General Surgeon PWS2.pdf

Description of Services

General Surgeon

4 September 2009

1.1. SCOPE OF WORK. The Contractor shall provide General Surgery services to perform inpatient outpatient General Surgery services required for government beneficiaries and other patients as directed. The Contractor shall perform outpatient hospital, emergency and regular clinic services in the

MTF or designated local civilian hospital. The Contractor shall provide care at the 39th Medical Group, also referred to as the “medical treatment facility” (MTF) herein, or in local civilian hospitals as required to support the general surgery needs of the MTF. Regular clinical services and consultation will be coordinated with the 39th Medical Group Staff for maximum support of general surgery requirements for the population’s need for care. Contractor shall furnish all labor, management, supervision, consultations, and reports. Contractor care shall be as comprehensive as government-supplied facilities, equipment, and support services permit. Performance shall be according to the requirements contained in the Performance Work Statement (PWS), and professional standards of the Accreditation Association for Ambulatory Healthcare.

1.2. CONTRACT PERSONNEL.

1.2.1. POINT OF CONTACT. The Contractor shall provide a point of contact that shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The Contractor shall designate this individual, in writing, to the Quality Assurance Personnel (QAP) before the contract start date.

1.2.2. ROUTINE AVAILABILITY. Regular clinical services and consultation shall be scheduled during normal clinic hours 7:30AM-4:30PM Monday through Friday. The MTF staff will schedule the contract personnel for in-house service dependent upon the needs of the U.S. Government. Major and minor outpatient/inpatient procedures and consultations shall be performed during regular clinical hours. On-call telephone standby shall be provided on a 24-hour basis. Emergency consultations shall be performed as needed. Authorized callers will be all 39th Medical Group medical providers assigned to the MTF.

1.2.2.1. ON-CALL RESPONSE TIME REQUIREMENTS. On-call telephone standby shall be provided on a

24-hour basis 7 days a week. As required and directed by the MTF, the Contractor shall be required to provide General Surgery services after normal duty hours and also to respond to requests for on-call support at any hour of the day, since services are frequently required during night hours and on weekends. On-call support shall be billed on an hourly basis when those hours exceed 160 hours per month in combination with normal clinical services provided. The Contractor shall provide General

Surgery services on-site or at the local civilian hospital as directed by the MTF within 60 minutes of notification by a 39th Medical Group medical provider of a routing on-call consultation requirement and within 30 minutes of an emergency requirement.

1.2.2.2. HOURS OF OPERATION. Personnel will not normally be scheduled for regular clinic services or surgery during wing down days and Federal or Turkish Holidays. Care rendered under this contract while performing in local civilian hospitals to eligible beneficiaries is inclusive in this contract. Dual compensation in accordance with United States Code (USC) 55-36 will not be reimbursed to the

Contractor by US Government or TRICARE as Contractor is already considered a contract employee of the US Government.

1.2.2.3. FEDERAL HOLIDAYS. There are ten recognized Federal holidays each year. If a Federal holiday falls on a Saturday, it is observed on Friday; if it falls on Sunday, it is observed on Monday.

New Year’s Day (1 January)

Martin Luther King Jr Day (3rd Mon in January)

President’s Day (3rd Mon in February)

Memorial Day (last Mon in May)

Independence Day (4 July)

Labor Day (1st Mon in September)

Columbus Day (2nd Mon in October)

Veterans Day (11 November)

Thanksgiving Day (4th Thurs in November)

Christmas Day (25 December)

1.2.2.4. TURKISH NATIONAL HOLIDAYS. There are seven observed Turkish national holidays each year.

Note: The dates of Muslim holidays change from year to year.

New Year’s Day (1 January)

Sugar Festival

Sovereignty and Children’s Day (23 April)

Sovereignty and Youth Sports Day (19 May)

Feast of Sacrifice

Victory Day (30 August) Republic Day (29 October)

1 May

1.2.2.5. TIME OFF. The Contractor is required to give written notification to the 39th Medical Group 30 days prior to any absences that would affect performance of this contract. Time off will not exceed two consecutive weeks except for extenuating circumstances, which will be authorized by the QAP, in writing.

1.2.2.6. WORK SCHEDULE. Personnel will be scheduled in accordance with the MTF dictated work schedule for maximum heath care utilization. A flexible schedule may be requested based on the needs of the MTF. Normal MTF clinic hours are 7:30AM-4:30PM. Policy regarding daily lunch or other breaks will follow the Government’s standard procedures for contract personnel. The contract personnel should follow command announcement for reporting to work as it relates to inclement weather or base closures.

1.2.2.7. ARRANGEMENT FOR REPLACEMENT STAFF. When absences exceed 2 scheduled working days the Contractor shall arrange for a replacement surgeon with equal qualification and skill to care for eligible beneficiaries in case of emergencies or postoperative complications at the Contractor/s expense.

Replacement personnel will be required to treat patients within the MTF or a civilian facility. The name of qualified and credentialed surgeons shall be submitted to the MTF at the start of the contract and will be maintained on file for adequate general surgery coverage. Replacement personnel are required to meet the same credentialing criteria as that of contract personnel. The Government reserves the right to accept the recommended replacement provider. If not accepted, a qualified substitute will have to be resubmitted by the Contractor for acceptance by the government.

