Atch D - Statement of Work.pdf

Statement of Work for Radiology

Physician Services at PIMC

INTRODUCTION:

It is the intent of Phoenix Indian Medical Center (PIMC) to acquire non-personal Professional Medical Services for a

Board Certified Radiology Physician services as described herein for Phoenix Indian Medial Center (PIMC) located in

Phoenix, Arizona.

The recurring needs of the service unit are for a part-time Radiology Physician on an “as needed” basis for the duration of the contract. The specific need of this specialty is difficult to predict and therefore it is likely that PIMC may not use the estimated hours each year, however having them available when the need arises will minimize service disruptions.

Also, even when the best plans are made to hire and retain staff, our national need of medical services makes this difficult and we can have staff shortages despite trying to hire a full-time employee.

The intent of this contract is to establish a method whereby the PIMC can minimize disruptions in medical service because of staff changes and shortages over the next five (5) years. Requests for contractor coverage will be based on the consistently changing needs of the clinic.

This will be a single award with a one-year base period of performance with four (4) one-year option year periods of performance.

Physicians shall complete the Indian Health Service mandated security clearance requirements prior to commencement of services at the PIMC. The Contractor shall provide a Board Certified Radiology Physician for Phoenix Indian Medical

Center (PIMC). Provide services for a 12-month base period and four (4) 12-month option periods. Shift times and schedules are subject to change based on the medical needs of the patient populace and hospital and clinic operations.

Please note: The contractor shall provide and identify at least (3) weeks in advance of the scheduled performance date the provider for the scheduled shifts. This is due to the Government’s security clearance and credentialing/ and or privileging requirement.

LOCATION:

All services shall be performed in the Medical Imaging Department Phoenix Indian Medical Center (PIMC) located in

Phoenix, Arizona.

Phoenix Indian Medical Center Radiology

Department

4212 North 16th Street Phoenix, AZ 85016

A. STATEMENT OF WORK:

The overall scope of this contract is to provide qualified and experienced healthcare and medical care providers under a

Government service contract. The Contractor(s) will be expected to have the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department(s). The Contractor shall be qualified to cover the range of services required by PIMC to include diagnostic radiology, computed tomography, ultrasound, 2D and 3D mammography and MRI competency is optional and desirable. Any radiologist who interprets mammograms at PIMC must possess the credentials and qualifications established by the FDA’s Code of

Federal Regulations: 21CFR900.12. 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 Contractors(s) shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the respective 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 or at a minimum a request that the Contractor(s) be dismissed and a new Contractor(s) be dispatched. The contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this statement of work

The overall scope of this government service contract is to provide physician services in Medical Imaging

Department at the PIMC location. Clinic day services shall be performed in accordance with a work schedule established by the Chief of Radiology or designee. The following describes knowledge, skills and abilities physicians must possess:

1. Skill and knowledge of established concepts, principles and practices related to health care assignments and additional training or experience in assessing the conditions of patients, in providing medical care and in advising on health care needs, all with full consideration of mental, emotional and physical factors;

2. Knowledge of the diagnostic, preventive and therapeutic position related to a variety of medical health care fields to include Family Practice Physician, emergencies, medicine, minor/major surgery and nutrition;

3. Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience and reliability in carrying out patient care;

4. Knowledge of the availability and use of resources designated as primary care and referral services;

5. Skills in making diagnosis and in choosing, initiating and modifying selected therapies; and ability to provide emergency treatment;

6. Skill in diplomacy and tact while working in stressful situations;

7. Skill in working with people from a wide variety of backgrounds and different cultures;

8. Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health condition is that require medical management;

9. Ability to provide individual and family counseling, guidance and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health;

10. Ability to collect, organize, record and communicate, in a meaningful way, data relevant to primary health assessments including the detailed family and medical history, a physical examination and selective laboratory tests;

11. Ability to perform special screening and developmental tests and assess routine and specialized laboratory and radiological services;

12. Ability to provide guidance and leadership to other healthcare providers;

13. Attend required training in order to utilize the Electronic Health Record (EHR) for chart documentation to enter all lab, x-ray and medication requests.

