JA CDI Pro_Redacted.pdf

Control Number: VA 23-00001174

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

1. Contracting Activity: Department of Veterans Affairs (VA) Office of Procurement, Acquisition and Logistics

Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724

2. Description of Action: The proposed action is for a firm-fixed-price delivery order under the National Aeronautics and Space Administration (NASA) Solutions for Enterprise-Wide Procurement (SEWP) V Government Wide Acquisition Contract (GWAC) brand name Nuance Clintegrity 360 VA Clinical Documentation Improvement (CDI Pro) software, training, and support.

3. Description of the Supplies or Services: The Department of Veterans Affairs, VA Sunshine Healthcare Network, Veterans Integrated Services Networks (VISN) 8, Business Development Office, has a requirement for a CDI product that interfaces with the medical record (CPRS) and Veterans Health Information Systems and Technology Architecture (VistA). This product is currently used by VISN 8 Business Development Program to effectively support and enhance effective and efficient CDI programs throughout VISN 8. Clinical Documentation Improvement is a process where the health record is manually reviewed either concurrently or retrospectively for ambiguous, conflicting, incomplete, or nonspecific provider documentation.

The proposed Clintegrity 360, specifically the CDI Pro software module of the Clintegrity platform is required for all seven VA sites in VISN 8 which require CDI Pro software licenses required to support mandatory auditing of clinical documentation. CDI Pro is an additional function of the current coding software not procured under national contract.

Existing VISN 8 CDI programs will benefit from this software purchase because it will give VA’ users the ability to enhance documentation reviews and analysis.

The proposed software renewal with added functionality will provide VISN 8 with continued use of its existing CDI Pro software licenses and support and will provide an end-to-end clinical documentation improvement program which is an addition to VA’s current suite. CDI programs are highly specialized software applications used by VISN 8 Health Informatics staff to provide a Compliant Documentation Management Program (CDMP) for hospitals and their physicians and providers with the purpose of comprehensively improving clinical documentation for inpatient care at acute care facilities. Additionally, the VA requires consistent training, and CDI Pro license updates to meet the requirements for changing clinical documents and document standards. The renewal of this service will also provide all maintenance and support for the software to include bug fixes and software updates including updates to the software to support updates in International Classification of Diseases, 10th Revision (ICD-10) and Current Procedural Terminology (CPT) coding changes, edits and rules, CDMP and other

CDI Pro Control Number: VA 23-00001174 references content and other regulatory changes that affect CDI. Nuance Clintegrity with the new software version, will provide for a comprehensive CDI tracking and reporting solution to provide VA Medical Center (VAMC) and VISN monthly metrics and detailed feedback for provider education, with a CDI reference library with more than 10 standard references and Nuance industry leading CDMP Guide to support an end-to-end clinical documentation improvement program. The solution tracks Case Mix Index (CMI impact), VERA (Veterans Equitable Resource Allocation) funding impact and Patient Safety Indicators (PSI) (quality).

The software shall provide for concurrent clinical documentation reviews with education, strategies, and tools that allow real time feedback by clinical case from the moment the patient enters the facility. The Vendor shall provide continued annual licenses (31 concurrent licenses) for each of the seven VISN 8 facilities and ongoing support package including monthly support for metrics, web learning, quarterly auditing, and continuing education services. New outpatient CDI module shall include annual licenses and an implementation package that includes OP CDI principles training, OP CDI Workflow Optimization, installation/configuration training and implementation project management. The vendor will customize training and implementation for each facility.

Additional physician peer to peer inpatient and outpatient CDI education and focus clinical service revenue cycle workflow analysis (4 services per VAMC) shall also be delivered to support the CDI program at each VAMC.

VISN 8 currently has a facility license for each of the 7 VAMCs which vary in size based on their number of admissions per year. The VISN licenses for 31 total concurrent user licenses.

Nuance's Clintegrity VA CDI Pro solution provides resources to help the CDI team focus on clinically based queries so that VA physicians could:

• Fully document the Veteran care delivered

• Utilize terminology that is able to be coded into ICD-10 codes

• Capture all significant secondary diagnoses (comorbidities)

• Establish accurate severity of illness (SOI) and complexity of care

• Demonstrate medical necessity for ordered tests and procedures

• Document all Health Status Issues

The period of performance for this proposed contract action will consist of a one 12-month base period with one 12-month option period. The total estimated price of the proposed action inclusive of all option periods is .

