ATTACHMENT 1 PERFORMANCE WORK STATEMENT.docx

ATTACHMENT 1: PERFORMANCE WORK STATEMENT

?.## PERFORMANCE WORK STATEMENT – Tele- Radiology Physician Services

1. GENERAL:

1.1. Services Provided: The Contractor shall provide Board Certified Radiology Physician Services in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the VA Portland Healthcare System (VAPORHCS). The Radiologists shall have successfully completed an ACGME approved fellowship with a Certification of Added Qualification (CAQ) or be CAQ eligible by the American College of Radiology (ACR). The VA Radiology Services follow the standards & guidelines set forth by American College of Radiology (ACR) Practice Parameters and Technical Standards | American College of Radiology (acr.org). A contractor providing tele-radiology services shall provide services consistent with The Joint Commission (TJC) and that meet or exceed VA and the American College of Radiology Guidelines as defined in this document.

Specifically seeking a teleradiology provider which provides specialty and subspecialty interpretations of Diagnostic Imaging procedures as a 24/7/365 service, to include 24/7/365 in house IT support, Joint Commission and ACR certified internal peer review and credentialing mechanisms, dedicated communication support staff to help communicate results to referring providers and a web-based access with single number 24/7/365 support provided through a connection which is MPLS capable, meets speeds of 10 Gig per second, and has redundancy to allow transmission of multiple studies simultaneously as well as to maintain connectivity in cases of primary connection malfunction."

Based on the need for uninterrupted and urgent time frame for establishing the service, sufficient radiologists (at least 30) must be currently enrolled in an existing VHA system so that they have VetPro applications and credentials in a VHA system, ensuring timely processing for credentialing and privileging.

Therefore, to provide essential patient care, the need exists for a supplemental Teleradiology Service that will provide interpretation of radiological examinations after-hours as well as to serve as a backup, on demand for interpretation during normal working hours if such need should arise. Approximately 13,000 procedures would be performed during after-hours times. The substantial number of examinations performed, as well as the workflow of handling those examinations will require the services of an established supplemental teleradiology Service provider that can absorb up to 50% of after-hours subspecialty and specialty case load and meet specific institutional requirements for connectivity, turn-around time and security. Based on the complexity and size of the facilities, and the scope of the work performed, the contractor should have a sufficient number of board certified/board eligible radiologists for this contract. The Contractor shall provide all hardware and software necessary for radiological interpretations. These resources should be in a safe, secure environment designated by the Contractor and in accordance with MOU/ISA.

1.2. Place of Performance: Contractor shall furnish services to the VAPORHCS, 3710 SW US Veterans Hospital Road, Portland, OR, 97207.

1.3. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority and FAR Part 12, Acquisition of Commercial Products and Commercial Services, in combination with FAR Part 15, Contracting by Negotiation.

1.4. Policy/Directives/Handbooks. The contractor shall be subject to the following policies, including any subsequent updates during the period of performance. The policies listed below can be accessed electronically at the following: VA Publications VHA Publications

1.4.1. VA Directive 1663: Health Care Resources (HCR) Contracting – Buying Title 38 U.S.C. 8153

1.4.2. VHA Directive 1003.04: VHA Patient Advocacy

1.4.3. VHA Directive 1065: Productivity and Staffing Guidance for Specialty Provider Group Practice

1.4.4. VHA Directive 1088(1): Communicating Test Results to Providers and Patients

1.4.5. VHA Directive 1100.18: Reporting and Responding to State Licensing Boards

1.4.6. VHA Directive 1100.20: Credentialing of Health Care Providers

1.4.7. VHA Directive 1100.21: Privileging

1.4.8. VHA Directive 1105: Management of Radioactive Materials

1.4.9. VHA Directive 1105.02: Nuclear Medicine and Radiation Safety Administration Service

1.4.10. VHA Directive 1105.04: Fluroscopy Safety

1.4.11. VHA Directive 1105.05: Magnetic Resonance (MR) Safety

1.4.12. VHA Directive 1187: Administrative Practices for Ensuring Safe Injection of Radio-Labeled Blood Products

1.4.13. VHA Directive 1192.01: Seasonal Influenza Vaccination Program for VHA Health Care Personnel

1.4.14. VHA Directive 1220(1): Facility Procedure Complexity Designation Requirements to Perform Invasive Procedures in Any Clinical Setting

