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Questions and Answers
9th SoW Competitive
March 31, 2008
| Question Number |
| RFP Section |
| Question |
| Answer |
| 1 |
| General |
| Need to confirm that the definition of a “payor organization” does not encompass such activities as fiscal agent, claims processing, or other activities in which a company acts as an agent for government Medicaid or Medicare agencies. |
| Section H.11.C defines a payor organization as any organization other than a self-insured employer, which makes payments directly or indirectly to health care practitioners or providers whose health care services are reviewed by the organization or would be reviewed by the organization if it entered into a QIO contract. |
| 2 |
| C.7.2 |
| Interested respondents have rerun the new calculation and are prepared to comply but question whether the revised version is correct as it dramatically REDUCES the population size that the contractor is to work with, is counter to the work described within the RFP and what has been articulated by the program management. |
| The revised Power Calculation to determine population size is correct. This adjustment allows for smaller communities to achieve a 2% reduction in the rate of re-hospitalization and participate in the 9th SoW. Small communities can also now participate, if the projected improvements are great enough to produce the required statistical improvement on the re-hospitalization rate. |
| 3 |
| Section C6.3 Theme Task 1 and 2 Page 56 |
| What is the timeline and sequence of events for identification, matching, and final list supplied to the QIO by CMS regarding PPs and NPs. |
| This is clarified in the RFP. |
| 4 |
| Section C6.3 Theme Task 5 Page 57 |
| How will the bi-weekly reporting of actual rates required by QIOs vs. quarterly reporting by PPs be utilized? |
| This language is clarified. |
| 5 |
| Section C6.3 Theme Task 5 |
| How will the “information from the patient regarding vaccination that occurred outside the practice” be reported? i.e. The patient has a flu shot at the local grocery/other venue so the physician now reports the occurrence. |
| Information will be obtained through claims and EHR reporting. |
| 6 |
| Section 6.3 Theme Task 6 Page 58 |
| How will monitoring of statewide rates be collected and analyzed. Will an analyst/consultant complete the analysis? |
| A support contract will do this. |
| 7 |
| Section C.5 Overall Evaluation (Page 28) |
| Could CMS elaborate on how contractors new to the program would be evaluated in those areas where CMS has defined tighter limits based on previous SoW activities? |
| A new contractor will be evaluated the same as a continuing contractor. |
| 8 |
| Section C.5 Overall Evaluation. (Page 28) |
| How will individual Pass/Fail results from Themes and sub-themes be compiled into an overall evaluation? Does CMS have a weighting scheme or other methodology by which individual theme results will be summarized? |
| The evaluation methodology is outlined for each theme in the SOW. A weighting scheme will not be applied to the overall evaluation. |
| 9 |
| Section C.6.1 Beneficiary Protection B. Task B Quality Improvement Activities (Page 33) |
| Can CMS comment on the expectation for QIAs in areas with very low review volume that may not yield observable opportunities for system-wide improvement? |
| If QIOs do not have sufficient volume of data to implement a systems change, they may supplement their data by using other methods to identify focus areas. These include intensified review as necessary and within the budget along with collaboration with providers, i.e. QIOs will work with the provider directly to identify focus areas and implement a quality improvement plan. |
| 10 |
| Section C.6.1 Beneficiary Protection (Page 36) |
| Has CMS taken into account the impact of low numbers of reviews in evaluating the results of beneficiary satisfaction surveys? Also, has CMS considered the possibility of a ceiling effect for satisfaction results? |
| CMS recognizes your concerns and will account for low volumes in the evaluation process. |
| 11 |
| Section C.7.1 Prevention Disparities (Page 66) |
| Does CMS consider a Community Health Clinic (CHC) or Federally Qualified Health Clinic (FQHC) to be eligible sites? |
Yes, a FQHC or clinic is eligible to participate in the disparities subtask.
| 12 |
| C.7.2., Patient Pathways (Care Transitions) (Page 76) |
| For organizations assuming responsibility for an area as the QIO for the first time, will CMS make beneficiary-specific data available early in the contract period to support the analytic activities needed to develop an acceptable written Initial Report as described in Task 1.A? The analytic files that CMS will provide to the QIO would have information to support this effort, but as the RFP describes the timing of delivery (i.e., November 1, 2008) the report will be due before the data files are received. Given these circumstances, would CMS consider allowing additional time for a “new” QIO to conduct data analysis and an environmental scan, and prepare a draft intervention plan? |
| The intervention plan will be an evolving document. The QIO should meet deliverables on time with the data that they and CMS can make available and the time frame allowed. As more analyses and more experience shapes the plan, it can and should evolve in a responsive way. This will be true of “new” and “old” QIOs. |
| 13 |
| Theme C.6.1. General |
| In order to properly price this theme a bidder needs to understand how many cases of which type will need to be reviewed. In-state QIOs know this information. Will CMS be providing this information to bidders? When? |
| Please see attachment J-20 issued with this amendment. |
| 14 |
| Theme C.6.2. Section L: |
(pp.249-250 )
| It is a requirement for bidders to identify which hospitals and nursing homes they will work with under Theme C.6.2. Will CMS provide out of state bidders the names of Providers in Table B (pp. 47-48): State maximum provider pools by topic? When? |
| A list of specific facilities by state representing potential provider pools will be provided before the contract date. QIOs will recruit from these lists; additionally, QIOs may recruit facilities that are not on these lists in adherence to direction provided by CMS. See Attachment J-17 for provider lists and revised contract language for contract specifics. |
| 15 |
| Theme C.6.2. General. |
| In regards to C.6.2. once the names of the providers listed in Table B are identified, the current QIO already has access to a great deal of information about these providers such as the number of hospital and nursing home censuses, rates of pressure ulcers, SCIP, and restraints at particular providers. This information would be both useful and to a degree is required in the RFP. Will it be made available to out of state QIOs? |
| QIOs are directed to |
www.MEDQIC.org ; www.hospitalcompare.hhs.gov/hospital ; www.medicare.gov/NHCompare and individual state QIO websites for state specific information.
