SOW - Lawton Opthalmology.rtf

Ophthalmology Specialty Clinic

I. Statement of Work

The contractor shall provide 18 (one full retina day and one half day general ophthalmology each month) ophthalmologic specialty clinics per year at the Lawton Indian Hospital in Lawton, Oklahoma. These clinics shall be provided in accordance with the work schedule shown in Paragraph VI on an agreed upon date with the Lawton Indian Hospital, a total of eighteen clinic days per year. The hours of scheduled clinic shall be from 9:00a.m. to 4:00p.m each full day retina clinic and 8:00am to 12:00pm each half day general ophthalmology clinic. The clinic shall include:

A. Obtain and/or review of clinical data base relevant to the specialty problem, including history, examination, diagnosis, and treatment of eye diseases related to diabetes.

B. The Indian Health Service Diabetes Standards of Care will be utilized in the provision of care to persons with diabetes. Other clinical practice standards to follow are:

C. Provider notes for the medical record using the electronic health record (E.H.R.) and other related IHS documentation.

D. Provide any needed technicians and/or assistants other than front desk operations.

11. Y AG, Argon or micropulse laser peripheral iridotomy

12. A and B scan ultrasonography

13. minor surgical procedure (i.e. papilloma removal)

14. Avastin injections

F. Contractor shall review retinal photographs and retinal angiography results transmitted via email and provide phone consultative services related to these images.

II. Minimum Professional Qualifications

Contractor shall provide a Doctor of Ophthalmology who meets the following minimum professional qualifications and requirements:

III. Quality of Work

The contractor shall provide proper and adequate ophthalmology clinics for eligible Indian patients served under the terms of this proposed purchase order.

All services for patient care shall be in accordance with standard medical practices and shall be equal in quality to services for any facility accredited by Joint Commission on Accreditation for Health Care Organizations. All services shall be performed in accordance with the Performance Improvement program at the Lawton Indian Hospital.

IV. Indemnity and Insurance

The government assumes no responsibility for negligent acts of whether the contractor or his or her employees, therefore, the contractor is responsible for obtaining that amount of Professional liability insurance coverage that he or she considers appropriate. The contractor shall keep harmless and indemnify the government against any and all loss, cost damage, claims, expense or liability whatsoever resulting from the performance of this purchase order.

Contractors shall hold the Federal Government and its agent including the Chief Executive Officer. Lawton Indian Hospital and the Governing Board immune from civil or professional liability for all acts related to quality care management and enforcement of this purchase order.

RELATIONSHIP AND LIABILITIES OF PARTIES, INSURANCE REQUIREMENTS

It is expressly agreed and understood that the Professional Services rendered by the contractor are rendered in its capacity as an independent contractor. This contract contains provisions to allow the government to evaluate the quality of services provided, and for certain other administrative requirements. The government retains no control over the professional aspects of the services rendered by the contractor including the contractor's professional judgment and technical aspects of professional procedures. Therefore, the contractor shall be solely liable for any liability producing act or omissions by the contractor, employees of the contractor, subcontractor, or agents of the contractor.

V. Government furnished facilities, equipment and supplies

The government shall provide the facilities, standard equipment and specialized instruments of the Lawton Indian Hospital for use by the contractor in the provision of ophthalmology specialty clinics. The government shall provide supplies as necessary for use by the contractor for performance of Ophthalmology Specialty Clinics. The government shall provide assistance in scheduling of patients and in requesting and receiving supplies.

VI. Work Schedule The contactor shall provide 18 (1.5 days per month) Ophthalmology clinics per year at the Lawton Indian Hospital, Lawton, Oklahoma. The hours scheduled for the clinics are eight (8) hours for retinal clinic and four (4) for general ophthalmology clinic to be scheduled after consulting with the optometry staff. Overtime if necessary shall be at the expense of the contractor. Estimated patient workload is 40 patients for the full clinic, and 20 patients for the half-day.