1.2.2.8. TRAVEL. Contract personnel may be required to travel to various USAFE locations to participate in clinical case experience at government expense. Authorized expenses will be reimbursed supported by expense log and hand receipts not to exceed the maximum per diem rates in accordance with FAR

31.205-46 and Joint Travel Regulations Vol. II, Appendix E, Part III. Travel documentation requirements will be obtained at the Contractor’s expense to include passport, visa, etc. Estimated frequency of travel will be every other year, not to exceed ten days unless approved by the Medical Operations Squadron

Commander. Authorized expenses include, but are not limited to, airfare, ground transportation (taxi, shuttle), lodging, meals and applicable taxes (hotel). All travel requirements will be coordinated with the Contracting Officer at least sixty days prior to departure. After completion of travel, the Contractor shall submit an invoice via WAWF and attach a detailed breakdown of reimbursable travel costs incurred and receipts for all expenses using the expense log. Current per diem rates can be access via the following website: http://perdiem.hqda.pentagon.mil/perdiem/pdrates.html

1.2.3. PERSONNEL REQUIREMENTS.

1.2.3.1. ENLISH LANGUAGE REQUIREMENT. Contract personnel must be able to read, write, speak, and understand English. Language should be spoken with sufficient structural accuracy and vocabulary to participate effectively in most formal and informal conversations on practical and professional topics.

1.2.3.2. CRIMINAL BACKGROUND CHECK REQUIREMENT. Provider checks will be conducted by the

Government by means of written professional reference and screening of all prior and existing lawsuits and their outcomes. Screening of lawsuits will be requested in writing to the Turkish Health Department at the address listed below:

Saglik Mudurlugu http://perdiem.hqda.pentagon.mil/perdiem/pdrates.html

Stadyom Giris Kapisi Karsisi

Hifzisihha Mlid Bitsigi Adana

1.2.3.2.1. Concurrent with the consent of the Contracting Officer and the Chief of Medical Services, contract personnel may provide contract services prior to completion of background checks. However, at all times while children are in the care of that individual, the contract provider shall be witting sight and continuous supervision of a staff person whose background check has been completed, a chaperone, or parent/guardian.

1.2.3.2.2. Individuals shall have the right to obtain a copy of any background check pertaining to them and to challenge the accuracy and completeness of the information contained in the report.

1.2.3.2.3. Individuals who have previously received a background check shall provide to the CO or QAP proof o the check or obtain a new one.

1.2.3.2.4. All contract employees shall provide all reasonable and necessary assistance to the

Government.

1.2.3.3. UNIFORMS/PERSONAL APPEARANCE. Contract personnel shall present a neat appearance and be easily recognized as Contractor employees.

1.2.3.3.1. Clothing should present a professional, modest appearance in keeping with the normally accepted community standards of dress for the work being performed. In all cases, clothing shall be neat and clean. This includes being free from visible dirt, stains, strong cologne, and offensive odors.

When required and supplied by the MTF, personnel shall wear special protective clothing and shoe covers. These items shall remain the property of the Government and shall not be removed from the

MTF. Special protective clothing shall be turned in or destroyed after use as directed by the QAP.

1.2.3.3.2. All contract personnel shall wear a nametag designating them as a “Contractor.”

1.2.3.3.3. Facial hair including beards, mustaches, and sideburns shall be controlled (restrained) or trimmed to have a professional appearance and to maintain safe work practices. When duties will be performed in specified areas, a disposable protective hood shall be worn to ensure infection control standards are met. The Government will provide this hood.

1.2.3.4. OFFICE/WORK AREA APPEARANCE. Those areas (office examination rooms, etc.) provided for personnel shall present an orderly appearance. Contract personnel shall ensure these areas are tidy and any decorations present a professional and modest appearance in keeping with acceptable community standards.

1.2.3.5. CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the

United States Government f the employment of that person would create a conflict of interest. The

Contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval in accordance with DoD Directive

5500.7 and Air Force policy.

1.3. CREDENTIALS REQUIREMENTS.

1.3.1. PRIVILEGING. The credentials of all providers shall be reviewed and privileges granted as outlined in AFI 44-119, Medical Quality Operations. The Contractor is responsible to ensure that proposed staff possesses the requisite credentials enabling the granting of privileges by the applicable MTF sufficient to allow for performance of all tasks identified in section C-5 of this PWS.

1.3.2. Initial applications for clinical privileges, to include credentials action history, malpractice history, and completed copies of the below listed document, shall be submitted to the MTF Credentials

Committee 30 calendar days from receipt of notice of contract award, or when requested by the QAP.

Additionally, the Contractor shall make all proposed healthcare providers available for interview by the

MTF during the credentialing process.

a. Copy of any applicable medical licenses and board certifications.

b. Provider education and training.

c. Current Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certification.

d. Current certification in Neonatal Resuscitation Program (NRP), if applicable.

e. A signed consent for release of information.

f. A copy of the proposed contract provider’s professional resume, accompanied by that individual’s sworn affidavit of the truthfulness of same, indicating experience, training, and technical expertise in the type of car to be rendered.

g. A list of all places in which contract provider current holds or has held a license to practice related services

h. A certification of current physical examination for each employee. The certification shall contain a signed statement by the examining physician stating that the employee is free of any contagious diseases. Physical examination must be current and within the 12 months prior to the application for privileges.

