Performance Work Statement Diagnostic Ultrasound Technicinan.docx

STATEMENT OF WORK

Quentin N. Burdick Memorial Healthcare Facility Diagnostic Radiologic Technologist Services

Purpose of the Contract

GENERAL:

This is a non-personnel services contract to provide Diagnostic Radiologic Technologist (Ultrasound RDMS certified) Services for the Quentin N. Burdick Memorial HealthCare Facility Radiology Department. The Technologist must be Certified and have a minimum of two (2) years’ experience. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

BACKGROUND:

The Mission of the Quentin Burdick Memorial Healthcare Facility Indian Health Service is to provide the best possible healthcare services to the Native American population on the Turtle Mountain Indian Reservation. The 29-bed facility is also known as the Belcourt Indian Health Service Hospital, QNBMHCF, the Belcourt Service Unit, or the IHS Hospital, hereinafter designated as “Hospital” for the purpose of this Statement of Work

DESCRIPTION ON SERVICES:

The contract Diagnostic Radiologic Technologist agrees to provide all necessary covered services within the Hospitals scope of practice, under the direction of the Clinical Director or the Radiology Supervisor. The contracted Technologist shall provide a full scope of services to include children, adolescents, and adult patients at the Quentin Burdick Memorial Healthcare Facility Service Unit.

OBJECTIVES:

To meet the mission, the Quentin N. Burdick Memorial Health Care Facility requires Contractor support to assist the Hospital in the recruitment and placement of a Diagnostic Radiologic Technologist Certified in Ultrasound into temporary duty assignments at the Hospital. The contract effort shall be tailored to provide a limited range of radiology ultrasound services and the use of RPMS/EHR systems.

SCOPE

The services provided by the Diagnostic Ultrasound Technologist should be as comprehensive as the Hospital supplied facilities, equipment and support services permit. The Contractor shall provide a Technologist to provide ultrasound services for patients as required by this Statement of Work (SOW) and in accordance with the terms and conditions of this contract.

The Contractor must be capable of responding to rapidly changing and unexpected needs for temporary coverage. It is anticipated that the Hospital in Belcourt, North Dakota has a short term need for temporary ultrasound services during most times. It is important, therefore, that the Contractor have access to enough qualified technologists to meet the needs of the Hospital.

Individuals providing services under contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act” P.L. 101-630.

The Indian Health Service Personnel Office will conduct these investigations following award of a contract unless in the judgment of the Contracting Officer, in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individual shall not have unsupervised contact with Indian children.

The Contracting Officer has the authority to temporarily waive the character investigation of a contractor. The “Agreement to a Temporary Waiver of Character Investigation (See Attachment B) authorizes an agency to always hire a contractor prior to the completion of a background check provided that the contractor is within the sight and under the supervision of a government employee who has successfully completed the National Agency Check with written Inquiries (NACI).

The need for services is expected to remain constant during the term of the contract period. Therefore, the Contractor shall maintain the continuity of services to the maximum extent possible.

Each contract resulting from this solicitation shall be a fixed-price personal health care services contract:

GOVERNMENT FURNISHED PROPERTY: FACILITIES AND SERVICES:

The contract ultrasound technologist(s) will be authorized to use all areas of the medical treatment facility available to civil service and commissioned personnel in similar positions. The same restrictions apply to the contractor technician(s) as any other Indian Health Service personnel to use areas for official business activities only.

The service unit shall provide administrative and professional ancillary support deemed necessary to support the service unit physician staff. These services shall be available eight (8) hours per day.

The Hospital shall provide all equipment and medical supplies deemed necessary to provide medical care at the Hospital except for those items to be supplied by the Contractor.

The Hospital shall provide all required blank Government forms applicable to the Indian Health Service. Hospital personnel will also provide appropriate orientation to the necessity of such forms.

The Hospital shall provide the authority for the Contractor technologist(s) to purchase meals in the Hospital dining room when available.

When available a pager shall be furnished by the Hospital. A cell phone can be used by contractor as well at own expense.

The Hospital shall provide an ongoing method of monitoring and evaluation of the quality and appropriateness of patient care, and of identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

Transcription service is available at the Hospital. Additionally, legible handwritten documentation of medical records is acceptable.

STATEMENT OF WORK:

The Contractor shall furnish ultrasound technologist services for in-house medical services at the Quentin N. Burdick Memorial HealthCare Facility in Belcourt, North Dakota, and provide services for Indian Health Service beneficiaries served by the Hospital.

