Attachment 2 - Home Oxygen QASP.pdf

Attachment 2 36C25719R0027 January 10, 2020

Quality Assurance Surveillance Plan

VISN 17 Home Oxygen Services

The contractor will 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.

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 through contract modification. 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. The Administrative Contract Specialist (ACS) will assist the CO with the post-award functions of the contract.

Assigned CO: TONI A. CLENDENEN, Network Contracting Office (NCO) 17

E-mail: Toni.Clendenen@va.gov

Telephone: 972-708-0822 mailto:Toni.Clendenen@va.gov mailto:Toni.Clendenen@va.gov

Assigned ACS: JUAN MARTINEZ, Network Contracting Office (NCO) 17

E-mail: Juan.Martinez4@va.gov

Telephone: 210-694-6303

Organization or Agency: VISN 17 VA Heart of Texas Health Care Network; Network Contracting Office (NCO) 17

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: ELIZABETH M. SHELLMAN

VISN 17 Prosthetics Program Analyst

E-mail: ElizabethM.Shellman@va.gov

Telephone: 903-538-6775

Organization or Agency: VISN 17 VA Heart of Texas Health Care Network mailto:Juan.Martinez4@va.gov mailto:Juan.Martinez4@va.gov mailto:ElizabethM.Shellman@va.gov mailto:ElizabethM.Shellman@va.gov

VISN 17 VA MEDICAL CENTER CONTACTS:

504 Amarillo VAHCS

6010 Amarillo Boulevard, West

Amarillo, TX 79106 Paul Yarbrough, 806-355-9703 ex. 7500, Paul.Yarbrough2@va.gov

504 CBOC Lubbock, TX CBOC 6104 Avenue Q South Drive

Lubbock, TX 79412

Paul Yarbrough, 806-355-9703 ex. 7500, Paul.Yarbrough2@va.gov

519 West Texas VA HCS - Big Spring, TX 300 Veterans Blvd.

Big Spring, TX 79720

Nancy Rios, 432-263-7361 x7067, Nancy.RiosL@va.gov

549 North Texas VHCS - Dallas, TX 4500 South Lancaster Road

Dallas, TX 75216

Cassandra Hall, 214-857-1045, Cassandra.Hall@va.gov

671 South Texas VHCS - San Antonio, TX 7400 Merton Minter Blvd.

San Antonio, TX 78229

Esther Duarte, 210 617-5300 x15623, esther.padron@va.gov

674 Central Texas Veterans Health Care System - Temple, TX 1901 Veterans Memorial Drive

Temple, TX 76504-7451

Richard Punger, (254) 297-3532, Richard.Punger@va.gov

740 Texas Valley Coastal Bend HCS 2601 Veterans Drive

Harlingen, TX 78550

Cory Dressler, 956-291-9000 X69091, cory.dressler2@va.gov

740 CBOC Corpus Christi, TX CBOC 205 S. Enterprize Parkway

Corpus Christi, TX 78405

Cory Dressler, 956-291-9000 X69091, cory.dressler2@va.gov

740 CBOC McAllen, TX CBOC 901 East Hackberry McAllen, TX 78501

Cory Dressler, 956-291-9000 X69091, cory.dressler2@va.gov

756 El Paso, TX 5001 North Piedras Street

El Paso, TX 79930-4211

Michael Shieds, 915-564-6100 x6213, Michael.Shields3@va.gov

Station ID Facility (Ordering Activity) Address COR Name, Phone Number, email address

3. CONTRACTOR REPRESENTATIVES

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

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.

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

The Government shall use these standards (section 6) 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 SURVEILLANCE:

The Contracting Officer’s Representative (COR) shall use the surveillance methods listed below in the administration of this QASP. Each method listed below applies to all performance standards listed for the specific Task.

a. Direct Observation. Direct observation shall be performed periodically or through surveillance.

b. Periodic Inspection. Evaluate outcomes on a periodic basis. Inspections may be scheduled Daily, Weekly, Monthly, Quarterly, Annually or unscheduled, as required.

c. Progress or status meetings.

d. Complaints. Complaints from agency personnel shall be passed to the Contractor's quality control inspector (QCI) for correction

e. Complaints. Complaints from home oxygen patients shall be provided to agency personnel then it shall be passed to the Contractor's quality control inspector (QCI) for correction

f. COR or Designee conducts patient home visits: The COR at each medical center will complete visits at patient’s homes to verify contract compliance.

STANDARD: Performance shall meet or exceed the thresholds as measured for each performance objective. The COR shall notify the contracting officer for appropriate action in accordance with FAR 52.212-4, Contract Terms and Conditions-Commercial Items, if any of the above service areas exceeds the customer complaint thresholds.

