Final Performance Work Statement 2021.08.22.docx

?.## PERFORMANCE WORK STATEMENT

Performance Work Statement Critical Care Ambulance Service (Charles George VA Health Care System)

1. General:

The Charles George VA Medical Center (“VA”) has a requirement for ambulance transport in patient critical situations that need the most advanced level of care in emergent and non-emergent situations.

2. Scope:

The Contractor will provide critical care ambulance services as described below. This contract is a Requirements contract comprised of a base year period and four one-year option periods. Task orders for service will be issued from this contract, typically for the entire one-year period of performance.

3. Description of Services:

3.1. The Contractor shall provide critical care level of service for the beneficiaries of the VA. This will involve transports to and from any location within the Primary Service Area. The Contractor shall be credentialed by the North Carolina Office of Emergency Medical Services for Critical Care Transports. In addition, all critical care transport personnel shall be approved by the Medical Director of the Buncombe County Emergency Services System for critical care transports.

3.2. The Primary Service Area of this contract is the Charles George VA Health Care System (HCS) and its encasement area, occasionally including non-VA facilities, that includes the closest Critical Care medical facilities as necessary.

3.3. All ambulances providing critical care transports hereunder shall be equipped to the paramedic standards as stated by the North Carolina Office of Emergency Medical Services. The Contractor shall provide all vehicles, personnel, management, supplies, transportation, equipment and reports necessary to cover all scheduled and on-call ground ambulance transportation service.

3.4. Performance shall be in accordance with the requirements contained in this Performance Work Statement (PWS) and the standards of the Buncombe County Emergency Services Medical Director and State of North Carolina EMS Division.

3.5. Offered prices shall include all medications, equipment, and supplies necessary for the safe transport of all patients. This will involve trips to and from any location within the Primary Service Area (PSA) of the VA and beyond, as appropriate, but may encompass travel to points as far away as Richmond, VA or beyond, if necessary. Trips are generally confined to within the Primary Service Area (PSA).

3.6. Notwithstanding any other provision, the Contractor may terminate this agreement at any time with or without cause by providing the Government with sixty (60) days’ prior written notice of termination, which notice shall specify the date of termination.

4. Number of Patients:

It is understood and agreed that only one patient will be transported on a trip.

5. Rates:

Rates will apply twenty-four hours a day seven days a week. The base rate quoted in the schedule shall constitute full compensation for one-way trips within a 30-mile radius of the originating facility. For trips beyond a 30-mile radius, Contractor shall receive the base rate plus the per mile rate quoted in the schedule for all loaded miles (i.e., miles for which the patient is on board the vehicle). Contractor will track and bill trip mileage. Contractor shall document the odometer reading at the time the 30-mile radius is crossed as well as the odometer reading at the arrival of destination in the patient care report.

6. Orders:

6.1. Requests for services will be made by the VA in writing or by telephone through Contractor’s Medcom and confirmed by telephone shortly thereafter from authorized VA personnel. The VA will not be held liable for those non-emergent transport services performed by the Contractor(s) which are ordered by people who are unauthorized. The request will specify a range of dates and times for acceptable delivery of a transported patient. When contacted, the Contractor shall immediately notify the VA if they can provide the service. If the Contractor cannot provide the service requested the VA reserves the right to obtain the service from another source. In the event the VA obtains services from a different ambulance supplier, Contractor shall not be responsible for the additional cost, if any, associated with such transportation. The VA will be the sole judge in determining when to order service from another source. Contractor will be informed of the condition of the patient at the time of request for service. The Contractor will be required to assign appropriate personnel for the transportation of patient.

6.2. Contractor will be informed of the condition of the patient at the time of request for service. The Contractor will be required to assign appropriate personnel for the transportation of patient. The VA agrees to cooperate with Contractor to ensure appropriate level of transportation based on the patient’s status as well as medical necessity and payor requirements. In the event that Contractor determines that a transport requires a level of transportation different from a critical care transport (e.g., ALS or BLS), the VA agrees to reimburse Contractor for such transport at the applicable rates. In this event, the Contractor will utilize the Critical Care transport already dispatched to transport the patient and will not return the unit for an alternative ALS or BLS vehicle.