The Contractor shall and provide a radiologic ultrasound technologist to assist with the necessary medical procedures for patients that are seen in the radiology department and perform services compatible with the Hospital medical facilities operating capacity and equipment. The services should cover the range of ultrasound services typically provided in a rural civilian practice of similar size.

The contract ultrasound technologist shall:

1. Independently operate fixed arid portable ultrasound equipment as needed.

2. Perform a variety of ultrasound examinations, and routine-more complex procedures, this includes breast mammograms, ultrasounds, DVT, RVT functions if so certified.

3. While performing very complex (special examinations) the contractor will receive procedural directions from a higher-grade technologist (Chief, Technologist) and/or Area Office consultant.

4. Performs basic ultrasound examinations, providing that training in ultrasound comes available to the Contractor. The Chief, Radiologic Technologist, and/or Radiologist, if applicable will supervise this procedure.

5. Maintains a patient log daily, schedules patients for special examinations, educates patients on examinations such as preparation and all other aspects of the examination.

6. Will be involved in the daily Quality Control of the ultrasound department, daily Quality Control program, if this equipment is available.

7. Performs duties as assigned by a higher-grade technologist. If the Contractor functions independently, he/she will receive directions from the Clinical Director and Area Radiology Consultant.

8 Must be able to assist in cardiac arrest situations, CPR, anaphylaxis shock along with the other medical staff.

The standards of medical practice and duties of the contractor through its technologist shall be determined pursuant to the bylaws of the Hospital. The regulations of the Hospital, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to certification must be followed. Also the standards and recommendations of the Joint Commission on Accreditation. Health Care Organizations (JCAHO)(CMS)(ACR) must be adhered to.

The radiology department supervisor arranges the schedule with input from the contractor.

The Contractor shall locate, credential, and have available sufficient staffing to provide ultrasound services on a temporary schedule at the Hospital. The director of radiology or the Clinical Director will arrange the shift schedule with consultation from ultrasound technologist. Work shifts may be up to sixteen (16) hours in length and may be worked between the hours of 7:30 A.M. and 12:00 P.M. with an hour lunch break. Or the work shifts may be up to eight (8) hours in length and worked between the hours of 8:00 A.M. and 4:30 P.M. depending on the schedule agreed to. The ultrasound tech will be scheduled to be in an on-call status after the scheduled tour of duty, the next day depending on the schedule as presented by the radiology director on the days scheduled for being available in an on-call status.

Prior to assumption of duty on any scheduled work shift, the Contract ultrasound tech may be briefed by the Director of the radiology department or his/her designated representative concerning any matter relevant to the Contract technologist (s) assumption and discharge of responsibilities under the terms of this contract. The Contractor shall advise the radiology department supervisor or his/her designated representative of any problem encountered, or which may be encountered, in connection with meeting the needs of patients treated by the Contract technologist(s). The Contractor shall report continuing problems of any nature to the Contracting Officer Representative.

The Contract ultrasound technologist shall generate and maintain proper medical record information on patients to whom treatment is provided, in accordance with JCAHO/CMS/ACR and I.H.S. regulations. The Contract ultrasound tech shall prepare all medical record documentation to meet the established standards of the Hospital to include, but not be limited to timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of this contract shall remain the property of and subject to the exclusive control of the Indian Health Service (I.H.S.).

The Contract technologist(s) shall assess radiology services to ensure its quality. The Contract technologist(s) will participate in a continual process of self-evaluation and strive for excellence in radiology services and participate in medical staff functions, such as medical program reviews, performance improvement activities and organizational functions, including attending committee meetings and accepting committee assignments if and when requested by the Director of the Radiology Department.

The Contract technologist(s) shall comply with all Hospital infection control and safety procedures, practices and standards The Contract technologist(s) may be required to provide formal or informal continuing education to members of the Hospital Radiology Staff and other Hospital staff. The training shall be regarding the technologist’s field of expertise.

The Contract Technologist shall respect and maintain the basic rights of patients, to include but not be limited to personal dignity.

The Contractor technologist shall have a minimum six-hour rest period before beginning a scheduled shift. Regardless of patient workload, a Contractor technologist shall not sleep during a scheduled shift.

DIAGNOSTIC ULTRASOUND TECHNOLOGIST QUALIFICATIONS:

The Contractor shall ensure that the appropriate certification agency or equivalent has certified the contractor Technologist.