1.4.15. VHA Directive 1605.01: Privacy and Release of Information

1.4.16. VHA Directive 1907.01: VHA Health Information Management and Health Records

1.4.17. VHA Handbook 1100.17: National Practitioner Data Bank (NPDB) Reports

1.4.18. VHA Handbook 1400.04: Supervision of Associated Health Trainees

1.4.19. Privacy Act of 1974 (5 U.S.C. 552a) as amended: http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.4.20. 42 Code of Federal Regulations (CFR) Part 482 Conditions of Participation Hospitals:https://www.ecfr.gov/cgi-bin/text-idx?node=pt42.5.482&rgn=div5

1.5. Acronyms/Definitions: Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.5.1. ACGME: Accreditation Council for Graduate Medical Education

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. BLS: Basic Life Support

1.5.4. CDC: Centers for Disease Control and Prevention

1.5.5. CEU: Certified Education Unit

1.5.6. Clinical Privileging: Clinical Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific, and within available resources.

1.5.7. CME: Continuing Medical Education

1.5.8. CMS: Centers for Medicare and Medicaid Services

1.5.9. CO: Contracting Officer: The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.5.10. COR: Contracting Officer’s Representative: A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.11. COS: Chief of Staff

1.5.12. CPARS: Contractor Performance Assessment Reporting System

1.5.13. Credentialing: Credentialing is the process of obtaining, verifying, and assessing the qualifications of a health care provider to provide care or services in or for the VA health care system. Credentials are documented evidence of licensure, education, training, experience or other qualifications.

1.5.14. DEA: Drug Enforcement Agency

1.5.15. EHR: Electronic Health Record - electronic health record system used by the VA

1.5.16. FSMB: Federation of State Medical Boards

1.5.17. FTE: Full Time Equivalent VA’s standard definition is for full time working the equivalent of 80 hours every two weeks, 2080 hours per year. However, providers may propose using their standard FTE definition.

1.5.18. HHS: Department of Health and Human Services

1.5.19. HIPAA: Health Insurance Portability and Accountability Act

1.5.20. ISO: Information Security Officer

1.5.21. Key Personnel: The individuals specified in this contract who are essential to work performance.

1.5.22. NPI: National Provider Identifier. NPI is a standard, unique 10-digit numeric identifier required by HIPPA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers)

1.5.23. POP: Period of Performance

1.5.24. PPD: Purified Protein Derivative

1.5.25. PWS: Performance Work Statement

1.5.26. QA/QI: Quality Assurance/Quality Improvement

1.5.27. QASP: Quality Assurance Surveillance Plan

1.5.28. QM/PI: Quality Management/Performance Improvement

1.5.29. VETPro: is VHA’s mandatory credentialing software platform to document the credentialing of VHA health care providers. This system facilitates completion of a uniform, accurate, and complete credentials file.

1.5.30. VHA: Veterans’ Health Administration

1.5.31. VISN: Veterans Integrated Services Network

1.5.32. VISTA: Veterans Information Systems Technology Architecture

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License: Contract physician(s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or District of Columbia where services are being performed.

All licenses held by the key personnel working on this contract shall be full and unrestricted licenses. Information on state licensing in tele-radiology may be found at this site: Teleradiology | American College of Radiology (acr.org). Contract physician(s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2. Board Certification: All contract physician(s) shall be Board Certified in diagnostic radiology and/or nuclear medicine as relevant. All continuing education courses required for maintaining certification must be kept up-to-date at all times. Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance.

2.1.3. Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Directive 1100.20 and VHA Directive 1100.21 referenced above. The Contractor is responsible for ensuring that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any contract physician(s) prior to obtaining approval by the Facility Medical Executive Board and Medical Center Director.

