N62645-16-R-0016-_Amend_01.docx

N62645-16-R-0016

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

SUMMARY OF CHANGES

Question 1. What was the previous contract value?

Answer 1. The value of the current contract at the time of award was $4,810,021.40. It is noted that the predecessor contract doesn’t reflect the Government’s current requirement.

Question 2. Is there an incumbent contractor, or multiple contractors, performing this work currently? If so, can the Government please specify who the incumbents are?

Answer 2. The current contractor is Mid-Atlantic Cardiothoracic Surgeons LTD under contract N62645-12-C-4003.

Question 3. If there is an incumbent, are they eligible to bid on this opportunity?

Answer 3. The incumbent contractor is eligible to propose on the new contract.

Question 4. The Past Performance requirements for this small business set-aside only permit the reference of cardiothoracic surgery, cardiovascular perfusionist, and cardiothoracic physician assistant clinical services. That is a very specific requirement, thus decreasing the competition significantly in one of America’s most underserved service lines. According to The Society of Thoracic Surgeons, there are about 1.5 CTSs per 100,000 Americans, or only about 120 per state, and most of which are confined to Urban areas. Will the government, therefore, expand the initial past performance requirement of cardiothoracic specific services to “subspecialists” in surgery, perfusionist, and physician assistant?

Answer 4. The Government will not revise its criteria for determining relevant past performance.

SECTION C - DESCRIPTIONS AND SPECIFICATIONS

The following have been modified:

STATEMENT OF WORK

NOTE 1: The use of Commanding Officer means: Commanding Officer or other activity head, or a designated representative, e.g., Contracting Officer’s Representative(s) (COR) or Department Head.

NOTE 2: The term contractor means the offeror identified in block 15A on the Standard Form 33 or block 7 on Standard Form 26, and its Health Care Workers (HCW) who are providing services under the contract.

NOTE 3: The term health care worker (HCW) refers to the individual(s) providing services under the contract.

NOTE 4: The term MTF refers to the Military Treatment Facility or other Federal medical treatment facility at which services are to be performed.

NOTE 5: The term COR refers to the Contracting Officer’s Representative, a government employee appointed in writing by the Contracting Officer to serve as technical liaison between the government and the contractor.

C.1. STATEMENT OF WORK

C.1.1. Site of Services. The contractor shall provide personnel for service at Naval Medical Center, Portsmouth, VA in support of the Cardiothoracic Surgery Program.

C.1.2. The contractor shall provide Cardiothoracic Support Services to include, but not limited, to medical care and consultation for the Naval Medical Center, Portsmouth, VA in support of the Cardiothoracic Surgery Program. The HCWs providing care under this contract shall be subject to day-to-day supervision and control by Government personnel. Supervision and control is the process by which the individual HCW receives technical guidance, direction, and approval with regard to a task(s) within the requirements of this contract. The following services will be provided in accordance with the terms and conditions of the contract:

C.1.2.1. At all times, the contractor shall maintain not less than the minimum staffing level of one Cardiothoracic Surgeon, one Cardiothoracic Perfusionist, and one Cardiothoracic Physician Assistant. The Government does not in any way imply that the minimum staffing requirements are sufficient to perform the requirements of the contract. All HCW duties are described in Section C.5.

C.1.3. Contractor services shall be provided for the treatment of active duty military personnel, their dependents, eligible Department of Defense civilian employees, and other eligible beneficiaries, designated by the Government.

C.2. SUITS ARISING OUT OF MEDICAL MALPRACTICE

C.2.1. The HCWs are serving at the MTF under a personal services contract entered into under the authority of section 1091 of Title 10, United States Code. Accordingly, section 1089 of Title 10, United States Code shall apply to personal injury lawsuits filed against the HCWs based on negligent or wrongful acts or omissions incident to performance within the scope of the contract.

C.2.2. The HCWs are not required to maintain medical malpractice liability insurance. In the event of a claim or lawsuit relating to a HCW’s performance of duties under the contract, the parties shall follow the procedures established in SECNAVINST 6300.3A, a copy of which can be viewed at http://doni.daps.dla.mil/default.aspx.

C.2.3. The HCWs providing services under the contract shall be rendering personal services to the Government and shall be subject to day-to-day supervision and control by Government personnel. Supervision and control is the process by which the individual HCW receives technical guidance, direction, and approval with regard to a task(s) within the requirements of the contract.

C.3. DUTY HOURS.

