36C25220C0124-001.pdf

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Original Date: 03/22/11

Revision 08 Date: 04/18/2018

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A) for

Other Than Full and Open Competition (>SAT)

Acquisition Plan Action ID: 36C252-20-AP-1587

Purchase Request Number: 695-20-3-040-0014

Solicitation Number: 36C25220Q0320

1. Contracting Activity: Department of Veterans Affairs, Great Lakes Acquisition Center

(NCO 12), 115 South 84th Street, Suite 101, Milwaukee, Wisconsin 53214.

2. Nature and/or Description of the Action Being Processed: This procurement is for the acquisition of patient satisfaction data collection and analysis services (“Patient Satisfaction

Survey” services), in accordance with FAR 13.5 Simplified Procedures for Certain

Commercial Items and specifically FAR 13.501 Special Documentation Requirements, where acquisitions conducted under Simplified Acquisition Procedures are exempt from the requirements of FAR Part 6, but still require a justification using the format of FAR 6.303-2.

3. Description of Supplies/Services Required to Meet the Agency’s Needs: The goals of this acquisition are twofold: (1) provide actionable recommendations to improve patient care derived from qualitative and quantitative analysis of objective data; and (2) achieve the VA goal of Magnet Hospital designation for the Clement J. Zablocki VA Medical Center. The total value of this acquisition is expected to exceed the Simplified Acquisition Threshold, assuming all option years are exercised.

4. Statutory Authority Permitting Other than Full and Open Competition: The authority for applying the Simplified Procedures for Commercial Items of FAR 13.5 is 41 U.S.C.

1901 and is implemented by for restricting competition on this procurement via FAR 13.106-

1(b)(2).

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the

Acquisition Requires the Use of the Authority Cited Above (applicability of authority):

The central purpose of this acquisition, as set forth in Paragraph 3, is to provide actionable recommendations to improve patient care derived from qualitative and quantitative analysis of objective data. Core competencies to meet this requirement include the ability to draft a relevant survey, implement it, analyze the results, and provide actionable recommendations.

In other words, this contract requires data collection and statistical analysis. In order to provide the most relevant results from statistical analysis, the largest population sample size is required, i.e., the largest database of relevant information possible. Per the article, The

Advantages of a Large Sample Size, available at https://sciencing.com/advantages-large-sample-size-7210190.html, “Larger sample sizes provide more accurate mean values, identify outliers that could skew the data in a smaller sample and provide a smaller margin of error.” Accordingly, this contract requires a company that possesses the core competencies https://sciencing.com/advantages-large-sample-size-7210190.html https://sciencing.com/advantages-large-sample-size-7210190.html

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Revision 08 Date: 04/18/2018 previously identified, as well as the largest database of relevant information possible to ensure the more accurate results from statistical analysis.

As part of its acquisition package, Zablocki VAMC requested that the proposed contract, which is a follow-on to an existing contract expiring on March 31, 2020, be renewed with

Press Ganey Associates, Inc. (“Press Ganey”) as the contractor because of its outstanding execution of the current contract. See, e.g., FAR 17.207(e)(1) (considering “the

Government’s need for continuity of operations” as a determinative factor for the exercise of an option). Nonetheless, independent information was necessary to validate Press Ganey’s ability to provide the most accurate statistical analysis possible by possessing a large database of relevant information. Based on information available from disinterested third parties, it appears that Press Ganey is a leader in the field of patient satisfaction surveys and possesses a sufficiently large database to provide accurate statistical analysis. In a medical article, Factors Impacting Press Ganey Patient Satisfaction Scores in Orthopedic Surgery

Spine Clinic, published in The Spine Journal, Volume 16, Issue 11, (2016), the authors state, “Press Ganey is a private company that provides patient satisfaction surveys to improve patient care. This system is in use in more than 10,000 health-care organizations, and it has been used to quantify patient satisfaction in previously published works.” In addition, the

University of Utah published, About the Press Ganey Survey, available at https://healthcare.utah.edu/fad/pressganey.php, stating, “For more than 30 years, Press Ganey has been the industry's recognized leader in improving the patient experience. Today, Press

Ganey works with more than 26,000 health care facilities, including over 60 percent of all

US hospitals, to help reduce patient suffering and improve the quality, safety, and experience of care.” Based on this information, it appears that Press Ganey possesses a sufficiently large database to provide accurate results when conducting statistical analysis.

In order to validate whether Press Ganey is uniquely qualified to provide Patient Satisfaction

Survey services, confirmation is required via empirical evidence supplied by Government database research. Accordingly, the VA’s Vendor Information Pages, the Strategic

Acquisition Center, GSA Advantage, and the SBA’s Dynamic Small Business Search were all queried, producing no useful results except for a copy of Press Ganey’s GSA contract.

