36C25618R0078-011.docx

Quality Assurance Surveillance Plan (QASP) Outpatient Site of Care Service (HOUMA CBOC) Contract Number: (TBD)

Contractor’s name: (TBD)

Time Period (Quarter): (TBD)

The contractor shall be evaluated in accordance with the following:

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.

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: Melanie Hawley Organization or Agency: Department of Veterans Affairs, Network Contracting Office 16 (NCO 16)

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: Richard Breaux Alternate POC: Dr. Jamie Buth

3. CONTRACTOR REPRESENTATIVES

The following employee(s) of the contractor serve as the contractor’s program manager(s) for this contract.

Primary: (TBD – Contractor fill-in) ___________________ Alternate: (TBD – Contractor fill-in) ___________________

4. PERFORMANCE STANDARDS

The contractor is responsible for performance of ALL terms and conditions of the contract. CORs will provide contract progress reports quarterly to the CO reflecting performance on this plan and all other aspects of the resultant contract. The performance standards outlined in this QASP shall be used to determine the level of contractor performance in the elements defined.

To be paid the full capitated rate on the schedule, the contractor must provide services as required in the entire contract and to meet or exceed the acceptable quality level outlined in this section/sub-sections. If any portion of the requirement is not met and/or the acceptable quality level in any of the elements in this section/subsection are not maintained, the contractor will be notified by the contracting officer for response outlining the contractor’s proposed remedy. The Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming services per FAR 52.212-1.

Performance standards define desired services. The Government performs surveillance to determine the level of Contractor performance to these standards.

The Performance Requirements are listed below in Section 6. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the standard and assign a rating. At the end of the performance period, these ratings will be used, in part, to establish the past performance of the contractor on the contract.

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. Method not applicable

b. PERIODIC INSPECTION. Applies to 4.9.1, 4.9.2, 4.9.3, 4.9.4, 4.9.8, 4.9.9, 4.9.10, 4.9.11, 4.9.12, 4.9.13, 4.9.14, 4.9.15, 4.9.16 – VA will monitor using Electronic report using data from VA VISTA/CPRS system.

c. VALIDATED USER/CUSTOMER COMPLAINTS. Method not applicable; however, they will be provided to contractor if report received.

d. RANDOM SAMPLING. Applies to 4.9.5, 4.9.6, 4.9.7 – VA will monitor using Electronic report using data from VA VISTA/CPRS system.

e. Verification and/or documentation provided by Contractor. Contractor may report to COR or CO has needed/required.

ATTACHMENT D5 - HOUMA

6. Measures- PACT CBOC

Surveillance and frequency

4.9.1

VISTA/CPRS will automatically remind providers to complete clinical reminders during patients visits including but not limited to:

-Alcohol Use Screen -Alcohol Audit-C Pos F/U Eval -Depression Screening

- Evaluation Of Positive Depression Screening -PTSD Screening -Evaluation Of Positive PTSD Screening -Antipsychotic Med Side Eff Eval -MH High Risk No-Show Follow-Up -MHTC Needs Assignment -MST Screening -Breast Cancer Screening -Clinical Review Of Mammogram Results And Patient Notification

- Whether To Begin Breast Cancer Screening In 40's Or To Wait Until Age 50 -Cervical Cancer Screening -Clinical Review Of Pap Smear Results And Patient Notification -Tobacco Counseling by provider -Tobacco Counseling -Iraq & Afghan Post Deploy -Polytrauma Marker -TBI /Polytrauma Rehab/Reintegration -TBI Screening -AAA Screening -Embedded Fragments Screen -Embedded Fragments Risk Evaluation -Project Arch -Hep C Risk Assessment -Homelessness Screening -HTN Assessment Bp >=140/90 -HTN Assessment Bp >=160/100 -HTN Lifestyle Education -IHD Lipid Profile -Lipid Statin Rx Cvd/Dm -Influenza Immunization -Pneumovax -Colorectal Ca Screening -FOBT Positive F/U -Diabetes Eye Exam -Diabetes Foot Exam

100% Proper documentation and completion of all clinical reminders as they appear during a patient’s visit

95% completion of clinical reminders each month.