14. Shall be sensitive to the unique cultural factors of the patients they treat, which may include, use of an interpreter to communicate services being rendered. Unique cultural and socio- economic factors that may contribute to the patient’s treatment outcome include: use of their language communications; village and tribal customs; use of traditional healers; isolation; housing conditions and lack of resources.

15. Providers may be required to work beyond normal duty hours, on weekends, holidays and after regularly scheduled duty hours on an as needed basis for emergencies.

16. There will be no provision for Government housing as housing is readily available within metropolitan Phoenix, Arizona.

17. Physicians shall not have worked or have health restrictions which could directly or indirectly interfere with the performance of providing health care services.

18. Demonstrate proficiency in writing, typing and possess basic knowledge and understanding of computer hardware and software applications;

19. Possess sufficient initiative, interpersonal relationship skills, social and cultural sensitivities and appropriate professional behavior in order to relate constructively to IHS employees, contractors, vendors and individuals from various Native American communities or Tribes;

20. Possess a current, valid state driver’s license from any of the 50 United States or the Commonwealth of Puerto Rico;

21. 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.

B. SHIFT SCHEDULE:

a. Dayshift: 8:00 a.m. – 4:30 p.m. (8 hours shift) with 30-minutes unpaid lunch.

b. Currently, radiology services are scheduled for Monday through Friday Specific days may change based upon the needs of PIMC.

C. PRICE SCHEDULE:

See Attachment A – Rate Schedule

Hourly fixed rate shall be inclusive of all other fees (holiday, nights, and weekend) including travel expenses, per diem, lodging, local, city, state, federal taxes, and all miscellaneous costs associated with the provision of services. The government will pay one flat rate.

Physicians shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate

(one flat rate). There is no provision for nights, weekends, and holidays except for overtime and on-call.

*Thirty (30) minutes lunch breaks are included in the shift hours and will not be paid by the Government.

RATE TYPE:

Rate Type: Firm Fixed Price, ALL INCLUSIVE RATE.

D. PERIOD OF PERFORMANCE:

The period of performance shall be for a base plus four (4) one year option years commencing from the date of award.

E. QUALIFICATIONS/CERTIFICATIONS –RADIOLOGY PHYSICIANS

Contractor shall provide medical and related professionals with experience in these areas.

1. Radiology Physician:

a. Years of Experience: minimum of 1 year of experience as a Radiology Physician within the previous 2 years.

b. Minimum Education:

i. Must have successfully completed an Undergraduate Program, Medical School (M.D. or D.O.), Internship, and Residency Program.

ii. New Residency Graduates accepted. Must have completed a radiology residency which is a minimum of 4 years.

c. Certification:/License:

i. Be board certified/eligible in Radiology Services by the American Board of Radiology or American

Osteopathic Board of Radiology.

ii. Board of Internal Medicine or AOA equivalent (AOA osteopathic internal medicine).

iii. Have an active and unrestricted license to practice medicine in the USA, or the District of Columbia, or the

Commonwealth of Puerto Rico.

iv. Current certification in BLS (Basic Life Support)

d. Specialize In: Diagnostic radiology, computed tomography, and ultrasound. 3D Tomosynthesis mammography and MRI competency is optional and desirable.

F. CONDITIONS FOR REMOVAL/REPLACEMENT OF PHYSICIAN(S)

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a Physician.

The Contractor’s employee shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this award, and/or the Contractor’s VA/FSS contract.

The Contractor shall relieve contracted staff within 24 hours of notice and, if a replacement is needed, the replacement should be available within one week of the removal.

G. CONTRACTOR REQUIREMENTS

For Medical & Professional Contractors, the Physicians shall comply with IHS facility infection control; safety policy and procedures; and standards. During the performance of this contract, the Contractor shall provide consistent performance of patient care processes according to TJC and/or Centers for Medicare Services (CMS) who issues 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 Physicians 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 providers 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.

Each Contractor physician must be eligible for billing to the Centers for Medicare & Medicaid Services(CMS).

The Contractor’s employee must complete CMS-8551 and CMS-855R Medicare and Medicaid Enrollment Applications and any other insurance paperwork. Copies and/or access to patient medical records shall be provided to the business office personnel for the purpose of financial matters regarding billing and insurance collections. PIMC will process all eligible third party claims for reimbursement for services provided by the Contractor(s).

