36C25619R0141-0001003.pdf

Performance Requirements Summary Matrix

Task ID Indicator Standard Accept able Quality Level

Method of Surveillance Incentive

Access 1

Patients must receive subsequent treatment in a timely manner.

Provider on-site and available during all scheduled clinic hours.

98%

Direct Observation and random inspection

Exercise of Option Period and past performance

Quality Care 2

Contract employee qualifications and competency assessments.

All employees must have appropriate qualifications, training and annual competency assessments in line with OBVAMC standards.

100% Direct Observation

Exercise of Option Period and past performance

Patient Safety

Patient safety incidents must be reported to the authorizing VA medical center and the COR.

All incidents reported immediately (within 24 hours.)

100%

Direct Observation and random inspection

Exercise of Option Period and past performance

Patient safety incidents must be investigated, confirmed and resolved.

All incidents are investigated, confirmed and resolved.

100%

Direct Observation and random inspection

Exercise of Option Period and past performance

Patient safety incident investigations, conclusions and findings must be reported to the authorizing VA medical center and the COR.

Updates and findings of patient safety incident investigations are provided continuously (at least once a week.)

100%

Direct Observation and random inspection

Exercise of Option Period and past performance

Patient Satisfaction 6

MRI cases documented in Radiology

VISTA

package.

All cases. 99%

Direct Observation and random inspection

Exercise of Option Period and past performance

7 Provider Sign in/out process

Sign in/out sheets for all services rendered

98% Periodic inspection

Exercise of Option Period and past performance

QUALITY ASSURANCE SURVEILLANCE PLAN

For: MRI Services

Contract Number: _____________________________

Contract Description: Services are for an onsite MRI unit and staff to perform MRI procedures at the OBVAMC, Shreveport, LA.

Contractor’s name

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: Thomas M. Kovarovic (Contract Specialist

Organization or Agency: Department of Veterans Affairs, South Central Veterans Administration Health Care Network (SCVAHC) P&C

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: Brain Nash

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:__________________________________________________

Title: ______________________________________________________________________

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, in the Statement of Work (SOW), includes performance standards. The Government shall use these standards to determine contractor performance.

5. INCENTIVES

The Government shall use Exercise of Option Period and past performance as incentives and are based on exceeding and/or meeting performance standards.

6. METHODS OF QA SURVEILLANCE

The COTR shall use the surveillance methods listed below in the administration of this QASP.

a. DIRECT OBSERVATION. Can be performed periodically or through 100% surveillance.

ID #: 1, 2, 3, 4, 5, 8

b. PERIODIC INSPECTION. - Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.

ID #: 9

c. RANDOM INSPECTION: Evaluates outcome on a random basis.

ID #s: 1, 3, 4, 5, 8

e. Progress or status meetings.

Performance standard - Held twice a year or more often if required

f. Analysis of contractor's progress reports.

Performance standard - Random inspection of reports

8. 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:

1. Exceeds

2. Meets

3. Failed to meet

9. 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.

10. FREQUENCY OF MEASUREMENT

a. Frequency of Measurement.

During contract performance, the COR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

The COR shall meet with the contractor Bi-annually or as needed to assess performance and shall provide a written assessment.

________Concur ________Non-concur ________See comments

Signature – Contractor Program Manager

________Concur ________Non-concur ________See comments

Signature – Contracting Officer’s Representative