homepatient, its agents and employees where
appropriate and customary. Vendor's failure to obtain such releases or the
obtaining of such releases by Vendor shall in no way relieve Vendor of its
obligations in Paragraph F above except where the releases have been
obtained directly by American Homepatient. Except for works that have been
secured by permission, Vendor warrants and covenants that all works
provided by Vendor shall be original and shall not infringe any copyright
or violate any rights of any persons or entities whatsoever.
H. DURATION OF AGREEMENT
1. Term
This Agreement is effective as of the Effective Date and shall continue in
full force and effect until the earlier of (i) completion of the project
assigned hereunder, (ii) terminated by at least thirty (30) days written
notice by either party to the other, sent by registered mail to the address
for each party first set forth above, or to such other address which a
party may designate for its receipt of notices hereunder.
2. Payment on Termination
Upon termination of this Agreement American Homepatient is to pay for all
authorized work in process, and American Homepatient shall assume Vendor's
liability under and indemnify Vendor with respect to all outstanding
contracts made on American Homepatient's behalf. Upon written notice of
termination Vendor shall take all steps necessary to wind up the work under
this Agreement and to mitigate American Homepatient's liability therefore.
3. Transfer Upon Termination
Vendor shall transfer, assign and make available to American Homepatient or
American Homepatient's representative all property and materials in
Vendor's possession or control belonging to and paid for by American
Homepatient and all information regarding American Homepatient project(s)
covered by this Agreement, as set forth in Paragraph C herein. Vendor also
agrees to give all reasonable cooperation toward transferring with approval
of third parties in interest all contracts and arrangements, if any,
properly entered into by Vendor in the performance of this Agreement, and
all rights and claims thereto and therein, upon being duly released from
the obligation thereof.
I. INDEPENDENT CONTRACTORS
The parties to this Agreement are independent contractors and nothing
contained in this Agreement shall be construed to place the parties in the
relationship of employer and employee, partners, principal and agent, or
joint ventures. Neither party shall have the power to bind or obligate the
other party nor shall either party hold itself out as having such
authority.
J. THIRD PARTY OBLIGATIONS
In connection with this Agreement, Vendor shall make no commitments or
disbursements, incur no obligations nor place any advertising, public
relations or promotional material for American
Homepatient's parent, subsidiary or affiliate companies, nor disseminate
any material of any kind using the name of American Homepatient and/or
American Homepatient's parent, subsidiary or affiliate companies or using
their trademarks, without the prior written approval of American
Homepatient.
K. GOVERNING LAW
This Agreement is entered into in the State of New Jersey and shall be
constructed and governed under and in accordance with the laws of that
State.
L. MISCELLANEOUS
1) The terms of this Agreement shall be binding upon American Homepatient
and Vendor and their respective successors and permitted assigns.
Notwithstanding the foregoing, this Agreement is not assignable in whole or
in part by Vendor without the prior written consent of American
Homepatient. Factoring of accounts receivable is not permitted.
2) The failure of either party to take action as a result of a breach of
this Agreement by the other party shall constitute neither a waiver of the
particular breach involved nor a waiver of either party's right to enforce
any or all provisions of this Agreement through any remedy granted by law
or this Agreement.
3) American Homepatient and DSMI are Equal Opportunity Employers and do
not discriminate against any person because of race, color, creed, age,
sex, or national origin. Vendor represents that it has the same policy of
Equal Opportunity Employment.
4) The policy of American Homepatient and DSMI is to protect the health,
safety and quality of life of its employees and the public, and to exercise
responsible stewardship of natural resources that may be impacted by its
activities. To realize this, American Homepatient and DSMI are committed
to maintaining programs and procedures for the environmentally responsible
management of facilities, materials, production processes, products and
packaging, transportation and distribution, waste and ft minimization,
energy, general business operations and contracted goods and services.
Vendor agrees with this policy and further acknowledges that its
performance under this Agreement shall be in strict compliance with all
applicable governmental laws and regulations and in accordance with and in
furtherance of this policy.