2.1.3.1 If a contract physician(s) is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.3.2 When telemedicine services are being provided by contract physician(s) who direct, diagnose, or otherwise provide clinical treatment to a patient via a telemedicine link, the contract physician(s) must be appointed, credentialed, and privileged at the VA facility (facilities) which receive the telemedicine services (patient site), as well as at the site providing the services. The following requirements apply:

2.1.3.3 Contract licensed independent practitioners must be credentialed and privileged through the VA facility's Medical Staff Office in accordance Credentialing and Privileging Directives 1100.20 and 1100.21 and VHA Directive 1914, and VHA Teleradiology Programs 1916 (11.26.2025); VHA Teleradiology Programs 1916 (11.26.2025) specifically includes guidance for contracted teleradiology healthcare professionals (VHA Directive 1916 Section 2.g – link to Guidance for Contracted Teleradiologists PCM 11.25.25). Specifically note that VHA Directive 1916 allows for credentialing and privileging by proxy, specifically stating the following: 'Credentialing and Privileging by Proxy: Although contracted teleradiology healthcare providers are not covered by VHA directive 1916, contracted teleradiologists may undergo credentialing and privileging by proxy in accordance with Joint Commission guidelines which allow for credentialing and privileging by proxy under an established memorandum of understanding (MOU) or teleradiology services agreement (TSA) between Joint Commission accredited facilities, identical to the requirements outlined for credentialing and privileging by proxy outlined in VHA directive 1916.Separately delineated privileges for telemedicine services must be requested and assigned in this process.

2.1.3.4 In general, the credentialing process should be started at least 60-90 days in advance of estimated entry on duty. The time required for this process may be expedited when patient care needs are urgent.

2.1.3.5 The VA’s Medical Staff Office or Human Resources Management Service will provide an instruction packet containing forms and a detailed listing of required documentation, including curriculum vitae, current references, signed release of information from the candidate, and statement that the candidate does not have any physical or mental health condition that would adversely affect his/her ability to carry out the assigned duties, and additional credentialing forms. The candidate will also be required to make application through the VetPro internet-based process. The candidate will need to be enrolled in VetPro by the Credentialing Coordinator at the VA or by the Human Resources Management Service designee. The website address is: https://fcp.vetpro.org/Admin/Login/Index

2.1.3.6 It is the Contractor’s responsibility to contact the COR to request a package and instructions.

2.1.3.7 When contract physician(s) provide only teleconsultation by offering advice that supports care provided by VA’s on site licensed independent providers, the Contractor must furnish VA with a copy of the contract physician(s) credentials, verification of credentials, and current clinical privileges. The contract physician(s) providing teleconsultation services do not have to be separately privileged at the VA facility.

2.1.3.8 The Contractor must furnish a copy of its policy and procedures for credentialing and privileging to the Contracting Officer and COR for review to ensure these meet the VA’s requirements for establishment of competence through these mechanisms.

2.1.4. Technical Proficiency - Contract physician(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed. Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contract physician(s) and contract physician(s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the Facility. Contract physician(s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credential’s office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for contract physician(s).

2.1.6. Training (ACLS, BLS, EHR and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contract physician(s) as required by the VA.

2.1.7. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical facilities). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.8. DEA: Contractor shall provide copy of current DEA certificate.

2.1.9. Conflict of Interest: The Contractor and all contract physician(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.10. Citizenship related Requirements:

2.1.10.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

2.1.10.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.10.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.10.4. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.10.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.1.11. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.11.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contract physician(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employs or enters into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.11.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2. Clinical/Professional Direction: The qualifications of Contractor personnel are subject to review by VA Medical Facility COS or his/her clinical designee and approval by the Medical Facility Director as provided in VHA Directive 1100.20 and VHA Directive 1100.21. Clinical/Professional direction of all clinical personnel covered by this contract for quality purposes will be provided by the Facility COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non-Personal Healthcare Services: The parties agree that the Contractor and all contract physician(s) shall not be considered VA employees for any purpose.

2.4. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5. Prohibition Against Self-Referral: Contractor’s physicians are prohibited from referring VA patients to contractor’s or their own practice(s)

2.6. Inherent Government Functions: Contractor and Contract physician(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.7. No Employee status: The Contractor shall be responsible for protecting Contract physician(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.7.1. Workers’ compensation

2.7.2. Professional liability insurance

2.7.3. Health examinations

2.7.4. Income tax withholding, and

2.7.5. Social security payments.

2.8. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract physician(s). When a Contractor or contract physician(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract physician(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.9. Contingency Plan: Because continuity of care is an essential part of the Facility’s medical services, The Contractor shall have a contingency plan in place to be utilized if the contract physician(s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

2.9.1. Contractor shall submit a listing of proposed key personnel performing technical delivery of services in the following format:

Provider Name: ___________________ Title/Rank: __________________.

Curriculum Vitae and qualification documents of each key personnel shall be submitted with the proposal.