1.3.3. Professional staff appointments and clinical privilege actions will be based on review of documents listed in paragraph 1.3.2., in accordance with AFI 44-119. Reappointment shall occur not less than every two years, in accordance with AFI 44-119.

1.3.4. Applications for clinical privileges for replacement contract providers shall be submitted to the MTF

Credentials Committee through the QAP where services are to be provided not later than 30 calendar days prior to the provider assuming duty. The credentials requirements are the same as those identified for the primary provider in para 1.3.2.

1.3.5. The Contractor is required to begin full performance of the contract requirements within 45 days after the contract is awarded. It is absolutely critical that privileges be granted to a sufficient number of contract providers to meet the contract requirements by the commencement date.

1.3.6. The Contractor is required to submit a progress report within 30 days of contract award.

1.3.7. The Contractor must submit only complete credentials applications for processing. Incomplete applications

(those that do not fully comply with the requirements) will not be accepted by the Government and will be returned without action

1.3.8. The Contractor must take specific action, including Primary Source Verification, to ensure that contract provider applications have the required prerequisites for privileging and do not have disqualifying impediments for privileges at the MTF. This is a non-delegable responsibility of the Contractor.

1.3.9. The Contractor will submit applications for only those contract providers who can reasonably be anticipated to render the actual, substantial performance on the contact. The submission of primary contact providers for credentialing who lack the requisite qualifications, or who will not work at all, is unacceptable and will be considered a failure to perform.

1.4. DENIAL/TERMINATION OF PRIVILEGES.

1.4.1. Actions to limit, suspend, or revoke clinical privileges shall be in accordance with the procedures outlined in

AFI 44-119.

1.4.2. The CO and the Contractor shall be notified by the QAP as soon as possible when the necessity to exercise such authority becomes apparent. The QAP will also provide the CO and the Contractor with copies of documentation initiating the revocation process if such actions become apparent.

1.5. EDUCATION AND TRAINING REQUIREMENTS.

1.5.1. FORMAL EDUCATION. The contract providers must have graduated from an approved school of medicine or osteopathy, completed a residency or fellowship acceptable to the U.S. Air Force Surgeon General and

Turkish Doctor’s Chambers, and at a minimum be eligible (awaiting opportunity) for board certification. The

Contractor is required to turn in copies of all supporting documents prior to contract performance.

1.5.2. LICENSE/REGISTRATION. The contract provider shall possess a valid, unrestricted license to practice general surgery in the Republic of Turkey. The Contractor is required to turn in copies of all supporting documents prior to contract performance.

1.5.3. BOARD CERTIFICATIONS. The contract providers shall be board eligible or board certified by the

Turkish Doctor’s Chambers, Division of General Surgery. The Contractor is required to turn in copies of all supporting documents prior to contract performance.

1.5.4. EXPERIENCE. The contract providers shall be actively practicing General Surgery and will have a minimum of five years experience in their respective field. The Contractor is required to turn in copies of all supporting documents prior to contract performance.

1.5.5. OTHER CERTIFICATIONS. The contract providers must maintain current training in BLS and ACLS.

The Contractor is required to turn in copies of al supporting document s prior to contract performance.

1.6. HEALTH REQUIREMENTS.

1.6.1. PREASSIGNMENT MEDICAL EVALUATION. No contract employee shall perform health care services under this contract unless a preassignment medical evaluation has been performed prior to submission of credentials.

The purpose of this medical evaluation is to determine if the individual, from a medical standpoint, possesses the minimum physical abilities needed to perform the proposed job without significant risk to personal health or the health and safety of others. As a minimum, the individual shall be free of physical defects r medical conditions which might reasonably be expected to place other workers, patients, or the public at risk. Not later than five days prior to the commencement of performance of health care services under this contract by any employee, the

Contractor shall provide to the Public Health (Employee Health) Flight certification that such employees have completed the medical evaluation requirements identified below. This certification shall state the date on which the examination was completed, the doctor’s name that performed the examination and a statement concerning the physical health of the individual. Initial documentation is required for: MMR (immunization or titer levels for

Rubella and Rubeola), history of chicken pox disease or positive titer (varicella vaccination must be accomplished if lack of immunity), TB Mantoux skin test (IPPD) if positive, minimum requirement will be follow-up with

Contractor’s physician and a chest x-ray. A physician must provide documentation of “no active respiratory disease”, Hepatitis B vaccination/series are required for all personnel with occupational risk of exposure (declination are not acceptable, this is a condition of employment) and if the employee will be involved in exposure-prone procedures they will have their HbsAg status determined. This is to be done by providing documentation of the

HbsAb (if positive they will be referred to the MTF Credentials committee to determine scope of practice). If, in the opinion of the evaluating medical practitioner, the individual is found to be qualified for duty, the medical statement shall include the following wording: “(NAME OF EMPLOYEE) possesses the minimum physical abilities to perform the proposed duties of a (insert job title). He/she has documented proof of immunization against/immunity to rubeola, rubella, and hepatitis B and does not have an active infectious condition which might place others at risk.” If, in the opinion of the evaluating medical practitioner, the individual does not possess the minimum capabilities needed to perform the proposed job or does not meet the conditions of employment or will pose a risk to others, the medical statement shall contain the following wording: “For medical reasons, (NAME OF EMPLOYEE) is not qualified for employment as a (insert job title).” Certification shall be provided to the CO, who will forward to the MTF Employee Health Office.