Finally, the transactional databases were queried, including eCMS, Contract Opportunities, and FPDS. eCMS showed a current contract providing Patient Satisfaction Survey services to another facility within NCO 12, the contractor being Press Ganey. Contract Opportunities showed five separate VA contract awards to Press Ganey using the search term “patient satisfaction survey.” Finally, FPDS indicated that 62 of 65 (or 95%) of contract actions for the VA using the search term “patient satisfaction survey” involved Press Ganey. The most recent of the other three contract actions is 2012; the other two are from 2007 and 2005.

Market research indicated that Press Ganey is uniquely qualified to fulfill requirements of the proposed contract, so the decision was made to post a Notice of Intent to Sole Source

Acquisition on February 15, 2020, with a response deadline of February 21, 2020. No responses were received to this Notice.

https://healthcare.utah.edu/fad/pressganey.php

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Based on the foregoing, it appears that Press Ganey is uniquely qualified to provide patient satisfaction data collection and analysis services to the Zablocki VAMC, and this acquisition should proceed on a sole source basis.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable: As previously noted, a Notice of Intent to Sole Source

Acquisition was posted on Contract Opportunities on February 15, 2020, with an expiration date of February 21, 2020. No responses were received.

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and

Reasonable: The anticipated cost for this contract will be fair and reasonable because it is expected that the prices to be offered by Press Ganey will be in line with the prices previously found reasonable on the contract that is expiring on March 31, 2020, in accordance with FAR 13.106-3(a)(2)(ii). In addition, there are numerous contract actions with specific pricing available via FPDS to provide an additional check for price reasonableness, in accordance with FAR 13.106-3(a)(2)(i).

8. Description of the Market Research Conducted and the Results, or a Statement of the

Reasons Market Research Was Not Conducted: Thorough market research was conducted using the following sources: VA Vendor Information Pages (“VIP”); Strategic Acquisition

Center (“SAC”); GSA Advantage; SBA Dynamic Small Business Search; eCMS; Contract

Opportunities; FPDS; an online articles search; and information supplied by Press Ganey, as detailed in the Market Research Memorandum. See Attachment 1 – Market Research

Memorandum, without Attachments.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition: None.

10. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition: None.

11. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any

Barriers to Competition before Making subsequent acquisitions for the supplies or services required: The fundamental reason for this sole source acquisition is that Press

Ganey has positioned itself as the best option to provide Patient Satisfaction Survey services to the VA. It is anticipated that future acquisitions of this type will be sole source, unless there is a change in the market.

12. Requirements Certification: I certify that the requirement outlined in this justification is a

Bona Fide Need of the Department of Veterans Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Title: _______________________________

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13. Approvals in accordance with the VHAPM Part 806.3 OFOC SOP:

Contracting Officer or Designee’s Certification (required): I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

Contracting Officer

Great Lakes Acquisition Center (NCO 12) http://vaww.pclo.infoshare.va.gov/PMWeb/VHAPM_Part_806.3.aspx

Market Research Memorandum

VHAPM Part 810 Market Research SOP Page 1 of 5 Revision: 03, Effective Date: 02/04/19

Requirement Title: Patient Satisfaction Survey – Data Collection & Analysis

In accordance with FAR 7.102, contracting officers and acquisition planners are required to perform acquisition planning and conduct market research. The following information is a summary of the acquisition planning: In submitting this request for procurement, the customer considered available sources within the agency, any government furnished information/property, and security considerations IAW VA Directive/Handbook 6500. The contract type for this procurement is Firm Fixed Price and the milestone schedule will be accomplished and documented in the Electronic Contract Management System (eCMS). The information below summarizes the market research results for this requirement.

1. Objective: Per FAR 10.001(a)(2) and VAAR 810.001-70, this report is in support of (check as many as apply):

A new requirement

An acquisition with an estimated value in excess of the simplified acquisition threshold (see FAR subpart 2.1 for current threshold)

An acquisition with an estimated value less than the simplified acquisition threshold where adequate information is not available to develop the requirements package and the circumstances justify the cost of performing the market research;

An acquisition that could lead to a bundled contract (15 U.S.C. 644(e)(2)(A)) (see FAR subpart 2.1 for bundled contract definition);

Other:

2. Background:

a. Title: Patient Satisfaction Survey – Data Collection & Analysis for Zablocki VAMC and affiliated CBOCs, Milwaukee, Wisconsin

b. Product or Service Code: B599 (Other Special Studies and Analyses)

c. NAICS Code: 541611 (Main definition: Administrative management consulting services; also defined as: Medical office management consulting services or consultants)

d. Size Standard for NAICS: $16.5 million.

e. Estimated contract value: $540,000.00

3. Market Research Sources: In accordance with FAR Part 10, VAAR 810 and VAAM M810, market research has been conducted for this acquisition. The following techniques were used (check as many as apply):

Attachment 1

VHAPM Part 810 Market Research SOP Page 2 of 5 Revision: 03, Effective Date: 02/04/19

Used VA’s VIP database to identify verified capable SDVOSBs and VOSBs.

