PWS Teleradiology VHSO_4-30-26 Rev.docx

Performance Work Statement for Tele- Radiology Physician Services The contractor agrees to provide the Veterans Healthcare System of the Ozarks (VHSO), the services and prices specified in the Section entitled Schedule of Supplies/Services of this contract. The contractor will provide Radiology Clinical services in compliance with this document’s specifications.

GENERAL: The VHSO has the requirement to provide Veterans within the service area with Radiology Clinical Services. It is the intention of the Health Care System to supply these services with the most competitive vendor.

BACKGROUND: Physician personnel shortages in the Radiology Clinical Services of the VHSO have created a significant need to provide preliminary and final radiology interpretation for exams performed during both business hours (to cover leave and staff vacancies) and after hours/weekends/holidays. The use of Radiology Clinical Services outsourcing should provide a highly cost effective and expeditious alternative to meet an ongoing need within the VA.

WORK STATEMENT: Contractor shall provide professional Teleradiology Clinical services for radiology examinations performed throughout the VHSO. Radiology services are available at five VHSO sites (Fayetteville AR, Fort Smith AR, Harrison AR, Springfield MO, Branson MO and Joplin MO). Contract services will include off-campus image interpretation via network connection to the VA informatics system. Interpretation will include immediate communications of results both when an interpretation is requested stat or with a critical emergent test result. Contractor must be a U.S. based corporation capable of final interpretation and reporting services via the Contractor’s secure Teleradiology network. Interpretation services will be conducted by board certified or Board Eligible Radiologists. Contractor shall provide all professional personnel and technical support, medical and other equipment, telecommunication, supplies, and supervision necessary to perform, implement and administer these teleradiology clinical services to meet the specific medical needs of the VHSO. The Contractor is responsible for all Contractor personnel, subcontractors, agents, and anyone acting for or on behalf of the Contractor. Services provided under the contract are not to be performed outside of the United States.

All services SHALL be performed within the territorial borders of the United States.

1. GENERAL:

1.1. Services Provided: The Contractor shall provide Board Certified/Board Eligible TeleRadiology Clinical Physician Services in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Veterans Healthcare System of the Ozarks (VHSO). The VA Radiology Services follow the standards & guidelines set forth by American College of Radiology (ACR) https://www.acr.org/-/media/ACR/Files/Practice-Parameters/IRClin-Prac-Mgmt.pdf.pdf. A contractor providing tele-radiology services shall provide services consistent with TJC and that meet or exceed VA and the American College of Radiology Guidelines as defined in this document.

1.2. Place of Performance: Services shall be provided off-site at the Contractor’s location.

1.3. Authority: Title 38 USC 8153

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

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

1.4.2. VHA Directive 1003.04: VHA Patient Advocacy

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

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

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

1.4.6. VHA Directive 1100.20: Credentialing of Health Care Providers

1.4.7. VHA Directive 1100.21: Privileging

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

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

1.4.10. VHA Directive 1605.01: Privacy and Release of Information

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

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

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

1.4.14. 42 Code of Federal Regulations (CFR) Part 482 Conditions of Participation Hospitals:https://www.ecfr.gov/cgi-bin/text-idx?node=pt42.5.482&rgn=div5

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

1.5.1. ACGME: Accreditation Council for Graduate Medical Education

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. BLS: Basic Life Support

1.5.4. CDC: Centers for Disease Control and Prevention

1.5.5. CEU: Certified Education Unit

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

1.5.7. CME: Continuing Medical Education

1.5.8. CMS: Centers for Medicare and Medicaid Services

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

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

1.5.11. COS: Chief of Staff

1.5.12. CPARS: Contractor Performance Assessment Reporting System

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

1.5.14. DEA: Drug Enforcement Agency

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

1.5.16. FSMB: Federation of State Medical Boards

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

1.5.18. HHS: Department of Health and Human Services

1.5.19. HIPAA: Health Insurance Portability and Accountability Act

1.5.20. ISO: Information Security Officer

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

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

1.5.23. POP: Period of Performance

1.5.24. PPD: Purified Protein Derivative

1.5.25. PWS: Performance Work Statement

1.5.26. QA/QI: Quality Assurance/Quality Improvement

1.5.27. QASP: Quality Assurance Surveillance Plan

1.5.28. QM/PI: Quality Management/Performance Improvement

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

1.5.30. VHA: Veterans’ Health Administration

1.5.31. VISN: Veterans Integrated Services Network

1.5.32. VISTA: Veterans Information Systems Technology Architecture

2. QUALIFICATIONS:

2.1. Staff/Facility

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

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

2.1.3. Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Directive 1100.20 and VHA Directive 1100.21 referenced above. The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any contract physician(s) prior to obtaining approval by the Facility Medical Executive Board and Medical Center Director. Providers must be currently successful fulfilling the requirements of the American Board of Radiology Maintenance of Certification program.