| 16 |
| Theme C.6.3. General |
| Since existing QIOs already know which potential participating practices meet the EHR requirements for Theme C.6.3., will CMS be providing the names of those practices? Will they provide access to lists of PPs that do not qualify? |
| The ability for a QIO to recruit is not based on 8th SoW. It is based on the QIOs knowledge of practices with EHR that meet the eligibility requirements in the SoW. |
| 17 |
| Theme C.6.3. General |
| In regards to C.6.3. QIOs are required to give information regarding numbers of diabetics and the underserved that would be present in the PPs selected. Since the current QIOs have access to this information will CMS be making this information available to bidders? When? |
| Diabetes is under Theme 7.1. |
| 18 |
| Theme C.7.1. General |
| In order to be responsive to this theme, the bidder must provide information about the number and types of underserved beneficiaries and the providers that serve them in their response to CMS. Current QIOs have this information. Will CMS make this information available to bidders? When? |
| This will not be a requirement for information to be included in the QIO proposals at this time. |
| 19 |
| Theme C.7.2. General |
| In order to be responsive to this Theme, bidders are required to select a community that meets certain requirements including having an appropriate number of 30-day readmits, general information about the providers in the community, specific information regarding number and type of cases the provider handles, etc. The current QIO has this information. Will CMS be providing this information to bidders? When? |
CMS is looking for evidence that the bidder knows the community well and is situated to work well in it. There are a variety of information sources about communities that the bidder can draw upon.
| 20 |
| Section C.6.2.1, (page 37) |
| Can the QIO select the list of final providers for participation in a 9th SoW QIP, after August 1, 2008 and before September 30, 2008? |
The QIO must provide to CMS an expected list of providers that they hope to work with in their proposals. QIOs are then expected to recruit at least 70% of those providers.
| 21 |
| Section C.6.2.16, (page 39) |
| Can CMS evaluate QIO performance, if improvement is made among members enrolled in a MA plan? |
Based on comments received, the Drug Safety Component information in the SOW has been expanded upon. Please see the revised contract language for a complete description. The QIOs will work with entities who either self identify or are recruited by the QIO. Those entities are outlined under Section 1154(a) (17), as added by Section 109(b) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The QIO should have tools available to those entities who seek assistance with regards to Drug-Drug Interactions and Potentially Inappropriate Medications. Specific information about what constitutes a DDI or PIM can be found on the QMIS website at QualityNet.org. The QIO will track practices that are proven to be successful in reducing the incidence of each measure. The QIO will submit quarterly reports to CMS that reflect both the amount of technical assistance requested and associated successful practices.
First Contract Evaluation Criteria, Months 7-12 and Months 13-18, (pages 4 and 42)
| What are the numerators and denominators for the percents displayed in these tables? |
| Evaluation criteria are specific for each measure; if an improvement rate is used, it will be relative improvement. These percentages are not tied to evaluation but rather serve as a guide to QIOs about where they should be in reaching the 18/28 month evaluation criteria. These percentages also serve as a guide to the GTL/PO and are estimates. The 18th and 28th months goals will be based on data collected in prior months and will take into consideration time required for collection and validation. Please see revised contract language for further clarification. |
| 23 |
| Section C.6.2, First Contract Evaluation Criteria, Months 13-18, (page 42) |
| Is the MRSA goal at month 18 to increase by 50% the number of hospitals currently reporting to NHSN or the number of hospitals in the state? |
| See revised contract language. In order for a QIO to participate in the MRSA component, the QIO will need to establish an agreement with the NHSN hospital. The numbers provided in Table A (previously “Attachment B”) reflect numbers of hospitals currently reporting on the NHSN system. It is expected that QIOs may recruit additional facilities. Hospitals voluntarily report on this system. The three measures for the MRSA component and related evaluation are further clarified in the revised SOW. Please see revised contract language. |
| 24 |
| Section C.6.2, Final Evaluation Measures, MRSA, (page 43) |
| Is the quality improvement on MRSA measures, MRSA1 and MRSA2, expected for the originally recruited providers in Attachment J-17 or those providers and the providers that begin reporting after September 30, 2008? |
In order for a QIO to participate in the MRSA component, the QIO will need to establish an agreement with the NHSN hospital. The numbers provided in Table A (previously “Attachment B”) reflect numbers of hospitals currently reporting on the NHSN system. It is expected that QIOs may recruit additional facilities. Hospitals voluntarily report on this system. The three measures for the MRSA component and related evaluation are further clarified in the revised SOW. Please see revised contract language.