C.3.1. HCWs will be required to provide services during any hour of operation at Naval Medical Center, Portsmouth, VA. Services will include scheduled, unscheduled and emergency services. The Government will inform the contractor of the type of services and HCWs required to provide services.

C.3.2. Services will not be required on weekends or on the day of federally established holidays except in the case of on-call or call-back. See Section C.4.12.

C.4. SCHEDULES, LEAVE, ON-CALL AND CALL BACKS.

C.4.1. Historical Information. The information is provided for informational purposes only. Within the last 18 months, while providing on-call services, 90 cases were performed by the current contractor. During the same time period, approximately seven patients required a return to the Operating Room on the same day as their initial surgery, which required the HCWs to provide call-back services.

C.4.2. Shift Scheduling. Schedules (e.g., surgeries, on-call) shall be submitted to the Contracting Officer’s Representative (COR) four weeks in advance, on the first weekday (Monday through Friday) of the previous month. Any changes to the personnel schedule shall be submitted to the COR 72 hours in advance of the required change. The Government recognizes the unforeseen need for scheduling changes and events such as illness and injury. The required 72-hour advance notification for schedule changes may be waived by the Government for such occasions on a case-by-case basis. The contractor shall make all attempts to ensure that all shifts are staffed in accordance with the personnel schedule.

C.4.3. Scheduled Coverage. (This section excludes Physician Assistants.) The HCWs shall normally provide scheduled coverage services. Coverage services may be scheduled anytime between 0600 and 1800, Monday through Friday for an 8.5 hour shift or a 12-hour shift. As appropriate, depending upon actual number of hours worked per day, an uncompensated meal break of 30 minutes shall be taken when assigned an 8-hour shift and 45 minutes when assigned a 12-hour shift, respectively, on-site. This includes extending the work shift beyond the scheduled clinic closing time to complete patient care and administrative duties. No shifts shall exceed 12 ¾ hours, inclusive of breaks. The HCWs shall be on duty for approximately 40 hours per week, unless otherwise specified.

C.4.4. Physician Assistants. The HCWs shall provide approximately 60 hours of service per 2-week period. The HCWs will be notified when required to provide emergency services. The Physician Assistant services will be billed hourly and in accordance with the price stated in Section B.

C.4.5. When required to ensure completion of services that extend beyond the estimated time of completion, the HCWs shall remain on duty until services are completed to the satisfaction of the Government. This provision is not intended to apply to the time required to complete routine tasks (e.g., completion of paperwork or routine administrative tasks at the end of a shift), which are to be completed as part of the shift. HCWs shall always arrive for each scheduled surgery in a well-rested condition.

C.4.6. The contractor shall have sufficient qualified reserve personnel so that all services are provided in the event a HCW scheduled to work becomes ill, resigns, is terminated, or is otherwise unavailable to work. Contract requirements are not mitigated by inclement weather, except as addressed below in paragraph C.4.10.

C.4.7. If a HCW becomes ill or is otherwise unable to fulfill his/her obligation to work, he/she shall notify the contractor who in turn shall notify the COR. The contractor shall notify the COR within 30 minutes, or as soon as possible, of being notified of a HCW who is unable to fulfill their shift.

C.4.8. The contractor shall provide replacement coverage with a HCW who meets the minimum HCW contract qualifications and is approved for work (i.e., approved as qualified, credentialed/privileged, and has satisfactorily completed orientation).

C.4.9. Leave. The contractor is responsible for scheduling the HCWs, for providing the leave benefit for the HCWs, for approving leave for the HCWs, and for providing any holiday benefit. The HCWs will not accrue leave under this contract; individuals on leave, holiday status, or otherwise absent shall be subject to replacement coverage by the contractor. The contractor shall maintain sufficient back-up personnel to ensure coverage of the schedule during periods of both scheduled and unscheduled absence.

C.4.10. Administrative Leave. For unusual and compelling circumstances (e.g., weather emergencies) in which the Commanding Officer either excuses all facility personnel from reporting to work or dismisses all personnel early, the Commanding Officer is authorized to grant administrative leave to the HCW. This administrative leave may be compensated leave. Personnel who occupy “essential” positions may be required to remain on duty or return to the MTF in order to maintain continuity of patient care services.

C.4.11. Unscheduled Services. The contractor shall be responsible for emergency operative cases that arise between 0600 and 1800, Monday through Friday. Emergency operative services will not be required on weekends, or federally observed holidays. An exception will be call-backs, where the HCW returns to the NMCP for any patient who has already undergone primary surgery and requires emergent return to the operating room.