4. Statutory Authority: Pursuant to Federal Acquisition Regulation (FAR) 16.505(a)(4), the following brand name requirement is being justified and approved as an exception to fair opportunity under the statutory authority of Section 41 U.S.C. 4106(c)(2) as implemented by FAR 16.505(b)(2)(i)(B), entitled “Only one awardee is capable of providing the supplies or services required at the level of quality required because the supplies or services ordered are unique or highly specialized.”

5. Rationale Supporting Use of Authority Cited Above: Based upon continued market research, as described in section 8 below, it is determined that limited competition is available among authorized resellers of CDI Pro software license, training and support renewals. CDI Pro software has been used within VISN 8 since 2017. The CDI Pro software are the only software applications that meets all of VA’s interoperability and compatibility requirements. CDI Pro is custom software that is proprietary to Nuance Technologies and no other software or provider can provide the CDI Pro software features, nor could they maintain or reuse Nuance proprietary software. Further, no other provider other than Nuance or an authorized reseller can provide professional services to audit or enhance the CDI software.

VA has invested for over 10 years in the customization of the CDI Pro software licenses to meet the current and ongoing architecture needs of the VA. Even though CDI Pro is a proprietary software, VA has had to spend significant resources to interface the software with VistA and CPRS as well as configure the software to VA documents and processes. To work with another manufacturer’s product to achieve the current level of functionality of this software would require extensive rework and high-level programing along with system redesign to customize and retrofit another software product to meet VA’s needs. VA has not identified any other vendors who have the required integrations for their software with the active VA systems to include VistA and CPRS. Nuance has integrated VA-specific Veterans Equitable Resource Allocation (VERA) content, VA standard metrics within the reporting features and a robust import process to minimize data entry (significant time-savings) and assure data integrity between VistA and the CDI solution.

Clintegrity 360 VA CDI Pro is the only commercially available software and the only approved CDI software that can communicate with VistA and Computerized Patient Record System (CPRS). Only Clintegrity CDI Pro can access VA’s existing VistA data repository after patient encounters. Additionally, if another solution existed that could meet VA requirements, it would require a duplication cost of at least to replicate the configuration necessary to interoperate and connect to VistA and CPRS.

These estimates are based on historic costs for similar configurations. In addition, any other vendor would also require an estimated six to eight months of implementation time to complete the installation, configuration solution training, and go-live. Additionally, during this time an additional is anticipated to be required to run two CDI software suites concurrently as the current CDI software is replaced. This additional duplication of cost is based on previous acquisition history. These duplicative costs would not be recovered through competition.

It is imperative that VISN 8’s CDI programs have an automated solution to track and report on CDI issues and trends to provide clinically based, meaningful queries that ultimately impact the Veterans clinical documentation, continuity of care and patient safety. The solution provides monthly metrics to each medical center and the VISN to show the impact of CDI on the organization and also provides drill down data to the level of the patient encounter. This software ensures clinical documentation is complete and accurate which impacts patient safety and also impacts VA funding as proper documentation is crucial for proper reimbursement. This can impact VA’s allocation of resources as well as the funds allocated from private insurers.

Based on the above information, the Government's technical experts determined that only Nuance brand name products and services can meet all of VA's needs.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in the market research section of this justification. This effort did not yield any additional sources that can meet the Government’s requirements. In accordance with FAR 5.301 and 16.505(b)(2)(ii)(D), award of the resultant delivery order will be synopsized, and this justification will be made publicly available on the Federal Business Opportunities Page within 14 days of award. In accordance with FAR 16.505(a)(4)(iii)(A), the justification will be posted with the request for quote on the NASA SEWP V GWAC website with the solicitation to notify all interested parties.

7. Actions to Increase Competition: In order to remove or overcome barriers to competition in future acquisitions for this requirement, the Government will continue to perform market research to determine if there are any new products or maintenance services available that will fulfill the Government’s need.

8. Market Research: The Government’s technical experts have conducted research using internet searches looking for alternative software products with compatible CDI review tracking and reporting features that could be readily integrated with VA systems including Iodine and 3M Health Information Systems. It was determined, as of March 2022, the products of CDI Pro are the only software products that can meet VA’s specified healthcare requirements that permit full and seamless integration with VA Health Informatics Directives without six-eight months of development, configuration and associated testing.

