DRAFT PWS Clinical competence assessment.pdf

B.2 PERFOMANCE WORK STATEMENT

Part 1. Scope of Work

1.1 Description of Services/Introduction:

The Department of Veterans Affairs has a national need for services of an external agency to assist in assessing clinical competence of privileged providers who have triggered a concern related to their ability to provide safe patient care.

External assessment may be requested to include, but not be limited to, providers who have not actively practiced clinical care during a period of investigation by VHA or who have had clinical care reviews with findings that raising concern of the provider’s clinical competence. The review and conclusions from the assessment center will be utilized by the requesting VHA facility to support privileging decisions including granting of privileges, denial, or revocation of privileges, or need for unique and specific clinical performance monitoring. The external assessment agency must be nationally recognized, including endorsement and use by multiple state licensing boards, for provision of objective and comprehensive assessments for reviews from peers of the same specialty and occupation.

1.2 Background:

VHA privileges over 60,000 providers throughout the agency. Privileged providers are clinically monitored on an ongoing basis. If a clinical performance issue is identified, an in-depth objective assessment may be necessary to determine whether a provider is clinically competent to continue providing one or more aspects of clinical care within the agency. Often clinical assessments cannot be performed through retrospective file reviews and must be completed through direct observation, clinical competency/knowledge interviews, and technical simulations. Assessments must be performed by objective peers of the same specialty and occupation who are trained to perform specialty evaluations to identify clinical performance deficiencies.

1.3 Objectives:

The objective of this requirement is to:

• Establish a national contracting tool which may be utilized by individual VHA facilities when a privileged provider* has been identified as potentially having clinical performance issues which cannot be safely and thoroughly evaluated through retrospective file reviews. (Note: this contract may also be utilized to assess clinical competence of Physician Assistants who are not privileged within VHA but who are credentialed through the medical staff process).

• Provide a comprehensive and objective assessment of clinical practice of privileged providers for purposes of privileging decisions including reinstatement, renewal, revocation, or reduction.

• Provide objective assessments from peers in the same training, specialty, and scope of practice. Assessment center must be able to provide assessments from Physicians, Physician Assistants, and Advance Practice Nurses.

• Assessment Center must be able to provide specialty assessments for peers in specialties including, but not limited to, general surgery, urology, pain management, anesthesia, neurosurgery, cardio-thoracic surgery, general cardiology, interventional cardiology, gastroenterology, emergency medicine, primary care, psychiatry, neurology, and internal medicine.

• Provide comprehensive analysis including neuro-cognitive testing, structured clinical interviews, simulated patient encounters, and simulations on machines to assess technical skills such as laparoscopy, endoscopy, anesthesia, open surgery, general surgery, and emergency medicine.

• Provide assessments based upon tools for physicians will be based upon examinations put together by the National Board of Medical Examiners or the National Board of Osteopathic Examiners.

1.4 Scope:

Providers within occupations that are licensed to practice independently may be privileged at VHA facilities. The VHA facility where the provider is privileged is responsible for ongoing monitoring of all providers who are privileged and providing patient care to ensure safe patient care. If a provider triggers a concern related to the safety of their clinical practice, the respective VHA medical facility must complete a review of the provider’s clinical ability and use findings from the review to determine what action needs to be taken to ensure patient safety. Actions may include privileging actions (i.e., reduction or revocation of privileges) or establishing focused monitoring in specific aspects of the provider’s practice based upon findings from the clinical review.

Often reviews are conducted through retrospective chart reviews and documentation. However, retrospective chart reviews may not be comprehensive enough to truly assess a provider’s clinical competence and a more in-depth assessment is needed to observe the provider performing a procedure(s), demonstrating knowledge of specialty specific techniques, and assessing clinical judgement in high acuity scenarios. These assessments must be performed in an environment which does not place patients in harm, such as performance of technical skills utilizing simulation.

VHA facilities will assess provider specific clinical concerns, available evidence, and information required to base privileging decisions after clinical competence concerns have been raised. If the facility requires an assessment of clinical competence beyond what can be objectively, efficiently, and safely reviewed internally within the agency, a request can be made for an external review through this contract. The decision to utilize this resource is a facility leadership decision.

The contractor will be expected to have ability to provide a wide range of occupation and specialty specific assessments including physician assessments in specialties including, but not limited to, primary care, surgical subspecialties, medical subspecialties, anesthesia, and emergency medicine. The contractor must also have assessment ability for, and not limited to, Podiatrists, Physician Assistants and Advance Practice Nurses.