5) This Agreement contains the entire understanding of the parties with
respect to the subject matter contained herein, supersedes any prior
written or oral communications and may be modified in writing subject to
mutual agreement of the parties hereto.
6) The headings of each paragraph are for reference only and shall not be
construed as part of this Agreement.
7) Except for the obligation to pay money property due and owing, either
party shall be excused from any delay or failure in performance hereunder
caused by reason of any occurrence or contingency beyond its reasonable
control, including. but not limited to, failure of performance by the other
party, earthquake, labor disputes, riots, governmental requirements,
inability to secure materials on a timely basis, failure of computer
equipment, failures or delays of sources from which information or data is
obtained and transportation difficulties.
IN WITNESS WHEREOF, the parties hereto, each by a duly authorized officer, have
entered in to this Agreement this 24 day of June, 1996
AMERICAN HOMEPATIENT DISEASE STATE MANAGEMENT-SM-, INC.
By: /s/ Sen Serafino By: /s/ Xxxxxx X. Xxxxxxxx
-------------------------------- -----------------------------------
Title: Vice President Title: President & CEO
----------------------------- --------------------------------
Portions of this Exhibit have been omitted pursuant to a request for
confidential treatment. The omitted portions, marked by [****], have been
separately filed with the Commission.
ATTACHMENT A
ASTHMA
DISEASE MANAGEMENT
PROPOSAL
------------------------------------------
------------------------------------------
FOR
American Homepatient
PRESENTED BY
Disease State Management,-SM- Inc.
00 Xxxxxx Xxxxxx
Xxxxxxxxx, Xxx Xxxx 00000
000-000-0000
Disease State Management and DSMI are registered service marks
of Disease State Management, Inc.
Asthma places a tremendous burden on patients and health care providers and
demands a significant portion of our nations health care dollars. Disease State
Management, Inc.-SM- is committed to improving health outcomes through the
application of state of the art technologies. Our proprietary interactive voice
recognition systems, enhanced database modeling techniques and on-demand
publishing combine to provide the powerful educational intervention necessary to
enhance patient adherence to treatment recommendations, empower patients to
self-manage their disease and provide immediate referrals when specific "high
risk" triggers are met.
DSMI's-SM- staff of systems engineers, clinical experts and physician
consultants perform a comprehensive review of the targeted disease state to
insure that "best practices" and nationally recognized guidelines form the
program's foundation. Recognized leaders in outcomes management provide
guidance throughout the project development process.
Once the baseline parameters have been established, our staff begins the process
of building the intervention protocols. DSMI's-SM- asthma intervention program
consists of six interactive voice response based telephone interventions. Each
contact generates on-demand published educational materials targeting individual
concerns. Additionally, physicians and other health care providers receive an
at-a-glance formatted report for inclusion in the patient's medical records.
These reports highlight specific areas of concern for the patient and
demonstrate areas where an individual's adherence to the prescribed therapy is
lacking.
As an extra feature, DSMI's-SM- clinical staff establishes specific "at risk"
triggers that are continually monitored. patients meeting specific criteria
demonstrating an increased risk of hospitalization, emergency services or other
costly intervention will have their providers notified immediately for follow
up. This critical notification and tracking of key indicators has been
demonstrated to reduce the global cost of managing chronically ill patients.
Each intervention is uniquely structured and targets specific behaviors such as:
diet, exercise, smoking cessation, self-management, key triggers and compliance
with pharmacological therapy. By providing unique, individually tailored
intervention strategies, DSMI-SM- not only highlights areas where noncompliance
and poor self management are impacting the plan's expenditures but also provides
an active intervention to modify "at risk" behavior before an emergency room
visit or hospitalization occurs.
In addition to providing ongoing support for patients, DSMI's-SM- fully
integrated systems approach allows for immediate on-line data collection and
evaluation. Interactive Voice Recognition systems allow administration of
HEDIS, Health Quality, patient satisfaction, and Quality of Life surveys without
operator induced bias. The process streamlines data collection and provides a
cost effective method to query patients.
