Protected clinical peer review

Added: Sep 14, 2008 7:10 pm Modified: Oct 02, 2008 4:46 pmTrack Changes 1. Title: Protected Clinical Peer Review Services2. Solicitation Reference Number: VA-101-08-RP-0252 Amendment 01

3. Description: Request for Quote (RFQ) #: VA-101-08-RP-0252 is hereby amended to provide a summary of the information presented in the pre-proposal conference held October 2, 2008. Three presentations were made and are included as an Attachment to this Amendment.

Vendors were also afforded the opportunity to ask questions in response to the presentations. The questions and answers are as follows:

1) VA has requested a .9 measure of agreement for inter rater reliability (IRR). Is this a percentage or is this a kappa statistic? Answer: This is a percentage. Note, also, that VA considers a difference of 1 level to still be in agreement. Thus, we would consider there to be a disagreement only if one reviewer assigned Level 1 and the other reviewer assigned Level 3 and vice versa.

2) Will VA identify the type of personnel required for a multi-disciplinary review and how often will this be required? Answer: Yes. Note that audit reviews will generally result in the need for a single reviewer as opposed to a panel. It is anticipated that triggered reviews may necessitate multi-disciplinary review. In this instance VA will identify the types/specialties required of the review panel.

3) In the instance where a multi-disciplinary review is required, will the Contractor be paid on a per review basis based on the number of reviewers on the panel or will the Contractor be paid one flat review rate? Answer: The Government cannot estimate the number of multi-disciplinary reviews that will take place. Contractors shall identify any assumptions made relative to pricing in the cover to its price proposal as well as any assumptions made relative to technical capability in the cover to its technical proposal.

4) Is the Low Risk background investigation (ref. page 16 of the RFP) required before Contractor access to the electronic medical record? Answer: Yes. It takes approximately 24-48 hours from receipt of a complete package for the SIC to initiate a background investigation. Once the investigation has been initiated, access can be granted.

5) Sub-factor d. for Qualifications of Peer Reviewers identified on page 66 of the RFP states "all Clinical Peer Reviewers have documentation of appropriate training and credentialing to meet National Committee on Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC) standards to perform peer-to-peer interaction" Must peer reviewers meet the training and credentialing standards of both NCQA and URAC? Answer: Reviewers shall meet the training and credentialing standards of either NCQA or URAC.

6) Is all necessary data to conduct the peer review contained in the electronic medical record? Answer: The Government estimates that at least 90% of all necessary data is contained in the electronic medical record and is currently working to ensure all necessary data is included. Please note that audit reviews have already been reviewed at least twice before it is forwarded to the Contractor. As such, any information missing from the electronic medical record is generally available at that time of the review request. Additionally, VA anticipates strong communication between the Department and Contractor. This communication will assist in identifying missing information to ensure it is received by the appropriate parties.

7) If missing information is identified after receipt of the review request, does the 45 day turnaround restart? Can "cannot be determined" be provided as a rating? Answer: The Government will work to ensure the Contractor has all information necessary to conduct a review. In the event missing information is identified for which the Government does not timely provide, VA will work with the Contractor to establish a new due date. "Cannot be determined" shall not be provided as a rating.

8) What is the average size of a chart? Answer: VA utilizes an electronic medical record. As such, the actual average size/page length of a chart cannot be determined. Generally reviews are limited to a specific episode of care. As such, the review would consist of the events beginning with general admission of the patient to the discharge of the patient.

9) On average, how long does it take to complete a review? Answer: The length of time it takes to conduct a review is wholly dependent upon the complexity of the episode of care and/or trigger for the review. As such, the length of time needed to conduct the review can and does vary. The Contractor is responsible for the length of time for each review and will not be provided any additional funding based on the actual amount of time it takes to complete the review. However for estimation purposes, for most reviews, it should take an experienced peer reviewer approximately 1 hour to review the documentation needed to complete a review.

10) Will the Government identify the specific "trigger" that has resulted in the request for a triggered review? Answer: Yes.

11) On page 66 of the RFP, the Government requests 3 past performance references for work with the Federal Government and/or commercial customers? Can references with State agencies be provided? Also, can more than three references be provided? Answer: References for work with state agencies can be provided. Additionally, a minimum of three past performance references shall be provided; however, more than 3 references can be submitted.

12) The definition of peer according to QIO standards identifies a peer as an individual located within the same geographical region. Is this applicable to VA's definition of a peer? Answer: No. The VA holds itself to the highest standard of care regardless of geographic location. As such, a peer does not have to be located within the same geographic location.

13) How will audits be assigned? Answer: VA is willing to work with the Contractor as to the timing of the assignment of audits to ensure the Contractor has the necessary resources available to meet the review timelines.

14) Several physicians have VA appointments or are affiliated with VA in some manner. Does this represent a conflict of interest? Answer: Approximately 107 VAMCs have academic affiliations. As such it is highly likely and expected that Contractor reviewers may include physicians with VA experience or part-time appointments. The physician is not allowed to perform review services while at work performing VA duties to ensure there is no dual compensation. However, a physician operating under his/her personal time may perform reviews. The Government requests that physicians do not perform reviews for the specific facilities for which they are affiliated and expects the Contractor to ensure no personal conflicts of interest exist. Please reference page 40 Item b. of the RFP and Section F.3 VAAR clause 852.209-70 Organizational Conflicts of Interest for more information.

15) Does the Government have historical data on the number of reviews per sub-specialty? Answer: No. At this time the Department does not track this information.