VA has many years invested in the customization of the CDI Pro software licenses to meet the current and ongoing architecture needs of VA. To work with another manufacturer’s product to achieve the current level of functionality of this software would require extensive rework and high-level programing along with system design expertise to customize and retrofit another software product to meet the needs currently met by the existing software products which have been used for many years. To date, VA has not identified any other vendors who can successfully integrate their software with the active VA systems including VistA and CPRS.

Additional market research was conducted via Requests for Information (RFI) issued by the Technology Acquisition Center (TAC) on July 1, 2022, on the National Aeronautics and Space Administration (NASA) Solutions for Enterprise-Wide Procurement (SEWP) V Governmentwide Acquisition Contract (GWAC) and SAM.GOV to determine whether there were additional Vendors able to meet the

Government’s requirement. The RFI published in NASA SEWP yielded two initial responses: one, from Diamond Solutions Professionals (Service-Disabled-Veteran- Owned Small Business), another, from Alvarez, LLC (Service-Disabled-Veteran- Owned Small Business. The response received from Diamond Solutions Professionals, was deemed as not capable of providing the services required by the Government as they did not address the requirement directly, nor did they provide any technical information to review. Alvarez LLC, an authorized reseller of Nuance Clintegrity 360 systems, stated in its response that they cannot conform to the VA Acquisition Regulation 852.219-74, Limitations on Subcontract. A subsequent response was received from Allyhealth Solutions which proposed use of the required Nuance Clintegrity 360 systems after the closing date of the RFI. Although Allyhealth asserted being capable to provide all Nuance items listed in the Product Description, this company does not have an active registration in SAM and further communication with Nuance Communications, Inc. listed below confirmed that Alvarez and Carahsoft Technology Corp. (Large Business) are the only two authorized resellers for the required software. Moreover, the RFI published in SAM.GOV yielded zero (0) responses.

The NASA SEWP V GWAC Provider Lookup Tool was also utilized in July 2022 to gather additional market research information. It revealed that there are eleven (11) authorized resellers for Nuance Communications, Inc. under groups B,C,D (NAICS Code 541519). Nonetheless, despite the number of matches, as stated above, only Alvarez and Carahsoft are authorized resellers for the Clintegrity 360 VA Clinical Documentation Improvement (CDI Pro) software.

Limited competition is expected for this acquisition. Market research indicates that only the Original Equipment Manufacturer (“OEM”), Nuance Communications, Inc (Large Business), and, Nuance Clintegrity 360 Systems’ authorized resellers including:

Alvarez (SDVOSB) and Carahsoft Technology (Large Business) can provide the required CDI Pro product and services. Accordingly, the proposed action will be issued for a firm-fixed-price delivery order issued to all contract holders in NASA SEWP V GWAC Groups B, C and D for Brand Name Nuance Clintegrity 360 VA Clinical Documentation Improvement (CDI Pro) software product that interfaces with the medical record (CPRS) and VistA. The Government will continue to conduct market research to ascertain if there are changes in the marketplace that would enable future actions to be competed. Any other vendors that provide a response will be considered.

9. Other Facts: None

10. Technical and Requirements Certification: I certify that the supporting data under my cognizance, which are included in this justification, are accurate and complete to the best of my knowledge and belief.

Date:

Contract Officer Representative Signature:

11. Fair and Reasonable Cost Determination: I hereby determine that the anticipated price to the Government for this contract action will be fair and reasonable based on anticipated limited competition. Additionally, NASA SEWP V has already determined the prices on contract to be fair and reasonable and more competitive pricing may result from competition. Finally, the successful quote will be compared with the Independent Government Cost Estimate.

Procuring Contracting Officer Signature:

12. Procuring Contracting Officer Certification: I certify that this justification is accurate and complete to the best of my knowledge and belief.

Procuring Contracting Officer Signature:

Approval

In my role as procuring activity Advocate for Competition, based on the foregoing justification, I hereby approve the acquisition of brand name Nuance Clintegrity 360 VA Clinical Documentation Improvement (CDI Pro) software, training, and support on an other than fair opportunity basis pursuant to the authority cited in Section 4 above, subject to availability of funds, and provided that the property and services herein described have otherwise been authorized for acquisition.

Date: ____________ Signature: _________________________________