1.6.2. It is the Contractor’s responsibility to report (to the appropriate MTF staff member) all information necessary to assure hospital records can be maintained correctly, and therefore comply with the AAAHC, OSHA, and CDC health records requirements.

1.6.3. ANNUAL MEDICAL EVALUATION. All contract employees performing health care services under this contract shall complete annual medical evaluations as required by the MTF hospital employee health program. The

Contractor shall provide to the QAP a certificate, as described above, documenting the results of this evaluation.

1.6.4. PREVENTATIVE, PROPHYLACTIC, AND FOLLOW-UP PROCEDURES. The Contractor shall ensure that his/her employees are in compliance with preventive, prophylactic and follow-up procedures, as well as infection control and employee health program procedures, as established by the MTF. Required preventive, prophylactic and follow-up procedures will be provided by the Government to contract employees in the military

MTF. The Contractor shall reimburse payment for these services. If care is received elsewhere, the Contractor shall provide written verification of treatment.

1.6.5. PREGNANT EMPLOYEES. Contract employees should report their pregnancy to the Contractor. It is the responsibility of the Contractor to notify the QAP of the pregnancy. MTF Employee Health Office will provide information concerning any work hazards in that area. The Contractor is to notify their pregnancy employee of any work hazards. It will be the employee and the Contractor’s going decision whether the contracted employee works in the environment.

1.7. EMERGENCY HEALTH CARE. The MTF will provide emergency health care for contract personnel for injuries occurring while on duty in the MTF. These services will be billed to the Contractor at the current full reimbursement rate as directed by the Uniform Business Office Billing Procedures as directed by the Department of

Defense.

1.8. MEDICAL QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM).

1.8.1. Heath care providers shall participate in QA/RM activities to the extent required by AFI 44-119 and the individual MTF QA/RM plan or regulation.

1.8.2. The Government will evaluate the provider’s professional, as differentiated from administrative, performance under this contract using quality assurance standards specified in AFI 44-119. Nothing in this paragraph precludes the Government from also conducting inspections under the Inspection of Services clause.

1.9. ORIENTATION. The Contractor shall ensure that all contract providers and support staff participate in the

MTF orientation and service/clinic specific orientation prior to furnishing services under this contract. Clinic orientation must occur within five duty days of employment stat date. Medical Center orientation must occur within

30 days of employment start date.

1.10. CONTINUING MEDICAL EDUCATION (CME) REQUIREMENTS. Health care providers registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current as prescribed in AFI 41-117, Medical Service Officer Education. CME shall be obtained at no additional cost to the

Government and shall be reported o the QAP and MTF Credentials Committee annually no later than the first normal duty day in January for the previous calendar year. Periodic CME may be conducted at the MTF and will be available, at no cost, to any healthcare provider desiring to attend. CME hours are not billable hours for purposes of this contract.

1.11. ANNUAL TRAINING REQUIREMENTS. All contract employees must complete annual training required

IAW HIPAA, AAAHC, AF Computer Security Policy, and AF Safety Policy.

1.12. GOVERNMENT COMPUTER ACCESS. The Contractor will ensure that all contract employees comply with the requirement to obtain the minimum personnel security investigations as prescribed by DoD 5200.2-R and

AFI 31-501. The Contractor will work with the MTF to ensure that the pre-employment screening process for each employee classified as ADP I, II, III (as defined in DoD 5200.2-R) includes the appropriate investigations and that each contract employees have the appropriate questionnaires and forms to be completed. All completed forms will be reviewed by the Contractor and forwarded to the MTF for processing. The Contractor understands that, while the

MTF Commander may allow Contractor personnel to temporarily occupy non-critical sensitive positions pending

National Agency Check (NAC), employees will be immediately removed for the position if at any time the NAC received unfavorable adjudication, or, if other unfavorable information that would affect the NAC becomes known.

1.13. PATIENT SENSITIVITY TRAINING. Providers receiving more than two valid complaints (as determined by the QAP or CO) within 100 hours of service shall not be permitted to provide services through the MTF within this PWS until the provider successfully completes a government-approved patient sensitivity training class within a month of the second complaint. Training may include attendance at Customer College and/or computer-based customer sensitivity training. Provider participation in the training class shall be at no cost to the Government.

1.14. COMMUNICATION. The Contractor shall ensure contract providers under his/her supervision maintain open and professional communication with members of the MTF. Complaints validated by the QAP and Chief of the Medical Staff shall be reported in writing to the contract administrator and the Contractor for action. Failure of the Contractor to correct validated complaints raised by the MTF staff and the CO will be considered a failure to perform.