C.4.12. On-call and Call back. The HCWs will provide on-call and call-back services for emergent issues arising from a patient operated on during the week (no new patient responsibility on the weekends). Historical information indicates that call back services required the HCWs to return to the MTF one (1) time per performance year and an estimated 20 hours spent back in the hospital. The HCWs are required to provide 24/7 on-call services. Historical information indicates that the HCWs spent approximately 4,638 hours providing on-call services per calendar year. (These are estimates based on historical data and do not necessarily reflect actual future requirements.)

C.4.12.1. The on-call HCW(s) shall be available via a command provided pager within 30 minutes of travel time to the MTF. The HCWs shall respond within 10 minutes of being paged by calling the hospital communications center. The HCW shall arrive at the Medical Center within 30 minutes of being paged.

C.4.12.2. The HCWs will be assigned a pager to facilitate provisions of these services. Replacement costs, if the pager is lost or stolen, shall be borne by the contractor. Assignment of on-call services will be according to the on-call roster, which will be published 30 days in advance.

C.4.12.3. Any on-call or call-back services provided by the contractor will not be billed or reimbursed separately from, or in addition to, the price stated in Section B.

C.4.13. Consultative Services. The Cardiothoracic Surgeon will be available to provide consultative services via telephone at all times. The Cardiothoracic Surgeon shall provide both inpatient and outpatient consultative opinions for members of the MTF's staff as requested. Timely consultative opinions shall be provided within 72 hours (for “routine” consultation requests); within 24 hours (for "same day" consultation requests); and immediately (for “stat” consultation requests). Any consultative services provided by the contractor will not be billed or reimbursed separately from, or in addition to, the price stated in Section B.

C.5. GENERAL DUTIES AND RESPONSIBILITIES. The HCWs shall perform Cardiothoracic Support Services to include, but not limited to, medical care and consultation consistent with their labor category using government furnished supplies, facilities and equipment within the assigned unit of the Medical Treatment Facility (MTF). The HCW’s productivity is expected to be comparable with that of other individuals performing similar services. Workload occurs as a result of scheduled and unscheduled requirements for care. Due to the nature of medical personal services which require Government supervision, the need for HCW access to CHCS/AHLTA, and patients that present only at the MTF, this contract does not lend itself to allow HCWs to telecommute.

C.5.1. SPECIFIC DUTIES.

C.5.1.1. Cardiothoracic Surgeon: A maximum of six otherwise qualified Cardiothoracic Surgeons shall maintain delineated clinical privileges in the performance of the Cardiothoracic Support Services.

C.5.1.1.1. Serve as primary surgeon as necessary for caseloads, during times when the NMCP cardiothoracic surgeon is in a leave or Temporary Additional Duty status. The HCWs shall provide pre-operative care, operative care, and post-operative care.

C.5.1.1.2. Historical Information. This information is provided for informational purposes only. Within the last 18 months, the contractor was not required to serve as primary surgeon. There are currently three government cardio-thoracic surgeons at NMCP.

C.5.1.1.3. Assist as necessary on preoperative management of patients, to include clinical consultation, selection and timing of operative intervention, and the selection of operative procedures.

C.5.1.1.4. Provide surgical care for patients to include open and closed heart operations and operations on the great vessels of the chest.

C.5.1.1.5. Direct and provide appropriate diagnostic and therapeutic measures for inpatients.

C.5.1.1.6. Maintain a cohesive working interaction with the Cardiology, Vascular, and Pulmonary Product Lines of the NMCP.

C.5.1.1.7. Assist in the provision of postoperative management of Cardiothoracic surgery patients.

C.5.1.1.8. Provide technical direction and/or periodic training to members of the NMCP technical staff. Topics will include, but not be limited to Cardiothoracic Surgery procedures, developments, or related issues. This requirement may fluctuate during the period of the contract, but changes will be minor. This includes the actual training for completion of the training evaluation.

C.5.1.1.9. Provide detailed explanations and recommendations, as requested, to members of the NMCP medical staff regarding quality of care issues. These recommendations are generally due within 5 days of the request.

C.5.1.1.10. Assist in quality assurance and process improvement activities involving the cardiac surgical patient population.