7. Life Threatening Emergency Calls:

Contractor will arrive at the originating facility in response to requests for emergency ambulance transport within thirty (30) minutes of request by VA Authorized Personnel (defined below). The performance standard for the Contractor’s response to requests for emergency transport is that they shall be compliant with the 30-minute threshold 80% of the time to maintain a satisfactory performance rating on this metric. The Contractor shall communicate the estimated timeframe of arrival to VA Authorized Personnel within 5-minutes of a request for transport. The performance standard for communication is that the Contractor shall be 90% compliant with the 5-minute to maintain a satisfactory performance rating on this metric. When the Contractor is unable to respond within 30 minutes, the Contractor shall immediately contact the VA requestor and advise of its inability to provide services within the requested timeframe. At that time, VA personnel will take whatever action is appropriate. The parties acknowledge and agree that due to the anticipated low volume of transports under this contract, any failure on the part of the Contractor the meet the above metrics will not be deemed a breach of this contract. The parties shall review infractions as necessary and make reasonable efforts to agree upon ways to better meet such metrics.

8. Non-emergency Calls:

Contractor will arrive at the originating facility within sixty (60) minutes of time of notification request from VA Authorized Personnel for non-emergency transports where the patient is located at the Charles George VA Medical Center. Contractor will arrive at the originating facility within ninety (90) minutes of time of notification request from VA Authorized Personnel for non-emergency transports where the patient is located at a facility other than the Charles George VA Medical Center. The performance standard for the Contractor’s response to requests for non-emergency transport is that they shall be compliant with the 60-minute and 90-minute thresholds 80% of the time to maintain a satisfactory performance rating on this metric. The Contractor shall communicate the estimated timeframe of arrival to VA Authorized Personnel within 5-minutes of a request for transport. The performance standard for communication is that the Contractor shall be 90% compliant with the 5-minute threshold to maintain a satisfactory rating on this metric. When the Contractor is unable to respond within the 60 and 90-minute thresholds, the Contractor shall immediately contact the VA requestor and advise of its inability to provide services within the requested timeframe. At that time, VA personnel will take whatever action is appropriate. The parties acknowledge and agree that due to the anticipated low volume of transports under this contract, any failure on the part of the Contractor the meet the above metrics will not be deemed a breach of this contract. The parties shall review infractions as necessary and make reasonable efforts to agree upon ways to better meet such metrics.

9. Authorizing Personnel:

The following VA personnel are authorized to request or authorize ambulance services for the VA:

9.1. Chief, HAS

9.2. Assistant Chief, HAS

9.3. Patient Travel Assistant

9.4. Administrative Officer of the Day (AOD)

9.5. The VA shall be responsible for ensuring that the above “Authorized Personnel” request transportation services hereunder. Notwithstanding the above, Contractor shall not be penalized for any emergent transport that is provided without authorization from the above-referenced VA Authorized Personnel, and the VA agrees to reimburse Contractor at the appropriate rate for all such transports.

10. Loading/Unloading Patients:

Contractor(s) will be required to assist patient from point of pick-up to ambulance and from ambulance to point of destination.

11. Reimbursement:

11.1 The VA’s Travel Coordinator and Contracting Office Representative (“COR”) will review each invoice for transport. Contractor will invoice each transportation call separately. The VA shall provide Contractor with the name of the COR for this contract prior to the commencement of the term and advise Contractor of any changes to the COR for the length of the contract.

11.2 On a monthly basis, the Contractor shall provide a report showing the time of dispatch, arrival time, and total time of patient care for all transports for the previous month. This report is due by the 10th calendar day of each month.

12. Transport Personnel Qualifications:

12.1. Contractor shall provide a team of medical personnel consisting of at least two (2) personnel for every transport provided hereunder. At least one (1) transport personnel shall maintain active state certification in Critical Care Transport (e.g. Certified Flight Registered Nurse (CFRN), Certified Transport Registered Nurse (CTRN), Certified Emergency Nurse (CEN), Certified Critical Care Registered Nurse (CCRN), Flight Paramedic Certified (FP-C), Critical Care Paramedic Certified (CCP-P) and hold current certification in a national recognized Critical Care Certification Board. The licensure and qualifications of other team members shall be decided by Contractor based on patient condition.

