Attachment_D_-_Statement_of_Work.pdf

Attachment D: Statement of Work

STATEMENT OF WORK

The overall intent of this contract is to acquire non-personal health care services for a qualified Contractor under a Government service contract. The contractor shall provide the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department. Work performance shall be performed according to the requirements and conditions contained in this Statement of Work.

It is the intent of the Hopi Health Care Center (HHCC) to acquire professional medical physician healthcare services for the Hopi Health Care Center, hereafter referred to as the “Service Unit” located in Polacca, Arizona.

1. SCHEDULES/LOCATIONS/SHIFTS/QUALIFICATIONS/CERTIFICATIONS:

SCHEDULE:

The Contractor is requested to provide ER Physician Services, for a 12 month base period and four (4) 12-month option periods. The HHCC Emergency Room Department is routinely staffed by two physician providers at all times. In most cases on provider is a member of the HHCC full-time staff and the other is a contracted provider. The Contractor shall coordinate scheduling with the HHCC Emergency Room Director.

LOCATION: All services shall be performed at the following location;

Hopi Health Care Center (HHCC) P.O. Box 4000 Highway 263, Mile post 388 Polacca, Arizona 86042

WORK WEEK: Work week is defined as Sunday through Saturday.

SHIFTS: Contractors will be expected to abide by the facility’s Uniform Code and shift hour assigned, modalities of charting and care delivery and other rules and regulations of the facility.

Work within a designated schedule prepared by the HHCC Emergency Room Director or his/her designee. Any period of absence or changes in the schedule will be communicated with the HHCC Emergency Room Director or his/her designee 14 days prior, except for emergency situations.

Total shifts worked shall be in accordance to the total number of work hours allocated for the year by HHCC. 30 minute lunch breaks are included in shift hours and Government does not pay time taken for lunch. The Service Unit shall make every effort to submit a schedule two (2) weeks in advance. Shifts may be cancelled or shortened without time restriction or monetary penalty before the physician arrives for duty.

It is estimated the HHCC will require 15 (fifteen) 12 (twelve) hour night shifts per month.

LOCATION: Emergency Room Physician

Emergency Room Physician Day Shift: 8:00 A.M. – 8:00 P.M. (0800 - 2000) Night Shift: 8:00 P.M. – 8:00 A.M. (2000 - 0800)

NOTE: The duration of each shift may vary due to patient load, clinical complexity, weather and other circumstances. An estimated patient volume of 12-15 patients in one 12 hours period.

Contractors shall attend assigned meetings, participate fully as staff members, and actively participate in ongoing quality management activities and any other HHCC or Indian Health Services initiatives deemed applicable to the specialist’s work.

QUALIFICATIONS/CERTIFICATIONS:

Education: Physician shall have four (4) years of accredited medical school leading to

MD/DO doctorate level diploma.

Training: Physicians must have completed an Emergency medicine residency, or completed a Family Medicine or Internal Medial or other residency with 1.5 years of Emergency Medicine experience.

Experience: The Contractor shall provide physicians that have completed a residency in Emergency Medicine, Family Medicine or Internal Medicine or other residency completion with 1.5 years of Emergency Medicine experience.

Licensure: Physician must have an active and unrestricted license to practice medicine in the Sate of Arizona or on of the other 49 states in the United States or the district of Columbus, or the Commonwealth of Puerto Rico.

Certification: BLS (Basic Life Support), ACLS (Advanced Cardiac Life Support) and PALS (Pediatric Advance Life Support).

Insurance: Medical malpractice liability coverage.

Privileges: The Contractors employee shall maintain admitting and consultative privileges at a hospital.

2. PRICING SCHEDULE:

The unit price paid to the Contractor shall be considered as payment in full for services provided at the Service Unit under this contract. In no way, unless directed by the IHS, shall any provider attempt to bill or collect from any IHS patient, or from any alternate resource for which the patient may be eligible, any monies for services provided under this contract.

Services shall be inclusive of all other fees (holiday; nights; weekends) including travel expenses, per diem, lodging, all city, state, federal and local taxes, and all miscellaneous costs associated with the provision of services. (30 minute lunch breaks are included in the shift hours and will not be paid by the Government.)

Contractor shall be paid only for actual time services are performed under the terms of the contract at the fixed price rate. The quantities are estimated hours and estimated totals not to exceed.