2.10. Emergency Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within _7__ calendar day (s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least _7__ calendar days prior to making any permanent substitutions.

2.10.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within _30__ calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.10.2. For temporary substitutions where the key person shall not be reporting to work for three consecutive workdays or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

3. VA HOURS OF OPERATION/SCHEDULING

3.1. Business Hours: Standard hours of coverage are Monday through Friday, 8:00 a.m. to 4:30 p.m., local hospital time, including all Government Holidays. Evening hours of coverage are Monday through Friday, 4:30 p.m. to 8:00a.m., local hospital time, including all Government Holidays. Weekend hours of coverage are the same as listed above, including all Government Holidays.

3.2. Contractor shall be available to the Facility for consultation and interpretation 24 hours a day, 7 days a week, 52 weeks a year for STAT, urgent, and routine exams on an as need basis.

3.3. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

· New Year’s Day

· President’s Day

· Martin Luther King’s Birthday

· Memorial Day

· Juneteenth

· Independence Day

· Labor Day

· Columbus Day

· Veterans Day

· Thanksgiving

· Christmas

· Any day specifically declared to be a national holiday.

3.4. Continuity of services under contact:

3.4.1. Unless a state of emergency has been declared or services are otherwise cancelled by the VAMC, the Contractor shall be responsible for providing services.

Contractor is responsible for providing qualified personnel to read radiology/nuclear medicine images. Contractor is responsible for providing back-up staff if scheduled staff becomes unavailable due to illness or emergency.

3.4.2. The contractor shall maintain open and professional communication with members of the VISN and Facility Diagnostic Imaging staff. The contractor shall provide up-to-date points of contact to facilitate communication on clinical, technical and administrative issues. Clinical staff will be available by phone and pager 24/7. The Contractor will provide a schedule of radiologists with telephone numbers for consultation by VA technologists and referring physicians. The contractor will provide a FAX number for the transmission of radiographic orders.

3.4.3. Contractor shall be readily and bidirectionally available and consistent with the ACR Practice Guideline for Communication of Diagnostic Imaging Findings. Pathway of easy and prompt communication should be well established, agreed upon, and facilitated by both parties. Although various delivery formats are available, including a landline telephone, smart phone, electronic medical record, e-mail and voicemail, the delivery method should be the choice of the referring VA provider

3.4.4. The Contractor shall provide a single phone number with a list of individuals who could be contacted to immediately resolve any difficulties experienced during the hours of teleradiology services and STAT studies after hours. The COR will assure up-to-date rosters of staff are provided to the Contractor.

3.4.5. Tele-Communications

3.4.5.1. The contractor will secure and maintain the communications link between the contractor’s facility and the VAMCs’ facilities at the contractor’s expense. These expenses may be included in contractor’s proposal as a separate item. The cost to establish and maintain this communication link may be provided if the Government deems it is more cost effective to the Government. Vendor shall have a national Memorandum of Understanding with the Veterans Administration governing network interconnection, virtual private network configuration, DICOM image movement, bi-directional HL7 feed to VA EHR for patient demographic/report updates, and critical alert delivery and escalation

3.4.5.2. In the event of telecommunications failure, the Government shall package, hard copy film or alternative media in Government-provided shipping containers, and ship to the contractor’s facility; using Government provided pre-paid shipping documentation. The contractor’s place of business must be within the confines of the continental United States.

3.4.5.3. The contractor shall make provisions for the proper maintenance and functioning of all imaging, teleradiology and associated equipment, facilities and fixtures as may reasonably be required by Contract Physicians to perform services hereunder.

4. CONTRACTOR RESPONSIBILITIES

4.1. Clinical Personnel Required: The Contractor shall provide contract physician(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.2. Management and Supervision:

4.2.1. The Contractor shall be responsible for supervising the daily services provided under this contract by the Contractor’s staff.

4.2.2. The Contractor shall have written policies and procedures regarding staff credentials and privileging.

4.2.3. The Facility will provide to the Contractor policies, procedures and processes necessary to allow cooperative functioning between the agency and Facility. Updates and refreshers will be provided to the Contractor upon request and when policy procedures or process changes.

4.2.4. The Contractor shall complete background investigations to ensure that employees do not have a record of criminal offenses or substantiated incidents of patient abuse; and, if required to perform their duties, employees are properly licensed and insured to operate motor vehicles.