| 25 |
| Section C.6.2, Final Evaluation Measures, Prescription Drug Safety, (page 43) |
| Are QIOs expected to improve DDI and PIM rates statewide or in what subgroup within the state? |
| Based on comments received, the Drug Safety Component information in the SOW has been expanded upon. Please see the revised contract language for a complete description. The QIOs will work with entities who either self identify or are recruited by the QIO. Those entities are outlined under Section 1154(a) (17), as added by Section 109(b) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The QIO should have tools available to those entities who seek assistance with regards to Drug-Drug Interactions and Potentially Inappropriate Medications. Specific information about what constitutes a DDI or PIM can be found on the QMIS website at QualityNet.org. The QIO will track practices that are proven to be successful in reducing the incidence of each measure. The QIO will submit quarterly reports to CMS that reflect both the amount of technical assistance requested and associated successful practices. |
| 26 |
| Section C.6.2., Theme Description/Re-quired Activities #2, (page 37) |
| Under #2, “Analyze, rate, and catalog specific interventions and tools, as well as program and policy implementation”, will CMS be providing the QIO a “tool portfolio” of interventions to use? Please clarify. |
Tool updating and development will occur before the launch of the 9th SOW for each component in the Patient Safety Theme. QIOs should plan to use the available tools, but as hospitals and nursing homes begin to make large gains, new tools may need to be developed and used. QIOs are also expected to provide feedback to the support contractor on the effectiveness of tools. It is expected that the support contractor will provide definitive guidance in standardization of which QI interventions will be utilized by the QIOs. For evaluation purposes, the introduction of new QI interventions may be prohibited after a specific time period.
| 27 |
| B.8.(A), (page 13) |
| This section states “the Government is not obligated to reimburse the QIO for costs incurred in excess of the periodic allotment. What defines “periodic allotment”? Is it intended to be the contract total for a task divided by 36 months? |
| The periodic allotment is the contract funded amount for the period of time that is identified for its use. This is an incrementally funded contract as described in Section B8. |
| 28 |
| C.6.2.15, (page 39) |
| Will the Document TeamStepps trainer course be done locally, or will the QIO team have to travel to the training? If so where and for how long? |
| In order for a QIO to participate I the MRSA component, the QIO will need to establish an agreement with the NHSN hospital. The number provided in table A (previously “Attachment B”) reflect numbers of hospitals currently reporting on the NHSN system. It is expected that QIOs may recruit additional facilities. Hospitals voluntarily report on this system. The three measures for the MRSA component and related evaluation are further clarified in the revised SoW. Please see revised contract language. |
| 29 |
| C7.1,Appendix A,Disparity Task, (page 73) |
| Will the Diabetes Self-Management Education (DSME) program(s) be provided by CMS or purchased with contract funds? |
| Each QIO will be responsible for payment out of their contract funds. |
| 30 |
| L.16.A.Tab7, (page 273), L.16.B.Tab 5 (page 277), L.16.C. Tab 5, (page 280), & L16,D. Tab 5, (page 282) |
| Does the requirement to identify all government-owned property in the QIO possession include the GFP that will be listed in the forthcoming amendment? |
| The offeror should identify all the GFP that it has in its possession that is being proposed to perform the work under this RFP. |
CMS is releasing as part of this amendment (as separate documents) the individual state list of GFP that CMS may provided to the QIO who is awarded the 9th SOW QIO contract for each respective state.