It is a condition of this contract that all required certifications in this Statement of Work remain current during the life of this contract.

A current CPR card or Current Basic Life Support (BLS) certification is required of all technologists placed by the Contractor. Advanced Cardiac Life Support (ACLS) certification is also acceptable.

The Contractor technologist(s) shall not have any work or health restrictions, which interfere with the performance of radiology ultrasound services.

The Contractor technologists) shall speak, understand, read, and write English fluently and communicate with sufficient clarity to be understood by Great Plains Area Indian Health Service personnel, staff and patients.

The Contractor technologist shall possess sufficient initiative, interpersonal relationship skills, and social sensitivity such that he/she can relate constructively to patients from Native American communities in the Great Plains Area I.H.S.

The Contractor technologist(s) shall maintain standards of personal hygiene and grooming such that his/her image as a health care professional is compatible with the expectations of the Aberdeen Area Indian Health Service clinical staff and the Native American community.

VERIFICATION OF LICENSURE:

To ensure that technologist(s) providing services under this contract are properly licensed or properly documented as Radiology Ultrasound Technologist and that the I.H.S. is made aware of all disciplinary actions taken against such technologist, the contractor will:

1. Verify through the Federation of State Radiology Boards or equivalent database all active, inactive, and lapsed licenses/certifications that are held, or have been held, by radiology ultrasound technologists who would provide services in I.H.S. hospitals and clinics under this contract.

2. Inform I.H.S. of the status of all licenses/certifications for each technologist who would provide services under this contract in I.H.S. Hospitals and clinics, including all reasons for each inactive or lapsed license/certification.

3. Obtain at least two letters of reference from health care providers who have knowledge of the applicant’s radiology technologist practice skills. One letter must be from the Director of Radiology or X-ray supervisor, at the hospital where the technologist held or last held radiology ultrasound tech privileges.

4. Provide all information regarding performance and disciplinary actions that is collected from the technologist who would be placed under this contract to the receiving I.H.S. facility Director of X-ray Department. This includes all information that is collected and compiled on such technologist 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 technologist for placement under this contract.

5. Certify that all information obtained on technologists whom they would assign to I.H.S. hospitals and clinics has been reviewed and verified by the Contractor. This certification must include a statement that the Contractor has found no reason to reject the technologist application. The names of the contacts, their titles, telephone numbers, and dates of representative collecting and reviewing such information must be recorded in writing and made available to the I.H.S. by the Contractor.

The Contractor must provide all the applicable information required above to the Hospital’s Director of X-ray Department of no less than seven days before the technologist actual report date. When the requirements or the I.H.S. do not allow for hard copies of information to be received at least seven days before a technologist placement, the Contractor may provide such assurances to the Hospital’s Director of X-ray Department within five days after technological placement. Such instances shall be kept to a minimum and the reasons for each instance must be documented and well justified by the Director of X-ray at the Hospital. (Per amend. #2- 9/28/95)

REQUIREMENTS:

The Contractor shall recruit, credential, and place qualified radiology ultrasound technologists at the Hospital. Specific duties and work hours may vary. The on-call availability will be scheduled on a rotating basis. Hospital x-ray department personnel will share the on-call duties.

The Hospital shall initiate orders for primary care physician coverage. The orders shall be placed in the Order for Supplies or Services (Optional Form 347) format. Upon assignment, the Contractor shall provide to the ordering officer the curriculum vitaes and other requirement documentation and shall coordinate the technologist(s) travel and lodging arrangements to the Hospital.

The Contractor shall investigate, verify, maintain, and submit documentation of education, training, licensure and certifications held for each technologist that is proposed to provide services at the Hospital. Such documentation must show compliance with provisions shown under C-5 Radiology Ultrasound Technologist Qualifications and contain the following additional information:

(a) Letters of recommendation including character reference from:

- Residency Radiology Director if in training program within the past two (2) years

- Professional Supervisor/Department Chairman

- Professional Colleagues

(b) Statement concerning prior professional privileges, malpractice, drug/alcohol abuse, health, and history of disciplinary actions from a state board of Radiology Examiners, Federation of State Radiology Boards, etc.