C.5.1.1.11. Clinical Services. The Cardiothoracic Surgeons will practice within the scope of their privileges and must be capable of performing the following clinical procedures:

C.5.1.1.11.1. Chest Wall:

Resection of tumor (including rib mass) Thoracoplasty Plastic reconstruction (including Pectus) Reconstruction chest wall Repair chest wall hernia Repair of sterna fracture Resection of sternum Thoracic outlet Lung and Pleura Pneumonectomy Lobectomy Segmental resection Wedge resection/resection Bleb/abrasion Exploratory thoracotomy and biopsy Decortication/pleurectomy/abrasion Cavernostomy Closure broncho pleural fistula Drainage lung abscess Repair lung laceration/injury Resection of pleural tumor Resection of pulmonary cyst Drainage of emphysema (rib resection/Eloessar flap)

C.5.1.1.11.2. Thoractomy for:

Anterior spinal fusion Transthoracic vagotomy Sympathectomy Blunt or penetrating trauma Bleeding if not postoperative

C.5.1.1.11.3. Tracheobronchial operations:

Resection of stricture or tumor Mediastinal tracheostomy Repair of rupture or laceration

C.5.1.1.11.4. Mediastinum:

Excision of tumor or cyst Thymectomy Closure of thoracic duct Drainage of mediastinal abscess

C.5.1.1.11.5. Diaphragm

C.5.1.1.11.6. Hernia Repair:

Congenital Acquired Traumatic Plication Resection

C.5.1.1.11.7. Cardiovascular:

Patient ductus arteriosus Correction of coarctation Open cardiac Coronary artery fistula Vacular ring Closed valvulotomy Acquired Open Closed Cardiac tumor Insertion of cardiac assist device Pericardiectomy Repair of laceration or perforation Removal of foreign body Operations for coronary artery disease Great Vessels Injury to aorta/great vessels Pulmonary embolectomy Repair of aneurysm (intrathoracic) Embolectomy Endarterectomy Repair of excision or aneurysm Vascular graft or prosthesis Insertion intra aortic balloon pump Caval interruption

C.5.1.1.11.8. Other:

Bronchoscopy Endocopy Thoroscopy Exploration for hemorrhage Tracheostomy Mediastinoscopy or Scalene Node Biopsy Drainage of pericardium Pacemaker implant Archaneurysm repair/replacement Intraoperative use of lasers.

C.5.2. Cardiovascular Perfusionist: A maximum of seven otherwise qualified individuals are to serve as Cardiovascular Perfusionists in the performance of the Cardiothoracic Support Services.

C.5.2.1. Prepare and assemble the heart-lung machine, intra-aortic balloon pumps and other related extracorporeal apparatus with the appropriate modifications and adaptations thereof so as to be compatible with each patient, pathology and type of case.

C.5.2.2. Work in close professional support with government and contractor cardiothoracic surgeons, anesthesiologists, professional nurses and personnel of other disciplines in the planning and performance of cardio-vascular procedures.

C.5.2.3. Maintain and operate the extracorporeal circulation apparatus (heart-lung machine), provide oxygenated blood, anesthetics, blood chemical and base equilibrium, (specifically normal heart and lung functioning) to the patient during heart surgery.

C.5.2.4. Follow the rigid surgical aseptic techniques required to institute and maintain total body perfusion of the patient during open-heart surgery using extra-corporeal circulation.

C.5.2.5. Ensure that all systems function perfectly and in coordination with each other, as well as with the physiological status of the patient and the successive phases of the surgical procedure.

C.5.2.6. Prepare and assemble the extra-corporeal apparatus with appropriate modifications and adaptations compatible with the size of the patient, cardiac pathology, physiological status of the patient's cardiovascular system, degree of illness of the patient and the surgical technical problems that may be encountered.

C.5.2.7. Control the technical operation and coordinate the maneuvers by which extra-corporeal circulation is instituted, sustained, and discontinued so that the heart and lungs resume normal function.

C.5.2.8. Induce hypothermia when prescribed by the surgeon.

C.5.2.9. Operate the cardioplegia delivery system for infusion of cardioplegia to the coronaries for myocardial preservation.

C.5.2.10. Initiate, operate, and monitor the membrane respiratory or cardiac assist device for critically ill patients.

C.5.2.11. Operate intra-aortic balloon assist devices when necessary.

C.5.2.12. Adjust balloon inflation and deflation.

C.5.2.13. Detect arrhythmias and insure the balloon's proper functioning.

C.5.2.14. Maintain constant surveillance of overall performance of extra-corporeal apparatus in relation to the physical and chemical changes produced in the blood by obtaining samples during various phases of perfusion for the purpose of making the following determinations: pH, PC02 P02, acid base equilibrium, potassium and sodium content, and by interpretation of electrocardiographic and electroencephalographic recordings during perfusion.

