SOW_Emergency_Department_Physician.pdf

Statement of Work Emergency/Urgent Care Department Physician

Oklahoma City Area Indian Health Service

1. General

The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. The mission of IHS is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level and assure that comprehensive, culturally acceptable personal and public health services are available and accessible to members of the 566 federally recognized Tribes across the United States.

2. Statement of Objectives

The purpose of the Blanket Purchase Agreement (BPA) is for the placement of highly-skilled physicians in the Emergency Department of the inpatient hospitals. The care provided by the physicians shall be as comprehensive as the Indian Health Service supplied facilities; equipment and support services permit.

The contractor shall provide qualified physicians to provide medical services for patients as required by this statement of work (SOW) and in accordance with the terms and conditions of this BPA. Contractor physicians shall provide services to eligible beneficiaries of the Indian Health Service who present themselves for treatment. Contracted services encompass the provision of medical services that are emergent and non-emergent.

3. Statement of Work

The contractor shall provide emergency/urgent care physician services to evaluate and treat patients who present themselves to the Emergency Department. The physician shall furnish services to include but not limited to the following:

1. Maintain a continuous vigil within the immediate confines of the Emergency Department in order that services are readily and immediately available at a moments notice.

2. Obtain a medical history, performing a physical exam as appropriate to the presenting problem, and formulate a diagnosis of the patient’s problem, and secondary diagnosis, as required, to treat the patient.

3. Render immediate medical services to those patients determined as emergent. Render medical services to those patients determined as non-emergent within one (1) hour upon their arrival and reporting to the Emergency Department.

4. Request and interpret laboratory and radiologic tests, as necessary, for diagnosis.

5. Provide and order medically indicated treatment.

6. Prescribe medication.

7. Provide patients with a full explanation of diagnosis, procedures and treatments.

8. Interpret x-rays and electrocardiograms.

9. Suture minor lacerations.

10. Set uncomplicated fractures.

11. Refer patients to routinely scheduled clinics of the Outpatient Department.

11. Render initial assessments of which Emergency Department/Urgent Care patients will require transfer to a tertiary care center and consult the appropriate Indian Health Service physician on-call who in turn will render the final decision concerning transfer and arrange transfer, if indicated.

12. Render the initial assessment of which emergency/urgent care patients may require admission to the on-site Hospital and consulting the Indian Health Service physician on-call who in turn will render the final decision concerning admissions.

13. Chart, record and complete medical care data on Ambulatory Patient Care reports within 24-hours of patient visit.

14. Consult with appropriate IHS specialists on back up call for all complex cases, which, while not requiring admission to the hospital or transfer to another facility, do require further evaluation by the specialty physician, or more than routine follow up.

15. Provide medical advice to patients by telephone when the nurse requests a physician to do so.

16. Respond to in-hospital emergencies while on duty.

17. Provide basic life support in a first responder status for patients requiring resuscitation outside of the hospital on hospital grounds.

18. Evaluate emergency medical service (EMS) calls, i.e. patients en route to the Emergency

Department. If the physician is able to determine that the patient will need a higher level of care, then he/she may divert the ambulance to another facility.

19. Contractor’s performance shall be in compliance with CMS and TJC requirements.

4. Professional Qualifications

Emergency department physicians shall have a permanent, current, full and unrestricted license to practice medicine in a state, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. Physicians shall be board certified, or eligible, by the American Board of Emergency Medicine, Family Practice, Internal Medicine (with knowledge of pediatric emergencies), Pediatrics (with knowledge of adult emergencies) or other recognized board with adequate emergency medicine experience as deemed by the facility Clinical Director. Physicians shall comply with the policies, procedures and by-laws of the hospital/clinic. The physician shall also be required to perform this service in compliance with applicable standards of The Joint Commission and Quality Improvement.

4.1. Verification of Credentials

To ensure that physicians providing services under this contract are properly licensed, and that the IHS is made aware of all disciplinary actions taken against each physician, the Contractor shall:

1. Verify in writing to the IHS through the Federation of State Medical Boards database, all active, inactive, and lapsed licenses that are held or have been held by physicians who provide services in IHS hospitals and clinics under this blanket purchase agreement.

2. Inform the IHS of the status of all licenses for each physician including all reasons for each inactive or lapsed license.

3. Obtain at least three (3) letters of reference from health care providers whom have knowledge of the applicant’s clinical practice skills. One letter shall be from the Chief of Staff, or Service at the hospital where the physician holds or last held staff privileges. If the physician has just completed a residency, one letter shall be from the residency program director or serve chief.

4. Provide all information regarding performance and disciplinary actions that are collected on physicians who would be placed under this BPA to the receiving IHS facility Clinical Director. This includes all information that is collected and compiled on such physicians at the time of initial hire by the Contractor, and/or information that is reported during periods that the Contractor is an agent of such physicians for a placement under this contract.

5. Certify that all information obtained on physicians whom they would assign to IHS hospital and clinics have been reviewed, verified and recommended by the Contractor. The Certification shall include a statement that the physician is competently and adequately trained and experienced to provide the Services contemplated pursuant to the assignment in accordance with all applicable federal, state, and local laws, rules and regulations, all applicable standards of the Joint Commission and any other relevant accrediting organizations; and the Contractor has found no reason to reject the physician’s application. The names of the contacts, their titles, telephone numbers, date of contacts and the name(s) of the Contractor’s representative(s) collecting and reviewing such information shall be recorded in writing and made available to the IHS by the contractor.

