Attachment A - PWS_Hospitalist_PIMC_Phoenix_Area.pdf

Hospitalist Physician Services | PIMC and Participating Phoenix Area Ordering Activities | Revised BPA PWS

HOSPITALIST PHYSICIAN SERVICES

PHOENIX INDIAN MEDICAL CENTER AND PARTICIPATING PHOENIX AREA ORDERING

ACTIVITIES

Performance Work Statement (PWS)

1. PERFORMANCE-BASED SUMMARY

This requirement is structured as a performance-based acquisition for non-personal professional physician hospitalist services. The Contractor is responsible for achieving the performance outcomes stated in this PWS and each resulting

Blanket Purchase Agreement (BPA) Call, including reliable staffing, timely and appropriate inpatient clinical care, complete documentation, continuity of coverage, and compliance with applicable clinical, credentialing, patient-safety, and facility standards.

2. INTRODUCTION AND ACQUISITION STRUCTURE

The Phoenix Area Indian Health Service (IHS) requires qualified physician hospitalists to provide acute inpatient hospital medicine services. Phoenix Indian Medical Center (PIMC) is the principal Ordering Activity and the primary clinical requirement upon which this PWS is based. The Government intends to establish one or more BPAs. Individual funded requirements will be ordered through authorized BPA Calls.

Other Phoenix Area Service Units may use the resulting BPA(s) for hospitalist requirements that fall within the general scope of this PWS. Participation by another Ordering Activity does not alter PIMC clinical management of Hospital

Medicine services performed at PIMC. Each Ordering Activity remains responsible for its own facility-specific clinical coordination, credentialing and privileging, orientation, patient-safety requirements, and acceptance of services.

Each BPA Call will identify the Ordering Activity, place(s) of performance, required coverage hours or shifts, schedule, period of performance, funded ceiling, and facility-specific requirements. Establishment of a BPA does not guarantee issuance of a Call, any minimum quantity, or any minimum number of hours.

This is a non-personal services requirement. Contractor personnel are not Government employees and shall not be subject to continuous Government supervision or control. The Contractor retains responsibility for recruiting, employing, scheduling, assigning, supervising, managing, compensating, and ensuring the performance of its personnel.

3. ORDERING ACTIVITIES AND INCLUDED FACILITIES

PIMC is the principal Ordering Activity. Other Phoenix Area Ordering Activities may participate when an identified hospitalist need is within the scope of this PWS. The Government identifies the known primary and affiliated facilities below so that Quoters may consider the actual potential places of performance when developing fully burdened hourly rates, including geographic location, remoteness, provider availability, travel, transportation, lodging, and other performance-related costs. A BPA Call may require services at the primary facility, one or more affiliated facilities, or a combination of facilities within the applicable Ordering Activity. The specific place(s) of performance will be identified in each BPA Call. Inclusion of a facility does not guarantee that services will be ordered for that facility.

Ordering Activity Included Facilities

Phoenix Indian Medical Center (PIMC) Phoenix Indian Medical Center - principal facility and primary requirement; Ak-Chin Clinic; Fort McDowell Yavapai Health Center; Salt River Pima-Maricopa Indian Community (SRPMIC) clinic/facility, Yavapai Apache Health Center, Camp Verde, Arizona when hospitalist services within the scope of this PWS are identified in the applicable BPA Call.

Whiteriver Service Unit (WRSU) Whiteriver Hospital - primary facility; Cibecue Health Center/Health Station; other WRSU satellite facilities expressly identified in the applicable BPA Call and within the scope of this PWS.

Hospitalist Physician Services | PIMC and Participating Phoenix Area Ordering Activities | Revised BPA PWS

Ordering Activity Included Facilities

Colorado River Service Unit (CRSU) Parker Indian Hospital - primary facility; Peach Springs Health Center; Peach Springs Health Station; Irene Benn Health Clinic, Moapa, Nevada; Chemehuevi Clinic, Havasu Lake, California; Supai Health Station, Arizona;

other CRSU satellite facilities expressly identified in the applicable BPA Call and within the scope of this PWS.

Yuma Service Unit Facility identified in the applicable BPA Call.

Hopi Service Unit Facility identified in the applicable BPA Call.

Elko Service Unit Facility identified in the applicable BPA Call.

Fort Duchesne Service Unit Facility identified in the applicable BPA Call.

Unless the Pricing Schedule establishes a separate facility-specific rate, the fully burdened hourly rate established for the applicable Ordering Activity shall apply to the primary and affiliated facilities identified under that Ordering Activity.