| 31 |
| B.4.B, (page 10) & g.20 (page 183) |
| The Table of TEC refers to special studies as Section C-8 while Section G-20 refers to special studies as Task 4. Which is correct? |
| Section G20 has been corrected. It now reads Section C-8. |
| 32 |
| L.16.A.2.Tab 9, (page 274) |
| Requires a fully executed package including among other items the RFP Section B. Is this form available in Excel format for accurate completion? |
| No. |
| 33 |
| G.25., (page 190) |
| The Note at the bottom of the section states “CMS may waive the COA requirement on indirect purchases if it is determined to be in the best interest of the Government.” What is meant by the “best interest of the Government”? |
| Section G.25 has been revised. Please refer to the revised section. |
| 34 |
| G.25., (page 190) |
| Does CMS intend to review indirect purchases that are part of the QIO’s overhead pool? |
| Yes. CMS may audit any changes at any time. See revised Section G.25 |
| 35 |
| Attachment J.8, (page 5) & L.16.A.Tab 4, (pages 270 & 271) |
| Attachment J.8. Directs the QIO who have Fringe Benefits and Indirect Cost provisional rates approved by the DCAA to use those rates in the proposal. L.16.A.Tab 4 requires specific support for their proposed indirect rates. Does CMS want the detail provided that supports the current DCAA approved provisional rates? |
| CMS will develop the indirect rates for award of the 9th SoW QIO contract. Thereafter, CMS will utilize DCAA for annual provisional rate reviews and incurred cost audits, establishing the final indirect rates for the contractor’s fiscal year. |
Budget Assumptions
Beneficiary Protection
(No page number)
| What CRIS Report # did CMS use to determine the case/review counts for the Median Professional Hours per case and the Median Support Hours per case? |
| CMS did not utilize a standard report number. CMS requested an ad hoc data request from the SDPS contractor. |
Budget Assumptions
Beneficiary Protection
(No page number)
| There is not mention of FI Referrals in the grid for Median Hours per case. Will the QIO still be doing the Referrals as stated in the RFP or will there not be a median hours per cases for this type of activity? |
| Please see attachment J-20. CMS did not provide median hours per case for referrals. |
| 38 |
| Attachment J-4 QIO Manual Chapter 5, Section 5050 Data Analysis and Reporting Requirements |
(page 95)
| “Enter your complaint review findings from the PRAF into your database for pattern analysis. On an ongoing basis, analyze your data for potential improvement projects.” Will CMS use CRIS at some point and time to offer this type of reporting? |
| Please utilize the method you are currently using to fulfill this requirement as additional enhancements to CRIS are to be determined. |
| 39 |
| Attachment J-4 QIO Manual Chapter 5, Section 5050 Data Analysis and Reporting Require-ments |
(page 95) “Enter your complaint review findings from the PRAF into your database for pattern analysis. On an ongoing basis, analyze your data for potential improvement projects.” Will CRIS be redesigned this scope of work to accommodate this type of data gathering?
Please utilize the method you are currently using to fulfill this requirement as additional enhancements to CRIS are to be determined.
| 40 |
| Attachment J-4 QIO Manual Chapter 5, Section 5050 Data Analysis and Reporting Requirements |
(page 95)
“Enter your complaint review findings from the PRAF into your database for pattern analysis. On an ongoing basis, analyze your data for potential improvement projects.” Is the QIO expected to expend resources to program reports to gather data from the CRIS system?
Please utilize the method you are currently using to fulfill this requirement as additional enhancements to CRIS are to be determined.
| 41 |
| C.6.1 Beneficiary Protection, E. Task 5., (page 32) |
| How will the QIO be evaluated for this task? |
Please refer to TOP Memo 2006-02, Policy Regarding the New Quality Improvement Organization (QIO) Physician Acknowledgment Statements. TOP Memo 2006-02 is released as an attachment to these questions for informational purposes only.
| 42 |
| C.6.1 Beneficiary Protection, E. Task 7., 3 a,b,c,d, (page 33) |
| Will CMS provide a template for this report like the Annual Medical Services Review Report? Will this report be narrative or more data/number driven? Please clarify as this report could require ample data and communication resources. |
| This should be submitted as a narrative report, and should contain supporting data and or evidence that demonstrate the outcome and the impact of the QIAs. |
| 43 |
| Theme 7.1 Disparities, (page 64) |
| Does CMS break the QIO up into the peer groups? |
| Yes, this will be accomplished after the QIOSC contract is awarded. |
| 44 |
| Theme 7.1 Disparities, (page 64) |
| When will CMS let the QIO know how many peer groups are in the state? |
| Each QIO will be categorized in only one of four peer groups, to be determined after the QIOSC contract is awarded. |
| 45 |
| Theme 7.1 Disparities, (page 64) |
| When will CMS let the QIO know where the peer groups are located within the state? |
| See above response. |
| 46 |
| Theme 7.1 Disparities, (page 64 last paragraph) |
| When will CMS give the QIO the CMS-approved environmental scan tool? |
| After the QIOSC contract is awarded. |
| 47 |
| Theme 7.1 Disparities, (page 65) |
| Do PPs have to be participating in PQRI? |
| No, PQRI is not a requirement for this subtask. |
| 48 |
| Theme 7.1 Disparities, (page 65) |
| Are FQHCs eligible to be a PP? |
| Yes, FQHCs may be PPs. |
| 49 |
| Theme 7.1 Disparities, Appendix A, (page 72) |
| Over half of Arizona’s Medicare Diabetes population is Native American Indian, yet the two CMS-approved DMSE programs were not designed for that ethnicity. Will there be DMSE programs to address this population? |
| A QIO may submit a program they believe would be more effective for the disparities population in their state. See RFP, Appendix A, last paragraph. |
| 50 |
| Theme 7.1 Disparities, Denominator |
(page 69)
| Are Native American Indians included in denominator? |
| Yes. |
| 51 |
| Theme 7.1 Disparities, Denominator |
(page 69)
| Will QIOs be expected to work with the Indian Health Services on this task? |
| QIOs may work with the IHS. |
| 52 |
| Theme 7.1 Disparities, Denominator |
(page 69)
| Will IHS data be included in the denominator? |
| No. |
| 53 |
| Theme 7.1 Disparities, Schedule F, no.# 50 |
| The annual report of statewide trends references a quarterly report within #94. There is no deliverable #94. Please clarify. |
| It should read deliverable # 49, not 94. |
| 54 |
| Theme C.7.1, Disparities, (page 64), second paragraph and Appendix A (page 71) |