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

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

2.1.3.3 Contract licensed independent practitioners must be credentialed and privileged through the VA facility’s Medical Staff Office in accordance Credentialing and Privileging Directives 1100.20 and 1100.21 and VHA Directive 1914

2.1.3.4 Separately delineated privileges for telemedicine services must be requested and assigned in this process.

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

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

2.1.3.7 It is the Contractor’s responsibility to contact the VHSO Radiology Department to request a package and instructions.

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

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

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

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

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

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

2.1.8. Conflict of Interest: The Contractor and all contract physician(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential 15 organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.9. Citizenship related Requirements:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2.7.4. Workers’ compensation

2.7.5. Professional liability insurance

2.7.6. Health examinations

2.7.7. Income tax withholding, and

2.7.8. Social security payments.

2.8. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract physician(s). When a Contractor or contract physician(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract physician(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier. Contractor must confirm that they are covered by professional liability insurance that would cover the health care services they provide to VA.

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

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

Provider Name: (available when contract is awarded) Title/Rank: (available when contract is award) Curriculum Vitae and qualification documents of each key personnel shall be submitted with the proposal.

2.10. Emergency Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within (15) calendar day (s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least (15) calendar days prior to making any permanent substitutions.

2.10.4. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within (15) calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

3. VA HOURS OF OPERATION/SCHEDULING

3.1. Business Hours: The normal business hours for the VHSO are 8:00 AM to 4:30 PM, CST, Monday through Friday excluding federal holidays.

3.2. Work Schedule:

Normal Business Hours (8:00 AM to 4:30 PM, CST, Mon-Fri): The Contractor shall provide teleradiology services on an as-needed basis to interpret imaging studies that exceed the capacity of VA in-house radiologists during these hours. This may include STAT exams as well as routine overflow work that cannot be handled by VA staff.

Please Note: The Contractor must provide adequate support to addresss overflow of routine studies.

After-Hours Weekday Coverage (4:30 PM to 8:00 AM, CST, Mon-Fri): The Contractor shall provide teleradiology services to ensure that STAT imaging studies are interpreted promptly. Any routine studies performed during these hours may also need interpretation on as as-needed basis. Routine overflow work may also be interpreted during this period.

Weekend and Holiday Coverage (24 hr coverage):

STAT Coverage: The contractor shall provide continuous teleradiology services to cover STAT imaging studies during weekends and Federal Holidays. Any routine studies performed during these hours may also need interpretation on as as-needed basis. Routine overflow work may also be interpreted during this period.

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

3.3. Continuity of services under contact: Unless a state of emergency has been declared or clinics are otherwise cancelled by the VHSO, the Contractor shall provide the services specified under this contract.

3.3.4. Contractor is responsible for providing qualified personnel to interpret images. The VA must be informed at least fifteen (15) calendar days in advance if there will be a significant change in contractor’s ability to perform to allow for planning of service coverage and workload distribution.

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

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

3.3.7. Tele-Communications

3.3.7.1. The requirement for establishing and maintaining the communications link is the contractor’s responsibility, but the initial expenses associated with system setup and connectivity may be invoiced. Ongoing operational expenses for maintaining the link are not separately billable. The contractor will maintain the communications link between the contractor’s facility and the VAMCs’ facilities at the contractor’s expense.

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

4. CONTRACTOR RESPONSIBILITIES

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

4.4. Management and Supervision:

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

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

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

4.4.10. The Contractor shall complete and maintain background investigations to insure that employees do not have a record of criminal offenses or substantiated incidents of patient abuse; and, if required to perform their duties. A copy of the initiation of the background investigation as well as a completed background investigation shall be provided to the VHSO.

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

4.5.7. The American College of Radiology Guidelines: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/IRClin-Prac-Mgmt.pdf.pdf

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

4.5.9. VA Standards: All teleradiology interpretation services shall include a final report of findings and shall be provided to the VAMC by the Contractor as outlined below.

4.3.6.1. Routine: All routine imaging reports must be interpreted, finalized, and electronically signed within 24 hours of image receipt; a report is considered complete only when signed and available in the electronic health record.

4.3.6.2. STAT: Final report will be verified within 60 minutes of the teleradiologist receiving the request for interpretation. If the exam is a critical/emergent test result, results also must be communicated by telephone to the referring physician and the communication documented in the report.

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

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

4.3.9. The requirements contained in this PWS

4.4

4.5 MEDICAL RECORDS

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

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

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

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

4.5.4.1 All image interpretations will either meet or exceed established VA and VHSO standards of timeliness, accuracy, content and signature. Only VA approved abbreviations will be used for documentation of the patient health record.