Quoters are responsible for considering the geographic and logistical characteristics of those facilities when developing quoted rates.

3.1 PLACE OF PERFORMANCE AND CONTRACTOR TRAVEL RESPONSIBILITIES

Contractor personnel are responsible for their own transportation to and from the applicable place of performance and for all transportation necessary to report for scheduled services. The Contractor is responsible for arranging and providing all travel, transportation, airfare, mileage, lodging, meals, per diem, rental vehicles, relocation, and other expenses necessary for its personnel to perform at the location identified in the BPA Call.

Unless expressly authorized otherwise in the BPA Call, the Government will not separately reimburse travel, transportation, airfare, mileage, lodging, meals, per diem, rental vehicles, relocation expenses, or other travel-related costs. Such costs shall be included in the Contractor's applicable fully burdened hourly rate.

Government housing is not provided or guaranteed. The Contractor is responsible for identifying and arranging suitable lodging or accommodations for its personnel when necessary. Quoters are responsible for considering facility remoteness, availability and cost of lodging, transportation requirements, travel distances, and other location-specific conditions when developing quoted rates.

Travel time to or from the place of performance, commuting time, and time associated with obtaining meals, lodging, or transportation are not compensable hours unless expressly authorized in an applicable BPA Call.

4. COVERAGE HOURS AND SCHEDULING

The specific coverage requirements, including authorized hours, shifts, schedules, period of performance, and place of performance, will be identified in each BPA Call. The Contractor is responsible for determining the number of qualified physicians necessary to provide the coverage ordered under each BPA Call.

4.1 PIMC Anticipated Coverage Structure

PIMC Hospital Medicine requires on-site inpatient hospitalist coverage seven days per week, including holidays, as ordered. The anticipated shift structure below reflects the current PIMC operating model and may be refined in the solicitation pricing schedule or individual BPA Call based on patient census, clinical operations, funding, and actual coverage needs.

• Daytime coverage: generally 8-hour and/or 11-hour shifts, historically 7:00 a.m. to 3:00 p.m. and 7:00 a.m. to 6:00 p.m. Coverage may include one or more hospitalists based on the authorized requirement.

• Nighttime coverage: generally a 13-hour on-site shift, historically 6:00 p.m. to 7:00 a.m., as ordered.

• Off-site on-call coverage is not required unless expressly stated in an authorized BPA Call.

Coverage Hours. The solicitation Pricing Schedule may identify estimated annual hours for acquisition planning and price evaluation. Such estimated hours do not guarantee any minimum number of hours, services, staffing positions, full-time equivalents, or purchases under the BPA. Actual coverage requirements, authorized hours, schedules, periods of performance, and funding will be established through individual BPA Calls.

4.2 WRSU Anticipated Coverage Structure

Whiteriver Hospital maintains Hospitalist coverage in conjunction with Government-employed physicians. Contractor services under this BPA are intended to augment existing WRSU Hospitalist staffing and are not intended to represent the entirety of WRSU's Hospitalist coverage requirement.

Hospitalist Physician Services | PIMC and Participating Phoenix Area Ordering Activities | Revised BPA PWS

WRSU's current operating model includes daytime and nighttime Hospitalist coverage, generally using 12-hour shifts from

7:00 a.m. to 7:00 p.m. and 7:00 p.m. to 7:00 a.m. The overall staffing model may include two Hospitalists during daytime coverage and one Hospitalist during nighttime coverage. Actual contractor coverage, shifts, schedules, and authorized hours will be established in individual BPA Calls.

The Government currently estimates approximately 4,152 annual contractor hours for WRSU for acquisition planning and price-evaluation purposes. This estimate does not represent guaranteed hours, minimum purchases, staffing positions, or a commitment to order services.

5. QUALIFICATIONS, LICENSURE, AND EXPERIENCE

Unless a BPA Call establishes a more stringent facility-specific requirement, each hospitalist physician shall:

• Have successfully completed an accredited residency in Internal Medicine or Family Medicine. A Family Medicine physician shall possess sufficient recent inpatient hospital medicine experience and training to safely perform the required duties and obtain the necessary facility privileges.

• Possess and maintain an active, current, full, and unrestricted license to practice medicine in a State, the District of

Columbia, the Commonwealth of Puerto Rico, or another jurisdiction acceptable under applicable Federal law and

IHS policy.

• Maintain current Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certification.

• Be currently Board Certified or Board Eligible, as defined by the applicable recognized specialty board, in Internal

Medicine or Family Medicine, subject to applicable facility credentialing and privileging requirements.