The contractor will perform a complete assessment which will include, but not be limited to, structured clinical interviews, simulated patient encounters, procedure simulations, clinical knowledge assessment, and neuro-cognitive screening.

Upon completion of the assessment, the contractor will provide the facility with a comprehensive report which outlines findings from each component of the assessment and concluding statements.

1.5 Period of Performance:

The period of performance shall be for one, 12-month base period and four, 12-month option periods. Option periods are exercised as a required and are not guaranteed. The Period of Performance reads as follows:

Base Year March 15, 2023 – March 14, 2024 Option Year 1 March 15, 2024 – March 14, 2025 Option Year 2 March 15, 2025 – March 14, 2026 Option Year 3 March 15, 2026 – March 14, 2027 Option Year 4 March 15, 2027 – March 14, 2028

1.6 Recognized Holidays:

The contractor is not required to perform services on the following Federal holidays.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Independence Day Christmas Day

Juneteenth

1.7 Hours of Operation:

The contractor is responsible for conducting business, between the hours of 7:00AM and 5:00PM Monday thru Friday except federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. Some of the virtual trainings may occur on the weekends.

1.8 Place of Performance:

The contractor must be able to perform services both at the facility and virtually.

Providers may be assessed at the location of the assessment center if technical simulation is required, and virtual assessment is not possible. Determination of components of the assessment and location of assessment may vary depending upon the provider’s specialty, if technical simulation is required as part of the assessment, and where simulation equipment is located. If travel is required, Government will be responsible for funding of the provider’s travel and per diem.

1.9 Type of Contract:

The government will award a single vendor Firm Fixed Price (FFP) contract.

1.10 Security Requirements:

No specific security requirements are needed. The position sensitivity for this effort has been designated as LOW.

1.11 Physical Security:

The Contractor shall be responsible for safeguarding government information provided for contractor use. No Government furnished equipment is provided.

1.12 Kick-off Award Conference:

Within 10 business days of contract award or Notice to Proceed, the Contractor shall coordinate with the COR and the Contracting Officer (CO) to conduct a Project Initiation/Kickoff meeting with VA. The meeting shall initiate the communication process between VA and the Contractor and shall be held via conference call. The purpose of this meeting is to introduce the key contractor personnel performing work related to this requirement; provide an overview of requirement administration and reporting; Review contract, contractor and Government responsibilities and authority, and task order issuance, review significant dates; and complete any standard administrative issues.

1.13 Contracting Officer Representative (COR):

The COR will be identified by separate letter. The COR monitors technical aspects of the contract and assists in contract administration, per the contractor provided Performance / Quality Assurance Plan for quality monitoring.

A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially regarding changes in cost or price, or in estimates or changes in delivery dates.

The COR is not authorized to change the terms and conditions of the resulting order.

1.14 Contractor Travel:

Contractor will not be authorized travel expenses

Part 2. Government Furnished Items and Services

2.1 Government Provided Subject Matter Experts

n/a

Part 3. Specific Tasks

3.1 Assessment Requirements:

The Contractor Shall:

a. Conduct assessments at one of the Contractors established facilities when technical simulation is required. Assessments may be completed virtually for components of assessment which do not require specialized equipment for simulation purposes.

b. Provide capability to provide assessments from peers of the same occupation and specialty for physicians, physician assistants, and advance practice nurses.

Capability for specialty assessments must include, but not limited to, surgical subspecialties, medical subspecialties, anesthesia, primary care, and emergency medicine.

c. Provide an assessment process that includes a series of structured clinical interviews.

d. Offer an evaluation process that focuses on medical knowledge, clinical judgment reasoning, communication skills, and patient care documentation specific to the provider’s occupation and specialty.

e. Ensure the assessor has the same training, specialty, and scope of practice as the provider who is being assessed. The purpose is to provide accurate and specialized insight into the provider’s clinical knowledge, judgment, skills, and capabilities.

f. Provide on-site technical simulation to assess technical skills, when applicable. Technical simulation is required so that provider can demonstrate technical skills while not risking patient safety.

g. Include opportunity to interpret EKG tracings, fetal monitoring strips, or other measurements of clinical competence when applicable to the provider’s specialty and clinical duties.

h. Demonstrate endorsement and recognition of quality of assessments from multiple state medical licensing boards.

i. Ensure the agency COR is aware of all pertinent issues or concerns as they arise

j. Provide a comprehensive report which includes assessment(s) performed, findings, and conclusions within twenty business days.

