JA HICBA VIRR for Posting.pdf

VA-23-00001429

JUSTIFICATION FOR OTHER THAN FULL AND OPEN COMPETITION

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 contract for renewal of software licensing and maintenance and technical support for a Veterans Health Information Systems and Technology Architecture (VistA) Integration, Revenue and Reporting (VIRR) software solution. The proposed effort will be awarded under a standalone contract to Document Storage Systems, Incorporated (DSS), 12575 US Highway One Suite 200, Juno Beach, Florida 33408.

3. Description of the Supplies or Services: The Contractor shall provide the Office of Information and Technology (OIT) with a Health Information Coding, Billing and Auditing (HICBA) VIRR software solution with maintenance and technical support services, which provides functionality for coding, revenue workflows and reporting. HICBA business management falls within OIT’s Health Informatics Product line, Health Information Governance sub-product line. HICBA software solutions provide OIT with enterprise capabilities for health record coding and revenue cycle operations such as accounts receivable and billing. HICBA also provides for the management of health information and Revenue Operations business workflows and reporting from various management perspectives and Revenue Operations. HICBA is comprised of two (2) components: an Encoder software solution and the VIRR software solution. This procurement is for the VIRR software solution which provides VistA integration for the Encoder, workflow management for coding and revenue operations, and reporting functionality for these operations. HICBA VIRR requirements are stratified across the functional areas of billing software requirements, compliance requirements, Encoder integration and claims review (scrubbing) requirements, technical and on-call support requirements, training requirements and reporting capabilities. Facilities, Veterans Integrated Service Networks (VISNs) and the Enterprise require reporting for coding and revenue and integration with VistA and VA’s HICBA Encoder software solution to enable these functionalities. HICBA VIRR is a commercial bill scrubbing software solution which includes enterprise level software access.

The national HICBA VIRR software solution applications (and the national HICBA Encoder solution that the VIRR applications enable) are the standard applications mandated for use throughout OIT by OIT’s Office of the Assistant Deputy Under Secretary for Health Informatics/10A7 and OIT’s Office of the Assistant Under Secretary for Health Operations (AUSHO)/10N. Handbook 1901.07: Health Information Management (HIM) and Health Records (March 2015) and the OIT Health Information Management Clinical Program Guide V1.7 (December 2019) require use of the national VIRR applications to appropriately manage HIM coding and revenue cycle operations.

Veterans Health Information Systems and Technology Architecture (VistA) Integration, Revenue and Reporting (VIRR) software solution

This is in support of meeting the mandates of the of AUSHO/10N memorandums to VISN and VA Medical Center (VAMC) Directors in response to Government Accountability Office and the Office of Management and Budget findings and recommendations: “Coding Backlog Reduction and Monitoring (VAIQ #7843437)” (November 2017) and “Monitoring Accuracy of Provider Coding and Clinical Coding and Productivity (VAIQ #7688833)” (May 2016). The VIRR software solution applications also include billing tools currently used by all Consolidated Patient Account Centers (CPAC) billing and accounts receivable staff and management personnel.

The Contractor provides the HICBA VIRR software solution to include configuration, working modules and setup to interface the VIRR suite with VistA and with the HICBA Encoder solution, updates to the applications, compliance with International Classification of Diseases (ICD) translations, provision of a centralized reporting module for monitoring productivity, technical support and training. This effort will also include one (1) optional task for Transition Out Support with a period of performance of 120 days. The period of performance is for 12 months, plus two (2), 12-month option periods and one (1) optional task.

4. Statutory Authority: The statutory authority permitting other than full and open competition is 41 U.S.C. 3304(a)(1) as implemented by the Federal Acquisition Regulation (FAR) Subpart 6.302-1 entitled, “Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements.”

5. Rationale Supporting Use of Authority Cited Above: The proposed source for this action is DSS, 12575 US Highway One Suite 200, Juno Beach, Florida 33408. Based on extensive market research as described in Section 8 of this document, it was determined that there is no competition among resellers. DSS is the sole Government provider of the required VIRR software solution. Although DSS currently offers its VIRR software solution via National Aeronautics and Space Administration’s (NASA) Solutions for Enterprise-Wide Procurements (SEWP) V Governmentwide Acquisition Contract (GWAC), the associated services required as part of this effort would make the order out of scope of the NASA SEWP V GWAC.