5.1 PROCEDURES: The COR shall periodically inspect to ensure Contractor compliance with the appropriate section of the Performance

Work Statement (PWS). The COR or designee shall record results of inspection, noting the date and time of inspection. If inspection indicates unacceptable performance, the COR shall notify the CO of the deficiencies. The CO will notify the Contractor in writing and will request correction of the noted deficiencies within the specified time period. Contractor shall be given notification to correct the deficiencies within a reasonable amount of time, on a case-by-case basis. The CO shall have the final authority on the amount of time the

Contractor has to correct the deficiency. The COR shall not issue a receiving report accepting the services for the month in question until all deficiencies have been corrected. The COR shall evaluate the services required by each delivery/task order to ensure complete compliance.

6. PERFORMANCE MEASURES

TASK ID Location in PWS STANDARD Acceptable

Quality

Level

Method of

Surveillance

Patient Information Return (Timeliness)

Notification when patient refuses service

1 Paragraph 13(ii) NUM: # reported to HCS COR within one (1) hours

DEN: Total # of refusals of service each quarter

90% or greater compliance Electronic log kept by

HCS COR;

Reported in HCS monthly minutes of the Home Respiratory Care Team by

HCS COR

Notification when

Patient Declines back up system

2 Paragraph 2 NUM: # reported to COR within 24 hours

DEN: Total # declinations for back-up services each quarter

90% or greater compliance Electronic log kept by

HCS COR;

Reported in HCS monthly minutes of the Home Respiratory Care Team by

HCS COR

Emergency Service

Response

3 Paragraph 10(a) NUM: # reported to COR within 2 days

DEN: Total # of emergency services

NOT provided within 6 hours of request quarterly

90% or greater compliance Electronic log kept by

HCS COR;

Reported in HCS monthly minutes of the Home Respiratory Care Team by

HCS COR

Access (for all outpatient services)

(Volume)

Initial set-ups 4 Paragraph 5 NUM: # of samples reviewed where oxygen was provided within 24 hours of request

DEN: Random sample of 10% of initial setups provided each quarter

90% or greater compliance

COR Random audit of

10% Consults quarterly

Quality of Care

All equipment has preventative maintenance (PM) performed at least once a year or more often in accordance with manufacturer recommendations.

5 Paragraph 19(a) NUM: # with documented completed

PM

DEN: Total # equipment items on the inventory list due for PM quarterly

95% or greater PM list provided to

COR by vendor

5%,10%,15%,20% invoice reduction based on results

Evidence of initial and ongoing competency training of all staff providing delivery/recovery and patient education

6 Paragraph 18(b) NUM: # with documented current competency

DEN: Total # of contracted employees providing delivery/recovery and patient education services

95% or greater compliance with current competency record

Competency report provided by vendor to

COR annually

Patient Safety

A complete home safety assessment is performed at time of set-up and again during home visits, to include:

presence/functio ning smoke alarm, fire extinguisher, education about smoking & oxygen use, no smoking signage, cognitive impairment that could affect oxygen use, electrical cords / outlets, proper storage of oxygen tanks & provision of tank holders, fall risks, education about fall prevention

7 Paragraph 16 NUM: # with current and complete home safety assessment documented

DEN: # random home visits performed quarterly

90% or greater compliance with documented complete home safety assessment

COR random home visits

The patient has documented education about

Emergency

Preparedness to include: escape route, back-up supply / equipment

8 Paragraph 24(b) NUM: # with documented education about Emergency Preparedness and home oxygen equipment

DEN: # random home visits performed quarterly

90% or greater compliance with documented education related to Emergency

Preparedness

COR random home visits

Infection control reports will be sent to the COR on a quarterly basis.

9 Paragraph 12(iii) Semi-annual reports received on or before the 8th calendar day of the 6th and 12th months each year and analyzed by facility Infection Control

Prevention (ICP) Specialist.

There are no trends noted by facility ICP

Analysis of vendor-provided infection control report by facility ICP

Critical events reported to COR, including:

Sentinel events, observed

/reported falls, patient abuse/neglect, and oxygen mishaps.

10 Paragraph 13(i) NUM: # reported to COR within 24 hours of the event

DEN: # known critical events quarterly

95% or greater compliance with reporting critical events within 24 hours

Electronic log kept by COR

Patient

Satisfaction

Customer

Satisfaction report results provided quarterly

11 Paragraph 12(ii) Quarterly reports shall be received on or before the 8th calendar day of each quarter.

Trends identified.

Action plan implemented for any adverse trends.

Specific grievances reported and resolved within 5 days.

Quarterly reports of vendor to the COR

7. RATINGS

Exceptional: Performance meets contractual requirements and exceeds many to the

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. In addition, there should have been NO significant weaknesses identified.

Very Good: Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

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. In addition, there should have been NO significant weaknesses identified.

Satisfactory: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems, which corrective action is taken by the contractor appear or were satisfactory.

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. In addition, there should have been NO significant weaknesses identified.

Marginal: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor has proposed actions appear only marginally effective or not fully implemented.