1.15. SPECIFIC TASKS.

1.15.1. GENERAL. The Contractor shall provide a general surgeon to perform the professional general surgery services required for patients’ healthcare needs as stated in Technical Exhibit 2. The quality of medical practice shall meet or exceed reasonable standards of professional practice for general surgery healthcare as determined by the same authority that governs military medical professionals in general surgery and will be audited by the QA/EM

Committer and the individual MTF QA/RM plan or regulation. A percentage of all records will be reviewed of the

USAFE command consultant.

1.16. SPECIFIC PROCEDURES FOR WHICH THE CONTRACTOR SHALL BE RESPONSIBLE.

1.16.1. PROCEDURE GUIDANCE. Contract personnel shall perform procedures compatible with the MTF’s operating capacity and equipment. Medical Procedures/services other than those included in Technical Exhibit 2 shall not be introduced by the contract provider without prior recommendation to, and approval of, the MTF

Commander or authorized representative. New medical procedures/services shall not be introduced without prior recommendation to, and approval of, the MTF Commander or authorized representative.

1.16.2. DUTY ASSIGNMENT. Contract personnel shall be primarily required to perform general surgery services.

When the services are not required, or the physician’s services are more urgently required elsewhere, the provider may be assigned by the Chief of Medical Services to provide support in other sections/departments of the MTF commensurate with their experience. This may include seeing generalized primary care medical conditions in the primary care and/or family practice clinics and/or working in an urgent care clinic setting.

1.16.3. CLINIC SUPPORT AND OUTPATIENT SURGERY. The contract provider shall provide outpatient services for patients as schedule by the Government. This shall include but not be limited to examinations, diagnosis, and treatment of by surgical and other means, injuries and disorders consistent with injuries and disorders in the field of general surgery. This shall include initial visits as well as follow up visits.

1.16.3.1. The contract provider shall provide outpatient clinic visits at a minimum average of four patients each duty hour. This shall include initial visits as well as follow up visits.

1.16.3.2. The contract provider may work up to one hour past the end of the scheduled duty day, at no additional cost to the Government, to ensure provision of minimum services.

1.16.3.3. Patient scheduling will be at the determination of the MTF.

1.16.3.4. The contract provider shall maintain proficiency in all types of major and minor surgeries to include multiple traumas. The contract provider will maintain a log of surgeries done outside the MTF as proof of surgical proficiency. The log will be provided to the QAP on a quarterly basis within the first week of the following quarter.

1.16.4. MAJOR AND MINOR SURGERY. Major and minor outpatient procedures shall be performed during regular clinical services and consultation when possible.

1.16.4.1. Examples of Minor Surgery include:

Breast Biopsy

Colonoscopy

Hernia

Upper Gastrointestinal Endoscopy

Lipoma Removal

Scar Revision

Hemorrhoidectomy

Would Exploration

1.16.4.2. Examples of Major Surgery include:

Gallbladder

Appendectomy

Wound Exploration

* May be required to render assistance for Obstetrics/Gynecology Surgery, Orthopedic Surgery and ENT surgery during emergent situations to include Cesarean Sections.

1.16.5. DOCUMENTATION. Contract personnel shall prepare all documentation to meet established standards of the MTF and AFI 41-210 to include, but not limited to: timeliness, legibility, accuracy, content, and signature. Only

MTF and Air Force approved abbreviations can be used to document patient care I the health care record. MTF staff practitioners will note defects, omission, agenda, etc .in medical documentation. If errors or discrepancies exist, a request will be made to have contract personnel make required corrections.

1.16.5.1. Indicate responsibility for the content and correctness of all prepared and transcribed reports by affixing the contract personnel’s own signature to the documents and validating their contents.

1.16.5.2. Prepare appropriate narrative summaries, document recommendations for medical boards, profile changes, and job retraining recommendations.

1.16.5.3. Write patient progress note at appropriate intervals as determined by the clinic executive committee.

Ensure postoperative note and discharge summaries are prepared and signed within the MTF required time frame.

1.16.5.4. Provide a document appropriate history, physical examination, required laboratory and x-ray examination, provisional diagnosis and preoperative diagnosis, as required. Contract personnel shall complete these procedures prior to the performance of any treatment.

1.16.5.5. The provider shall ensure complete patient identifying information is on all documentation that is

Chronological Record of Medical Care; SF 513, Medical Record – Consultation Sheet and AF Form 781, Multiple

Item Prescription shall be stamped with a rubber stamp, provided by the Contractor, which includes the following information: Physician name, social security number or equivalent, professional degree (M.D., D.O., etc), and facility.

1.16.5.6. Documentation of patient visits shall be on the SF 600 in the Subjective, Objective, Assessment, Plan

(SOAP) or as required by the Executive Committee of the medical staff.

1.16.5.7. All contract providers will be trained on and required to use Composite Health Care System (CHCS) and/or AHLTA.

1.16.6. MEDICAL CODING OF PROCEDURES/OFFICE VISITS. All contract personnel will be required to accurately and timely code all medical encounters in the Ambulatory Data Module (ADM) of CHCS. Coding encounters must meet the documentation in the medical records for procedures and services performed. Coding of all encounters must be completed within 24 hours of medical encounter.

