Quality Assurance Surveillance Plan (QASP) - Hudson Valley AMBULANCE ALS - BLS.pdf

Quality Assurance Surveillance Plan

For: Hudson Valley Ambulance ALS/BLS Service

Contract Number: To Be Determined

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

Contractor’s Name: To Be Determined

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: Natalie Acevedo 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: Caprice Pack, Member Service Manager

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.

Performance Objective ID Indicator Performance

Standard

Acceptable Quality Level

Method of Surveillance

Incentive Incentive/Penalty

Initial Pickup Delivery /wait time

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

SOW

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

90%

Daily Observation/ Review of Transportation Log

See Paragraph 5

Excellent = 96%- 100%

Satisfactory =90- 95%

Unsatisfactory= below 95%

Patient Safety 2

Patient safety incidents must be reported to the COR immediately (within 24 hours)

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.

2-3 validated complaints in a 12 month period

Incident Report;

Random Audit/Inspection;

Validated Complaints

See Paragraph 5

Excellent = 0-1 validated complaint in a 12 month period

Satisfactory = 2-3 validated complaints in a 12 month period

Unsatisfactory = 4 or more validated complaints in a 12 month period

Trip Reports 3

The Contractor shall document each VA authorized transport in eCAMS

The Contractor shall include a copy of this report with all invoices and also provide the trip documentation form upon request by the VA. These reports will serve as documentation of the transport and will be a source document for reconciliation of the Contractor’s requests for payment

3 to 7 late reports in a 6 month period or 1 to 2 missing reports

Daily Observation/ Review of Transportation Log

See Paragraph 5

Excellent = no more than 3 late reports in a 6 month period no missing reports

Satisfactory = 3 to 7 late reports in a 6 month period or 1 to 2 missing reports

Unsatisfactory = 8 or more late reports in a 6 month period or 3 or more missing reports.

*A LATE REPORT IS DEFINED AS A REPORT RECEIVED MORE THAN 24 HOURS

AFTER IT WAS DUE BUT NOT MORE THAN 72 HOURS AFTER REPORT IS DUE. A

MISSING REPORT IS A REPORT NOT RECEIVED WITHIN 72 HOURS OF WHEN IT IS

DUE.

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. DAILY OBSERVATION: Review of Transportation Log(Can be performed periodically or through 100%surveillance.)

B. RANDOM REVIEW.

6. RATINGS

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

Excellent = Exceeds Standards

Satisfactory = Meets Standards

Unsatisfactory = Fails To 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.

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

Signature – Contractor Program Manager

Signature – Contracting Officer’s Representative