| The two CMS DSME approved programs (DEEP and Project Dulce) target lay individuals, CDE and other clinicians who are not technically “appropriate personnel.” Do the practices (PPs) have to become ADA certified? |
| No, the PPs do not have to become ADA certified. |
| 55 |
| Theme C.7.1, Disparities, (page 64), third paragraph |
| Will the CHWs that the QIOs train be able to bill for the DSME services they provide through the PP? |
| No, only CDEs are reimbursed by Medicare. |
| 56 |
| Theme C.7.1, Disparities, (page 65), Task 2, Schedule F, deliverables 43 and 44 |
| What is the difference between the PP of deliverable 43 and the intervention participants QIO attempted to recruit in Deliverable 44? |
| The intervention participants are all of the PPs the QIO attempted to recruit. The PPs are the practices the QIO knows will definitely participate. |
| 57 |
| Theme C.7.1, Disparities, (page 65) |
| Can a PP be a nursing home or a home health agency, as well as a physician office? |
| No, only a physician practice. |
| 58 |
| Section C, Theme 7.1, Task Description, (page 66), Task 3 |
| Do the QIOs rely on the practices self-report to get the number of practitioners at the site, total number of diabetes patients, number of underserved diabetes patients? |
| The QIO will need to utilize the CMS Medicare claims data to help create the practice sites. It would be expected that the environmental scan and other resources would be used to provide the most accurate information available. |
| 59 |
| Section C, Theme 7.1, Task Description, (page 66), Task 3 |
| Is the QIO responsible for recruiting the NPs? |
| No, recruitment of NPs is not necessary since they are non-participants. |
| 60 |
| Section C, Theme 7.1, Task Description, (page 66-67), Tasks 5 and 6 |
| The deliverables in this task would be near impossible to produce in a practice site that does not have an EHR. Are the PPs and NPs required to have an EHR? |
| No, they are not required to have an EHR. |
| 61 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 37) |
| The RFP states that the Patient Safety Theme will focus on five topics yet 6 are listed: 1) improving inpatient surgical safety, 2) reducing rates of nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) infections, 3) improving drug safety, 4) reducing rates of pressure ulcers, 5) reducing rates of use of physical restraints, and 6) poorly performing nursing homes. Then under the Theme Description/Required Activities it states that the following activities (of which there are 17) shall be conducted for each topic of the theme yet activities 15 - 17 appear to be slated for one topic only -MRSA, drug safety and poorly performing nursing homes respectively. Please clarify what activities are required for which topics. |
| Please see revised contract language. Tool updating and development will occur before the launch of the 9th SOW for each component in the Patient Safety Theme. QIOs should plan to use the available tools, but as hospitals and nursing homes begin to make large gains, new tools may need to be developed and used. QIOs are also expected to provide feedback to the support contractor on the effectiveness of tools. It is expected that the support contractor will provide definitive guidance in standardization of which QI interventions will be utilized by the QIOs. For evaluation purposes, the introduction of new QI interventions may be prohibited after a specific time period. |
| 62 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Activities 7-14 do not contain any narrative description. Please clarify CMS’ expectations for these activities (i.e., “Distribute implementation tools” – what tools? to whom are we to distribute the Tools? etc.). |
| Please see revised contract language. |
| 63 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 37) |
| In an effort to budget for the activity #2, “analyze, rate and catalog specific interventions and tools, as well as program and policy implementation”, can CMS provide more detail on the breadth and depth of the tool portfolio that each contractors is expected to analyze, rate and catalog? |
| Yes, thank you for your question. Please see the revised contract language for this information. |
| 64 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 37) |
| Activity #2 requires each contractor to “analyze, rate and catalog specific interventions and tools, as well as program and policy implementation and suggest improvements”. Is this an activity that a support contactor could do prior to the start of the 9th SOW, so that this information is available to all contractors at the start of the 9th SOW when the need for these tools is greatest? |
| Thank you for your suggestion. Please see the revised contract language for further clarification. |
| 65 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 37) |
| Activity #1 requires recruitment up to a specified maximum number of Medicare Providers from a state pool. The number of providers we can work with is largely dictated by staffing ratios, which are tied to funding. For budgeting and staffing purposes, can CMS provide contractors with the methodology that will be used to fund the Patient Safety Theme so that we can provide for a feasible estimate? For example, will CMS use the number of providers recruited, or the number of beneficiaries affected by specific providers, or the number of beneficiaries in the state, county, zip code etc.? |
| The CMS will consider the value to the government based on the strategy presented, the population provided to and the amount of people benefiting from QIO interventions. QIOs should aim provide the maximum assistance they can while still ensuring their success in obtaining the goals. |
| 66 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 37) |
| Activity #1 requires recruitment up to a specified maximum number of Medicare Providers from a state pool. Will contractors be evaluated negatively if we propose our intent to recruit the maximum number of providers but end up with a smaller number who agree to work with us on QIO-led projects to improve quality? |
| QIOs are expected to recruit at least 70% of the projected providers they indicate in their proposals. |
| 67 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Activity #3 requires contractors to administer, collect and utilize the results of HLQAT and other Patient Safety Survey Instruments presumably at least twice during the 9th SOW. For budgeting purposes can you specify whether or not there is a specific administration method required and the number of times that the contractor is to administer these survey instruments? |
As specified, administration is twice during the contract period. Please see the revised contract language for further clarification.