C.5.2.15. Initiate and operate (as directed by the cardiothoracic surgeon) Haemonetics cell saver machine, facilitating the salvaging and washing of blood cells, and returning these viable blood products to the patient.

C.5.2.16. Ascertain the proper sterilization of all supplies, components of the heart-lung machine and all equipment used for extra-corporeal circulation.

C.5.2.17. Provide post operative perfusion services as required for ventricular assist patients.

C.5.2.18. Participate with cardiothoracic surgeons and other disciplines in clinical investigation and research conducted in connection with open-heart surgery by suggesting modifications and/or improvements based on technical knowledge of equipment.

C.5.2.19. Provide standby services for Percutaneous Transluminal Coronary Angioplasty (PTCA) procedures.

C.5.3. Cardiothoracic Physician Assistant: A maximum of seven otherwise qualified Physician Assistants shall maintain delineated clinical privileges in the performance of the Cardiothoracic Support Services.

C.5.3.1. Obtain patient health and developmental history.

C.5.3.2. Perform and record a health appraisal including physical assessment and evaluation.

C.5.3.3. Differentiate between normal findings and those that require consultation and/or referral.

C.5.3.4. Diagnose patients with common acute conditions, illnesses or minor trauma within legally accepted protocols, or in accordance with applicable instructions.

C.5.3.5. Request X-Rays and laboratory tests as deemed necessary.

C.5.3.6. Formulate a health care plan for clinic patients emphasizing self-care responsibility through the participation of the patient, family, physician and other health care professionals.

C.5.3.7. Treat patients with common acute conditions, illnesses or minor trauma within accepted protocols, Physician Assistant scope of practice, in accordance with applicable instructions and/or, in collaboration with a physician.

C.5.3.8. Collaborate with the physician in the health care of patients with chronic illnesses.

C.5.3.9. Identify resources and coordinate referrals for patients and families requiring further evaluation and services.

C.5.3.10. Assist in staff education.

C.5.3.11. Analyze the results of the health care plan.

C.5.3.12. Modify the health care plan as needed.

C.5.3.13. Implement and participate in follow-up.

C.5.3.14. Provide for an optimum physical environment for patients and staff, emphasizing good safety practices and cleanliness.

C.5.3.15. Support preventive maintenance and report equipment failures and inadequacies.

C.5.3.16. Promote economical utilization of equipment, supplies and be cost conscious when ordering lab and radiological studies.

C.5.3.17. Know the location and operation of emergency equipment.

C.5.3.18. Adhere to departmental and hospital safety guidelines.

C.5.3.19. Maintain patient records in accordance with MTF requirements.

C.5.3.20. Collect and record all examination data in proper format for review, approval and/or recommendation by physician.

C.5.3.21. Become thoroughly familiar with and apply procedures documented in the MTF's Standard Operating Procedures (SOP).

C.5.3.22. Provide first assist, opening and closing during operations.

C.5.3.23. Perform harvesting of vascular conduits and closure of wounds for saphenous vein and radial artery.

C.5.3.24. Opening and closing of median sternotomy and thoracotomy incisions.

C.5.3.25. Femoral artery and vein exposure and cannulation.

C.5.3.26. First assist in cardiac and thoracic surgical procedures.

C.5.3.27. Insertion and removal of intra-aortic balloon pumps.

C.5.3.28. Insertion and removal of chest tubes, central venous lines and pulmonary artery catheters.

C.5.3.29. Removal of epicardial pacing wires.

C.5.3.30. Provide wound care to include suture and staple removal, debridement, incision and drainage of abscesses and dressing changes.

C.5.3.31. May insert a nasogastric tube, bladder catheter, needle, or peripheral intravenous catheter, but not a flow-directed catheter, and may perform minor suturing, venipuncture, and subcutaneous intramuscular or intravenous injection under General Supervision.

C.5.3.32. All other invasive procedures not in the above paragraph must be performed under Direct Supervision unless the following conditions are met. The Physician Assistant may request the addition of an invasive procedure to his/her scope of practice and he/she may perform that procedure under General Supervision if:

C.5.3.33. His/her supervising physician has directly supervised the performance of that procedure at least three times.

C.5.3.34. The supervising physician attests to the competence of the Physician Assistant to perform the specific procedure without Direct Supervision.

C.5.3.35. The Commonwealth of Virginia Board of Medicine has granted permission to the Physician Assistant to perform the procedure under General Supervision.