VA will monitor progress thru automated reports. (VHA SAIL report) Periodic Sampling VA will monitor using Electronic report using data from VA VISTA/CPRS system. VA will send these reports monthly to the contractor to notify them to their current performance

Contractor can check status of their performance by running reports in VISTA/CPRS as frequently as needed.

99% monthly established PC appointments completed no later than 30 days from Preferred Date (patient desired date) or the clinically indicated date.

VHA SAIL Report Frequency: Monthly. Contractor can check status of their performance by running reports in VISTA/CPRS as frequently as needed.

SAME-DAY

APPTS W/ PCP

Periodic Inspection audit of PACT Compass (Quarterly)

VA will monitor progress (weekly) thru automated reports. VA will send these weekly reports to the contractor to notify them to their current performance.

Random Sampling VA will monitor using Electronic report using data from VA VISTA/CPRS system VA will monitor progress monthly thru automated reports. VA will send these monthly status reports to the contractor to notify them to their current performance.

PHARMACY NEW DRUG ORDER REQUESTS

99% of new drug order requests follow all prescribing guidelines. This is including but not limited to ensuring all appropriate labs have been previously ordered and that the order is not a non-formulary drug

Random Sampling VA will monitor using Electronic report using data from VA VISTA/CPRS system VA will monitor progress quarterly thru automated reports. VA will send monthly status reports to the contractor to notify them to their current performance.

Contractor to maintain greater than 2.3% of required enrolled patients in HT.

2.2% of required enrolled patients enrolled in HT

VA will monitor using Electronic report using data from PACT Compass.

VA will monitor progress quarterly (non-cumulative) thru automated reports.

PCMHI

PENETRATION

RATIO OF NON-TRADITIONAL ENCOUNTERS

PWS para.

4.9.10

VA will monitor using Electronic report using data from the PACT Compass.

4.9.11

4.9.12

PACT 19:

PCP CONTINUITY

PWS para.

4.9.14 Patients see same PCP for appointments

VA will monitor progress quarterly (non-cumulative) thru automated reports.

7. Ratings:

Metrics and methods are designed to determine rating for a given standard and acceptable quality level. The following ratings shall be used:

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Note: To justify an Exceptional rating, you should identify multiple significant events in each category and state how it was a benefit to the GOVERNMENT. However a singular event could be of such magnitude that it alone constitutes an Exceptional rating. Also there should have been NO significant weaknesses identified.

Note: To justify a Very Good rating, you should identify a significant event in each category and state how it was a benefit to the GOVERNMENT. Also there should have been NO significant weaknesses identified.

Note: To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract. Also there should have been NO significant weaknesses identified.

b. If contractor performance does not meet the Acceptable Quality level, the CO shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the CO shall document the discussion and place it in the contract file. When the COR and the CO determines formal written communication is required, the COR shall prepare a Contract Report (CR), and present it to CO. The CO will in turn review and will present to the contractor's program manager for corrective action.

The contractor shall acknowledge receipt of the CR in writing. The CR 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 CR will also state how long after receipt the contractor has to present this corrective action plan to the CO. The Government shall review the contractor's corrective action plan to determine acceptability. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance and the acceptability of the Contractor’s corrective action plan.

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

9. FREQUENCY OF MEASUREMENT

a. Frequency of Measurement.

The frequency of measurement is defined in the contract or otherwise in this document. The government (COR or CO) will periodically analyze whether the frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Reporting.

The COR shall communicate with the Contractor and will provide written reports to the Contracting Officer quarterly (or as outlined in the contract or COR delegation) to review Contractor performance.

10. COR AND CONTRACTOR ACKNOWLEDGEMENT OF QASP

SIGNED:

COR NAME/TITLE DATE

SIGNED:

CONTRACTOR NAME/TITLE DATE

CONTRACT REPORT

5. DATES

a. CR PREPARED

6. Issue Identified (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

10. CONTRACTOR RESPONSE AS TO CAUSE AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable quality control program procedures or new procedures. Attach continuation sheet(s) if necessary.)

12. GOVERNMENT EVALUATION.

13. GOVERNMENT ACTIONS

14. CLOSE OUT

CONTRACTOR NOTIFIED

COR

CONTRACTING OFFICER