4.5.4.2 Interpretations shall include the following information:

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

4.5.4.2.1 Contractor will provide interpretation per routine exams to VHSO Facility within 24 hours after receipt of images. All routine imaging reports must be interpreted, finalized, and electronically signed within 24 hours of image receipt; a report is considered complete only when signed and available in the electronic health record. This requirement aligns with industry best practices and the standards set forth by the American College of Radiology (ACR) to ensure timely and effective patient care. The Contractor must demonstrate the capacity to meet this 24-hour turnaround time consistently throughout the performance period. Contractor will not be held responsible for late reports caused by delays in the respective transcription service system. All exam study interpretation reports shall be reported and verified to the VHSO Facility system.

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

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

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

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

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

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

4.6 Direct Patient Care: Estimated 100% the time involved in direct patient care interpreting imaging studies listed in section 4.6.1.1. Contractor shall be responsible for.

4.6.1.1 Scope of Care: Contract physician(s) shall be responsible for providing interpretations for the following modalities, including, but not limited to:

4.6.1.1.1.1 General Radiologic Procedures (X-ray)

4.6.1.1.1.2 Computed Tomography Scans (CT)

4.6.1.1.1.3 Computed Tomography Angiography (CTA)

4.6.1.1.1.4 Ultrasound (U/S)

4.6.1.1.1.5 Magnetic Resonance Imaging (MRI)

4.6.1.1.1.6 Magnetic Resonance Angiography (MRA)

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

4.6.1.1.3 Contractor shall provide board certified Board/ Board Eligible Radiologists to perform final teleradiology Interpretation services. Examination images captured by VA medical centers will be transmitted to the contractor using the DICOM protocol and the Federal Information Processing Standard (FIPS) compliant encryption. Upon receipt of captured image and patient information from a VA facility, the contractor shall provide an interpretation for studies. These procedures will be rendered in writing once the contract is awarded.

4.6.1.1.4 The Contract physician (s) shall have control of the reporting process from dictation to report sign-off/electronic signature/approval/verification. The contract physician(s) dictates, self-edits, codes, and approves/signs/verifies their reports. No transcription services shall be provided by the VAMC. Final reports are transmitted to the VA using secure HL7 messages. Report quality/content shall follow ACR standards of report structure and communication of results. Contract physician(s) shall notify clinicians of critical findings in accordance with American College of Radiology (ACR) standards, VHA and VISN alert notification policies and in a manner appropriate to the clinical urgency of the case. The Contractor shall communicate all critical radiology findings to the ordering provider (or designee) in accordance with ACR standards, TJC/VHA directives, and VHSO policy MCP 11-079. Actual diagnoses and definitions of “critical results” are listed in Appendix A of policy MCP 11-079. For Code 201 findings (life-threatening/urgent), verbal notification must occur within one hour, with documentation of notification/read-back in the report. Infectious (Code 202) and suspicious malignancy (Code 203) findings shall be reported as specified in the policy. Facility policy will be provided to the Contractor upon award and whenever updated.

4.6.1.1.5 If a serious medical condition is identified during the interpretation, the report shall be immediately called in telephonically to the attention of the medical facilty’s designated POC for their information and action.

4.6.1.1.6 Mechanisms must be in-place to provide notification of test results for patients receiving care in accordance with VHA Directive 1088, Communicating Test Results to Providers and Patients. To meet the requirements in VHA Directive 1088, contractor workflows must meet requirements outlined in VHSO facility Medical Center Policy 11-079 Communication of Test Results to Providers and Patients, specifically Appendix A and also with VHSO Radiology Standard Operating Procedure titled “Radiology Critical Results Communication”. Facility and departmental policies will be provided to the Contractor upon award and whenever updated.

4.6.2 SYSTEM REQUIREMENTS:

4.6.2.1 The contractor must maintain a Teleradiology system that is reliable and functional to prevent any disruption in the delivery of services. Data transmission security must be maintained at all times. Facility personnel must be notified immediately of any equipment malfunctions that would hinder the transmission of images.

4.6.2.2 Contractor warrants that any data containing patient-specific identifiers will be handled in such a way as to prevent disclosure to unauthorized parties. This includes transmission of the data (from the point at which the data leaves the VA network to the point at which the images are interpreted) as well as storage of the data by the Contractor. Contractor agrees to comply with all applicable data security laws and guidelines, as well as HIPAA and various JCAHO provisions. The contractor will provide utmost care and attention to patient data. All patients will be assured of their privacy and personal dignity in accordance with applicable laws, rules and regulations.

4.6.2.3 VA will act as primary custodian of the patient information (including both the image data and the report) for all purposes related to VA and Government records retention requirements.

4.6.2.4 Patient information, including images, will be retained by the Contractor only for the minimum period of time required to comply with any applicable laws, and should then be purged.