4.3. Standards of Care: The contract physician(s)’ care shall cover the range of Radiology services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality meeting or exceeding currently recognized national standards as established by:

4.3.1. The American College of Radiology Guidelines: Practice Parameters and Technical Standards | American College of Radiology (acr.org)

4.3.2. ACR Practice Parameter for Communication of Diagnostic Imaging Findings: communicationDiag (acr.org)

4.3.3. VA Standards: VA Standards: The contractor shall provide timely interpretations on all previously listed modalities including Digital X-rays (DX, also referred to as plain films), Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (US), and Nuclear Medicine (NM). Turn-around times are defined by the exam type and begins at the time when all images from the VAMC are received by the contractor and ends when contractor provides a final interpretation, and it is received by the VAMC systems. Turn-around times are listed below based on the nature of the exam and the required response time of the contractor. Stroke protocol CT exam guarantee turn-around time: Read within one half hour. STAT exam guarantee turn-around time: Read within one (1) hour. Urgent exam guarantee turn-around time: Read within two (3) hours, Inpatient Routine exam guarantee turnaround time: Read within six (6) hours. Situation may allow for this time to be adjusted on a case by case basis. Outpatient Routine exam guarantee turnaround time: 90% of cases read within 48 hours, 100% within 72 hours.

4.3.4. The professional standards of the Joint Commission (TJC): http://www.jointcommission.org/standards_information/hap_requirements.aspx

4.3.5. The standards of the American Hospital Association (AHA): http://www.hpoe.org/resources?show=100&type=8 and;

4.3.6. The requirements contained in this PWS

4.4

4.5 MEDICAL RECORDS

4.5.1 Authorities: Contractor’s physician(s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the 5 U.S.C.552a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.5.2 HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment of VA patients. Based on this exception, a BAA is not required for this contract. Health records generated by this contract or provided to the Contractors by the VA are covered by the VA Privacy Act system of records entitled ‘Patient Medical Records-VA’ (24VA10A7). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services provided to VA patients are captured in the VA electronic health record system as required by VA policy as discussed in 4.5.4.

4.5.3 Disclosure: Contractor’s physician(s) may have access to patient medical records for the purpose of providing medical care and services to VA patients and performing services under the contract. VA authorizes the Contractor to discuss patient health information for coordination of care with community health care providers in compliance with VA regulations, HIPAA and VHA Directive 1605.01, Privacy and Release of Information. The VA will provide the Contractor with a copy of VHA Directive 1907.01, Health Information Management and Health Records and VHA Directive 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.5.4 Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Directive 1907.01 Health Information Management and Health Records: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9235 and all guidelines provided by the facility.

4.5.4.1 All film interpretations will either meet or exceed established VISN standards of timeliness, accuracy, content and signature. Only Facility approved abbreviations will be used for documentation of the patient health record. All imaging exam interpretations shall either meet or exceed established standards of timeliness, accuracy, content, and signature. Only medical abbreviations from The Joint Commission’s National Patient Safety Goals, current edition, will be used for documentation of the patient health record. Those abbreviations not acceptable to conform with the JCAHO directives are included Attachment “Do Not Use List”.

4.5.4.2 Contractor radiologists shall compare the exam being interpreted to any relevant priors which will consist of same modality and/or of same body region performed in different modality. Interpretation will include appropriate references to the comparison exam/s. Contractor shall be responsible for accessing and obtaining via query electronic retrieval of prior images and reports from VA system if not readily available in contractor system at the time of interpretation. Contractor shall not contact VA staff to routinely push relevant priors unless contractor is unsuccessful in querying. Technical issues prohibiting contractor's ability to retrieve query shall immediately be addressed with cooperation between Contractor and VA technical support. Contingent on timely completion of MOU/ISA agreement at time of contract activation. Continued progress for successful completed MOU/ISA with full implementation of query retrieve must be achieved in a timely manner during base year of contract.

4.5.4.3 Contractor will provide an automated update each morning via email of unread exam statuses for each VAMC facility to include Accession Number, modality, facility, procedure description, study age, and contractor worklist age.

4.5.4.4 Interpretations shall include the following information:

Patient's full name, SSN Date of birth, clinical history, exam case (accession number), date of interpretation, requesting physician, exam type, diagnostic code, and signature of contract radiologist providing interpretation."