See Attachment A, Pricing Schedule, for inputting bid amounts.

3. STATEMENT OF WORK:

The overall scope of this contract is to acquire a qualified Contractor under a Government service contract. The contractor shall provide the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department. Work performance shall be performed according to the requirements and conditions contained in this Statement of Work. The contract resulting from this solicitation includes:

The contractor shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the department and personnel. The contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the contractor to meet these standards can result in cancellation of this contract. The contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this statement of work.

The contractor shall prepare and complete in a timely fashion, the medical and other required records for all parties he/she admits or in any way provides care for the hospital or health care facility (Service Unit Medical By-Laws). Documentation in the patient’s health record are to be completed on the day services are rendered. During the performance of their duties, the contractor shall provide for the consistent performance of patient care processes according to the standards for TJC accreditation program within IHS. These standards include: The Comprehensive Accreditation Manuals for Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

The contractor shall possess a professional medical education from a post-secondary academic institution or be licensed in a field of medical study as detailed in Attachment D. The contractor should be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications. The contractor shall have sufficient knowledge, competence and experience in providing these services on a regular schedule to the HHCC. The contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the contractor can relate constructively to IHS employees, contractors, vendors and individuals from the Native American community. The contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services. The contractor shall maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The contractor shall be required to utilize the electronic health record for chart documentation, after receiving training at Government expense.

The Contractor’s employee(s) shall be sensitive to the unique culture factors of the people they treat, which may include use of an interpreter as necessary in communication of services being rendered. Unique cultural factors that may contribute to the patient’s treatment include: use of their language communications; village and tribal customs; use of traditional healers; isolation;

housing conditions and lack of resources.

4. CONDITIONS FOR REMOVAL/REPLACEMENT OF MEDICAL PERSONNEL:

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a Contractor employee. The Contractor’s employee shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this contract.

The Contractor shall request government pre-approval to substitute or replace any of the Contractor’s employee of which it has provided qualifications and resumes under this contract. All Contractor-requested substitutes or replacements’ qualifications, experience and professional certifications must be at least equal to or greater than the original Contractor’s employee provided by the Contractor under this contract.

5. CONTRACTOR REQUIREMENTS:

For Medical & Professional Contractors, the contractor shall comply with all IHS facility infection control and safety procedures, and standards. During the performance of this contract, the Contractor shall provide for the consistent performance of patient care process according to the standards of The Joint Commission (TJC) and/or Centers for Medicare Services (CMS) who supplies accreditation to the Phoenix Area Indian Health Service hospitals and health centers. These standards shall include: The Comprehensive Accreditation Manual for Critical Access Hospitals, and the Laboratory Standards as they represent the scope of services of this contract.

For Medical& Professional Contractors, the contractor shall complete in a timely fashion, the medical and other required records for patients he/she admits or in any way provides treatment. Chart notes are to be completed on the day services are rendered. The contractor shall abide by the Service Unit Medical By-laws and rules and regulations and meet all credentialing requirements in accordance with the Service Unit Medical Staff By-laws. If required by the Service Unit, the IHS will provide training for the Contractor’s employee on Electronic Health Records (EHR). Failure to abide by this requirement is basis for cancellation of this contract. Medical Records will be the property of the U.S. Government and will be placed in each patient’s chart at the health center. The Medical Records shall not leave the premises.

Medical records used for patients treated by the Contractor’s employee shall conform to the Privacy Act and Standards for Patient Confidentiality. An unauthorized disclosure from a person’s record, protected by the Privacy Act, may be subject to a penalty of up to $5,000 per incident.

The Contractor shall be responsible for notifying the Chief of Emergency Department or the Acting in case of an emergency or inclement weather that would prevent him/her from providing his/her schedule/shift.

The Contractor shall contact the Chief of Emergency Department or the Acting Chief and be responsible for all documentation required for eligibility and temporary staff privileges at Health Center. The Government will provide all space, equipment, supplies and forms to perform services.

The Contractor shall not be authorized to perform any services for the Government until the IHS Governing body has granted the Contractor such privileges in writing. Federal contract employees do not accrue any form of retirement, social security, insurance or any other form of benefits.