12.2. All patient care providers shall maintain certification in Advanced Cardiac Life Support, and Basic Cardiac Life Support.

13. Contractor Personnel:

13.1. Training: Critical Care Transport personnel shall be appropriately experienced, credentialed and licensed according to applicable local and state authorities for the level of care required for critical care transports and defined patient population. Skills include but not limited to: Advanced Airway Management; Mechanical ventilation initiation and management of all modes of ventilation. Cardiovascular; Management of Ventricular Assist Device; 12 Lead EKG management including pacing, defibrillation, cardioversion; Intraosseous access, Indwelling port access; Invasive hemodynamic monitoring. Gastric tube placement and management; Urinary catheter initiation and management. Ability to calculate and independently administer medications applicable to the critical care environment and covered in protocols, guidelines, or standing orders.

13.2. On a quarterly basis, the Contractor shall submit the names and credentials of critical care transport personnel to be used in performance of this contract.

14. Transport Criteria for Critical Care Patients may include but not limited to:

14.1. Intubated patients that require ventilator management of all modes of ventilation; to include but not limited to: volume pressure, and dual mode ventilation; non-invasive positive pressure ventilation.

14.2. Management of Ventricular Assist Device, including but not limited to percutaneous or central Left Ventricular Assist Device; Right Ventricular Assist Device; Bilateral Ventricular Assist Device.

14.3. Management of Extracorporeal Membrane Oxygenation (ECMO) with or without heater/cooler capability; note: may require RN from sending facility to assist.

14.4. Intra-Aortic Balloon Pump (IABP) counterpulsation (The VA sending facility will send a VHA RN for IABP use during transport. The nurse from the VHA will manage the pump during transport but will not be responsible for primary patient care. For non-VA sending facilities, the Contractor will need to request that the sending facility provides an RN to operate the pump during transport. In no event will Contractor be required to provide a transport, or be liable for the inability to provide a transport, if the sending facility is unable to provide a qualified RN.)

14.5. Invasive hemodynamic monitoring (e.g. CVP, Pulmonary Artery Pressures, Abdominal Pressures, arterial pressures, intracranial pressures)

14.6. Patients requiring sedation, paralytics

14.7. Patients that ICU staff considers unstable and require the highest level of care in transport.

14.8. Cardiac patients that require transcutaneous pacing capabilities, cardiac cardioversion.

14.9. Patients requiring monitoring of chest tube drainage system management.

14.10. IV placement equipment via peripheral, intraosseous and/or central IV access or other suitable means for medication and or fluid administration.

15. Equipment:

16. Vehicles:

The ambulances used under the terms of this contract shall be licensed and meet the minimum requirements governing emergency vehicles that is mandated by the State of North Carolina. Contractor shall maintain in good standing all licenses, certifications and permits as are necessary throughout the term of the contract and a copy of updates provided accordingly. The Contractor must have an adequate number of vehicles to meet the requirements of this contract, along with the evidence of satisfactory vehicle inspection prior to use under this contract. Vehicles and equipment used in the performance of this contract must be clean, orderly, and in excellent operating condition always, and records of maintenance/preventive maintenance must be made available for inspection upon request. All vehicles shall be smoke free and have “No Smoking” signage posted. Contractor agrees to clean its vehicles and equipment consistent with its standard operating procedure between patients and provide evidence of compliance with such cleaning processes upon the VA’s reasonable request subject to verification by the COR. The Contractor shall notify the COR of any vehicle and equipment added/changed/deleted after award of contract. The VA reserves the right to thoroughly inspect contractor vehicles prior to award and at any time during performance of any awarded contract. Mechanical defects noted at the time of inspection must be corrected and the ambulance (s) re-inspected prior to use under the contract.

17. Ambulance Medical Equipment and Supplies:

Every ambulance in service under this contract shall be equipped as required by the State of North Carolina for advanced life support and carry at least the minimal equipment necessary for the type of service to be provided, as determined by standards adopted by the State of North Carolina. Each emergency care vehicle shall have patient compartment facilities, oxygen and suction systems and equipment, environmental climatic equipment communications and additional systems equipment accessories and supplies as required by the applicable codes, rules and regulations established by Federal, State and Local regulating authorities. The Contractor will be responsible for all medical and non-medical supplies needed to perform services. On Advanced Life Support vehicles, the contractor shall supply intravenous administration pump with the ability to maintain and administer at least two liquid medications in a precise volume-controlled manner.