| 68 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Activity #4 requires contractors to “Conduct training session(s) for provider staff, survey the participants on the training effectiveness, provide feedback on training effectiveness, potential improvements, and lessons learned. Please clarify what training contractors are to conduct with provider staff? |
| Conduct Training Sessions: |
The QIO shall receive training and then conduct training sessions for both QIO and provider staff over the course of the contract.
QIO Staff Training:
Two individuals from the QIO will receive training for TeamSTEPPS and serve as Master Trainers to train additional QIO staff and provider staff. TeamSTEPPS is one of many interventions that can be used by the QIOs to reduce healthcare associated MRSA. To the extent that TeamSTEPPS would be beneficial to other clinical settings, QIOs should feel free to spread this knowledge. However evaluation will be tied specifically to the NHSN hospitals working with QIOs.
CMS will train 2-3 individuals (National Quality Improvement Leaders) from each QIO on the use of action generating effective meeting management techniques among other subjects. The Quality Improvement Leaders will train other QIO staff on the methodologies for generating action in the region and use these techniques in conjunction with a proven change methodology (to be determined by the QIO) and other tools to positively impact the patient safety measures. Two of the three meetings will be held in the Baltimore/Washington corridor, 1 meeting will be held in the central U.S.. In year three of the contract, only 2 meetings will be held, likely in the Baltimore/Washington corridor. All of these meetings will include other topics that will assist QIOs in managing change in their region, including the sharing of proven practices occurring at the QIO and at the provider level.
The two-three individuals chosen to serve as National Quality Improvement Leaders should be individuals who have a direct connection with the QIO Administration but who are keenly aware of what is occurring in the field at the provider level. They should be excellent public speakers, well versed in change methodologies and passionate about quality improvement. These will be key individuals driving change with the QIO region and serving as the “go-to” individuals in a national capacity.
Provider Training/Meetings provided by QIOs.
Trainings/Meetings that generate action are an effective and efficient use of contract funds for reaching large numbers of provider staff. QIOs are expected to use trainings/meetings (number and specific topics to be determined by the QIO) as a way of facilitating change in their regions and ultimately in obtaining results with regards to each patient safety measure. Training targeted provider staff will include the application of knowledge learned from TeamSTEPPS (for those choosing the MRSA component), effective meeting management techniques, and proven practices among others; these will be used in conjunction with tools and a proven change methodology (type to be determined by QIO and/or in conjunction with the provider). Effective meeting management techniques will be used to engage providers and spread best practices to QIO-chosen providers across their region. A summary report is due to the PO/GTL on a quarterly basis. The report format will be provided.
The evaluation of meetings/trainings provided by QIOs that offer CEUs will likely have considerable overlap with the evaluation of effectiveness training.
| 69 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Activity #4 requires contractors to “Conduct training session(s) for provider staff, survey the participants on the training effectiveness, provide feedback on training effectiveness, potential improvements, and lessons learned. Please clarify whether or not contractors must first be trained (train the trainer) and the number of training sessions contractors are expected to conduct per topic? |
Please see 68 and revised contract language.
| 70 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Activity #4 requires contractors to “Conduct training session(s) for provider staff, survey the participants on the training effectiveness, provide feedback on training effectiveness, potential improvements, and lessons learned. Please clarify if there is a standardized survey that CMS wants contractors to use for assessing training effectiveness or if each contractor is to develop their own survey and if so, are there specific requirements for a QIO developed survey? |
Please see 68 and revised contract language.
| 71 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Activity #4 requires contractors to “Conduct training session(s) for provider staff, survey the participants on the training effectiveness, provide feedback on training effectiveness, potential improvements, and lessons learned. Please clarify to whom contractors are to provide feedback on the training effectiveness, potential improvements and lessons learned and if there is a specific manner in which this information must be conveyed? |
Please see 68 and revised contract language.
| 72 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Activity #5 requires contractors to obtain agreement from executive leadership of specific providers to work on a project to improve quality. Please define executive leadership by setting? For example is the CEO sufficient or should agreement also include the CFO, CMO, CNO, Administrator etc.? |
Executive leadership refers to the primary signatory (person(s) with authority to enter into an agreement with an outside entity) of a facility. In most instances, the hospital CEO or Nursing Home Administrator has this authority. If the QIO feels that it is to their benefit to have others sign they should include those individuals.
| 73 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Activity #5 requires contractors to obtain agreement from executive leadership of specific providers to work on a project to improve quality. Please clarify if CMS has a standardized agreement that contractors are expected to use or if each contractor is to develop their own agreement and if so, are specific elements required? |
The Patient Safety support contractor will provide a template that the QIO can modify to make their own.
