Q522--VA Pittsburgh Healthcare System Teleradiology Staffing Services This is not a Request for Quote.

Department of Veterans Affairs VA Pittsburgh Healthcare System. Teleradiology Services-VAPHS Pittsburgh Imaging PERFORMANCE WORK STATEMENT (PWS) The contractor agrees to provide the Pittsburgh Veterans Affairs Medical Center (VAMC), the services and prices specified in the Section entitled Schedule of Supplies/Services of this contract. GENERAL: The Pittsburgh Department of Veterans Affairs has the requirement to provide Veterans within the service area with Radiology Services. BACKGROUND: Physician personnel shortages in the Radiology Services of the Pittsburgh VAMC have created a significant need to provide preliminary and final radiology interpretation for exams performed on off tours and in some cases for exams performed during routine tours to cover leave and staff vacancies. The use of Radiology Services outsourcing should provide a highly cost-effective and expeditious alternative to meet an ongoing need within the VA. The Pittsburgh VAMC uses an electronic image management and distribution system called VISTA Imaging. In conjunction with Vista Imaging, the facility uses Powerscribe and ISite radiology to complete Imaging Dictations. WORK STATEMENT: Contractor shall provide professional teleradiology services for radiology examinations performed at the Pittsburgh VAMC. Contract services will include off-campus film interpretation via network connection to the VA informatics system. Interpretation will include immediate communication 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 Radiologists. Contractors shall provide all professional personnel and technical support, medical and other equipment, telecommunication, supplies, and supervision necessary to perform, implement and administer these teleradiology services to meet the specific medical needs of the Pittsburgh VAMC. The Contractor is responsible for all Contractor personnel, Subcontractors, agents, and anyone acting for or on behalf of the Contractor. All services SHALL be performed within the territorial borders of the United States. I. Teleradiology Services: 1. The Contractor shall be responsible for management of all aspects of the contract, and this includes the following: Electronically distribute appropriate studies to board certified Radiologists for primary diagnosis. Provide professional radiology services, offsite from Pittsburgh VAMC. The most frequent regular usage of teleradiology services will be Monday-Thursday 8pm-8:00 am, and Friday 8pm through Monday 8:00 am, but 24-hour coverage is expected. Some interpretations will be requested STAT and other interpretations will be requested routine. Imaging procedures will include plain film cases, US cases, CT cases, CTA cases, and MRI cases. Provide configuration of the physical, operational, and procedural environment within the Pittsburgh VA Medical Center facilities radiology department and installation for the system to include broadband connectivity and assist VA Pittsburgh Healthcare System (VAPHS) facility in site preparation and support during transition. The images will be sent by VA's Teleradiology System (ISite Radiology) to the Business Partner through a VA approved Business Partner Gateway (BPG). Radiologists shall be available for telephone consultation regarding examinations and provide recommendations for appropriate procedures to referring clinicians. VA Technologists performing procedures to be interpreted may consult the Radiologist/contractor with questions regarding protocol of exams, possible contrast allergy questions or for direction regarding abnormal laboratory values, or questions regarding premedication. Relevant prior studies will be made available to the teleradiologist. Interpretations must compare current and prior studies. Radiologists will have access to CPRS, or to a health summary or be able to contact the ordering physician to obtain clinical information such as history, progress notes, medications, and laboratory values, as well as reports of prior radiologic examinations. The Radiologist providing the preliminary interpretation shall also perform the final interpretation and communicate any change in that interpretation to the referring or treating clinician and the practitioner contacted, date and time of this communication must be documented in the final report. If the study is technically limited or incomplete, and cannot be interpreted with certainty, the teleradiologist shall notify the referring clinician so that the study may be repeated. If this is not feasible, cannot be done immediately, or is not likely to be productive, the study must be reported, and the technical limitations of the interpretation described in the report. Documentation. All film interpretations will either meet or exceed established standards of timeliness, accuracy, content, and signature. Only VAPHS approved abbreviations will be used for documentation of the patient health record. (1) Routine interpretations: Completed and verified reports for routine studies are available in CPRS/Vista Imaging Information System within 48 hours of exam registration. (2) STAT interpretations: Provide preliminary