Medicare and Medicaid:

Enrollment Initial Application: If physician is approved for credentialing and privileging, PIMC will send CMS forms to the contractor for the physician to complete/sign and return to PIMC Business Office.

Contractor shall not allow physician to interpret studies for PIMC until CMS forms are returned and approved by the PIMC Business Office within 21 business days. Confirmation can be obtained by contacting the PIMC Business

Office

Revalidation Application: Contractor shall be notified 6 months prior to revalidation of CMS Applications. PIMC will send CMS forms to the contractor for the physician to complete/sign and return to PIMC Business Office. Contractor shall not allow physician to interpret studies for PIMC until CMS forms are returned and approved by the PIMC Business

Office within 21 business days. Confirmation can be obtained by contacting the PIMC Business Office

H. CONTRACTOR CREDENTIALS:

The Contractor shall provide a list of qualified physicians and the following documents for each provider: (During

Solicitation the highlighted elements in yellow are to be submitted)

1. Current Resume or C.V

2. Credentialing documents and degree conferred

3. Conferred degrees and certified training in the field

4. Copy of active unrestricted License to Practice Medicine and Radiology Certification

5. License Certification Statement

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

7. Past Work Performance Statement, applicants must describe their present and previous experiences in this field

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

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

10. Current Health Status Report

11. Certificate of Immunizations

I. MAJOR DUTIES REQUIRED BY POSITION:

Radiology Physician:

The Contractor shall provide a Physician – Radiologist for the Phoenix Indian Medical Center (PIMC) Radiology

Department:

1. Contractor provides comprehensive radiological interpretation of radiology studies on inpatients and outpatients of all ages from newborn to elderly. Incumbent functions as a general radiological consultant to the government medical personnel, physicians and ancillary providers at all facilities whom refer patients. Workload should conform to the National Standard of 15,000 to 18,000 procedures per year, indexed to hours worked.

2. Contractor obtains history for radiographic diagnosis, carries out appropriate physical examination, if required, obtains indicated laboratory test results, and assess the severity of illness. Contractor may contact patients and referring physicians to provide results of studies and tests.

3. Contractor may be required to oversee the radiographic examination, ensuring the correct radiographic procedure is conducted, relating the symptom to the pain and/or illness of the patient.

mailto:CheryleLynn.King@ihs.gov

4. Contractor provides consultation, reporting the radiological diagnostic examination, delivering interpretation of the study and the diagnoses of the x-ray to the clinician. Recommends and directs the care and treatment of the patient.

Consults with the requesting physician before a procedure is done, deciding on the procedure and ensuring the minimization of the invasion of the patient.

5. Contractor shall be responsible for submitting Diagnostic Radiology reports. These reports of diagnostic interpretations shall be submitted as electronic or transcription dictation (on Hospital furnished equipment), handwritten, or typed as directed in Departmental Standard Operating Procedures (SOP) by the Chief, Department of

Radiology. Reports shall be approved each day by close of business.

6. Contractor may provide technical direction for the technologists and ancillary personnel in the Department in the performance of their duties.

7. Contractor shall be required to maintain professional knowledge and proficiency in Diagnostic Imaging through continuing education, staff meetings and workshops.

8. Contractor will be required to comply with department Performance Improvement criteria.

9. Contractor shall immediately notify ordering clinician of any critical findings and values, by person and/or phone and document the notification in the medical record. (1 hour or less)

10. Contractor shall notify the physician or other ordering provider of the results of Pulmonary Embolism CTs within 30 minutes of receipt of the study, whether the study is positive or negative. The written report should be completed as soon after that as possible, and definitely within one hour. The written report should document the time that the study was received, the time that the verbal report was given to the provider, and the name of the provider.

11. Contractor will provide/demonstrate profile of Radiologist, providing complete work experience/history of work experience, education, current licensures, and a complete PIMC credentialing package.

12. Contractor shall be licensed in accordance with regulations in the state of principal practice and maintain licensure during performance of this contract.

13. Contractor shall familiarize himself/herself with the particular requirements of the facility and beneficiary patient population.

14. Contractor shall be sensitive to the cultural aspects of providing health care to this particular population of Native

Americans.