• Possess the education, training, clinical experience, professional judgment, and competencies necessary to provide acute inpatient hospital medicine services within the scope of privileges granted by the applicable facility.

Hospitalists with two or more years of hospital medicine experience are preferred. Recent residency graduates may be considered when their training and experience demonstrate the ability to safely perform the required inpatient duties and they satisfy all applicable credentialing and privileging requirements.

5.1 PIMC-Specific Clinical Capability

PIMC Hospital Medicine manages medically complex and potentially critically ill adult inpatients. Physicians proposed for

PIMC shall demonstrate recent experience and clinical capability appropriate to an acute inpatient hospital environment, including evaluation and management of complex conditions that may include liver failure, respiratory failure, heart failure, renal failure, sepsis, and other serious acute and chronic medical conditions encountered by the PIMC Hospital Medicine service. The applicable BPA Call and PIMC credentialing/privileging process may identify additional competencies or privileges required for the ordered coverage.

PIMC may consider documented current or recent experience in comparable inpatient hospital medicine environments, including demonstrated ability to manage admissions, transfers, discharges, medically complex patients, and coordination with emergency, surgical, intensive-care, and specialty services, as applicable.

6. SCOPE OF HOSPITALIST SERVICES

Hospitalist physicians shall provide acute inpatient physician services consistent with the applicable BPA Call, the capabilities of the ordering facility, granted clinical privileges, medical staff bylaws, facility policies, and accepted standards of medical practice. Duties may include, as applicable:

• Evaluate, admit, manage, round on, and discharge inpatients assigned to the Hospital Medicine service, consistent with the physician's granted privileges and the applicable BPA Call.

• Perform initial and ongoing assessment, diagnosis, treatment, medication management, daily or nightly rounds, and follow-up care.

• Evaluate patients in the Emergency Department or other clinical areas for potential hospital admission when requested and within granted privileges.

• Manage medical admissions and provide consultation or co-management of surgical patients when requested and clinically appropriate.

• Provide care on medical/surgical units and, when within facility capability and granted privileges, intensive-care or other higher-acuity inpatient settings.

Hospitalist Physician Services | PIMC and Participating Phoenix Area Ordering Activities | Revised BPA PWS

• Discuss and coordinate incoming transfers and determine, consistent with facility capabilities and clinical judgment, whether the receiving facility can provide the required level of care.

• Coordinate transfers out of the facility when a higher or different level of care is required, including communication with receiving clinicians and assistance identifying an appropriate destination.

• Order and interpret diagnostic studies and provide or arrange treatment, specialty consultation, referral, rehabilitation, skilled nursing, or other disposition as clinically indicated.

• Respond to urgent and emergent inpatient care needs during scheduled shifts in accordance with facility protocols.

• Participate in discharge planning, utilization management, patient-safety, quality-improvement, and care-coordination activities applicable to Hospital Medicine.

• Complete all required medical record documentation, orders, discharge documentation, and other clinical records within applicable facility and PWS timeframes.

• Provide consultation to other clinicians when requested and within the physician's scope of privileges.

6.1 PIMC Hospital Medicine Duties

At PIMC, the primary assignment is inpatient care for adult patients admitted to general medical/surgical units and, when within granted privileges and facility capability, the intensive care unit. PIMC hospitalists may also evaluate patients for admission from the Emergency Department, provide medical consultation or co-management, coordinate transfers, and support appropriate placement or disposition of patients. Contractor physicians shall remain available on site throughout scheduled shifts unless otherwise authorized by the applicable BPA Call.

PIMC hospitalists shall be available during scheduled shifts for urgent/emergent admissions and inpatient evaluations, including requests from clinical staff when a material question concerning diagnosis, deterioration, or patient condition requires hospitalist evaluation. Clinical decisions remain the independent professional responsibility of the privileged physician consistent with facility policies and standards of care.

6.2 Pediatric Services

Depending on the capabilities and needs of the Ordering Activity, a BPA Call may require Hospitalist services involving pediatric patients when such services are within the general scope of inpatient Hospital Medicine at the facility. A physician assigned to pediatric services shall possess the education, training, experience, clinical competency, and facility privileges necessary to safely perform the required pediatric care. Pediatric services shall be limited to those services authorized by the applicable BPA Call, within the capabilities of the ordering facility, and within the physician's granted clinical privileges. Patients requiring care beyond the capabilities of the facility shall be transferred or referred to an appropriate higher level of care in accordance with facility procedures.