DSS is the only vendor that currently provides a suite of applications (Veterans In- Patient (VIP) Workplace, VIP Director, Compliant Coding Module (CCM), Audit Compliance Module (ACM)) that make up a VistA-integrated VIRR framework. While this VIRR solution is tightly coupled with VistA on the one end, it includes multiple integration entry and exit points, and standardized application programming interfaces on the other end to allow it to be easily integrated with various commercial Encoder solutions. Over the last 10 years, DSS has customized its commercial software solution to integrate with VistA and be fully compliant with all of VA’s requirements. This VIRR solution is currently in use at 141 VAMCs and seven (7) CPACs. This customization has been performed under VA’s current and preceding contracts, giving the Government intellectual property rights. However, the customization which was done to integrate the DSS VIRR solution with VA’s current

Encoder solution and VistA, for which the Government has intellectual property rights, are specific to the DSS software applications, their specific data types, data fields and communication types, some of which are proprietary, and would not be reusable for any other solution. The underlying DSS software framework the Government licenses was developed at DSS’s private expense, is proprietary and the Government does not own intellectual property rights to that commercial product.

Based upon market research, further detailed in Section 8, no other software solution provider offers a suite of software applications and underlying framework that provides the needed functionality. The one (1) response received from the Government’s Request for Information (RFI), other than DSS, did not provide sufficient information to determine that the vendor could meet VA’s VIRR needs. As no other commercial software solution has been identified, any potential software solution would have to be custom developed. Any vendor, other than DSS, would require an elongated development, testing, integration and transition period, estimated at four (4) to six (6) years and duplicated costs of at least $100M. These estimates of duplicative cost and time are based on historical experience with this requirement, and which would be required to duplicate work already performed by DSS before reaching full-service delivery capability. For example, any other source would need to develop a suite of applications to meet VA’s billing review, claims scrubbing, compliance and reporting requirements, in addition to developing the bi-directional integration with VistA and the VistA Gateway for integration with VA’s HICBA Encoder. This would result in extensive delivery delays and duplicated costs that would not be recovered through competition.

The applications have real-time integration with the VistA packages identified in Section

8. Therefore, DSS is the only vendor currently capable of providing VA with the VIRR software solution at the 141 VAMCs and seven (7) CPACs using VistA.

Without the HICBA VIRR software applications, there will be agency delinquencies and inaccuracies in entering crucial clinical and administrative data into the above-mentioned VistA packages (which in turn feed the VA Equitable Resource Allocation algorithms which are used to distribute Congress’s funding allocations for VAMCs as well as third-party insurance claims). Also, without the VIRR software, no national Encoder solution would be available for use since VIRR provides the VistA integration required to enable the Encoder functionality. Without this automated encoding capability, HIM coding, management and revenue operations staff will require remedial training on how to manually enter these codes into VistA and will also have to research using outdated methods that are currently not accepted by standard industry practice, such as paper coding books, and costly online resources.

Without the VIRR capability, billers will be forced to manually research every claim for any business rules that apply in order to ensure all entries are accurate, complete and no errors exist on the bill prior to submission to the third-party payer. The loss of this VIRR software solution will require all coding and billing to be completed manually, using a paper process; thus delaying these important processes and having a direct, negative impact on third party revenue generation. Without the VIRR applications, medical providers could end up not providing medical treatment to

Veterans in need due to lack of payment and billing information. Veteran patients’ safety will be risked if Veterans are denied treatment.

Additionally, every inpatient discharge and billable encounter would have to be manually evaluated to ensure all current business rules are applied. Many facilities no longer have code books, so patient workload capture for providers would be halted until the paper books are purchased and obtained. Acquiring paper code books and other required references and business workflow tools to accomplish these operations by the more than 3,000 daily users of these applications would significantly impede critical VA operations in support of clinical care and administrative functions. Purchasing timeframes would present weeks to months of delays and implementing antiquated paper and manual processes for completing these functions would add additional weeks to months. Additionally, exponentially more full-time employees would be required to perform these manual processes, with hiring timeframes in the weeks to months. Funding these changes at the local levels would also require significant shifts in medical center spending, taking resources away from provision of care for Veterans. Veterans would face extreme delays and unacceptable difficulties obtaining any required pre-authorization for care from third-party insurance due to new manual procedures that are not accepted by the industry.

In addition to delinquent timelines, VA would also experience unacceptable risks of inaccurate data capture in HIM coding and inaccurate billing in revenue operations due to the potential for errors inherent in manual data entry and review. The VIRR software enables automated mechanisms that are industry standard to perform “edit checks” in HIM coding and “claim scrubbing” in accounts receivable and billing to prevent erroneous coding of clinical information and billing inaccurate claims to third-party insurance. Failing to provide these industry-standard safeguards would be regarded as waste, fraud and/or abuse in consideration of Government ethics, compliance and business integrity. Coding and billing errors that are not caught by time-consuming and resource-intensive manual procedures would result in VA depending on erroneous clinical data for provision of care to Veterans, erroneous documentation of physician workload, inaccurate reporting of quality measures and inaccurate reporting to Congress for allocation of VA’s funding to medical centers.