15. Contractors shall work within the designated schedule prepared by the Contracting Officer Representative.

16. Contract shall complete time and attendance logs or sign-in/out sheets in RPMS menu.

17. Current certification is recommended as noted below:

[X] BLS (Basic Life Support)

[ ] ACLS (Advanced Cardiac Life Support

[ ] PALS (Pediatric Advanced Life Support)

[ ] ATLS (Advanced Trauma Life Support) for Emergency Room Physicians

J. SUPERVISORY CONTROLS

The Chief or Supervisor of the Department, or designee, provides administrative supervision and conducts the following:

1. Sets overall health care objectives and specifies available resources

2. Provides clinical supervision during tour of duty during clinic operating hours

3. 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

4. Work which involves out-of-the-ordinary diagnostic decisions or treatment is discussed with supervisor or supervising emergency department physician who keeps aware of the condition of such patients and all aspects of treatment regimen

5. Work performance is reviewed for conformance to IHS policy, procedures and accepted professional practices

6. Assures participation in Quality Assurance and Performance Improvement activities. In accordance with hospital policy, each contractor is subject to a prescribed focused peer review at the initiation of practice at PIMC. After that has been completed, if the contractor’s level of practice is deemed satisfactory, the contractor will be a part of the conventional peer review in which all radiologists participate. This includes radiology/pathology correlation, structured review of randomized interpreted cases, review of all breast biopsies, and morbidity and mortality review.

Within established guidelines, Physicians 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 performance reviews will be conducted jointly by the clinical director/supervising physician for effectiveness in meeting requirements for healthcare services.

K. SECURITY CLEARANCES

The Contractor shall ensure their physicians complete the following security clearance activities prior to reporting to work:

1. Obtain Fingerprint cards or

2. Process their fingerprints electronically, in person, at the PIMC Human Resources Department

3. Complete the appropriate background investigation form which will be submitted for processing to the Office of the Inspector General's exclusion list at http://exclusions.oig.hhs.gov/

4. 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

No performance under this contract shall be allowed until security clearances have been received by the PIMC Human

Resources Department and a PIMC employee badge has been issued.

L. CREDENTIALING AND PRIVILEGING

The physicians will participate in the credentialing and privileging process in accordance with existing procedures.

Physicians shall provide no services prior to obtaining approval by the Government Medical Executive and Governing

Board. The physicians 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 the Joint Commission requirements.

M. DELIVERABLES

The Contractor is required to provide a copy of each Contractor’s employee profile to the COR prior to providing services at the PIMC.

Timesheets shall be submitted to the Chief or Supervisor of the Department, or designee. The timesheets shall be reviewed for accuracy and certified by signature as accurate and acceptable for payment by the Practice Manager; or his/her designee;

and forwarded to the receiving official for further processing of receipt of services

N. PERFORMANCE CONDITIONS

The COR will submit schedules of required coverage a minimum of 15 calendar days prior to the first day of coverage requested.

In the event the Contractor’s employee is unable to render service on a previously agreed schedule, the Contractor http://exclusions.oig.hhs.gov/ shall provide a minimum seventy- two (72) hour notification to the COR. The Contractor shall then make a full, good-faith effort to provide coverage with a replacement.

Both parties recognize that on occasion there shall be a need to fill coverage requests with less than a 15-day notice. In such an emergency scheduling situation, the Contractor shall make a full, good-faith effort to accommodate the emergency request. If the Contractor is unable to meet the emergency scheduling request, they shall immediately notify the

COR and those involved in scheduling.

O. PERFORMANCE STANDARDS

(a) Introduction – Performance Requirements:

(1) A Quality Assurance Surveillance Plan (QASP) has been developed for in-house operations or to implement a service contract. It is designed to aid the PO in providing effective and systematic surveillance of all aspects of professional services. This plan provides for monitoring the contract requirements

(b)

The objective of this surveillance plan is to evaluate how the Contractor is performing in key areas. The government is primarily interested in the final service being provided and not in the details of accomplishment.

(c) The principal method of surveillance will be daily in some cases or by use or periodic inspections.

Appropriate indicators are provided for recording observations in this type of surveillance.