| 74 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Can a QIO opt to not work on a topic such as MRSA? |
| Yes. Please see the revised contract language for specifics about mandatory components. |
| 75 |
| C.6.2. Patient Safety Theme Description/Required Activities (Page 38) |
| Please clarify what the evaluation expectation is for the MRSA topic. For example if we have 5 hospitals currently reporting using NHSN, is the expectation that we increase the number of hospitals reporting using the NHSN to 8 at 18 months? |
Please see revised contract language.
| 76 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 37), #2: (Analyze, rate, and catalog…) |
| What is the source of the tool portfolio? |
| Tool updating and development will occur before the launch of the 9th SOW. QIOs should plan to use the available tools, but as hospitals and nursing homes begin to make large gains, new tools may need to be developed and used. The expectation will be that QIOs share successful tools and practices with one another to foster a community of quality improvement with regard to the patient safety measures, examples may include but not be limited to effective PDSAs, dashboards, clinical que-cards, etc. |
The repository that CMS will house should not be considered final as this will be a living process. To that end, QIOs will work closely with the support contractor during this process.
| 77 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 37), #2: (Analyze, rate, and catalog…) |
| What is the deliverable associated with this activity? |
| Please see the revised Section F |
(Deliverable schedule)
| 78 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 37), #2: (Analyze, rate, and catalog…) |
| What are the evaluation criteria associated with this activity? |
| Please see revised contract language. |
| 79 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #3: (Administer and collect |
| Could you please clarify which tools are required and which are optional? |
| Only the tools that are linked to deliverables and 18/28 month measures are required. Please see 76 and the revised contract language for specifics. |
| 80 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #3: (Administer and collect results…) |
| Could you please clarify whether you want the results of the surveys as the deliverable? |
| No. CMS does not want the results. The results should be utilized by the QIO for working with their providers in obtaining the 28 month evaluation criteria. |
| 81 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #3: (Administer and collect results…) |
| If you do not want the results of the surveys as the deliverable, what are we supposed to send as the deliverable? |
| Confirmation that it has been completed. Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 82 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), # 9: (Customize tools…) |
| What is the deliverable associated with this activity? |
| Please see the revised Deliverable schedule (Section F). |
| 83 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #9: (Customize tools…) |
| What are the evaluation criteria associated with this activity? |
| Please see the revised Deliverable schedule (Section F). |
| 84 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #9: (Customize tools……) |
| Can you clarify what is meant by tools? |
| Examples may include but not be limited to effective PDSAs, dashboards, clinical que-cards, effective tools from the 8th SOW etc… |
| 85 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #10: (Distribute) |
| What is the deliverable associated with this activity? |
| Please see the revised Deliverable schedule (Section F). |
| 86 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #10: (Distribute) |
| What are the evaluation criteria associated with this activity? |
| Please see the revised Deliverable schedule (Section F). |
| 87 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities |
activity (page 38), #10: (Distribute)
| Can you clarify what is meant by implementation tools? |
| Please see revised contract language and Section F (Deliverable Schedule) |
| 88 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #10: (Distribute) |
| Can you clarify to whom the implementation tools are to be distributed? |
| Minimally, providers with which the QIO chooses to work. |
| 89 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #11: (Identify improvements…) |
| What is the deliverable associated with this activity? |
| Please see the revised Deliverable Schedule (Section F) and the revised contract language. |
| 90 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38) #11: (Identify improvements …) |
| What are the evaluation criteria associated with this activity? |
| CMS is requesting quarterly reports. Please see the revised Deliverable Schedule and contract language. |
| 91 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38, #11: (Identify improvements …) |
| Can you clarify what is meant by improvements? |
| Improving the measures. Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 92 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #12: (Instruct provider staff…) |
| What is the deliverable associated with this activity? |
| Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 93 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #12: (Instruct provider staff …) |
| What are the evaluation criteria associated with this activity? |
| Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 94 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #13: (Review improvement…) |
| What is the deliverable associated with this activity? |
| Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 95 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #13: (Review improvement …) |
| What are the evaluation criteria associated with this activity? |
| Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 96 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #13: (Review improvement …) |
| Can you clarify what is meant by improvement cycle data? |
| This language was removed from the contract. Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 97 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #14: (Review individual…) |
| What is the deliverable associated with this activity? |
| Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 98 |
| Section C.6.2. Patient Safety, paragraph Theme Description/Required Activities activity (page 38), #14: (Review individual…) |
| What are the evaluation criteria associated with this activity? |
| Please see the revised Deliverable schedule (Section F) and the revised contract language. |
| 99 |
| General |
| Is it possible for a QIO to partner with a specific hardware/software company on a patient activation/education product to help providers improve on several quality improvement measures? |
If the nature of this question concerns utilization of a commercial product that will be modified to be used by the QIO in performance of the 9th SOW, then the QIO is cautioned that they must meet the requirements of FAR 52.227-17 Rights in Data Special Works. Additionally, QIOs must follow the ERB process when seeking to purchase any hardware/software products.