VII. Reporting Requirements

The contractor will submit to the Contracting Officer's Representative the following items in the quantities stipulated within the time frame identified below:

Special Reports Original + two (2) As specified

a. Monthly invoices shall be submitted on Contractor's stationary and shall reflect a signature of duly authorized agents of Contractor. Invoices shall include a register of patients treated ref1ecting the following: name, date of birth, chart number and date of clinics during which each service was provided. This shall be separate from the invoice.

Monthly Report of services and invoices shall be submitted within the time periods stipulated above to:

Financial Management, Oklahoma City Area Indian Health Service 701 Market Drive, Oklahoma City, OK 73114

FAX: 405-951-3873

b. Special reports may be requested by the program during the contract on technical or administrative aspects of contract performance. These special reports would entail peer reviews or OPPEs/FPPEs.

The contractor shall complete all records, documentation, audits and reports in compliance with Indian Health Service Program policies for patient services and medical records.

VIII ORIENTATION (PRE-PERFORMANCE)

b. The IHS shall provide appropriate information to the contractor’s personnel regarding the topics and shall document the meeting.

c. The Contractor shall be responsible for ensuring that contractor’s personnel performing services receive the information required above.

X. MEDICAL RECORDS CHART REVIEW FOR CLARITY/COMPLETENESS:

All medical records entries shall be complete and signed by the attending physician. The Contractor shall document services utilizing the appropriate electronic medical record system for patient encounters. Completes all required administrative paperwork in a timely manner to include electronic consults, co-signatures, completion of chart or Risk Management Reviews, unusual occurrences, and peer review as required. Receiving Reports for time periods worked SHALL NOT BE COMPLETED until Medical Records has reviewed chart entries certifying he/she has completed all required information and signatures are completed. Before departing the contract, the Contractor shall report to Contracting Officer that all medical records entries have been completed. If medical records are not completed, the last invoice will not be paid until the Physician completes the medical records entries. Contractor shall be paid for actual hours worked.

XI. PRIVACY ACT NOTIFICATIONS:

This contract requires the Contractor, on behalf of the Indian Health Service (IHS), to provide health care to American Indians and Alaskan Natives and report selected medical record and financial information to IHS. The Snyder Act (25 U.S.C. 13) and Public Law 83-5658 (42 U.S.C. 2001) authorizes the collection of this information. To be reimbursed by IHS, you must provide the information requested by delivery/task orders issued under this contract. IHS will use the information for financial, legal, research, and health care purposes.

Disclosure of this information may be made by IHS to: other providers of health care for treatment or health maintenance of American Indian or Alaskan Native people; the Office of Worker's Compensation Programs, Department of Labor; the Department of Justice for their representation of the United States; and for congressional inquiry; quality assessment, medical audit, or utilization review; billing third parties for the payment of care; analytical and evaluation studies; to Federal or State agencies as required by law, research purposes supported by IHS; and identification of handicapped children under 10 U.S.C. 1401 et. Seq.

Disclosure of the appropriate medical record information without prior consent of the subject patient may be made by you to: another provider of health care treating the same patient; a Federal or State agency as required by law such as the reporting of communicable diseases, births, deaths, or the commission of crimes (i.e., gunshot wounds, rape, child abuse or neglect, alcohol or drug abuse, etc.); and billing third parties for the payment of care not reimbursed by IHS. You must forward all other requests for information contained on this form to the applicable IHS Ordering Official.

XII. CHARACTER INVESTIGATION:

Individuals providing services on personal or non-personal services contract, the duties and responsibilities of which involve regular contact with, or control over, Indian children, are subject to a character investigation. IHS personnel offices shall conduct these investigations following award of personal or non-personal services contract unless in the judgment of the Contracting Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individuals shall not have unsupervised contact with Indian children.

All contractors providing services will also need to be cleared by Indian Health Services Human Resources before allowed to report on-site and see patients.