TRENDS IN ASTHMA
Chronic lung diseases such as asthma, bronchitis and emphysema pose serious
challenges to both patients and health care providers. Despite an increased
understanding of these disorders, improved pharmacological therapies and a
greater awareness among potential sufferers, the incidence rates continue to
soar. In fact, between 1982 and 1993 the number of people reporting chronic
bronchitis increased seventy-nine percent, while those having emphysema and
asthma increased twenty-five and forty-eight percent respectively.(1)
Currently, over twelve million people suffer from asthma in the United
States, making it not only one of the nation's most common diseases but one
of the most costly as well.
INCREASE IN INCIDENCE RATES: 1982 - 1992
[GRAPH]
DEATH RATE FOR ASTHMA: 1982 - 1992 (PER MILLION)
[GRAPH]
While the reason for the rapid growth in the number of chronic suffers remains
uncertain, one thing is certain: these diseases pose a serious threat to
patients' well being. Despite tremendous advances in both diagnostic and
pharmacological therapies in recent years asthma continues to exact a tremendous
financial toll in terms of both direct and indirect costs.
-----------------------------------
(1) American Lung Association, Adapted form information published by the
Division of Epidemiology, National Heart, Lung and Blood Institute
IMPACT OF INCREASED PATIENT EDUCATION EFFORTS
The economic impact of asthma is staggering. In asthma patients diagnosed as
moderate to severe the annual cost of treatment often exceeds $ 100,000. In
fact, Xxxx Xxxxxxx Mutual Life Insurance Company in Boston has identified 1,300
patients whose care resulted in $28 million dollars in expenditures. Among the
most common reasons for exacerbation of symptoms are: an inability of the
patients to self-manage their disease, poor pharmacological compliance, low
adherence to provider recommendations, a lack of patient knowledge concerning
their disease and failure of the provider to adhere to established treatment
guidelines; all areas that DSMI's-SM- asthma intervention program will impact.
- Study of severe asthmatics found 1,300 patients generated $ 28 million
in claims
- Highest individual level of asthma-specific costs was $ 126,343
- Highest expense for all care were for a 2 year old female - $ 584,211
- 235 members had claims exceeding $ 100,000 annually for treatment
Targeted educational intervention programs for asthma patients have proven
effective. A recent study, conducted at the National Jewish Center for
Immunology and Respiratory Medicine and the Xxxx Xxxxxxx Managed Care Group,
demonstrated significant improvements in patient outcomes for severe asthmatics
following a comprehensive initiative to educate patients.
PATIENTS ADMITTED WITHIN THE PAST 6 MONTHS
[GRAPH]
ADMISSIONS WITHIN THE PAST 6 MONTHS WERE LOWER IN PATIENTS RECEIVING TARGETED
SUPPORT.
Additionally, personalized asthma self management, which tailors program
materials to the individual, has demonstrated positive results in moderate to
severe asthmatics.(2),(3) In a recent investigation incorporating
targeted support, the extension of face-to-face treatment via follow-up
telephone calls to the patient's home was rated more convenient and more
acceptable to patients than traditional group sessions (X.X. Xxxxx, personal
communication, July 12, 1994). Finally, in a cost-benefit analysis of a
self-management program for 47 adult asthmatics effectively reduced
hospitalization cost from $18,488 to $1,538 and lost income from $11,593 to
$4,589.(4)
FINANCIAL IMPACT OF ASTHMA
----------------------------
(2) Kotses H., Xxxxx X., Environmental control of asthma self-management.
Journal of Asthma. 1990; 27:373
(3) Kotses H., Xxxxx C., Xxxxx X.X., Individualized asthma self-management:
A beginning. Journal of Asthma. 1991; 288:287-289.
(4) Taitel M.S., A self-management program for adult asthma. Part II:
Cost-benefit analysis. Journal of Allergy and Clinical Immunology.
1995;95(3):672-6.
The following analysis reflects admission costs data for patients having severe
asthma. It reflects incident and admission rates for severe asthma as indicated
by the American Lung Association.