Every report interpretation must include Impression: section.

Critical findings documentation when applicable.

Document comparison if performed.

All IV contrast, type and dose must be documented in imaging report.

Dictation System must automatically populate the date and time the final report was signed and submitted.

Reports requiring editing must be done so with addendum. If there are errors/addenda impacting clinical care/outcome, a phone call to the provider must be made immediately when error discovered with documentation within the corrected report.

4.5.5 Supervision of residents for any services provided by such residents must meet all applicable Medicare documentation requirements for teaching physicians. The teaching physician must document that he/she personally reviewed the image and resident's interpretation and either agree with it or edit the findings. A countersignature by an attending of the resident's interpretation is not sufficient.

4.5.6 Release of Information: The VA shall maintain control of releasing any copies of patient health information or health records and will follow policies and standards as defined, but not limited to Privacy Act requirements. Contractor will not release or disclose copies of records and will refer all such requests to the Release of Information Department at the VA facility were assigned.

4.5.7 Management for Medical Records: National Archives and Records Administration record disposition requirements are found in RCS 10-1 Chapter 6, 6000 series.

4.5.8 MEDICAL RECORDS/COMPUTERIZED RECORD SYSTEMS/ DISCLOSURE/ RECORD RETENTION: All records created from these actions shall be managed per Record Control Schedule (RCS) 10-1. Close attention shall be given to disposition schedule found in RCS 10-1 Chapter 4, 4000 series (General Record Schedule 1.1). Other records included but not limited to Chapter 1, 1180.15 and 1180.23 (GRS 1.1), Chapter 5, 5020.5 (GRS 5.4). There are some specific special contracting record schedules in RCS 10-1 for individual groups of records.

4.5.9 MEDICAL RECORDS REQUIREMENTS: Authorities: Contractor providing treatment and healthcare services to VHA patients in the community shall comply with 45 C.F.R. Parts 160, 162, and 164 (Health Insurance Portability and Accountability Act’s Privacy Rule) and any other applicable law regarding health information, including contractual obligations as outlined in the Community Care Network (CCN) contract.

4.5.10 Health records provided to the Contractor by the VA for the medical care and services to VA patients are covered by VHA Privacy Act system of records entitled ‘Patient Medical Records-VA’ 24VA10A7 at http://vaww.oprm.va.gov/docs/Current_SORN_List_11_13_2020.pdf. Address and authority exists to disclosure these records to the Contractor for treatment purposes.

4.5.11 Contractor generated patient medical records are the property of the contractor and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that copies of all health records pertaining to medical care and services provided to VHA patients are available for transmission and release when requested by VHA in accordance with the CCN contract, for treatment or payment purposes. As part of reimbursing the contractor for medical care and services provided to VHA patients, copies of health records may be required for payment and quality reviews.

4.6 Direct Patient Care: estimated _99__% of the time involved in direct patient care. Contractor shall be responsible for

4.6.1 Scope of Care: Contract physician(s) shall be responsible for providing: including, but not limited to:

4.6.1.1 Physicians provided in satisfaction of this contract shall be required to perform their assigned duties with regards to all admitted patients, outpatients, and eligible beneficiaries regardless of underlying disease process or physical condition of such patients or beneficiaries. The contract shall provide physicians who shall:

4.6.1.2 Contractor shall provide board certified Radiologists to perform final teleradiology Interpretation services. Examination images captured by VISN medical centers will be transmitted to the contractor using the DICOM protocol and the Federal Information Processing Standard (FIPS) compliant encryption. Upon receipt of captured image and patient information from a VISN facility, the contractor shall provide an interpretation for studies. VISN personnel will inform the contractor once images are ready for viewing once the images are sent using the PACS electronic system. These procedures will be rendered in writing once the contract is awarded.

4.6.1.3 The Contract physician(s) shall dictate all interpreted studies and transmit them electronically into the VAMCs electronic medical record via HL7 compatible interface. Contract Radiologists will have control of the reporting process from dictation to report sign-off/electronic signature/approval. The contract Radiologist dictates self-edits and approves their reports within their approved system application. No transcription services will be provided.

4.6.1.4 If a Critical Finding is identified during the interpretation, the report shall be immediately called in telephonically to the attention of VISN 20 medical facility's designated requesting physician or their surrogate Licensed Independent Practitioner (LIP) for their information and action as per Critical Findings policy (Communication of test results). Reference Communication of Test Results attached. Changes and/or updates will be supplied for the duration of the contract.