report by fax to referring clinicians within 45 minutes of the teleradiologist receiving the request for interpretation. If the exam is a critical/emergent rest result, results also must be communicated by telephone to the referring physician. Final report will be verified within 48 hours of exam registration and available in CPRS/VISTA Imaging Information System. Each report (routine and stat interpretations) shall identify the films reviewed, objective findings, the Radiologist s impression of the patient s condition, and recommendation for treatment. Any incomplete report will be dedicated, transcribed, and verified within 24 hours of notification at no additional cost to Pittsburgh VAMC. Additional requirements apply if any exam demonstrates a critical/emergent test result, as defined in a Medical Center Memorandum, as excerpted, and listed as diagnoses #1 - #8 re-listed below in this SOW under 1(a) (4).) Reporting Imaging Test Results/Critical Results . In the case of a critical finding, results must also be communicated by telephone to the referring physician or a licensed clinician who can address the critical finding. This communication must be documented in the report and includes the name of the clinician receiving the report, date, and time communicated. (3) All reports are to be in accordance with American College of Radiology (ACR) standards. Interpretations must include the following information: patient s full name, SSN, date of birth, reason for study, exam case number (accession number), date of study, date of interpretation, requesting physician, description of the exam, (body of the report), impression, name of interpreter and signature of Radiologist providing interpretation. The report shall list pertinent positive and negative findings. (i) Preliminary reports are to be provided by fax to referring clinicians within 45 minutes of receipt of exam. If the exam is a critical/emergency test result, the report also must be communicated by phone to the referring physician. Preliminary written reports must be kept until the final report is verified and until they are no longer needed for quality assurance and peer review purposes. Preliminary reports need not be entered in the medical record, however, any significant discrepancies between the preliminary and final report must be documented in the final report and the treating team notified with date and time of notification in the final report. (ii) Final written reports shall be transcribed and verified by the teleradiologist (electronically signed) within 48 hours of exam registration. (iii) The facility or Contractor providing teleradiology interpretation may temporarily store copies of reports and images but must delete or destroy all copies after the contract has expired, excepting records required for billing and reimbursement purposes. (4) Reporting Imaging Test Results/Critical Results Critical Test results in Imaging are defined as those interpretation findings which, if left untreated, could be life threatening or place the patient at serious risk. These results will require urgent intervention or change in patient management. Emergent Test results are findings that are associated with a high likelihood of short-term poor outcome and require immediate intervention or close monitoring. The Radiologist will communicate results of critical/emergent exams to the ordering practitioner or surrogate practitioner immediately upon interpretation as outlined below. Critical/Emergent Test results for Imaging Service will include, but not be limited to: Ectopic Pregnancy Testicular or Ovarian Torsion Pneumoperitoneum-not postoperative Acute Intracranial Hemorrhage Unstable Cervical Spine Fracture Thoracic or Lumbar Spine Fracture with cord compression Aortic Dissection Mediastinal or Retroperitoneal Hematoma Intracranial Mass with New Herniation Acute Pulmonary Embolism or Acute above the Knee DVT Hemoperitoneum Acute laceration of the Liver, Spleen or Kidney Acute cord compression Appendicitis Abscess requiring medical/surgical attention or intervention Bowel Necrosis Portal Venous Gas Acute Arterial Embolism/Occlusion Tension Pneumothorax Significantly Mal-positioned line or tube or unexpected foreign body Communication of critical/emergent imaging results will be direct. Direct Communication is defined as non-electronic dialogue between the diagnostic practitioner and ordering practitioner or another appropriate licensed provider by telephone. Documentation of communication of critical/emergency results will be included in the imaging report. This will include the name of the practitioner contacted, as well as date and time of communication. Electronic Communication (view alerts) may be used to communicate important/abnormal study findings that require attention by the ordering practitioner, but not necessarily in an immediate time frame. (ii) In addition, all reports (normal and abnormal) must have a diagnostic code which is dictated and transcribed along with the report or inserted at the time of report verification. Inline below are the diagnostic codes which must be used as they are used by the VHA.] Some of the diagnostic codes will generate view alerts which can convey