If a Contractor technologist (s) privileges are revoked at any time during the term of the contract, the Contractor shall remove the Technologist(s) from providing services to the Indian Health Service under the terms and conditions of this contract. The Contractor shall provide a qualified radiology ultrasound technologist(s) to complete the removed technologist(s) placement assignments. If at any time it is determined that improper or falsified credentials have been submitted or any of the contractor technologist(s) credentialing documents expire or be revoked, privileges for the technologist(s) to which they pertain will be revoked, initially by verbal notification, followed by written notification to the Contractor. The replacement technologist(s) travel costs to the Hospital shall be the responsibility of the Contractor.

Employee Performance. The Contractor shall not allow any technologist to perform work under this contract who is under the influence of alcohol, drugs, or any other incapacitating agents.

Project Manager. The Contractor shall provide a project manager who shall be responsible for the overall management and coordination of this contract and who shall act as the central point of contact with the Indian Health Service. In the event the project manager is not a Radiologist; a radiology director who is a Registered Radiologist shall be named to be responsible for Quality Assurance (QA) issues.

CHARACTER INVESTIGATION:

Individuals providing services on personal or non-personal services contract, the duties and responsibilities of which involve regular contact with, or control over, Indian children, are subject to a character investigation. IHS personnel offices will conduct these investigations following award of a personal or non-personal service contract unless in the judgment of the Contracting Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified such individuals shall not have unsupervised contact with Indian children.

This non-personal services contract shall place the Contractor within the Radiology Department and under the general direction of the supervisor of the department.

Any problems or questions can be relayed to the Contracting Officer responsible for this contract.

This position is subject to P.L. 101-630, the Indian Child Protection and Family Violence Prevention Act, as determined by the service unit director. The Indian Health Service personnel office will conduct the criminal background investigation on the awardee following award of the service contract. The character investigation may be waived if, in the judgment of the contracting officer, in consultation with the personnel officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the contracting officer notified of the results, the contractor must not have unsupervised contact with Indian children.

CONTRACT ADMINISTRATION:

CONTRACTING OFFICER RESPONSIBILITY:

Authority to negotiate changes in terms, conditions, or amounts sited in this contract is reserved to the Aberdeen Area Indian Health Service contracting officer.

BILLING AND PAYMENT:

Payment shall be made through the IPP.gov platform upon submission by the contractor of an appropriate time sheet form and required invoices. The original copy of the time sheet form and one copy of the invoice will be submitted to the project officer:

• Radiology Manager, Quentin N. Burdick Health Care Facility, Indian Health Service, P0 Box 160, Belcourt, North Dakota 58316-0160 will review the invoice, sign it recommending approval, and forward.

INVOICE SUBMISSION:

• The contractor shall submit an invoice through the IPP.gov platform

• The contactor agrees to include the following information on the invoice:

1. Contractor’s name

2. Invoice number and date

3. Contract number or other authorization for delivery of property and/or services

4. Description, dates when services were provided, cost or price, and quantity of property and/or services delivered or rendered

5. Other substantiating documentation or information as required by the contract

6. Name, title, phone number, and complete mailing address of responsible official to whom payment is to be sent (electronic transfer information)

PAYMENT DUE DATE

• Payments under this contract will be due on the 3O’ calendar day after the date of approval in IPP.

CONRACTING OFFICER REPRESENTIVE:

The Contracting Officer Representative representing the government for the purpose of this contract shall be designated in writing by the contracting officer, Great Plains Area Indian Health Service, Aberdeen, South Dakota 57401.

The COR is responsible for:

• Monitoring the contractor’s technical progress, including surveillance and assessment of performance and recommending to the contacting officer changes in requirements.

• Interpreting the scope of work.

• Performing technical evaluation, as required.

• Performing technical requirements and acceptance required by this contract (recommending approval of invoices).

• Assisting the contractor in resolution of technical problems encountered during performance.

• Serving as systems manager to ensure compliance with the Privacy Act.

The contract officer is responsible for directing or negotiating changes in the terms, conditions, or amounts cited in the contract.

DESIGNATION OF CONTRACTING OFFICER REPRESENTATIVE:

The person identified below is hereby designated as the contracting officer representative for this contract. The responsibility of the project officer (or his duly authorized representative) is to ensure that the government’s technical objectives are met. To this end, the project officer will provide necessary information, direction, coordination, etc., within the contractual work description. Issuance of changes that affect the articles, terms, or conditions of this contract will be accomplished through the contracting officer, who is the only party authorized to bind the government to the contract.

Contracting Officer Representative: Yvette Wallette or Nathan Albertson Quentin N. Burdick Health Care Facility Indian Health Service P0 Box 160 Belcourt, North Dakota 58316-0160.