4.6.2.5 Upon request, Contractor will provide VA with access to information pertaining to the way in which the Contractor maintains VA patient data and the steps taken on an ongoing basis to assure the privacy and security thereof. This includes, but is not limited to, information regarding computer network architecture, configuration of firewall(s), routers, and other pieces of networking equipment, information about installed security software, and audits of patches of known security vulnerabilities. All relevant security-related patches and anti-virus updates must be installed within 30 days of initial release.

4.6.2.6 Patient medical data transfer and storage complies with the American College of Radiology ( ACR) and Digital Imaging and Communication of Medicine (DICOM) standards and meets and anticipates all current, known CONFIDENTIALITY requirements and regulations.

4.6.2.7 All routine imaging reports must be interpreted, finalized, and electronically signed within 24 hours of image receipt; a report is considered complete only when signed and available in the electronic health record.

4.6.2.8 Contractor will have ability to interpret images from commercial PACS or VA’s VISTA RAD PACS system. Contractor shall maintain its teleradiology equipment in good working order and in accordance with the specifications of the manufacturer. Equipment quality control shall be performed in accordance with manufacturer's specifications. Records of equipment quality control activities shall be made available to VA for review upon request.

4.7 PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT (QI)

4.7.1 Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, and Peer Reviews. Methods of Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE). Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.7.2 Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel.

4.7.3 Performance Standards:.

4.7.3.1 Measure: Timeliness of Reports

Performance Requirement: Prompt delivery (timeliness) of interpretations.

Standard: 100% of Routine exams read within twenty-four (24) hours and STAT exams read within one (1) hour. No exams exceed 7 days turnaround time.

Acceptable Quality Level: 98% meet timeliness standards each month. Surveillance Method: Direct Observation and Validated User/Customer Complaints Frequency: Daily

4.7.3.2 Measure: Provider Quality Performance

Performance Requirement: All contract physician(s) shall perform in accordance with clinical standards.

Standard: The Contractor shall conduct peer review and Ongoing Professional Practice Evaluation (OPPE) for all contract radiologists as required by national standards. Results of these reviews shall be made available to the VA upon request and incorporated into contract performance monitoring.

The VA reserves the right to initiate a Focused Professional Practice Evaluation (FPPE) or other quality review of any contract physician if concerns regarding quality or safety of care are identified through incident, routine case audit, report review, clinical complaint, or other quality monitoring processes. The Contractor shall cooperate fully in providing necessary documentation and access for any such review.

Acceptable Quality Level: 98% meet Standards Surveillance Method: Peer review/OPPE data provided by Contractor; additional VA FPPE or quality review may be conducted as needed.

Frequency: Contractor conducts OPPE/Peer Review at least annually. VA-initiated FPPE is conducted as required by quality triggers.

4.7.3.3 Measure: Qualifications of Key Personnel

Performance Requirement: All Contractor’s physician(s) shall be Board Certified/Board Eligible in accordance with ACR Standards.

Standard: All (100%) contract physicians are Board Certified/Board Eligible. Acceptable Quality Level: 100% No deviations accepted.

Surveillance Method: Credentialing upon Contract Award Frequency: Upon award and periodically for recredentialling

4.7.3.4 Measure: Scope of Practice/Privileging

Performance Requirement: Contract physician(s) performs within their individual scopes of practice/privileging.

Standard: All (100%) contract physician(s) perform within their scope of practice/privileges 100% of the time.

Acceptable Quality Level: 100% Contractor’s physician(s) perform within their scope of practice/privileges 100% of the time.

Surveillance Method: Random Sampling of records during performance of annual OPPE, peer review and Direct Observation Frequency: Random Sampling and Annual Review

4.7.3.5 Measure: Patient Access

Performance Requirement: The Contractor shall provide Contractor’s physician(s) in accordance with the schedule outlined in this PWS. Standard: All (100%) contract physician(s) are on time and available to perform services.

Acceptable Quality Level: Contract physician(s) is available to perform services 98% of the time.

Surveillance Method: Periodic Inspection or Random Sampling of radiology documentation and interpretations Frequency: Direct Observation Reports from VHSO Staff to COR

4.7.3.6 Measure: Maintains licensing, registration, and certification Performance Requirement: Updated Licensing, registration and certification shall be provided as they are renewed. Licensing and registration information kept current.

Standard: All (100%) licensing, registration(s) and certification(s) for contract physician(s) shall be provided as they are renewed. Licensing and registration information kept current.

Acceptable Quality Level: 100% licensing, registration(s) and certification(s) for Contractor’s physician(s) shall be provided as they are renewed. Licensing and registration information kept current. No acceptable deviation.

Surveillance Method: Periodic Inspection Frequency: Upon award and annually or during credentialing processes

4.