important study findings that may require a change in patient management, but not necessarily within an immediate timeframe. The list of diagnostic codes used will be provided at time of contract award. Value Label � 1200 1200 No AAA 1201 1201 AAA Present 1202 1202 Unsat for AAA Screen 1000 1000 No Alert Required 1001 1001 Significant Abnormality, Atn 1002 1002 Critical Abnormality 1003 1003 Possible Malignancy (iii) A method has been established to relay the results of abnormal exams performed off routine business hours. The AOD will be contacted by the contractor and the AOD will facilitate communication with either the ER attending or responsible clinician on call. In all cases, should there be difficulty in reaching the clinician responsible, the ER attending Medical Officer of the Day will serve as point of contact. All Radiologists providing preliminary or final reports will be required to read the abnormal reporting policy, sign that the policy was reviewed and is understood, prior to providing interpretations. The contractors shall distribute the policies, obtain signed policies, and ensure that the process outlined in MCP TX-144 is followed by Radiologists reading for Pittsburgh VAMC. The contractor will distribute these to all Radiologists and obtain signed receipt and acknowledgement of understanding for Radiologists providing interpretation. Signed acknowledgement must be submitted prior to contract implementation. A schedule for teleradiology service days will be submitted monthly and approval is required by Radiology Manager or Imaging Chief. The names of the VETPRO credentialed Radiologists and dates of their scheduled coverage must be received by the VA in advance from the contractor no later than the 20th workday of the month prior to the work schedule. Contractor must all at least 3 months after receipt/completion of all required documentation for any new Radiologist to be credentialed and privileged prior to scheduling. Contractors will be responsible for transcription services, report corrections, and sign reports electronically. Again, ALL reports must be signed by the interpreting Radiologist within 48 hours of exam registration. Contractor will install, secure, and maintain external communication systems required for image study delivery to remote Radiologists. Configure, install, and maintain Virtual Private Network all remote workstation software on the remote reading Radiologist workstation. These connections must comply with specifications in VA Handbook 6500. The remote Connection to the VA will be through a VA approved Business Partner Gateway (BPG). Teleradiologists performing work under this contract may also connect remotely to the VA using the Citrix Access Gateway VPN. Contractors must ensure that their own specific computers are capable of diagnostic interpretation and at the same time adhere to all VA security requirements. The extension of the network is fully functional, and Radiologists must have clinical privileges at the Pittsburgh VA Medical Center. Contractors will access current and prior comparison studies (if comparison studies exist) utilizing a secure VA Business Partner Gateway or similarly functional, rapid, and secure technology. Contractors shall provide and maintain the means for enabling this access. Contractor should install and maintain external communication systems required for secure, VA-compliant image and data delivery to its teleradiologists and will configure, install, and maintain all remote workstation software at its teleradiologists reading stations and will ensure security to VA Data. Contractor will expeditiously provide all requested information to VAPHS Information Security Officer (ISO) and Information Resources Management (IRM). Implement a Vista Rad/Vista Imaging/Philips ISite compatible DICOM appliance for transfer of images from Philips ISite Radiology to the DICOM server. Contractor Proposal shall include the specific hardware and software to be utilized by the contractor. Provide training on the new workflow for location activated. This training course will be no more than four hours. Provide maintenance on all contractor-provisioned equipment and installed systems. 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 Physicians to perform services hereunder. Provide security as required by Health Insurance Portability and Accountability Act of 1996 (HIPAA) and maintain the security and integrity of patient information in accordance with applicable VA regulations and HIPAA. Contractor will be required to follow all U.S. Laws and VA regulations regarding sensitive information, patient confidentiality, and information security, as set forth in; Privacy Act of 1974, Computer Security Act of 1987, Clinger Cohen Act of 1996, OMB A-130 Appendix IIIk and VA, VHA Directives 6500, and all other applicable regulations. See FAR clauses 52.224-1 and 52.224-2 included herein. Develop a project implementation strategy with the Pittsburgh VAMC to include preparing building, establishing telecommunications VISTA interface, policies and procedures transfer, credentialing, privileging and training staff, reporting procedures, operational readiness, and phase in schedule. The Contractor