QIOs must also follow their consent to subcontract agreements as a part of that submission to their Contracting Officer, they must identify any hardware and software they wish to purchase so CMS can properly review and approve.
| 100 |
| General |
| Can a QIO help pay for a specific hardware/software product for provider use in improving the quality of services provided related to quality improvement measures in the 9th SOW? |
| No. |
| 101 |
| General |
| If a QIO is permitted to partner with a specific hardware/software company on a patient activation/education product to help providers improve on several quality improvement measures, what process must the QIO undertake? |
| If the nature of this question concerns utilization of a commercial product that will be modified to be used by the QIO in performance of the 9th SOW, then the QIO is cautioned that they must meet the requirements of FAR 52.227-17 Rights in Data Special Works. Additionally, QIOs must follow the ERB process when seeking to purchase any hardware/software products. |
QIOs must also follow their consent to subcontract agreements as a part of that submission to their Contracting Officer, they must identify any hardware and software they wish to purchase so CMS can properly review and approve.
| 102 |
| Theme C.6.3, (page 58) |
| “The baseline period for the cancer screening and immunization measures for the population cared for by physicians with EHR capabilities will be in the reporting quarter of April – June 2008.” Is the ‘reporting’ strictly based on claims data or PQRI reporting? (The baseline measurement is from a time period before the contract begins) |
| Baseline will be based on claims and EHR data, the most current data available prior to contract start date. |
| 103 |
| Theme C.6.3 Note for Definition of a PP, (page 55) |
| Which Interoperability Standards recognized by HITSP will be required of the PP’s EHR; i.e., transport standards, messaging standards, terminology standards (which ones), decision support standards, the lab reporting standard, data content management standards, etc? |
| EHR must be CCHIT certified. |
| 104 |
| Theme C.6.3 Note for Definition of a PP, (page 55) |
| Which version of CCHIT will the PP be held to, the 2006 criteria – or the 2007 Interoperability criteria, which is dramatically different than the 2006 criteria for Quality improvement reporting? |
(Quality improvement reporting for ’06 marked the roadmap for May of ’07 using the DOQ-IT Implementation Guide, but the ’07 criteria says that it is new for ’07 and that standards and implementation guides are not yet available It is expected that the HER is CCHIT certified by October 31, 2008.
| 105 |
| Theme C.6.3 Note for Definition of a PP, (page 55) |
| Are there specifications for a QIO data repository? If so, is the QIO expected to translate the data to the DOQ-IT HL7 specifications and transmit to the DOQ-IT Clinical Warehouse? |
| Refer to instructions in RFP Task 5. |
| 106 |
| Theme C.6.3 Note for Definition of a PP, (page 55) |
| Will the PPs be required to have a bi-directional lab interface installed and working in their EHR, per the HITSP Lab Results Reporting Interoperability Specification (and which version)? |
No.
| 107 |
| Theme C.6.3 Note for Definition of a PP, (page 55) |
| Are there any specific versions of the HITSP Interoperability Specifications the CCHIT vendors will be held to? If so, what version for which topics? |
| No. |
| 108 |
| Theme C.6.3 Prevention, (pages 55 and 56) of RFP |
| How can the final list of PPs and NPs be given to the QIO at the end of month one of the contract (page 56 of RFP), if ‘the QIO shall successfully recruit at least 80% of the target by the end of Quarter 2’ (page 55 of RFP)? |
Needs to be corrected to remove “at the end of month one of the contract”.
| 109 |
| Theme C.6.3 Prevention, Task 3, (page 56) |
| Do the NPs have to sign a consent form like the PPs, or are their clinical measures from claims just compared to the PPs claims? |
| Yes. |
| 110 |
| Theme C.6.3 Prevention, |
(page 56)
Task 3 Outside of the materials available in DOQ-IT University, will QIOs be responsible for developing EHR vendor specific materials in order to educate clinics on how to improve rates of breast cancer and CRC screening and immunizations, and to generate the necessary reporting?
The QIO will provide technical assistance to PPs on interventions.
| 111 |
| Theme C.6.3 Prevention, |
(pages 58–62) Evaluation
| What recourse do QIOs and PPs have if the PP has a CCHIT system that cannot generate the exact data needed to produce the baseline, interim, and follow-up measures without further hardware or software investment? |
| That is a QIO decision and a practice business decision. |
| 112 |
| Theme C.6.3 Prevention, |
(page 57)
Task 6
| How will statewide (rates) data to support the QIO monitoring and analyses for the specified “report on disparities” be structured? |
| The QIO shall provide an analysis of findings and recommendations for interventions. |
| 113 |
| Theme C.6.3 Prevention, |
(pages 56, 57 and 59), Task 5
| It appears from page 59 that the PP either submits data to the QIO, to CMS directly, OR to a support contractor on a quarterly basis. If the PP is able to submit directly to the CMS clinical data warehouse, how are they supposed to get their rates to the QIO every two weeks? |
| If the PP submits directly to the CMS Management Information System, no further reporting is required. |
| 114 |
| C.7.3, Evaluation, Task 1.A and 1.B, pages 113 to 114 |
| Are the performance targets for CKD Task 1a (timely testing of measures) and Task 1b (slowing the progress of CKD) based on absolute or relative improvement over baseline? |
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