1.16.7. REFERRALS AND CONSULTS. Contract personnel shall follow DoD, Air Force and MTF regulations and policies when arranging for a referral or consult. Contract personnel shall inform patients of the required referral or consult by indicating the specialty involved. Contract personnel shall not recommend to the patient that he/she should consult a specific practitioner or use a specific practice in the local civilian community. Contract personnel may not refer patients for consult to her/herself outside of this MTF. The Contractor will not be reimbursed outside this contract or any eligible beneficiaries seen for medical care outside of the MTF. TRICARE reimbursement will neither be pursued nor granted under this contract. All general surgery services for eligible beneficiaries are all inclusive of this contract for payment. There will be no other forms of compensation for services rendered except what is identified herein in this contract.

1.16.8. PRESCRIPTONS. The contract provider shall use and be guided by the MTF formulary and enter all prescriptions into CHCS and/or ALHTA. The Pharmacy and Therapeutics Committee must approve drugs not listed on the formulary.

1.16.9. TOTAL QUALITY IMPROVEMENT. The contract provider shall assess general surgery care to assure its quality. The contract provider shall also respect and maintain the basic rights of patients to include, but not limited to, personal dignity.

1.16.10. ATTENDANCE AT MEETINGS. The contract provider shall attend and participate in meetings, professional staff conferences, and other appropriate professional activities within the MTF as directed by the Chief of Hospital Services.

1.17. GOVERNMENT ORIENTATION TRAINING.

1.17.1. INITIAL ORIENTATION. The contract provider shall attend government provided initial training for procedures and use of government provided equipment, supplies and forms; safety, infection control and quality assurance (QA) procedures and policies, personnel reliability program; and facility orientation.

1.17.2. CONTINUING ORIENTATION. Contract personnel shall participate in orientations for new equipment, procedures, etc., as determined by the Chief of Hospital Services.

1.17.3. ANNUAL TRAINING. The contract provider providing services at the MTF shall attend annual training.

This training will include topics such as safety, QA, Risk Management, infection control, fire protection, security, and patient sensitivity training. The classes may be scheduled individually throughout the year or scheduled at one time. These classes will take approximately eight hours total per individual.

1.17.4. RECORDS. The Contractor shall be responsible for creating, maintaining, and disposing of only those government required records which are specifically cited in the PWS or as may be required by the provisions of a mandatory directive listed in Section C-6 of this PWS. If requested by the Government, the Contractor shall provide the original record or a reproducible copy of any such records within five working days of receipt of the request.

1.17.5. PATIENT LISTS. Patient lists, no matter how developed, shall be treated as privileged information. Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the MTF without prior written permission by the Chief of Hospital Services.

1.17.6. PATIENT SENSITIVITY. Contract personnel shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. Personnel receiving complaints validated by

QAP and Chief of the Medical Staff shall be subject to counseling and, depending on the nature and severity of the complaint, separation from performing services under this contract.

1.17.7. RELEASE OF MEDICAL INFORMATION. The contract provider shall only release medical information obtained during the course of this contract to either MTF staff involved in the care and treatment of that individual patient.

1.17.8. HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT (HIPAA). Contract personnel shall be briefed and trained on HIPAA and the requirements for protecting patient information and confidentiality, along with release of information. The Contractor will assist the MTF in ensuring all network providers or local providers comply with HIPAA to the maximum extent practicable. The Contractor will assist with ensuring all local providers have on file a signed acknowledgement of all HIPAA requirements. The Contractor will assist in resolving disputes in the healthcare arena for the MTF.

1.17.9. PERFORMANCE EVALUATION MEETINGS. The CO shall require the Contractor or his representative to meet with the CO, contract administrator, QAP and other government personnel at least quarterly and as often as deemed necessary. The Contractor may request a meeting with the CO when deemed necessary.

Meetings will be documented in the contract file with written minutes signed by the contract manager and the CO, or contract administrator. Should the Contractor not concur with the minutes, such nonconcurrence shall be provided in writing to the CO within ten calendar days of receipt of the minutes.

1.17.10. EMERGENCY RESPONSE. The contract provider will be required to respond to patient codes occurring in the MTF while the provider is physically present. In addition, the contract provider is considered mission essential personnel and will be required to respond to the MTF if the National Command Authority declares and emergency.

1.17.11. PERSONAL RELIABILITY PROGRAM (PRP). The contract provider shall be responsible for knowing and adhering to the regulations and guidelines under the PRP program as outlined in AFI 36-2104. The

Contractor accepts full responsibility or any missed notifications that result from the actions or negligence.

1.17.12. ACCREDIDATION ASSOCIATION for AMBULATORY HEALTHCARE (AAAHC). Personnel shall meet all applicable AAAHC standards during the performance of this contract.

SECTION C-2

SERVICE DELIVERY SUMMARY

2. GENERAL INFORMATION.

2.1. QUALITY CONTROL. The Contractor shall develop and maintain a quality program to ensure services are performed in accordance with commonly accepted commercial practices. Develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. As a minimum, the Contractor shall develop quality control procedures that address the areas identified in Section 6.5.5. Service Delivery Summary. The government evaluator must have a specific quality control inspector to notify in case of customer complaints.