shall provide a system that maintains a minimum of 99% up time performance rate (excludes downtime related to VA s network problems, Internet traffic or ISP provider problems used by Contractor). Failure to provide this will result in contract termination. Contractor shall provide hardware and selected software to be utilized at contractor site to include: (1) Facsimile, telephone, networking and other telecommunications equipment to be utilized at contractor facility. (2) all supplies, services, maintenance, repairs and upgrades required at contractor facility to provide services as described above. (3) equipment hardware, software and supplies must be compatible with the VA s software (Vista Imaging, Powerscribe, Philips ISite Radiology) and hardware used during performance of this contract including critical patches and antivirus updates. Contractor shall provide proof of installation of critical patches and/or antivirus updates to the VA upon request. (4) network and security system must be compatible with the VA s network and security system. Contractor s system must be able to receive DICOM images to the Contractor server via secure VA facility-initiated VPN connection over the Internet. q. Contractor shall provide peer review data (quality assurance cross reads) on a quarterly basis for each Radiologist providing interpretations to Pittsburgh VA Medical Center. A copy will be provided to VAPHS for review. r. Contractor shall be responsible for ensuring that all providers/subcontractors complete training required by Pittsburgh VA Medical Center (Ethics, Cybersecurity, Privacy, etc.). The VAPHS will require documentation of completion. s. Contractor shall appoint one Radiologist to serve as a trainer for other Radiologists assigned to VAPHS. 2. The Pittsburgh VAMC will be responsible for: (a) The Pittsburgh VA Medical Center will be responsible for credentialing doctors to work in a timely fashion. An application package will be provided by the VA to be completed by the candidate. This includes Curriculum vitae, current references, signed release of information from candidate, and statement that candidate does not have any physical or mental health condition that would adversely affect his/her ability to carry out assigned duties, and additional credentialing and privileging forms. Candidate will also be required to make application through the VET-PRO Internet process. Candidates will need to be enrolled in VET-PRO by the Credentialing and Privileging Coordinators. The website address is: http://fcp.vetpro.org/ (b) Prepare site for installation of the system. Obtain VA Authorization for installation of a separate network connection, located inside the hospital but outside the firewall, and a network connection of the DICOM store and Forward device that will be installed inside the Pittsburgh VAMC. The VA will establish accounts and authorize radiology module privileges for the use by contractors. IF REQURED c through e. (c) Floor space, workspace, and power adequate for a PC tower computer, monitor and keyboard at customer site. (d) 19" Rack space equivalent to 6u in computer room (to accommodate the server and IPS) and an outlet. (e) Physical space in computer/Telco room for installation of Contractor-provided router and any remoter connectivity devices typically used by communications provider. (f) Physical security for computer systems. (g) Access to server and object forge devices for the installation of Category 5 cabling, if required. (h) Availability of technician for two hours of assistance. (i) IRM designated staff for testing and approval of installed remote connectivity solution. (j) Provide pertinent historical and demographic information on each patient sufficient for Contractor to perform its services. 3. PROCEDURE FOR TRANSMISSION OF IMAGES: Patient images along with exam Request forms for each patient will be transmitted via the VA's PAC System (VISTA IMAGING) through a data line provided by the Contractor. The request forms will include patient information, along with CPT codes. The Contractor shall interpret an exam and provide the Radiologist's final report and transmit using hardware/software provided by Contractor. Contractors shall use the same transcription services used at the Pittsburgh VAMC (CPRS/VISTA/Powerscribe Imaging Information System). Request(s) for stat interpretation or routine interpretation will be noted on the request form. CONTRACTOR REQUIREMENTS The Contractor shall provide all services specified in this contract for any person determined eligible by the Chief Medical Director, or Designee, regardless of the race, color, religion, sex, or national origin of the person for whom such services are ordered. The Contractor shall not subcontract as a means of circumventing this provision. Contractor must have a minimum of three years of experience providing off routine teleradiology interpretations for VA Medical Centers. The Contractor must be able to demonstrate consistent coverage (> 99% uptime for 3-year period). MEDICAL RECORDS STANDARDS: The Contractor shall maintain up-to-date medical records based on the Medical Record Compliance Standard as stated above. Utilization of CPRS is required. Medical