Note: To justify Marginal performance, you should identify a significant event in each category that the contractor had trouble overcoming and state how it affected the GOVERNMENT. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g. Management, Quality, Safety or Environmental Deficiency Report or letter).

Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Note: To justify an Unsatisfactory rating, you should identify multiple significant events in each category that the contractor had trouble overcoming and state how it affected the GOVERNMENT. However, a singular problem could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g. Management, Quality, Safety or

Environmental Deficiency Reports, or letters).

8. DOCUMENTING PERFORMANCE

a. Acceptable Performance: The Government shall document 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 in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file and provide a copy to the CO.

When the COR determines, formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR) and present it to the

Contracting Officer (CO). In turn, the CO shall present the CDR to the Contractor’s contracting personnel.

The Contractor shall acknowledge receipt of the CDR in writing. The CDR shall 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 shall 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.

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

9. FREQUENCY OF MEASUREMENT: During contract performance, the COR shall periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

a. Frequency of Performance Assessment Meetings: The COR shall meet with the Contractor quarterly to assess performance and shall provide a written assessment.

Signature of Offer / Contractor Signature of COR

Name and Title of Signer (Type or Print) / Date Name of COR (Type or Print) / Date

HOME OXYGEN CONTRACT ROLES AND RESPONSIBILITIES

Scope/Type of Service VAMC Contracted Provider

1. Role and responsibilities of the organization and the contracted provider in:

a. Patient Admission Process Clinical coordinator or designee reviews, verifies medical need, obtains physician order, and contacts contracted oxygen provider.

Contractor will furnish oxygen supplies, equipment, and services to VA beneficiaries for the applicable

VA Medical Centers and Health Care Centers during the period of the contract.

b. Patient Assessment Process, initial and ongoing Service provided solely by VA staff, Pulmonary/respiratory

Contractor, as part of the initial delivery protocol, completes the initial equipment assessment and provides education on equipment use and care, safety, patient rights and responsibilities, etc.

Contractor will provide ongoing assessment report related to equipment use, condition, and education every 3 months.

c. Plan of Care, development, review and revision Service provided solely by VA staff, pulmonary/respiratory.

Contractor is responsible for providing care as prescribed.

d. Plan of Service, equipment, maintenance, refills Service provided solely by Contractor. Contractor is responsible for developing, reviewing, and revising the patient's plan of service. The Plan of service will be maintained at the Contractor’s local office providing service to the VA beneficiary and will be developed, reviewed, and revised per contract.

e. Scheduling care or services Clinical Coordinator and or COR will schedule with the contract vendor and home visits with the patient in keeping with the most current VHA

Directive on Home Oxygen Therapy.

Contractor is responsible for scheduling services with VA beneficiaries.

f. Discharge Planning

(f.1) Discontinuing therapy

Clinical Coordinator or designee, either by direct notification from physician, death of the beneficiary, or reassessment no longer qualifies patient for therapy, will contact the contracted provider to discontinue therapy.

Contractor will notify patient/family and arrange time for pickup of equipment.

g. Patient Privacy and IT Security VA will abide by local policy related to patient privacy and record security

Contractor is responsible for maintaining the integrity of the VA Beneficiary’s patient records and compliance with The Joint Commission

Standard related to patient confidentiality and privacy.

Scope/Type of Service VAMC Contracted Provider

2. Documentation requirements and time frames Service provided solely by the Contractor Contractor will maintain a complete record of services provided to VA beneficiaries to meet current Joint Commission Standards and as stipulated in the contract. The Contractor will maintain this documentation in the VA beneficiary’s folder.

3. Monitoring, evaluating, and auditing of contracted care and/or services. Clinical COR and/or Administrative COR will make scheduled and unscheduled on-site

Contractor and home oxygen patient visits, on at least a quarterly basis, to monitor the contracted provider's performance under this contract.

Contractor agrees to make available all records and documentation necessary to perform these reviews.

4. Responsibility of contracted provider to comply with applicable organization policies and personnel qualifications

Policies: Clinical COR and/or Administrative

COR will review the Contractor’s policies/procedures for compliance with VA policies/procedures and Joint Commission

Standards.

Contractor agrees to make available all records and documents necessary per the Contract.

Contractor is responsible for policy and personnel compliance with current Joint Commission

Standards.

5. Procedures for determining charges and reimbursement VISN purchasing agents review monthly bills from the contracted provider for appropriate charges.

Contractor will submit billing reports monthly as stipulated in this contract.

6. Terms of agreements and conditions for renewal or termination Government may extend the term of this contract by written notice to Contractor. The total duration of this contract, including the exercise of any options under this clause, shall not exceed 10 years.

Termination for the Government's convenience:

Government reserves the right to terminate this contract for its sole convenience.

Termination for cause: Government may terminate this contract for cause in the event of any default by the Contractor.

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