18. The following equipment shall be supplied, but not limited to for proper patient care:

18.1. Medication administration device

18.2. Intravenous infusion pump that delivers a specific amount of fluids

18.3. Blood and blood products for adults, pediatric and neonatal patients (The Contractor can carry, but not initiate, blood products. Paramedics can continue blood already initiated at sending facility but cannot initiate during transport per State and local regulation.)

18.4. Pump Infusion Sets; Minimum of four (4) Infusion modules

18.5. Cardiac Monitor: Cardiac defibrillation, cardioversion, and transcutaneous pacing capabilities,

18.6. Defibrillator capable of delivering a minimum up to 200 joules biphasic, monitor 12-leads, synchronize cardioversion, and cardiac pacing.

18.7. Equipment to monitor waveform capnography of a breathing and/or tracheal intubated patient

18.8. Linen supplies are the responsibility of the contractor.

19. Equipment that may be needed for transport include but not limited to:

19.1. Multi-mode transport ventilator that is specific to patient age and ideal weight by height specifications and scope of practice:

19.2. Volume and pressure control ventilation with strongly recommended mode of Pressure Regulated Volume Controlled (PRVC)

19.3. Invasive ventilation control modes of controlled, Assist Controlled (AC), Synchronized Intermittent Mechanical Ventilation (SIMV) with Pressure Support (PS) available, Positive End Expiratory Pressure (PEEP), and the ability to adjust inspiratory time

19.4. Continuous Positive Airway Pressure (CPAP) with the ability to adjust pressure and FiO2 from 21% to 100%

19.5. Non-invasive positive pressure ventilation (NPPV) (e.g. Biphasic Positive Airway Pressure) with the ability to adjust iPAP, ePAP, FiO2 from 21% to 100%, Rise Time, iTime, flow and time termination. Ventilator should provide clinicians the ability to assess key respiratory monitoring outputs (e.g. respiratory rate, PIP, MAP, Plateau Pressures, expired Vt, minute volumes, etc.)

19.6. Fixed oxygen cylinder or liquid oxygen system with at least two flow meters and a

19.7. source at 50 psi, and compressed air or other required inhaled agent to meet specific patient needs and transport duration for the Primary Service Area. The minimum gas volume available must be able to meet any ventilator and patient specific flow requirement for the longest possible transport by the Contractor a 30-minute reserve. For planned long transports when it is impossible to carry the amount of oxygen required to complete the transport there should be a plan in place to replenish the supply.

20. Medications that address protocols

Medication Formulary; minimum requirements will be based on the Contractor’s scope of practice and needs of the VA’s patient population. Contractor must maintain sufficient medication for the maximum duration of transport, plus a 30-minute reserve. The Contractor must assure temperature stabilization of all pharmaceuticals within limits prescribed by manufacturer and including blood products if carried by the Contractor.

21. Response Times:

21.1. Response time will be calculated from the receipt of the telephonic request for service from a VA Authorized Personnel. At the time of the request, the Contractor shall acknowledge their ability to provide the service within the requested response time. If the Contractor cannot provide the service for any reason, they must notify the VA Authorized Personnel requesting the service of their inability to provide the service. Emergency Orders require response times quicker than standard orders. Response times are outlined below:

21.2. Emergency Orders: Contractor shall arrive at the point of pickup no later than thirty (30) minutes from the time of request.

21.3. Non-Emergency Orders: Contractor shall arrive at the point of pickup no later than sixty (60) minutes from the time of request if the pickup point is the Charles George VA Medical Center. If the pickup point is other than the Charles George VA Medical Center, the Contractor shall arrive at the pickup point no later than ninety (90) minutes.

22. Justification for Contract:

The present contractor has personnel that are certified at the paramedic level, but not credentialed for Critical Care Transport. In addition, the present contractor is not authorized for Critical Care Transport per the Buncombe County Emergency Medical Services Medical Director.

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