center staff will provide technical training on the use and operation of CPRS during the start-up early operation stage and as updates become available. Medical center staff will provide at least annual Privacy Act training to appropriate contractor staff. The contractor, contractor employees, and subcontractors shall be subject to the Privacy Act of 1974 and HIPAA of 1996. The Contractor is not authorized to release any medical record information. The VAPHS is the sole entity authorized to release this information upon written request submitted via facsimile or mail from the patient. The VAPHS will provide the Contractor with access to pertinent patient medical information, within the existing privacy rules and regulations for the purpose of providing coordinated comprehensive primary care. Contractors shall ensure the confidentiality of all patient information and shall be held liable in the event of the breach of confidentiality. GUIDELINES: The Contractor will perform the functions required under this contract in accordance with the rules of medical ethics, Federal, State and local laws, rules and regulations, Joint Commission, and American College of Radiology (ACR.) for communication and teleradiology. The Contractor shall not participate nor be a party to any activities which are in conflict with Federal and/or State guidelines. In the event the Contractor encounters said conflicting situations, the Contractor shall notify the COTR or the Contracting Officer to resolve such issues. The Contracting Officer will document and be responsible for resolution of any such situations. Neither the VA nor the Contractor will be responsible for any delays or failures to perform due to causes beyond each party's control. The VA and the Contractor may, upon mutual consent, modify the timing and schedule of services. The Contractor shall be following Joint Commission standards and shall submit a copy of either their Joint Commission accreditation OR comparable statement with their proposal. Complications review, double reading, and other appropriate monitors must be conducted and report forwarded to Pittsburgh VAMC quarterly. Failure to provide required documentation would be a breach of the contract and subject to the contract being revoked. Any occurrence of a sentinel event or potential sentinel event involving a VA patient will be reported to the facility as soon as the event is detected. Comprehensive review of the case will be provided to the appropriate VA facility. 4. QUALITY MONITORING PROGRAM: The Contractor shall have a quality monitoring program and shall agree to comply with the requirements for meeting the JCAHO program as outlined by the VA radiology programs. Quarterly data will be provided to the VAPHS Pittsburgh Manager/Supervisor for each Radiologist credentialed at Pittsburgh VA Medical Center. Contractor must perform quality assurance cross reads and monitor appropriate communication of critical/emergency results as per MCM TX-144. Both sets of data will be provided to VAPHS quarterly. QUALITY CONTROL: The Contractor's facilities, methodologies, and quality control procedures may be examined by the VA Contracting Officer or his (her) designee at any time during the life of the contract. Quality Assurance Surveillance Plan (QASP): Performance Objective SOW Paragraph Performance Measure 1. Prompt delivery of interpretations and return of films. 1.c. and 1.d.. Zero tolerance for late reports 2. Availability of Radiologist. 1.a. Zero tolerance for non-availability 3. Maintains patient privacy/confidentiality. Special Contract Requirements Standard is zero breaches of privacy 4. Maintains appropriate Federal, state licensure/ certification requirements Special Contract Requirements Mandatory prior to performance of duties 5. All documentation will meet or exceed standards, to include but not limited to accuracy, content and signature. 1.d. Zero tolerance for violations 6. Timeliness Patient Records. Reports are to be completed and verified within 48 hours of exam registration. Stat reports must be faxed to requesting clinician within 45 minutes of when the contractor receives request. All critical/emergent exam results must be called to requesting clinician and this is documented in the final report (clinician name, date, and time). 1.f. 95% Compliance Acceptable Quality Level COTR will monitor Zero tolerance for violations. 7. Adheres to all HIPAA requirements. Special Contract Requirements Standard is zero breaches of HIPAA requirements. 