Applying personal knowledge in procuring supplies/services of this type.

Contacting knowledgeable individuals in Government and industry regarding market capabilities to meet requirements.

Reviewing the results of recent market research undertaken to meet similar or identical requirements.

Publishing formal requests for information in appropriate technical or scientific journals or business publications.

Querying the Government-wide database of contracts and other procurement instruments intended for use by multiple agencies available at www.contractdirectory.gov and other Government and commercial databases that provide information relevant to agency acquisitions.

Strategic Acquisition Center

GSA Advantage

SBA – Dynamic Small Business Search eCMS

Contract Opportunities (formerly FBO)

FPDS

Participating in interactive, on-line communication among industry, acquisition personnel, and customers.

Obtaining source lists of similar items from other contracting activities or agencies, trade associations or other sources.

Reviewing catalogs and other generally available product literature published by manufacturers, distributors, and dealers or available on-line

Article: Should I Work for a Magnet Hospital, available at https://nurse.org/articles/magnet-hospitals/

Article: The Advantages of a Large Sample Size, available at https://sciencing.com/advantages-large-sample-size-7210190.html

Article: Factors impacting Press Ganey patient satisfaction scores in orthopedic surgery spine clinic, The Spine Journal, Volume 16, Issue 11 (2016)

VHAPM Part 810 Market Research SOP Page 3 of 5 Revision: 03, Effective Date: 02/04/19

Article: About the Press Ganey Survey, available at https://healthcare.utah.edu/fad/pressganey.php

Conducting interchange meetings or holding presolicitation conferences to involve potential offerors early in the acquisition process.

Conducting market survey:

Other:

Preceding contract: Contract Number GS-10F-0205R, Order Number 36C25219F0469

Notice of Intent to Sole Source Acquisition, posted to Contract Opportunities on February 15, 2020

4. Market Research Findings: The purpose of this contract is to provide patient satisfaction survey data collection and analysis for the Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, and its affiliated CBOCs (“Zablocki VAMC”). The goals of this contract are twofold: (1) provide actionable recommendations to improve patient care derived from qualitative and quantitative analysis of objective data; and (2) achieve the VA goal of Magnet Hospital designation for the Clement J. Zablocki VA Medical Center.

This contract is a follow-on to a contract providing this service, which expires on March 31, 2020. See Attachment 1. The Contractor for this contract is Press Ganey Associates, Inc. (“Press Ganey”). Press Ganey is performing well on this contract, but the purpose of this market research is to explore all available options to provide the best service at a fair and reasonable price to Zablocki VAMC.

As a starting point, research was conducted to define this contract’s goals. The first goal, improving patient care, is self-evident, but the second goal of Magnet Hospital designation required explication. Designation as a Magnet Hospital is accomplished through a rigorous validation program known as the Magnet Recognition Program, which is promulgated by the American Nurses Credentialing Center. See Attachment 2. As of 2015, only 8.8% of U.S. hospitals had achieved this designation. See Attachment 3. A key requirement for achieving this designation is data collection, which must “be used to identify problem areas and the means for improvement.” See Attachment 3.

Research was then conducted to identify the parameters for the best company for this contract. Core competencies must include the ability to draft a relevant survey, implement it, analyze the results, and provide actionable recommendations. In other words, this contract requires data collection and statistical analysis. In order to provide the most relevant results from statistical analysis, the largest population sample size is required, i.e., the largest database of relevant information possible. “Larger sample sizes provide more accurate mean values, identify outliers that could skew the data in a smaller sample and provide a smaller margin of error.” See Attachment 4. Accordingly, this contract requires a company that possesses the core competencies previously identified, as well as the largest database of relevant information possible to ensure the more accurate results from statistical analysis.

VHAPM Part 810 Market Research SOP Page 4 of 5 Revision: 03, Effective Date: 02/04/19

As part of its acquisition package, Zablocki VAMC requested that this contract be renewed with Press Ganey as the contractor because of its outstanding execution of the current contract. See, e.g., FAR 17.207(e)(1) (considering “the Government’s need for continuity of operations” as a determinative factor for the exercise of an option).