2.2. QUALITY ASSURANCE. The Government will periodically evaluate the contractor’s performance by appointing a representative(s) to monitor performance and patient satisfaction surveys to ensure services are received. The Government will also receive and investigate complaints from various customers located on the installation. The Government will give the Contractor a written copy of the complaint and the Contractor shall sign for the copy. The Contractor shall reply in writing to the Government of the complaint within ten calendar days from the date of receipt of the complaint from the Government. The government representative will evaluate the contractor’s performance through intermittent on-site surveys with customers and receipt of complaints from customers. The Government may inspect each task as completed or increase the number of quality assurance inspections if deemed appropriate because of repeated failures discovered during quality assurance inspections or because of repeated customer complaints. Likewise, the Government may decrease the number of quality assurance inspections if performance dictates. The Contractor shall be responsible for initially validating customer complaints.

However, the government representative shall make a final determination of the validity of customer complaint(s) in cases of disagreement with customer(s).

2.3. SERVICE DELIVERY SUMMARY.

Performance Objective PWS

Reference

Performance Measure Performance

Threshold

Replacement Staff

Contingency Plan

1.2.2.7. Locum tenums are pre-credentialed

with MTF (annual)

100%

Routine Availability 1.2.2. Contract personnel available for duty

(monthly)

100%

Provider Licensure 4.19. Contract provider shall possess valid, unrestricted license (annual)

100%

Board Certification 1.5.3. Contract provider shall be board eligible or board certified (annual)

100%

Annual Medical Evaluation 1.6.3. Contractor provides certificates of annual medical evaluation for contract staff to the QAP (annual)

100%

Continuing Medical

Education

1.10. CME shall be obtained at no additional

cost to the Government and shall be reported to the QAP and MTF

Credentials Committee annually on the first normal duty day in January for the previous calendar year (annual)

100%

Attendance at Meetings 1.16.10. Contract personnel attend and participate in meetings, professional staff conferences, and other appropriate professional activities as directed

(monthly)

95%

HIPAA Training 1.11. Contractor employees complete all required HIPAA training (annual)

100%

On-all/After Duty Response

Time

1.2.2.1. Within 60 minutes of notification for

routine on-call consultation and 30 minutes for emergency requirement

100%

Referrals and Consults 1.16.7. Contract personnel shall follow DoD, Air Force and MTF regulations and policies when arranging for a referral or consult

95%

Documentation

Accuracy/Timeliness

1.16.7. Contract personnel shall follow DoD, Air Force and MTF regulations and policies when arranging for a referral or consult

100%

Medical Coding of

Procedures/Office Visits

1.16.6. Contract personnel must accurately and

timely code medical encounters

100%

Patient Sensitivity 1.17.6. Contract personnel shall respect the basic rights of patients, demonstrating concern for personal dignity

100%

SECTION C-3

GOVERNMENT FURNISHED PROPERTY AND SERVICES

3. GENERAL. The Government will provide the following equipment, supplies, and services listed below:

3.1. EQUIPMENT. Contract personnel shall have joint use of all available equipment for performing services required by this contract only, including a computer for use while in the MTF.

3.2. PERSONAL PROTECTIVE EQUIPMENT (PPE). The Government will furnish contract personnel with appropriate PPE. The Government will be responsible for any repair, cleaning and inventory required for the PE.

This does not include any type of uniform or laboratory coat.

3.3. FORMS. The MTF will provide required government forms used in the performance of services.

3.4. SUPPLIES. The MTF will provide medical and non-medical supplies commonly used in the facility for the care and management of patients. This does not include any type of uniform or laboratory coat, with the exception of “scrubs” for use in those parts of the MTF where they are commonly worn by government personnel.

3.5. SERVICES.

3.5.1. PATIENT SCHEDULING. MTF personnel shall arrange patient scheduling. Complete administrative control of the patient shall remain with the Government.

3.5.2. ADMINISTRATIVE SUPPORT. Personnel will be authorized to use all administrative support available to government employees. This will include, but not be limited to, copy machines, telephone-fax machines, medical library, installation distribution, government e-mail account, and Defense Switching Network (DSN) lines. The same restriction to use these items for government official business only applies.

3.5.3. HOUSEKEEPING. The Government, as part of the MTF housekeeping contract, will provide routine housekeeping.

3.5.4. GOVERNMENT ORIENTATION/TRAINING. The Government will provide training on Government provided forms and equipment, initial orientation and continuing orientation.

3.5.5. TRANSCRIPTION SERVICES. The MTF will provide transcription services. Legible handwritten documentation of medical records is acceptable in place of recorded dictation. In the event that MTF transcription services cannot adequately perform, the Contractor may hire outside transcription service as part of the contract upon approval from the Chief of Medical Services. Reimbursement for transcription services will be at cost.

3.5.6. CENTRAL STERILE SUPPLY. The MTF will provide Central Sterile Supply services to personnel.

Sterile equipment trays, instrument packs, and supplies will be provided by this service. After use, personnel shall follow local policies and procedures to have the Government clean and re-sterilize the supplies. This service will be available to contract personnel on an equal basis with those of other clinic personnel/services.

