SOW_Emergency_Urgent_Care_Physician.doc

Emergency Department Statement of Work

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.

To meet the mission, IHS requires contractor support to assist the facility in the placement of Emergency Medicine physician(s) into temporary duty assignments in the Indian Health Service (IHS) Claremore Indian Hospital. 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 contract. 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.

Statement of Objectives The purpose of this contract is to obtain contracted Emergency Department/Urgent Care non-personal services for the Indian Health Service (IHS) Claremore Indian Hospital. Contracted services encompass the provision of medical services that are emergent and non-emergent.

The emergent category of patients is defined as:

A patient that has presented to an emergency department when: an unforeseen condition of a pathophysiological or psychological nature develops which a prudent layperson, possessing an average knowledge of health and medicine, would judge to require urgent and unscheduled medical attention after consideration of possible alternatives. This would include:

1. Any condition resulting in admission of the patient to a hospital within 24 hours.

2. Evaluation or repair of acute (less than 72 hours) trauma.

3. Relief of acute or severe pain.

4. Investigation or relief of acute infection.

5. Protection of public health.

6. Obstetrical crisis and/or labor.

7. Hemorrhage or threat of hemorrhage.

8. Shock or impending shock.

9. Investigation and management of suspected abuse or neglect of person which, if not interrupted, could result in temporary or permanent physical or psychological harm.

10. Congenital defects or abnormalities in a newborn infant, best managed by prompt intervention.

11. Decompensation or threat of decompensation of vital functions such as sensorium, respiration, circulation, excretion, mobility or sensory organs.

12. Management of a patient suspected to be suffering from a mental illness and posing an apparent danger to the safety of himself/herself or others.

13. Any sudden and/or serious symptom(s) which might indicate a condition which constitutes a threat to the patient’s physical or psychological well-being requiring immediate medical attention to prevent possible deterioration, disability or death.

14. In addition, any patient presenting to the emergency department must be evaluated with at least a medical screening exam in compliance with all EMTALA regulations.

15. Non-emergent patients will be evaluated and treated consistent with the urgent care needs of the facility and our patients.

Statement of Work

The contractor shall provide emergency/urgent care physician services to evaluate and treat eligible patients who present themselves to the Emergency Department.

The contractor shall furnish services to include but not limited to the following:

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

17. 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.

18. Render immediate medical services to those patients determined as emergent.

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

20. Provide and order medically indicated treatment.

21. Prescribe medication.

22. Interpret x-rays and electrocardiograms.

23. Suture minor lacerations.

24. Treat uncomplicated fractures.

25. Refer patients as appropriate 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 document complete medical care in the Electronic Health Record system provided by the facility or on any paper forms approved by the facility in case of EHR outage. Medical records shall be completed in a timely manner as determined by the service unit. The physician shall be proficient in electronically documenting services utilizing the appropriate electronic medical record system for patient encounters; complete all required administrative paperwork day of the patient encounter to include electronic consults, referrals, co-signatures, completion of chart or Risk Management Reviews.

14.

Consult with appropriate IHS specialist 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.

The emergency department physician shall 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 shall participate in quality assurance activities that ensure quality patient care as well as efficient use of hospital resources. These activities may include, but not limited to, chart review and discussion with the Clinical Director or his designee.

20.

The contractor 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.

Statement of Performance

The contractor shall perform to a minimum of published National Standard Averages in their delivery of medical care in the Emergency Department.

1. Monthly Measured Total Time in the Emergency Department for discharged patients (“Turn Around Time”) : Less than mean time of 123 minutes (2013 National Rural Emergency Department Study, Establishing Rural Relevant Benchmarks, Ivantage Health Analytics, July 25, 2013.)

2. Monthly left without being seen (Left before Treatment completed) rate of less than 2% (Welch SJ, Volume Related Differences in Emergency Department Performance. Joint Commission Journal of Quality and Patient Safety, September 2012; Vol 38:9)

3. Monthly average arrival to provider (Door to Physician) time of less than 32 minutes.

(Welch SJ, Volume Related Differences in Emergency Department Performance. Joint Commission Journal of Quality and Patient Safety, September 2012; Vol 38:9)

Whenever these thresholds are not met, analysis will be made to determine if variances are due to contractor performance or due to a need of facility process improvements. The Contractor agrees to participate in this analysis and if internal facility processes are responsible, contractor shall participate in identifying and improving departmental processes for the betterment of patient care. Claremore Indian Hospital retains the right of determining the final decision regarding whether variances are due to contractor performance or a need for internal improvement of departmental processes.

Professional Qualifications

Emergency department physicians shall have a permanent, current, full and unrestricted license to practice emergency medicine in a state, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. 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 contract 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.

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 in emergency medicine.

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 and tail coverage.

N. Physicians who spend 50 percent or more of their clinical time under contract with the Federal Government, and prescribe controlled substances shall obtain IHS Opioid Prescriber Training and provide Certification within six months of appointment and every 3 years after.

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.

Work Schedule

Normal shifts for the Emergency Department consist of 12 hour shifts, including 7am to 7pm and 7pm to 7am, but other shift times may be added to best suite patient care. Double coverage may be required to allow for increased patient care. The work schedule will be determined by the Emergency Department Director. All shifts assigned to the contractor is the responsibility of the contractor to cover.

Any changes to the proceeding shall require mutual agreement of the Contractor and the Contracting Officer.

Base Year: January 1, 2019-December 31, 2019

Option Year II: January 1, 2020-December 31, 202

Option Year II: January 1, 2021-December 31, 2021

Option Year II: January 1, 2022-December 31, 2022

Option Year II: January 1, 2022-December 31, 2022

Reporting Requirements

The contractor shall perform quality assurance activities that are acceptable for The Joint Commission (TJC) certification regarding the monitoring of emergency/urgent care services and shall provide a quarterly quality assurance letter to the Emergency Department Director. This letter shall identify the kind of studies performed, results, and recommendations.

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 contract 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.

Reference Material

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

Contractor 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 Contractor 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.

Quality Review

The professional services of the contractor shall be evaluated for quality by the Government via routine staff members review of emergency department/urgent care charts on a quarterly basis or more often as appropriate, however, the government retains no control over the medical professional aspects of services rendered (e.g. professional judgements, diagnosis for specific medical treatment).

Security

All contractors shall undergo a fingerprint check and shall be cleared prior to hire. Contractor’s continued employment is contingent upon the outcome of a complete and favorable background investigation as determined by the sensitivity level of the position. If contractors are found not suitable, they will be removed.

This is a designated position covered by Public Law 101-647, 101-630, Crime Control Act of 1990, and the Indian Child Protection and Family Violence Prevention Act, requiring contact or control over Indian children. Contractors shall be required to complete, sign, and submit the Addendum to OF-306, Child Care & Indian Child Care Worker Position form. Due to this requirement, the agency shall ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. Failure to comply with these statutes shall result in immediate removal.

Immunization

The contractor shall provide during the term of the contract documentation of provider’s immunization record to reflect CDC’s Recommended Vaccines for Healthcare Workers (specifically MMR, Tdap, varicella, Hep B immunity, current (within the past year) influenza vaccination) and current annual tuberculosis screening. Documentation shall be provided with the completed Application for Appointment to Medical Staff and continual updates to the immunization record supplied to the Employee Health Nurse.

Orientation

All providers furnished by the contractor shall be required to complete orientation sessions conducted by the on-site Health Records Department and the Human Resource Department.