Critical findings documentation when applicable. Reference VAMC Critical Findings Policy attached. Critical findings must include the full name of the clinician, time of communication, date of communication, as well as confirmation that the provided critical finding(s) is/are understood and read back confirmation of these findings. Read back confirmation must be documented in the interpretation, i.e., Critical Findings called to Dr. Mouse at 08:00 EST via telephone with read back. The word 'discussed or discussion' can not be substituted for the word read back.

4.6.1.5 All Stroke Protocol CT exams, when properly identified, will be performed and results communicated within thirty (30) minutes to ordering provider. All STAT exams, when properly identified, will be performed and the results communicated within one (1) hour of receipt of images and appropriate paperwork. STAT exams shall be identified by a telephone call to contractor or by a stamp or other indication on the paperwork provided by contractor. All STAT exams must be identified at or prior to receipt of the images and paperwork by contractor. For STAT exams, a image interpretation will be provided by a radiologist within 1 hour of the image being transmitted to the reading site. The level of experience of the preliminary reader must be, at a minimum, the same level the Contractor provides for its own patients. A preliminary reading will be transmitted back to the referral site within 1 hour of the image being transmitted to the reading site. This can occur by fax, email, or by direct entry into the VA electronic medical record. (Note: “Preliminary” is defined as abbreviated results. The actual substance of the interpretation is NOT to change in any significant way from “preliminary” to “final” interpretation). All stat exams require the contractor to call the requesting physician within one hour from the time the images were transmitted providing a verbal interpretation. The signed dictated report will be completed within 1 hours of interpretation. VA will not need to guarantee any minimum image volume.

4.6.1.6 Final interpretation and official signature will be electronically uploaded into the VA VISTA Radiology package and electronically signed in VISTA by an attending radiologist within 24 hours of the image being transmitted to the reading site.

4.6.1.7 Availability to consult with a radiologist to determine the most appropriate study for the clinical scenario involved; although for the most part, pre-defined protocols would be used. Fees may be charged for such consults if the consult does not result in an imaging study being performed.

4.6.1.8 Mechanisms must be in-place to provide notification of test results for patients receiving care in accordance with VHA Directive 1088, Communicating Test Results to Providers and Patients.

4.7 ADMINISTRATIVE: estimated __1_% of time not involved in direct patient care.

4.7.1 Must take part in medical staff functions as required to meet the standards of the Joint Commission on Accreditation of Health Care Organizations.

4.7.2 QA/QI documentation: The contract physician(s) shall complete the appropriate QM/PI documentation pertaining to all procedures, complications and outcome of examinations.

4.7.3 SYSTEM REQUIREMENTS:

4.7.3.1 If VAPORHCS chooses to use the contractor’s teleradiology system and PACS in lieu of supplying its own teleradiology system and PACS, then the contractor must maintain a teleradiology system that is compatible, reliable and functional to prevent any disruption in the delivery of services. Data transmission security must be maintained at all times, both for receipt of images and transmission of reports. Facility personnel must be notified immediately of any equipment malfunctions that would hinder the transmission of images. Contractor equipment must be capable of receiving VA images at the same speed they are transmitted from the VA MPLS line. Contractor backup/disconnect recovery lines need to meet the same standards for rapid transmission of medical images. Contractor must specify the speeds of their image receiving equipment in the vendor proposal. Vendors must specify backup/disaster recovery plans in place to assure uninterrupted processing of medical images. Contractor equipment must be capable of implementing MPLS Network connection with VISN 20 facilities shall be provided via a Site-to-Site Virtual Private Network connected through a VA gateway that is MPLS capable and can be expected to transmit at least 10 GB of patient images daily. This connection will be configured and maintained by the VAO IT WAN Manager or their designee. No GFE will be provided other than equipment necessary to make this connection.

4.7.3.2 Contractor warrants that any data containing patient-specific identifiers will be handled in such a way as to prevent disclosure to unauthorized parties. This includes transmission of the data (from the point at which the data leaves the VA network to the point at which the images are interpreted) as well as storage of the data by the Contractor. Contractor agrees to comply with all applicable data security laws and guidelines, as well as HIPAA and various JCAHO provisions.