7. PROCEDURES AND CLINICAL PRIVILEGES

Contractor physicians shall perform only those procedures for which they have been credentialed and specifically privileged by the applicable Service Unit. Hospital Medicine core privileges and separately requested privileges may differ by facility. Depending on the facility and privileges granted, procedures may include paracentesis, thoracentesis, lumbar puncture, skin biopsy, central venous catheter placement, arterial line placement, or other inpatient procedures. No procedure is required unless it is within the physician's granted privileges and within the capabilities, policies, and available resources of the facility.

8. STAFFING, CONTINUITY, AND REPLACEMENT PERSONNEL

The Contractor shall maintain sufficient recruiting and staffing capability to meet each awarded BPA Call. The Contractor is responsible for developing staffing schedules, assigning personnel, managing routine leave and vacancies, maintaining continuity, and providing qualified replacement personnel when necessary.

The Government will identify required coverage and communicate scheduling requirements through the BPA Call and authorized Government representatives. The Contractor shall coordinate proposed schedules sufficiently in advance to support continuity of operations. PIMC may require schedules several weeks or months in advance when stated in the

BPA Call.

If scheduled personnel become unavailable, the Contractor shall promptly notify the COR or designated facility representative. The Contractor remains responsible for providing the coverage required by the BPA Call and shall provide qualified replacement personnel when necessary, subject to Government credentialing, privileging, and approval

Hospitalist Physician Services | PIMC and Participating Phoenix Area Ordering Activities | Revised BPA PWS requirements. The Contractor shall maintain a mechanism for responding to urgent or emergent staffing needs, including nights, weekends, and holidays, when such coverage is within the scope of an awarded BPA Call.

9. HOURS CONTROL AND AUTHORIZATION

Services shall be performed only in accordance with an authorized BPA Call and approved schedule. The Contractor shall not exceed the authorized hours, shifts, funded ceiling, or period of performance without written authorization from the Contracting Officer or other authorization expressly permitted by the Call.

When immediate continuation of care is clinically necessary to protect patient safety, Contractor personnel may remain beyond a scheduled shift and shall notify the COR or designated facility representative as soon as practicable with supporting justification. Clinical necessity does not authorize the Contractor to exceed a funded BPA Call ceiling without appropriate contractual authorization.

10. PRICING AND PAYMENT

Unless otherwise expressly stated in the BPA or applicable BPA Call, each hourly rate shall be fully burdened and inclusive of all costs necessary to perform the services, including wages, fringe benefits, recruitment, credentialing and onboarding support, insurance, travel, transportation, airfare, mileage, lodging, meals, per diem, rental vehicles, relocation costs, taxes, subcontractor costs, overhead, general and administrative expenses, profit, and all other direct, indirect, or incidental costs associated with performance.

No separate premium will be paid for nights, weekends, holidays, overtime, extended shifts, travel, or lodging. Authorized hours worked beyond a scheduled shift will be invoiced at the same applicable fully burdened hourly rate established in the BPA and BPA Call. The Contractor shall not perform or invoice hours beyond the authorized coverage or funded ceiling except as permitted by the BPA Call or authorized by the Contracting Officer.

11. PERFORMANCE REQUIREMENTS AND QASP

Performance Objective Standard AQL Scheduled Coverage Fill scheduled coverage required by the

BPA Call with qualified, credentialed, privileged, and approved personnel.

98%

Urgent/Emergent Response Provide hospitalist evaluation within facility-required timeframes; when a Call specifies a 60-minute standard, meet that standard.

95%

Clinical Documentation Complete required charting and clinical documentation within facility-required timeframes and no later than 24 hours unless a more stringent standard applies.

95%

Clinical/Regulatory Compliance Comply with applicable IHS, Service Unit, medical staff, TJC/CMS, patient-safety, and professional standards.

100%

Contractor Responsiveness Respond to urgent Government staffing or contract-administration communications within the Call-established timeframe or, if none, within one hour during normal business hours.

95%

Achievement of an aggregate AQL does not excuse failure to provide an individual scheduled shift when that failure materially affects patient care or facility operations.

The Government may use schedule review, chart review, EHR audit, communication records, complaints, quality data, credentialing records, and other reasonable surveillance methods. Performance standards may be made more stringent by a BPA Call when justified by facility-specific clinical requirements.

12. MEDICAL RECORDS, EHR, AND PROFESSIONAL STANDARDS

Contractor personnel shall use the electronic health record and other clinical systems designated by the applicable

Ordering Activity. Medical records shall be accurate, complete, timely, and compliant with facility policy, medical staff requirements, applicable law, and accepted professional standards. Contractor personnel shall comply with applicable infection prevention, privacy, security, patient safety, quality assurance, and performance-improvement requirements and demonstrate professional conduct and cultural sensitivity appropriate to the population served by IHS.

