Another (and Exhaustively Named) Insider RFP: CMS Transforming Clinical Practice Initiative (TCPI), Support and Alignment Network (SAN)

We may be seeing an increase in “insider” RFPs.

By “insider” RFPs, we mean RFPs that don’t allow any random nonprofit to compete. HUD’s Continuum of Care (CoC) program (explained at the link) is an example: a nonprofit already has to be a CoC member to get a Cut of the Cash (which is another sort of “CoC”), which naturally creates barriers for new organizations that wish to try to do things better or at least differently than the existing funded organizations. The grant system as we presently know it got started in earnest in the ’60s because it was believed that local organizations were better suited to figure out what needed to be done than centralized federal bureaucrats. In addition, the threat of funding stream removal may make local organizations more disciplined than government bureaucracies—an idea that anyone who has dealt with a DMV may appreciate.

But designating small groups of eligible applicants is one way to get around open competition, particularly if the eligibility details are cryptic. As you may imagine given the title of this post, we have an example in mind: the Centers for Medicare & Medicaid Services (CMS) just issued the Transforming Clinical Practice Initiative (TCPI), Support and Alignment Network (SAN) FOA. Unless you’re already a professional organization or medical specialty group you’ll probably have no idea what it means to:

leverage primary and specialist care transformation work and learning in the field. The action by PTNs and SANs is planned to contribute to the overall operational efficiency and movement of the clinician practices through the 5 Phases of Transformation and their achievement of the TCPI goals.

I love leveraging transformations in order to effect effective and immediate action by PTNs and SANs and BBQs. Don’t you? “Cryptic” does not do this acronym stew justice.

In short, this is another insider RFP. For, say, organizations devoted to nurses, there are only going to be a handful of eligible applicants, because there are only so many nursing organizations that could be construed to be eligible applicants.

For applications like TCPI SAN, some interesting competitive dynamics can still take place within warring fiefdoms. For example, there are at least two large general-purpose national nurse organizations or trade groups, which we know because we’ve worked with one. Not surprisingly the two groups don’t like each other very much. As often happens, one likes one set of ideals that the other opposes, and vice-versa. Also not surprisingly, they fight for the same dues, grant opportunities, and foundation support; though both want to cast their aspersions as ideological or intellectual in nature, it’s always a good idea to follow the money too.*

In addition, there might be specialists within specialists groups. Is nursing the right level of specialty, or is oncology nursing? Is the association of surgeons correct, or the association of neurosurgeons? Those are the distinctions that’ll come into play in TCPI grant applications. We look forward to grabbing our axes, forming a shield wall, and fighting to the end.**


* A theme you should notice running throughout Grant Writing Confidential and indeed world history itself. How much of the 100 Years War was about the souls of English- and Frenchmen and the merits of Protestantism versus Catholicism, and how much was about money, trade, land, and political control? Today most historians probably argue as the latter, but almost any battle, whatever else it may be about, will also be cast as a war of ideas. Ideas are easier to fight and die for.

** I’ve been watching Vikings, which is set in an imagined 800 AD and in which a lot of characters die unpleasant deaths. The link also goes to the Blu-Ray version, which is to say the European version, which is to say a version much better and realer than the one that airs on American TV.

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