36C24918R0178-007.docx

Attachment 5 - QUALITY ASSURANCE SURVEILLANCE PLAN

For: Mobile Lithotripsy

Contract Number: ________________________

Contractor Name: ________________________

Contract Description: Mobile Lithotripsy Services

Contractor’s Name: Veterans Affairs Medical Center (hereafter referred to as the contractor)

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: Kimberly Carson, CO; Pretial Caston, Contract Specialist Organization or Agency: Department of Veterans Affairs, Network Contracting Office 9 (NCO 9), Murfreesboro, Tennessee

a. 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: Reginald Penny, Radiology, Administrative Officer; Memphis VAMC

c. Other Key Government Personnel –

3. CONTRACTOR REPRESENTATIVES

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

a. Program Manager -

b. Other Contractor Personnel:

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 in the Performance Work Statement (PWS), includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).

Duties:

Individual will follow and meet all medical center and clinical policies, procedures, rules and regulations. Individual will be provided with and will follow the Medical Staff Bylaws, as well as specific direction from the Program Manager, or his designee.

5. INCENTIVES

The Government shall use Exercise of Option Period as incentives.

6. METHODS OF QA SURVEILLANCE

Computer generated report "Summary Verification Timeliness Report", run monthly, shall be used as a method of Quality Assurance Surveillance. The COR shall use the surveillance method listed below in the administration of this QASP.

7. DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE

Full payment of monthly invoice.

b. UNACCEPTABLE PERFORMANCE

A deduction of 2% from the monthly invoice each month that 98% or above of the performance is not met.

8. FREQUENCY OF MEASUREMENT

Frequency of Measurement.

During contract performance, the COR or designee will generate a monthly computer report for the billing period.

Signature – Contractor Program Manager

Signature – Contracting Officer’s Representative