Reports:

In accordance with FAR 37.114(c) all documents or reports produced by the Contractor shall be suitably marked to clearly show they are Contractor products, or that the Contractor participated in creating the document or report. The Contractor shall:

a. Provide a copy of the final report to the requesting official from the respective VHA facility

3.2 Kickoff Meeting

The contractor shall participate and have all critical positions required to meet the PWS requirements present at the meeting. The time and place shall be designated by the CO. No performance shall begin on the contract until after the Kickoff Meeting and a Notice to Proceed is provided by the CO.

The objective of this task is to provide a post award orientation to aid both Government and contractor personnel to achieve a clear and mutual understanding of all contract requirements and identify and resolve potential problems. The desired outcome is the clear understanding of the requirements by both parties and the Notice to Proceed is issued.

3.3 Reporting (Feedback and Monthly):

Contractor will provide a report which includes, but is not limited to, requesting facility, date assessment was requested, date assessment was completed, and date final report was submitted to the requesting facility.

Facilities will be asked to complete a satisfaction survey and return to the COR of this contract upon completion of each assessment.

Part 4. Deliverables:

4.1 Deliverables/Reporting Requirements:

The Contractor shall provide a final report consisting of a clinical competence assessment, an evaluation/analysis of the participant, and a detailed report of summarizing all evaluation findings.

4.2 Method and Distribution of Deliverables:

Unless specified or otherwise mutually agreed to, all information, data, and reports used or produced for this contract shall be in an electronic format fully compatible with Microsoft Office software.

Part 5. Performance Metrics:

5.1 Performance Requirements Summary (PRS)

The contractor shall perform to the requirements in the PRS. The Government shall utilize the performance metrics in relation to the final approved contractor QAP and the PRS to ensure performance to the requirements of the PWS.

5.2 Acceptable Quality Level (AQL):

The ratings shall be used as a guide when conducting quality assurance throughout the life of the contract. This is to ensure the Contractor is performing the services required by this PWS in an acceptable manner as indicated in the Acceptable Quality Level (AQL).

TASKS

ITEM

DESCRIPTION

QUANTITY DELIVERY DATE

3.1 clinical competence assessment anticipated minimum of 3 per year

Final report will be provided within 20 business days after completion of assessment.

3.2 Kickoff Meeting

One per contract. Within 10 business days of contract award.

3.3 Assessment

Report

After each consultation

20 business days after each consultation.

TASKS /

DESCRIPTION

PERFORMANCE

STANDARD

ACCEPTABLE

QUALITY

LEVEL (AQL)

SURVEILLANCE

METHOD /

MEASURE

REMEDY

3.1 clinical competence assessment

Appropriate expertise and staffing level to successfully complete assigned tasks within required deadlines

90% access to appropriate expertise and staffing level to successfully meet suspense/estab lished dates

Periodic review by VA COR

Task re-performance;

CAR;

Termination;

CPARS

3.2 Kickoff Meeting

Attendance by Contractor and Key Contractor Personnel;

Cooperative;

prepared; ready to perform

100%

Attendance taken and recorded;

any deliverables required presented IAW

PWS.

No Notice to Proceed or Stop Work;

CAR;

Termination;

CPARS

3.31 Feedback Report

Submits reports as described in the PWS, and

PRS

90% as defined in PWS and PRS for timeliness quality of the product

Periodic review by VA COR

Task re-performance;

CAR;

Termination;

CPARS

3.31 Cumulative Quarterly Report

Submits reports as described in the PWS, and

PRS.

90% as defined in PWS and PRS for timeliness of the product

Periodic review by VA COR

Task re-performance;

CAR;

Termination;

CPARS

5.3 Performance Ratings:

The following ratings shall be used to determine the level of performance achieved by the contractor in accordance with the PWS, in relation to the AQLs, along with the PRS as a guide when conducting quality assurance throughout the life of the contract. Performance above or below the standard, for above factors, will be documented in the Contractor’s Performance Assessment Reporting System (CPARS) for the reporting period.

EXCEPTIONAL Performance significantly exceeds contract requirements as related to the PWS, PRS, and AQLs.

SATISFACTORY Performance meets contractual requirements as related to the

PWS, PRS, and AQLs.

UNSATISFACTORY Performance does not meet contractual requirements as related to the PWS, PRS, and AQLs.

B.2 PERFOMANCE WORK STATEMENT