Nonetheless, independent information was necessary to validate Press Ganey’s ability to provide the most accurate statistical analysis possible by having a large database available. Based on information available from disinterested third parties, it appears that Press Ganey is a leader in the field of patient satisfaction surveys and possesses a sufficiently large database to provide accurate statistical analysis. In a medical article published in The Spine Journal (2016), the authors state, “Press Ganey is a private company that provides patient satisfaction surveys to improve patient care. This system is in use in more than 10,000 health-care organizations, and it has been used to quantify patient satisfaction in previously published works.” See Attachment 5. The University of Utah published an article about its use of the Press Ganey survey, stating “For more than 30 years, Press Ganey has been the industry's recognized leader in improving the patient experience. Today, Press Ganey works with more than 26,000 health care facilities, including over 60 percent of all US hospitals, to help reduce patient suffering and improve the quality, safety, and experience of care.” See Attachment 6. This information appears to confirm Press Ganey’s statement that it “has the most representative national health care databases in the U.S.” See Attachment 7. Based on this information, it appears that Press Ganey possesses a sufficient database to provide accurate results when conducting statistical analysis.

The next step in the market research process is to see what companies have been used by the Department of Veterans Affairs to conduct patient satisfaction surveys. The first database checked was VIP using the search term “patient satisfaction survey” because the NAICS code assigned to this acquisition, 541611 – Administrative management consulting services, is far too general to be useful. This search yielded no results. See Attachment 8. The next database checked was the Strategic Acquisition Center (“SAC”), which showed a Multiple Award IDIQ for survey analysis services, but nothing for survey data collection, a critical element of the pending contract. See Attachment 9. A search of GSA Advantage using the search terms “patient satisfaction survey” and “hospital” yielded 522 catalogs. See Attachment 10. A review of these results showed that the majority of these companies offer either general office staffing or land surveying.

The only relevant company identified was Press Ganey with Contract Number GS-10F- 0205R, which expired February 17, 2020. See Attachment 11. Press Ganey was contacted via e-mail inquiring about a new GSA contract, which appears to be forthcoming. See Attachment 12. An SBA Dynamic Small Business Search was also conducted using the search term “patient satisfaction survey” for the same reasons as noted for the VIP search. This search yielded one company, which focuses on custom computer programming services and not patient satisfaction data collection and analysis.

See Attachment 13.

A check of eCMS proved more fruitful, which showed there is a current NCO 12 contract for patient satisfaction surveys, Contract Number GS-10F-0205R, Order Number VA69D-17-F-1227. See Attachment 14. This contract is with Press Ganey. A search of Contract Opportunities using the search term “patient satisfaction survey” for VA

VHAPM Part 810 Market Research SOP Page 5 of 5 Revision: 03, Effective Date: 02/04/19 contract awards revealed 5 separate awards, all to Press Ganey. See Attachment 15.

Finally, a search of FPDS using the search term “patient satisfaction survey” for the VA revealed 97 contract actions. See Attachment 16. Of the contract actions listed, only 65 are relevant to the current contract. Of these 65 relevant actions, 62 (or 95%) involve Press Ganey. The most recent of the other three contract actions is 2012; the other two are from 2007 and 2005.

Market research appeared to indicate that Press Ganey is uniquely qualified to fulfill the proposed contract, so SAM was checked to ensure Press Ganey is current and able to be awarded a contract. See Attachment 17. The decision was also made to post a Notice of Intent to Sole Source Acquisition on February 15, 2020, with a response deadline of February 21, 2020. See Attachment 18. No responses were received to this Notice.

5. Customary Commercial Practices/Standards: The standard benchmark for statistical analysis is a confidence level of 95%, which equates to two standard deviations. This benchmark is not applicable to this contract, because it is used to determine a random sample size from a large population. In this case, the Contractor is required to survey every Zablocki VAMC patient, so the use of a confidence level is inapplicable to this contract.

6. Market Price: Per the most recent contract, approximately $120,000/year.

7. Acquisition History: Preceding contract: Contract Number GS-10F-0205R, Order Number 36C25219F0469, expiring March 31, 2020.

8. Other pertinent information: None.

9. Recommendations: Based on the foregoing, it appeared that Press Ganey is uniquely qualified to provide patient satisfaction data collection and analysis services to the Zablocki VAMC, and this acquisition should proceed on a sole source basis.

10. Based on the above information, the basic clauses and provisions prescribed in FAR Part 12:

Are sufficient for use in this acquisition and do not require any tailoring to be consistent with industry's commercial practices.

Require tailoring to be consistent with industry's commercial practices as noted below. All such tailoring will be included in the solicitation issued for the required supplies/services.

PREPARED BY:

Contract Specialist

Robert H Knight III 1776235

Digitally signed by Robert H Knight III 1776235 Date: 2020.02.22 13:36:08 -06'00'