(d) How to Use the Performance Based Matrix

Outcome Required

Services

AQL

Standard

Max

Allowable

Degree of

Deviation from

Requirement

/ (AQL)

Normal Method of

Surveillance

Incentives and Deduction from Contract

Patriciate and meet conventional peer review

Supervisory Controls Participate in conventional peer review and maintain satisfactory rating.

This includes radiology/pathology correlation, structured review of randomized interpreted cases, review of all breast biopsies, and morbidity and mortality review.

100%

Compliant

Government review of

Contractors interpreted cases for compliance and satisfactory rating.

Incentive: Government approves documentation

De-incentive: Government reject documentation and remove physician.

Notify ordering provider within

30 minutes of receipt of

Pulmonary

Embolism CT study

Major Duties - Timely

Reporting Results

Radiologist shall notify emergency room of positive or negative Pulmonary

Embolism within 30 minutes of receiving exam.

100%

Compliant

Government review of

Contractors exams.

Incentive: Government approves documentation

De-incentive: 2 incidents (per month) may result in removal of physician.

Notify ordering provider within 1 hour of critical finding.

Major Duties -Timely

Reporting Results

Radiologist shall notify ordering provider within 1 hour to report critical findings.

100%

Compliant

Government review of

Contractors exams.

Incentive: Government approves documentation

De-incentive: 2 incidents (per month) may result in removal of physician.

Medical

Providers in compliance with Services

Contract

CMS-8551 and CMS-

855R Medical

Enrollment applications completed.

CMS-8551 and CMS-

855R Medical

Enrollment

Applications completed prior to physician interpretation services.

100%

Compliant

Government review of

Contractors documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation;

physician cannot read under contract, Government payment may be withheld.

(i) Each defect observed will be recorded on the tally report. These documents will then become a formal record for later reference. The tally of defects at the end of each clinic or year (dependent on criteria) will be compared to the acceptable number of defects appearing in the surveillance plan. Errors detected by the PO in the course of surveillance will be transmitted to the Contractor or in-house personnel for correction. Notification of errors will take place within five (5) working days. Specifics concerning any errors should be recorded on the tally checklist. The Contractor or in-house personnel, as applicable, should be asked to initial this record.

(ii) Project Officer shall forward a copy of Contractor’s compliance with performance and non-performance compliance reports.

(e) Quality Assurance Surveillance Plan (QASP):

(i) The Government shall monitor the Contractors’ performance through a Quality Assurance

Surveillance Plan (QASP). The QASP is for informational purposes only and not considered part of the contract.

(ii) Surveillance systems will include periodic inspection and acceptance of all deliverables as cited in the contract.

The Quality Assurance Surveillance Plan (QASP) outlines required standards and will be a part of the contract.

ADDENDUM

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA): The Contractor shall adhere to the Provisions of Public Law 104-191, HIPAA of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). Medical records of IHS patients are Federal records and are subject to some or all of the following laws: the Privacy Act. 5 U.S.C. 552a; the Freedom of Information Act. 5 U.S.C.

552; the Drug Abuse Prevention. Treatment. and Rehabilitation Act. 21 U.S.C. 1101. the Comprehensive Alcohol

Abuse and Alcoholism Prevention. Treatment and Rehabilitation Act. 42

U.S.C. 4541. the Health Insurance Portability and Accountability Act of 1996.42 U.S.C. 1301. PIMC's Confidentiality of Certain Medical Records. 38 U.S.C. 7332; Confidential Nature of Claims. 38 U.S.C. 5701; Medical Quality

Assurance Records Confidentiality. 38 U.S.C. 5705. and Federal regulations promulgated to implement those acts. 38

U.S.C. 5705 (Confidentiality of Healthcare Quality Assurance Review Records), 38 U.S.C. 7332 (Confidentiality of certain medical records), as well as 45 C.F.R. Parts 160,162 and 164 (Health Insurance Portability and Accountability

Act) should be followed.

MEDICAL RECORDS:

Patient medical records are confidential and are protected by the Privacy Act of 1974, 5

U.S.C. 552a. Any breach of confidentiality and/or unauthorized release of information is subject to monetary penalty. Any individual making unauthorized disclosures may be criminally liable for violations of the Act.

End of Statement of Work