3.6. RECORDS, FILES, DOCUMENTS, AND WORK PAPERS. All records, files, documents, and work papers provided by the Government remain government property (per current HIPAA guidelines). The QAP will provide guidance for personnel who shall maintain and dispose of these records, files, documents, and work papers.

SECTION C-4

GENERAL INFORMATION

4. GENERAL DEFINITIONS. As used throughout this PWS, the following terms shall have the meaning set forth below:

4.1. CLINICAL PRIVILEGES. Those inpatient and ambulatory clinical activities permitted a provider in the granting MTF after evaluation by the credentials function and approved by the Medical Facility Commander (MFC).

4.2. CONTRACTING OFFICER (CO). A person duly appointed with the authority to enter into, administer, and terminate contracts on behalf of the Government.

4.3. CREDENTIALS. Documents providing evidence of the education, training, licensure, experience, board certification and expertise of a health care provider.

4.4. CREDENTIALS COMMITTEE. The professional body set up to review credentials, make recommendation on clinical privileges for providers and to promote quality control practices.

4.5. CRISIS SITUATION. Any emergency so declared by the National Command Authority (NCA), or the overseas Combatant Commander, whether or not U.S. Armed Forces are involved, minimally encompassing civil unrest or insurrection, civil war, civil disorders, terrorism, hostilities buildup, wartime conditions, disasters or international conflict presenting a serious threat to DoD interests.

4.6. GOVERNMENT. The federal government of the Unites States of America.

4.7. GOVERNMENT QUALITY ASSURANCE. Those actions taken by the Government to assure services meet the requirements of this contract.

4.8. HEALTH CARE PROVIDER. Any care professional who, under regulations of a Military Department, is granted clinical practice privileges in a military MTF or Dental Treatment Facility or who is licensed or certified to perform heath care services by a government board or Agency or professional heath care society or organization.

4.9. INVASIVE MEDICAL PROCEDURE. Any procedure that involves a puncture or incision of the skin, the insertion of an instrument or foreign material into the body or breaking the mucous lining of the body.

4.10. EXPOSURE-PRONE PROCEDURE. Certain invasive surgical and dental procedures that have been implicated in the transmission of the hepatitis B virus from an infected health care worker to a patient. Examples include certain oral, cardiothoracic, colorectal and obstetrics/gynecological procedures. Characteristics of exposure-prone procedures include the following: Surgical procedures or objects in a poorly visualized or highly confined anatomic site.

4.11. MEDICAL TREATMENT FACILITY (MTF). Air Force hospitals or clinics, including all activities providing outpatient and/or inpatient health care services for authorize personnel.

4.12. PERFORMANCE WORK STATEMENT (PWS). A document that accurately describes a service in terms of the output requirements and the required quality level or a standard of acceptable performance of those outputs.

4.13. PRACTITIONER. An individual providing direct patient care other than contract personnel.

4.14. PREPRIVILEGING. The application of screening process whereby prospective DoD health care providers, required to be privileged to provide patient care within MTFs have their education, training and past performance evaluated preliminary to their being considered for a contractual relationship.

4.15. PRIVILEGING. Frequently referred to as credentialing. The process whereby the MFC or the Major

Command Surgeon General, upon recommendations from the MTF credentials function, grants to individual health care providers the privileges and responsibilities of providing specific medical and dental care within the MTF.

4.16. QUALITY ASSURANCE PERSONNEL (QAP). Government employee responsible for evaluating the quality of the Contractor’s performance.

4.17. QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM) COMMITTEE. Committee responsible for the execution of the MTF QA/RM plans to include the duties outlined in AFI 44-119. The committee ensures an ongoing assessment of the quality and appropriateness of all medical care and will put in priority sequence suspected problems for evaluation, resolution, and follow-up.

4.18. QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM) PLAN. An organized document which describes the methods of doing quality assurance (QA) reviews within the program and the mechanisms for monitoring and evaluating patient care. It is consistent with the Accreditation Association for Ambulatory

Healthcare (AAAHC) monitoring and evaluation (M&E) approach and the Air Force Risk Management (RM) efforts.

4.19. VALID LICENSE. A grant of permission by an official agency of the Republic of Turkey to provide care independently as a health care professional. Licenses must be current.

4.20. TECHNICAL DEFINITIONS. Includes definitions peculiar the particular PWS.

4.21. ON CALL. Contractor shall be available for emergency and routine consultations via beeper, telephone, or cellular phone.

4.22. CONTRACTOR FURNISHED ITEMS AND SERVICES.

4.22.1. GENERAL. Except for those items or services specifically stated in Section C-3 to be government furnished, the Contractor shall furnish everything required to perform this contract in accordance with all of its terms.

4.22.2. SPECIFIC. The Contractor shall furnish a cell phone number which must be available 24 hours a day, 7 days a week. Cell phone service must be for the entire Republic of Turkey to ensure 24-hour support.

4.22.2.1. Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. The Contractor shall immediately implement those changes in publications which result in a decrease or no change in the price and notify the Contracting Officer (CO) in writing of such change. Should a decrease in contract price result, the Contractor shall provide a proposal for reduction in the price to the CO. Prior to implementing any change that will result in an increase; the Contractor shall submit to the CO a price proposal within 10 days of receipt of the change by the Contractor.