36C24219R0168-003.pdf

Quality Assurance Surveillance Plan For: Ambulance - Special Mode Transportation

Contract Number: pending

Contract Description: Ambulance Service – Advanced Life Support (ALS) and Basic Life Support (BLS)

Contractor’s name: Pending

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

• What will be monitored?

• How monitoring will take place.

• Who will conduct the monitoring?

• How monitoring efforts and results will be documented.

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. GOVERNMENT ROLES AND RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities.

A. Contracting Officer (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO: Brad Mills Organization or Agency: Department of Veterans Affairs, RPO East, VISN 2

B. Contracting Officer’s Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Assigned COR: Steve Gordon, Administrative Officer Organization or Agency: Northport VA Medical Center, Northport, NY

C. Other Key Government Personnel:

Ms. Kristin Sievers, Chief HAS Organization or Agency: Northport VA Medical Center, Northport, NY

Ms. Patricia Sangenito, Assistance Chief HAS Organization or Agency: Northport VA Medical Center, Northport, NY

Nancy Mirone, Chief, Business Office Service Organization or Agency: Northport VA Medical Center, Northport, NY

April Esposito, Assistant Chief, Business Office Organization or Agency: Northport VA Medical Center, Northport, NY

3. CONTRACTOR REPRESENTATIVES

The following employees of the contractor serve as the contractor’s program manager for this contract.

A. Program Manager: To Be Determined upon vendor selection

B. Dispatcher: To Be Determined

4. PERFORMANCE STANDARDS

Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.

The Performance Requirements Summary Matrix, paragraph (N/A) in the Statement of Work (SOW), includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).

Contractor agrees to maintain an on-going Quality Management/Assurance Program which include the following activities Quality Assurance: The contractor will be evaluated throughout the contract period in regard to their compliance with all VA quality performance measures and monitors as it pertains to Ambulance Services; proper documentation, adherence to performance measures, timely access, excessive waits/delays, pickup and delivery of special mode. Additionally patient safety and patient complaints will be researched and addressed as necessary.

Task ID Indicator Standard Acceptable

Quality Level

Method of Surveillance

Incentive/Penalty

Hours of Operation 1 Work Hours

The Contractor shall provide 24 hour/7 days a week, regardless of distance, ALS and BLS Transportation Service.

100% Daily Observation Negative past performance rating for failure to comply.

Initial Pick-up Delivery /wait time

Patient must be picked up and/or Delivered by the Contractor’s employees in a timely manner as defined by their SOW

Contractor will be responsible for pick-up and delivery points, actual time of arrival at pick-up and delivery points and actual waiting time at pick-up and delivery points.

95% Daily Observation/ Review of Transportation Log

Negative past performance rating for failure to comply.

Environment of Care 3

Vehicles and medical equipment

Contractor shall be responsible to ensure that all vehicles operated and medical equipment utilized under the terms of this agreement meet all established requirements defined by this contract .

100%

Periodic Review of Contractor On-Site Vehicle and Equipment Maintenance/Inspection Records validating compliance with all State requirements.

Contractor will be required to provide annual compliance logs for all vehicles/equipment utilized to provide service to the VA.

Contractor vehicles will also subject to physical inspection by the VA at any time during the contract.

Contractor will be fully responsible to ensure that all vehicles in operation under this agreement meet all requirements.

Negative past performance rating for failure to comply.

Quality Level

Method of Surveillance

Incentive/Penalty

Contractor Personnel

Contractor shall test drivers for prohibited drug use and alcohol misuse;

administer a criminal background check, to the maximum extent permitted by NY State Law.

Contractor shall be responsible to maintain on-site records of all employee competency requirements.

100%

Periodic Inspection of Contractor On-Site Competency Records for employees

If it is determined that a Contractor operator failed to meet all specified requirements, VA may provide negative past performance information and choose not to exercise any remaining option periods.

Additionally, VA may issue a cure notice and potentially terminate the contract for default.

Patient Safety Patient Satisfaction

Patient safety incidents must be investigated, confirmed and resolved.

The Contractor shall notify the COR of any problems transporting patients. The COR or designee shall be notified within one hour of the occurrence of the incident(s) by telephone and, if requested by the COR and/or Contracting Officer (CO), a written report of the incident(s) will be delivered to the COR or his/her designee by close of business the next working day.

100%

Direct Observation/ Review of Trip Sheets/logs/Contractor notifications

If it is determined that a Contractor operator failed to meet requirements regarding the reporting of patient safety incidents, VA may provide negative past performance information and choose not to exercise any remaining option periods.

Additionally, VA may issue a cure notice and potentially terminate the contract for default..

Driver Adequacy / Fitness for Duty

Quality Level

Method of Surveillance

Incentive/Penalty

Patient complaints about the quality of service will be reported to the COR, and the Contractor

The Contractor shall notify the COR and Contracting Officer, in writing within 24 hours, of any complaints made by the patients with regards to transportation services.

100% Customer Feedback

If it is determined that a Contractor operator failed to meet requirements regarding the reporting of patient safety incidents, VA may provide negative past performance information and choose not to exercise any remaining option periods.

Billing Errors 7

Invoice Procedures

Billings must comply with Mileage Guide/Rates listed in the contract

100%

COR will perform random sampling of monthly trip tickets against monthly invoice to ensure accuracy.

VA will not pay for services not requested or for any charges which exceed agreed upon base and mileage rates.

5. METHODS OF QA SURVEILLANCE

Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

A. DIRECT OBSERVATION. (Can be performed periodically or through 100% surveillance.)

B. PERIODIC INSPECTION. (Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

C. 100% INSPECTION. (Evaluates all outcomes.)

D. RANDOM SAMPLING. (Designed to evaluate performance by randomly selecting and inspecting a sample of cases.

E. CUSTOMER FEEDBACK/COMMENT CARDS (Evaluates feedback from Veterans receiving transportation service) Insert performance standard(s)

6. RATINGS

Metrics and methods are designed to determine if performance exceeds, meets, or does not

Handling Patient Complaints meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used for measurement will be: meets standards/does not meet standards

7. DOCUMENTING PERFORMANCE

A. Acceptable Performance

The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

B. Unacceptable Performance

When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's program manager.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

8. FREQUENCY OF MEASUREMENT

A. Frequency of Measurement.

During contract performance, the COR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

B. Frequency of Performance Assessment Meetings.

The COR shall meet with the contractor monthly to assess performance, discuss concerns, and troubleshoot existing problems.

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