The Contractor shall assist and provide services and duties as may be requested for normal operational requirements for the department and personnel. The Contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the Contractor to meet these standards can result in the cancellation of the contract.

The Contractor shall have sufficient knowledge, competence and experience in providing these services on a regular scheduled clinic at Hopi Health Care Center. The Contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the Contractor can relate constructively to IHS employees, Contractors, patients, clients and individuals from the Native American Community.

The Contractor shall inform the COR, Contracting Officer or Program Manager or their designated representative of any problems encountered or which may be encountered in connection with meeting the needs of the Contractor’s duties.

The Contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services as there will be some moderate lifting with regard to boxes of office supplies, boxes of medication, and equipment.

The Contractor shall maintain acceptable standards of personal hygiene and grooming such that their image as a Federal contract employee is compatible with the expectations of the IHS staff.

The Contractor shall be required to provide regular report of hours worked to the Designated COR with an invoice. This report shall be verified by the Chief of Emergency Department, or, his/her designee, that can confirm the coverage.

If the Contractor is a locum tenens company, the Contractor(s) shall designate an individual who will be the “Project Manager” that will be available to discuss any problems or issues that arise with the COR. (Reference Addendum to FAR 52.212-2 Evaluation – Commercial Items, Technical Evaluation Factors, B Key Personnel).

The Contractor shall obtain and maintain, at his/her own expense, all state and/or medical licenses, registrations or certification required in the performance of the contract, and shall comply with all laws, regulations, (Federal, State, Tribal and respective hospital) ordinances in the performance of this contract.

Pursuant to the Federal Information Security Management Act (FISMA) of 2002 the Contractor shall complete the Computer Security Awareness Training (CSAT) course before computer access is provided or within a few days after receiving their access and annually after that. Within the Health and Human Services (HHS), there is a requirement for this training to be completed annually by all employees that includes the Contractor.

Upon award, the selected medical professional(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site for the Phoenix Indian Medical Center. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the Inspector General's exclusion list at http://exclusions.oig.hhs.gov/. Documented evidence of the clearances shall be provided to the Chief Contracting Officer at the Phoenix Area Indian Health Service, 40 North Central Avenue, Phoenix, AZ 85004.

6. MAJOR DUTIES REQUIRED:

The Contractor shall provide physicians that have completed a residency in Emergency Medicine, Family Medicine or Internal Medicine or other residency completion with 1.5 years of Emergency Medicine experience.

a. Contractor(s) serve as a Medical Officer (Emergency Medicine) which involves performance of Ambulatory Medical Treatment for emergency, surgical and medical care services, at Hopi Health Care Center, Polacca, Arizona.

b. The contract physician(s) of this position are designated as staff Medical Officer (Emergency Medicine) who provides direct care and services in the specialty are of Emergency Medicine.

c. Assignments include providing comprehensive and continuing health and medical care services for adult and pediatric patients. The incumbent is expected to handle the full range of cases and problems in specialty, including the very difficult and complex. Cases are sometimes critical and require immediate decisions. Incumbent also functions as consultant specialist to HHCC medical personnel and to physicians at Indian Health Service field hospitals. Participates in teaching activities as needed.

d. Provides emergency care as required, by interviewing (if possible) and examining any and all patients seeking emergency care. Contract physician(s) review past medical history, and immediately requests and/or performs diagnostic tests and examinations deemed necessary to obtain all possible information related to each case.

e. Contract physician(s) Make preliminary diagnosis, directs, prescribes or provides treatment, or arranges for specialized care or patient referral as required. Physician(s) base medical decisions upon information obtained and professional medical knowledge and skills. Contract physician(s) makes notes of observations and incorporates these into clinical records. Contract physician(s) provide definitive management, in all medical categories, for cases that do not require a referral. The provider gives total patient care including prevention, developing patient care plans, health maintenance, early diagnosis, providing instruction/counsel, treatment, and follow-up services to patients under his/her care.

f. Emergency Department Contract physician(s) shall respond to all ‘Code Blue” pages throughout the HHCC campus.