In addition, Revenue Operations has projected over $4 billion for FY23 in revenue from third-party claims. Revenue for FY23 would be severely compromised if HICBA solutions do not remain continuously functional at their current capacity. VAMC Directors depend on this funding for an estimated 10-20% of their annual operating and capital improvement budgets.

It is critical that HIM coding and revenue operations personnel have the tools necessary to continue OIT business and keep revenue flowing to OIT. A disruption in continuity of health care services caused by administrative failures, such as a failure to support industry revenue cycles, could compromise or delay Veterans’ access to care. Access to the VIRR applications is necessary for OIT employees to carry out their duties in support of OIT’s mission.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in the market research section of this document. This effort did not yield any additional sources that could meet the Government’s requirements. Additionally, the proposed action will be synopsized on the Contract Opportunities Page in accordance with FAR 5.201. Any proposals that are received shall be evaluated.

7. Actions to Increase Competition: The Government will continue to conduct market research to ascertain if there are changes in the market place that would enable future actions to be competed.

8. Market Research: VA’s technical experts conducted market research in July and August 2022 to ascertain the ability of any other products, other than the DSS VIRR solution, to meet the Government’s requirements. VA technical experts conducted web-based market research and review of industry trade publications to research other similar software and services from alternative vendors including those from AthenaHealth and Nextgen Healthcare. After an extensive review by VA’s technical experts, it was determined that these alternative products and services were unable to meet VA’s functional requirements for an existing commercial-off-the shelf VIRR solution without the extensive development effort and time as detailed in Section 5 of this justification.

In addition, VA issued a Request for Information (RFI) on July 18, 2022, via the Contract Opportunities website. The RFI included the draft HICBA VIRR performance work statement and a list of technical requirements. The RFI was posted as part of the Government’s market research to ascertain if there were any other sources that could meet the Government’s requirements. The RFI closed on August 1, 2022, and responses were received from two (2) sources: DSS and Eclipse Technical Systems (ETEK). The response received from ETEK was deemed not capable of meeting VA’s VIRR requirements. ETEK only provided a generic one-page data sheet as its response to the RFI. Based on the response submitted, it was unknown whether it would have the required capabilities and functionality to meet the Government’s needs. ETEK’s response did not indicate that it has an existing commercially available off-the-shelf (COTS) VIRR solution. The Government’s RFI included specific questions related to a vendor’s ability to meet VIRR requirements. Rather than directly answering the specific questions to demonstrate an ability, ETEK merely sent a generic one-page data sheet that was not responsive to its ability to perform the current VIRR requirements. On December 7, 2022, the Contract Specialist responded directly to ETEK informing them of the Government’s assessment. Additionally on December 9, 2022, the intended acquisition strategy was also posted on SAM.gov. To date, no additional responses have been received. As the incumbent HICBA VIRR solution vendor, providing the current VIRR software solution application suite (VIP Workplace, VIP Director, CCM, ACM) used in VA for connectivity to VA’s legacy VistA system, DSS is currently the only vendor capable of meeting VA’s VIRR requirements. Detailed responses by DSS to each RFI question indicated a strong understanding of the requirements based on its extensive experience providing VA with these solutions today. Each requirement is currently being met with the VIRR solution DSS currently provides. DSS meets the HICBA VIRR billing software requirements, compliance requirements, Encoder integration and claims review (scrubbing) requirements, training requirements and reporting capabilities with its application suite which includes VIP Workplace, VIP Director, CCM and ACM. In addition to these VistA-integrated applications, DSS also provides a VistA Gateway to enable the HICBA Encoder functionality. These VIRR applications and HICBA software architecture components are the configuration, working modules and VistA integration required for providing the HICBA solution. DSS provides the necessary configuration services for enabling these applications to work with VistA, coordinating with the OIT, COTS Division as required for making software updates. Each application is a separate module providing functionality for inpatient coding, outpatient coding, compliance and reporting and interfacing with VistA packages including: Global Coding, Lexicon Utility, Text-integrated Utility, Patient Care Encounter, Patient Treatment File, Diagnosis-Related Group, Computerized Patient Record System, Admissions, Discharges and Transfers, Absent Sick In Hospital, Scheduling, Surgery, Event Capture, Accounts Receivable, Integrated Billing, Claims Tracking and Fee Basis. The currently supported ICD and Current Procedural Terminology code sets are following Accredited Standards Committee X12 5010 transaction standards and are managed by the DSS VIRR solution to support the timely maintenance of updates.

Based on all of these market research efforts, the Government’s technical experts have determined that only DSS’s currently fielded software solution can meet VA’s needs.

DSS confirmed that the HICBA VIRR solution can only be purchased directly from DSS and there are no resellers and therefore DSS is currently the only source for this software solution.

9. Other Facts: N/A