# of Covered Lives 500,000 500,000 500,000
Asthma Incidence Rate 0.05 0.05 0.05
# Asthma Patients 25,000 25,000 25,000
# Patients with Severe asthma 1250 1250 1250
Cost per Day as Inpatient $1,000.00 $1,000.00 $1,000.00
Average Length of Stay ( days ) 4 4 4
# Hospitalizations/year 3 2 1
Annual Hospitalization Cost/Patient $12,000.00 $8,000.00 $4,000.00
Total Hospitalization Cost to Plan $15,000,000.00 $10,000,000.00 $5,000,000.00
IMPACT OF DISEASE MANAGEMENT PROGRAM
# Patients Enrolled in DM Program 1250 1250 1250
Estimated Operational Costs/Patient $70.00 $70.00 $70.00
Total Operational Costs $87,500.00 $87,500.00 $87,500.00
PROJECTED REDUCTION IN ADMISSIONS
5% Reduction 5.00% 5.00% 5.00%
Annual Savings $750,000.00 $500,000.00 $250,000.00
7.5 % Reduction in Admissions 7.50% 7.50% 7.50%
Annual Savings $1,125,000.00 $750,000.00 $375,000.00
10 % Reduction in Admissions 10.00% 10.00% 10.00%
Annual Savings $1,500,000.00 $1,000,000.00 $500,000.00
% Success Rate Required to Break Even 0.58% 0.88% 1.75%
# Pts. Avoiding Admission to Break Even 7 11 22
PROGRAM OVERVIEW
See the "Program Intervention Description" section for details about each of the
interventions. The selected intervention schedule will be delivered to patients
who are enrolled in the program. Note that the term "provider" is used to
denote a case manager or another health care provider designated to receive
communications regarding the patient.
I. COMPONENTS
- Business reply mailer
- Patient diary
- Program description/overview
- Custom designed educational materials
- Demand published patient reports
- Demand published provider reports
- Crisis flags
- Voice demonstration line
- Logo integration
II. INTERVENTION PROTOCOL:
MONTH 1:
- Patient enrollment via business reply mailer
- Initial telephone intervention within seven days of business reply mailer
receipt
- Patients receive demand published report following IVR intervention
- Appropriate preprinted educational materials sent to patients
MONTHS 2 - 4
- Patients receive interactive voice response based telephone interventions
monthly
- Patients receive demand published report following each IVR intervention
- Appropriate preprinted educational materials sent to patients
- Physician receives demand published, patient specific report for inclusion
in patient record following IVR intervention at month 2 and 4
- Additionally physician receives immediate notification via phone/fax for
any patient reporting status indicating a critical "at risk" trigger has
been met
MONTHS 6 AND 8
- Patients receive interactive voice response based telephone interventions
- Patients receive demand published report following each IVR intervention
- Appropriate preprinted educational materials sent to patients
- Physician receives demand published, patient specific report for inclusion
in patient record following IVR intervention at month 8
- Additionally physician receives immediate notification via phone/fax for
any patient reporting status indicating a critical "at risk" trigger has
been met
Month 1 2 3 4 6 8
IVR Intervention * * * * * *
Patient Report * * * * * *
Physician Report * * *
Preprinted Materials * * * * * *
"At risk" Reporting
(as needed) * * * * * *
PROGRAM INTERVENTION DESCRIPTION
See the "Program Schedule" section for an outline of the protocol for delivering
these program components. Note that the term "provider" is used to refer to a
physician, case manager or other health care provider designated to receive
communications regarding the patient.