g. The contractor physician(s) shall comply with all HHCC policies and procedures. The physician(s) shall prepare and complete, in a timely fashion, the medical and other required records for all parties he/she admits or in any way provides care for the hospital or health care facility (Service Unit Medical By-Laws). During the performance of their duties, the contractor(s) shall provide for the consistent performance of patient care processes in accordance with the CMS Conditions of Participation and EMTALA, and the Joint Commission. The physician(s) shall also adhere to the Comprehensive Accreditation Manuals for Hospitals, The Laboratory Standards and Ambulatory Care Standards as they represent the scope of services of this contract. The Indian Health Service is moving toward a 100% use of the electronic health record (EHR). Once the emergency department is converted over to this electronic health record the contract provider(s) shall use the system for documentation. At that time, HHCC will provide training to all E.D. providers on the use of the EHR.

h. Provider(s) conducts urgent/emergent services, making observations appropriate to the patient’s underlying disease and treatment plan. Physician(s) review the patient’s medications, diet therapy course, and management plan. The provider modifies regimen as indicated. Physician instructs and counsels patients and family members as required.

i. Contract physician(s) refer patients to appropriate contracted medical (or other) facilities, providing full clinical information for care and diagnostic procedures that cannot be adequately provided at local IHS facilities. Coordinates and integrates information obtained into the ongoing Health Care Program at the Service Unit and assures timely follow-up care as required. Contract physician(s) also complete all necessary paperwork for Contract Health Services for all patients referred.

j. Contract Physician(s) work closely with allied health professionals (i.e., nursing, Community Health Nurse, Social Workers, Health Educator, etc.) to utilize and coordinate the services of Health Care Professionals in the management of the patient’s medical, psychological and social problems.

k. All contract physician(s) shall be formally granted clinical privileges in Emergency Medicine by the HHCC Governing Body or Executive Committee prior to assuming clinical responsibilities.

l. Supervision: The contract physician(s) shall provide guidance and instruction to all midlevel providers that work in the emergency department during each shift worked. The contract physician shall perform his/her professional work independent of Government supervision. However, matters of an administrative and non-technical nature will be referred to the Chief of Emergency Department Services and his/her designee. For the purposes of this order, the Chief of Emergency Department Services is designated as the “Supervisor”.

m. Schedule: The contractor shall record time and attendance which shall be verified by the supervisor and/or his/her designee.

n. Contractor shall ensure that proposed providers cooperate with and assist the Government in conduction of any necessary background checks.

7. CONTRACTOR MINIMUM REQUIREMENTS/QUALIFICATIONS:

A. The contractor shall provide the Government with the qualifications physician(s) who are Board Certified or "Board Eligible", or with a minimum of three (3) years of current medical physician experience in a facility with a minimum annual census of 10,000 patients.

B. Licensure shall be from the state of Arizona. The Contractor shall validate individual Pulmonary Specialist license and assure each license is in good standing.

C. Each licensed physician shall present an original current license when reporting to the HHCC for duty or for orientation whichever comes first. A copy is required for the contract file. No reimbursement will be made for physicians who report to work with an expired license or a license that is not in good standing.

D. Copy of valid BLS (Basic Life Support) certification.

E. According to current HHCC Policy as referenced by the HHCC Credentialing Education and Competency Plan. All Contractor’s employee shall have current certification described.

F. All Contractors must provide copy of resume for file. Contractor file will be kept by the HHCC for verification of license or certificate, also file will contain personal information such as home, address, and phone number, next of kin, person to notify in case of emergency, health requirements, mandatory in-service and continuing education, competency assessments and awards or disciplinary action.

G. Contractor’s employee is responsible for his/her own reliable transportation, travel, hotel, and per diem expenses in the performance of this contract.

H. Contractor is responsible for maintaining satisfactory standard of competence, conduct, appearance and integrity. The quality of work performance of the Contractor shall be subject to review.

I. Contractor shall abide by HHCC Standard of Conduct and policies and procedures.

J. Contractor is responsible for notifying the Chief Medical Officer and the on-call Chief

Medical Officer if he/she will be late or will be unable to work due to illness or any other reason.

K. Contractors who become sick while on duty will seek medical care from their own private physician, unless Contractor is eligible to receive health care from Indian Health Service.

L. Contractor is responsible for completing time sheets for actual hours worked.

M. The contractor(s) shall attend a Hopi Health Care Center orientation and all Contractors, Students, Volunteers and Temporary Staff are required to provide immunization records as proof of immunity or disease for MMR, Varicella, Hepatitis B or declination form, Hepatitis B titer for staff with potential for contact with blood or body fluids, seasonal influenza vaccine (October-March), Tdap and two TB Skin tests with results administered in the past 12 months, one must be within 30 days prior to the start date.