4.2. Qualification Requirements

Physicians shall meet the following minimum qualifications and requirements:

A. Permanent, current, full and unrestricted license to practice medicine in the United States, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

B. Physicians shall be Board Certified in or Board Eligible as stated in section 4.

C. Physicians shall apply and be accepted as clinic/hospital associate member.

D. Shall provide a copy of documentation of physician’s current Basic Life Support (BLS).

E. Documentation of Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS) and Pediatric Advance Life Support (PALS) certification is required of physicians not boarded in emergency medicine.

F. Shall speak, understand, read and write English fluently and communicate with sufficient clarity to be understood by IHS personnel and patients.

G. Shall be a United States Citizen.

H. Shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to patients of the Native American/Alaska Native communities.

I. Shall maintain standards of personal hygiene and grooming such that his/her image as a physician is compatible with the expectations of the on-site Clinical Director.

J. Shall have a current DEA license.

K. Shall provide a complete IHS Medical Staff Application to include documentation of work history since graduation from professional school to present day in chronological order. Any time period of gaps greater than 30 days since graduation from professional school, shall be explained in writing along with contact information of an individual who can verify the gaps.

L. Shall provide a copy of documentation of current and past insurance carriers and contact information during the past 10 years.

M. Shall provide documentation of and maintain current professional liability insurance coverage in the amount of $1 million per occurrence and $3 million aggregate per provider.

4.3. Credentials

Physicians shall be credentialed and have privileges as active members of the medical staff. The physician shall be required to provide completed applications for Medical Staff appointments and privileges, as specified in the By-laws, for all providers to the Clinical Director and at least 30 (thirty) days prior to assignment for periods of coverage.

Credentialing activities shall require a minimum of thirty (30) calendar days to insure (1) that written or printed information is received at the on-site Hospital Quality Assurance Department from the National Physicians Data Bank, (2) that three letters of reference for each sub-contractor are received in the Credentials Office and are recent within the last year, and (3) the credentialing package (application for appointment and request for privileges) is completed and received by the Medical Executive Committee and OCA IHS Governing Board.

4.4. Immunization

The contractor shall provide written evidence prior to award and during the term of the contract regarding rubella and measles immunity and negative tuberculosis skin tests of all medical physicians to be utilized in the performance of this contract. Written evidence must be included in the completed Application for Appointment to Medical Staff.

Physicians requesting privileges shall submit documentation of a current (within the past 12 months) TB skin test or chest x-ray if the skin test was previously positive. Special considerations may be allowed to individuals, who are allergic to component of a vaccine, has history of severe reaction of a vaccine or who are currently pregnant.

Physicians shall provide documented evidence of annual current season influenza vaccination, unless medically contraindicated.

4.5. Indian Child Protection and Family Violence Prevention Act

The physician shall perform in accordance with Section 231 of the Crime Control Act of 1990, P.L. 101- 647 and the Indian Child Protection and Family Violence Prevention Act, P.L. 101-630, and failure to comply with these statutes shall result in immediate removal.

5. Work Schedule

Normal shifts for the Emergency Department consist of 12 hour shifts. Double coverage, noon to midnight, may be required if the patient workload becomes heavy. The work schedule will be determined by the Emergency Department Director.

The Urgent Care shifts will be determined by the Emergency Department Director.

Item Schedule Cost per Hour

1 Emergency/Urgent Care Department Physician Services $

Base Year: August 1, 2015-July 31, 2016

2 Emergency/Urgent Care Department Physician Services $

Option Year I: August 1, 2016-July 31, 2017

3 Emergency/Urgent Care Department Physician Services $

Option Year II: August 1, 2017-July 31, 2018

4 Emergency/Urgent Care Department Physician Services $

Option Year III: August 1, 2018-July 31, 2019

5 Emergency/Urgent Care Department Physician Services $

Option Year IV: August 1, 2019-July 31, 2020

The physician shall advise the Clinical Director or designated representative of any problem encountered in connection with meeting the patient care needs as required in the statement of work.

6. Government Furnished Facilities/Equipment/Supplies/Specialty & Support Staff

The government will provide the facilities, supplies and the equipment of the Emergency Department and all hospital and Emergency specialty/support staff. The on-call specialty staff consists of staff in obstetrics/gynecology, pediatrics, internal medicine, family practice and general surgery as well as a person to provide orientation to contract physicians. Use of government furnished facility space, equipment, supplies, and personnel are for the provision of care and services set forth in this BPA only.

A written Orientation Manual of Policies and Procedures for the Emergency Department, and on-call room, and application forms for appointment and privileging as associate staff members and will also be provided by the Government. The Government will provide assistance, orientation and guidance in seeing patients as well as receiving supplies, utilizing and ordering laboratory, x-ray and pharmacy services.

7. Reference Material

The physician shall be required to be familiar with and comply with the “Emergency Assurance ER Plan” already established by the Emergency Room Director. Both reference publications are available on-site.

Physician shall be required to develop familiarity and abide by current policies, procedures, by-laws and regulations of the on-site clinical and medical staff.

The physician shall perform services in compliance with applicable standards of The Joint Commission (TJC), which is available to the general public and the Professional Services Policies of the IHS Manual, which is available from the IHS.

8. PLACE OF PERFORMANCE

Claremore Indian Hospital 101 South Moore Ave Claremore, OK 74017 Monday-Friday: 7:45 am-4:30 pm

Lawton Indian Hospital 1515 Northeast Lawrie Tatum Rd Lawton, OK 73507 Monday-Friday: 8:00 am-5:00 pm

9. ANNUAL ESTIMATED USAGE

Facilities with no previous usage could have a need this year.

Facility No. of Hours

Claremore Indian Hospital 6978 Lawton Indian Hospital 11,949