BUSINESS REPLY MAIL (BRM)/PROGRAM DESCRIPTION
- Two (2) page pre-printed mailer designed for distribution by providers
to patients and return via postage paid mail
- Provides brief assessment for identifying patient data (e.g., name,
phone number, best time to contact) necessary for DSMI-SM- to initiate
a telephone call to patient
- Program description includes a brief program overview
INTERACTIVE VOICE RECOGNITION BASED TELEPHONE INTERVENTIONS
- Six (5) minute interactive voice recognition base telephone
interventions initiated by live operators to patients at preferred
contact times
- Cost-efficient interface: operator-initiated contact to identify
patient and transfer to automated, voice response system
- High appeal voice response system using a recorded human voice versus
computer synthesized speech
- Patient responds in normal speaking voice versus pushing touch tone
buttons
- Self-report follow-up assessment of relevant medical and behavioral
factors: update on disease status, prescribed treatment including
diet, exercise, and medications, patient motivation, treatment
barriers, patient knowledge indicators regarding symptom
identification and disease self-management
- Patient receives personalized questions and clinically appropriate
feedback driven by expert system to promote patients' awareness of
their condition and adherence to their treatment regimen
- Allows identification of patient concerns
- Adds vital progress information to the longitudinal patient database
PATIENT REPORTS
- Laser printed, on-demand published report including personalized text
and graphics
- Mailed to patient within a week after each telephone intervention
- Personalized and pre-printed materials reinforce patient awareness and
knowledge regarding their condition and promote treatment adherence
PHYSICIAN REPORTS
- One page laser printed, on-demand published report integrating
patient's follow-up and enrollment data
- Mailed to patient's provider within a week after each patient
interactive voice response intervention
- "At-a-glance" format provides efficient documentation of critical
patient data, ready for insertion into the medical record
Portions of this Exhibit have been omitted pursuant to a request for
confidential treatment. The omitted portions, marked by [****], have been
separately filed with the Commission.
- Facilitates identification of patient education needs and
hard-to-manage patients, appropriate allocation of health care
resources, and timely modification of treatment regimens
- Enhances patient-provider communication
"AT RISK" REPORTING:
- Physicians/providers will be notified via fax when patients report
symptoms, noncompliance or other critical factors indicating an increased
risk for an acute event, hospitalization or emergency procedure
OPERATIONAL REPORTING:
DSMI-SM- will provide operational and outcome reports quarterly.
PROGRAM FEES:
American Homepatient agrees to pay DSMI-SM- a one time joint marketing fee of
$[*****] payable upon contract signing. Payments exceeding 30 days past due will
accrue a service charge of 1.5% per month of the outstanding balance.
Additionally, American Homepatient agrees to implement the Asthma intervention
described herein in a minimum of three accounts, each account having a minimum
of 100,000 covered lives, within 18 months of the effective date of this
contract. Provided that American Homepatient has successfully implemented the
program in a minimum of three accounts, American Homepatient shall pay DSMI-SM-
an additional marketing fee of $[*****]. This fee shall be payable in
installments as described:
Payment 1: $[*****] due eighteen months from the effective date of this
contract.
Payment 2: $[*****] due twenty-one months from the effective date of this
contract.
Payment 3: $[*****] due twenty-four months from the effective date of this
contract.
Operational Fees for the program shall be scaled as follows:
- Fees for the first 1000 patients enrolled shall be $[*****] per patient
- Fees for the next 2000 patients enrolled shall be $[*****] per patient
- Fees for all patients exceeding 3000 shall be $[*****] per patient
These operational fees include full funding for the Asthma Intervention Program
Protocol which includes 6 interactive voice recognition based telephone
interventions, associated demand published patient reports, associated demand
published physician reports, "at risk" reporting as necessary, data collection
and assessment, and outcomes reporting.
The program may include additional preprinted materials. Such items are a
business reply mailer, patient diary, program description/overview, or custom
designed educational support materials. Since the anticipated number of
enrollees is unknown, printing fees for these pre-printed components will be the
responsibility of American Homepatient. DSMI-SM- will furnish estimates for
printing costs upon determination of volumes and final specifications.
Additionally, DSMI-SM- agrees to provide these additional preprinted materials
at costs.
Program operational fees shall be billed monthly based upon the total number of
patient interventions completed. Payment is due within 30 days of receipt.
Payments exceeding 30 days past due will accrue a service charge of 1.5% per
month of the outstanding balance.
CUSTOMIZATION
Any customization will constitute a revision to the intervention protocol (i.e.,
additional patient and/or physician reports and/or variations in on-demand or IV
content). Any logo design used on the demand published reporting is limited to
black and white/grayscale. DSMI-SM- shall furnish estimates for development and
delivery to American Homepatient prior to undertaking any revision.