Persons with LTBI are required to complete the TB screening form and will be referred to the Employee Health Provider. Meningococcal is required for microbiology staff who are routinely exposed to isolates of Neisseria meningitides, boosters are needed every 5 years if the risk continues. Volunteers, contractors, students and temporary staff without proof of immunity or vaccination cannot report to duty, be scheduled into orientation, or be issued a badge until the immunization status has been confirmed. Employee health creates a file for all contractors, students, volunteers, and temporary staff. Contracting Coordinators/Supervisor are responsible to obtain complete immunization records for contractors and fax to the Employee Health Office for clearance.

8. CONTRACTOR CREDENTIALS:

The contractor shall provide a list of qualified candidates and the following documents per candidate as applicable:

1. Current Resume.

2. Two (2) letters of reference from current or previous employers.

3. Verification of Employment (VOE) required from a current or previous employer within the last three (3) years.

4. Copy of valid credential of certification by the American Board of Emergency Medicine, American Board of Family Practice, or equivalent.

5. Copy of a valid, unrestricted License to practice issued by the state of Arizona or another

US state.

6. Copy of valid BLS (Basic Life Support) certification.

7. Copy of medical malpractice liability coverage.

8. OMB NO 0917-0028, Addendum to Declaration of Federal Employment (OF-306).

9. Past Work Performance Statement, applicants must describe their present/previous experience in this field.

10. Current Health Status Report.

11. Copy of College Transcripts; conferred degrees and certified training in the field.

12. Certificate of Immunization.

13. Child Care Form, Addendum OMB Approved Form-2012.

9. SECURITY CLEARANCES:

The contractor shall ensure their employees have been properly screened prior to presenting to HHCC for employment under this contract. The contractor shall inform their employees to obtain Fingerprint cards or electronically submit their fingerprints through the HHCC Human Resources Department and complete the appropriate background investigation form which will be submitted for processing. No performance under this contract shall be allowed until the contractor’s employee is cleared through the HHCC Human Resources Department and issued a badge.

10. CREDENTIALING AND PRIVILEGING:

The contractor will participate in the credentialing and privileging process in accordance with existing procedure. Contractor shall provide no services prior to obtaining approval by the Government Medical Executive and Governing Board. The Contractor will be provided copies of current requirements and updates as they are published. Privileges will require renewal at least every one - two years in accordance with Government credentialing privileging policy and JCAHO requirements.

11. SUPERVISORY CONTROLS:

The Supervisory Department Officer, or designee, provides primarily administrative supervision. The supervising designee sets overall health care objectives and specifies resources available. The supervising designee provides for clinical supervision on a 24-hour, media and tour of duty coverage. The supervising designee reviews work performance on a periodic basis in order to evaluate proficiency in providing health care, discuss deficiencies and problems encountered, outline and/or approve new or changed practices to be employed, and provides consultation on specific cases and related problems. Work which involves out-of-the-ordinary diagnostic decisions or treatment is discussed with supervisory department officer or designee who keeps aware of the condition of such patients and all aspects of treatment regimen. Work performance is reviewed for conformance to IHS policy, procedures and accepted professional practices;

and the Quality Assurance improvement Program of the Medical staff of the Service Unit.

HHCC Medical professional(s) will provide guidance and instruction to the contractor’s staff providing services during each shift worked. Within established guidelines, contractor(s) exercise latitude in planning and carrying out health care assignments and in undertaking new procedures, practices and approaches to extend both services provided and increase individual proficiency. Overall work performance is reviewed jointly by the clinical director/supervising physician for effectiveness in meeting requirements for healthcare services.

12. DELIVERABLES:

A. The Contractor is required to provide a copy of each Contractor’s employee profile to the

Contracting Officer Representative prior to providing services at the Hopi Health Care Center.

B. Timesheets shall be submitted to the Supervisor or designee of the department at HHCC;

the timesheets shall be reviewed for accuracy and certified by signature as accurate and acceptable for payment, then forwarded to the receiving official for further processing of receipt of services through UFMS/PRISM.