Hospitalist Physician Services | PIMC and Participating Phoenix Area Ordering Activities | Revised BPA PWS

13. CREDENTIALING, PRIVILEGING, SECURITY, AND ONBOARDING

No Contractor physician may provide patient care until all applicable security, onboarding, credentialing, and privileging requirements of the Ordering Activity have been completed and the physician has been authorized to begin performance.

Submission or Government review of a representative CV during the BPA establishment evaluation does not constitute credentialing, privileging, approval of the individual for performance, or authorization to provide patient care.

Representative CVs are submitted for evaluation purposes only. Personnel proposed for an individual BPA Call remain subject to all applicable qualification verification, credentialing, privileging, security, onboarding, and facility approval requirements before performance.

The Contractor shall timely provide all documentation required by the applicable Service Unit, which may include a current CV/resume, professional licenses, board certification/eligibility documentation, references, education and training verification, health/immunization documentation, background investigation materials, exclusion screening information, and other credentialing or onboarding documentation required by IHS or the facility.

The Contractor shall ensure its personnel maintain required credentials, licenses, certifications, privileges, security clearances, and facility access throughout performance and shall immediately notify the Contracting Officer and COR of any lapse, restriction, investigation, exclusion, or other condition that may affect eligibility to perform.

14. NON-PERSONAL SERVICES AND GOVERNMENT CLINICAL COORDINATION

The Contractor retains responsibility for supervision, management, scheduling, assignment, compensation, and conduct of its personnel. Government personnel will not exercise continuous supervision or control over Contractor personnel.

Government medical staff may provide clinical coordination and direction necessary for patient care, including prioritization of clinical activities, consultation, coordination of care, and direction regarding facility policies, protocols, patient safety, and quality standards. Such clinical coordination does not create an employer-employee relationship and does not relieve the Contractor of responsibility for managing its personnel or the physician of independent professional judgment within the scope of granted privileges.

15. DELIVERABLES

Deliverable Frequency / Due Date Recipient Provider qualification, credentialing, privileging, security, and onboarding package

Prior to performance and as updated Ordering Activity / designated Government recipient

Staffing schedule and schedule updates As required by BPA Call COR / clinical designee Timesheet or other documentation supporting hours worked

As required for acceptance/payment COR / receiving official

Monthly performance and expenditure report

Monthly, when required by BPA Call COR

Staffing disruption / vacancy / replacement notification

Promptly upon identification CO and COR, as applicable

Corrective Action Plan Within timeframe specified by CO when requested

Contracting Officer

16. QUALITY ASSURANCE SURVEILLANCE

The Government will monitor Contractor performance using this PWS, the applicable BPA Call, and the Ordering

Activity's quality and patient-safety requirements. Failure to meet required performance standards may result in corrective action, removal or replacement of personnel, nonpayment for unperformed services, or other remedies available under the BPA and applicable Call.

17. BPA CALL-SPECIFIC REQUIREMENTS

Each BPA Call will identify the final requirement for the Ordering Activity. As applicable, the Call will state:

• Ordering Activity and specific facility/location(s).

• Shift start/end times and required days of coverage.

• Estimated hours and/or shifts.

Hospitalist Physician Services | PIMC and Participating Phoenix Area Ordering Activities | Revised BPA PWS

• Period of performance and funded ceiling.

• Applicable BPA hourly rate.

• Required schedule submission and staffing-coordination timeframes.

• Facility-specific credentialing, privileging, onboarding, clinical capability, procedures, reporting, and performance requirements.

• COR/clinical points of contact and invoicing/timesheet instructions.

If a BPA Call establishes a more specific facility requirement within the general scope of this PWS, the Call will control for that facility-specific requirement. The Contractor remains responsible for all other applicable terms of the BPA and this

PWS.

18. PIMC-SPECIFIC BPA CALL CONSIDERATIONS

Because PIMC is the principal Ordering Activity, PIMC BPA Calls may identify additional Hospital Medicine requirements necessary for its higher-acuity inpatient environment, including specific experience expectations, coverage patterns, ICU-related privileges, transfer responsibilities, procedures, EHR or workflow orientation, schedule coordination, and other clinical competencies supported by PIMC Hospital Medicine and credentialing requirements. Such requirements must remain within the general scope of the BPA and shall be identified in the applicable candidate request or BPA Call, as appropriate.

END OF PERFORMANCE WORK STATEMENT