8. Adequate Coverage 1.a. 100% Acceptable Quality Level COTR will monitor Zero tolerance for violations. (a) The Government will periodically evaluate the Contractor s performance by appointing a representative(s) to monitor performance to ensure services are received. The Government may inspect each task as completed or increase the number of quality assurance inspections if deemed appropriate because of repeated failures or because of repeated customer complaints. Likewise, the Government may decrease the number of quality assurance inspections if performance dictates. VAPHS Quality Assurance Personnel will validate any complaints and report to the Government Contracting Officer who will then take necessary action to enforce contract compliance. (b) If any of the services do not conform to contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements, at no increase in contract amount. When the defects in services cannot be corrected by re-performance, the Government may result in contract termination. CONTRACTOR STANDARDS: Contractor is responsible for developing and maintaining written policies and procedures for licensure and certifications, competency evaluations, orientation, and continuing education, that are appropriate for the scope of care and services provided by employees and subcontractors under this contract. SPECIAL CONTRACTOR RESPONSIBILITIES: The Contractor must possess all licenses, permits, accreditation and certificates as required by law. The Contractor must perform the required work in accordance with Joint Commission, VHA and other regulatory standards. Joint Commission standards may be obtained from the Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd, Oakbrook Terrace, IL 60181. Requirement Timeline Peer Review (FPPE/OPPE) Quarterly Invoices Monthly VA Cyber Security Awareness and Rules of Behavior Yearly at beginning of Option Year Contractor Rules of Behavior Yearly at beginning of Option Year VA privacy training Yearly at beginning of Option year SUBCONTRACTOR PROVIDED SERVICES: All personnel that provide services under this contract and are not employees of the Contractor will be regarded as Subcontractors. The Contractor shall be responsible and accountable for the quality of care delivered by all of its Subcontractors. The Contractor shall hold the Subcontractor accountable for the requirements for availability and accessibility of services as outlined in this contract. The Contractor shall use a systematic approach to monitoring the availability and accessibility of services of the Subcontractor as they relate to the quality-of-care monitoring. CONTRACTOR EQUIPMENT/SOFTWARE: Upon completion or termination of the contract VPN software will be removed from contractor s equipment. Any network accounts will be disabled. All VA data gathered, created, received, or processed during the performance of the contract will be returned to the VA or certificate of destruction provided. No data will be retained by the contractor or its subcontractors. CONTRACTOR NETWORK ACCESS: The VA network is protected from unauthorized access by assigning a distinct Access and Verify code to each user of the network. Each Contractor staff person, hereinafter referred to as user , must agree to the VA standard user application. Violation of the agreement as a whole or in part may result in permanent revocation of access for the user. REGULATORY INFORMATION: The Food and Drug Administration classifies VistARad as a medical device. As such, it may not be changed except as directed by the Vista Imaging SD&D group. Modifications to this software may result in an adulterated medical device under 21CFR820, the use of which is a violation of US Federal Statutes. To ensure compliance the VA will implement measures, including but not limited to, security policies, anti-virus devices, anti-intrusion devices, and periodically monitor the equipment. Any attempt to defeat or circumvent any of these measures may constitute a breach of this contract and result in revocation. II. SPECIAL CONTRACT REQUIREMENTS 1. SERVICES: The services specified herein of this Work Statement may be changed by written modification to this contract. The modification will be prepared by the VA Contracting Officer. The services to be performed by the contractor will be performed in accordance with VA policies. (already mentioned) 2. RESPONSIBILITY OF THE CONTRACTOR: The Contractor must obtain authorization from the Contracting Officer for any services required outside the scope of work provided herein. 3. TERM OF CONTRACT AND PRICING: Pricing will be based on a flat fee for type of procedure. One invoice will be submitted to Pittsburgh VAMC for interpretations performed for radiology monthly, listing all studies interpreted, time and date of receipt by the contractor and time and date of final interpretation provided by the contractor for each. 4. HOURS OF WORK: The Contractor as defined herein shall furnish the services covered by this contract. The Contractor is required to furnish teleradiology services 24 hours a day / 7 days a week. 5. QUALIFICATIONS: The Contractor shall be responsible to ensure that Contractor personnel providing work under this contract are fully trained and completely competent to perform the required work. Prospective providers must present appropriate credentialing information including, but not limited to, the following: (a) Possess the M.D. (medical doctor) or O.D. (Doctor of Osteopathic Medicine) degree (b) Board certification in Diagnostic Radiology by the American Board of Radiology (c) licensure in state of practice (d) Clinical practice experience of at least two years (e) General Liability and Malpractice insurance (f) Barrier free office environment, equipment, and space to meet JCAHO, Federal and State standards (g) The 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. The contractor shall provide all professional person...