C.5.3.36. Specific guidelines for practice. In the Operating Room, the Physician Assistant’s duties will include all the following. In those duties, he or she will be supervised by the respective Department Head or a Government designated representative.

C.5.3.37. Assist in receiving the patient in the Anesthesia Induction Room or Operating Room.

C.5.3.38. Establish ECG monitoring, introduce bladder catheters, shave and perform surgical scrub.

C.5.3.39. Function as a First and Second Assistant in the Operating Room during part or all of the cardiac surgical procedures.

C.5.3.40. Place radial artery catheters for monitoring and peripheral venous lines for Infusion under Direct Supervision.

C.5.3.41. Assist in the introduction of Swan-Ganz pulmonary artery catheters under Direct Supervision.

C.5.3.42. Remove segments of the greater saphenous vein and/or radial artery for use as conduits in cases of coronary artery bypass surgery under Direct Supervision.

C.5.3.43. Prepare the femoral vessels for cardiopulmonary bypass cannulation, and for intra aortic balloon catheter insertion as required under Direct Supervision.

C.5.3.44. Assist in the safe transportation of the patient at the completion of surgery to the Surgical Intensive Care Unit.

C.5.3.45. Assist in the safe transition of patient monitoring devices from the Operating Room system to the ICU system.

C.5.3.46. Instruct and assist the junior cardiac surgical house officers in the techniques of Arterial and venous catheter insertions and saphenous vein techniques.

C.5.3.47. Oversee and instruct the student surgical assistants in the performance of their Operating Room duties.

C.5.3.48. Make daily rounds on postoperative patients with the writing of progress notes and routine orders in accordance with the Medical Staff Bylaws and Rules and Regulations.

C.5.3.49. Perform specific procedures in the Intensive Care Unit, to include starting intravenous and intra-arterial lines, placing central venous or pulmonary artery catheters, inserting or removing chest tubes, and initiating emergency treatment for tamponade, hypovolemia or arrhythmias under direct Supervision.

C.5.3.50. Assist in the insertion, maintenance, or removal of the intra-aortic balloon pump under Direct Supervision.

C.5.3.51. Evaluation and treatment of preoperative patients, including potential heart transplant recipients after consultation with the supervising surgeon and physician.

C.5.3.52. Perform thoracentesis as needed under Direct Supervision.

C.5.3.53. Remove pacer wires.

C.5.3.54. Dictate routine discharge summaries under the supervision of the representative Department Head or a Government designated representative .

C.5.3.55. Provide in service education to CCU and CVT nursing staff concerning the care and evaluation of potential heart transplant recipients and postoperative heart transplant patients.

C.5.3.56. Provide in service education for Operating Room staff and personnel concerning the intra-operative needs during heart transplantation.

C.5.3.57. Provide pre- and postoperative care in the ICU and wards, taking patient history and performing physical examinations.

C.5.3.58. Provide initial consultation as required.

C.5.3.59. Ensure that appropriate and timely administrative duties for admission and procedures are performed.

C.5.3.60. Coordinate patient management to include, but not limited to, pre-and post hospital surgical care.

C.5.3.61. Provide cardiothoracic surgical technical training to the Operating Room staff, interns and residents, to include, but not limited to, opening and closing sternum, cannulation assistance, harvesting and closing venous and arterial conduits, assisting in distal and proximal anastomosis, and decannulation.

C.5.4. ADMINISTRATIVE AND TRAINING REQUIREMENTS. The HCWs shall:

C.5.4.1. Attend annual renewal of the following Annual Training Requirements: family advocacy, disaster training, Sexual Harassment, infection control, blood borne pathogens and other courses as directed.

C.5.4.2. Comply with command infection control guidelines; practice universal precautions.

C.5.4.3. Comply with the HIPPA (Health Insurance Portability and Accountability Act) privacy and security policies of the treatment facility. Providers shall obtain/maintain a National Provider Identifier (NPI) in accordance with DoD and MTF policy/instruction as applicable.

C.5.4.4. Comply with the standards of the Joint Commission, applicable provisions of law and the rules and regulation of any and all government authorities pertaining to licensure and regulation of health care personnel and medical treatment facilities, the regulations and standards of medical practice of the MTF and the bylaws of the MTF’s medical staff. Adhere to and comply with all Departments of the Navy, Bureau of Medicine and Surgery and local instructions and notices, which may be in effect during the term of the contract.

C.5.4.5. Contribute to the health care system and support the clinical environment to provide quality services and positive patient outcomes.

C.5.4.6. Demonstrate appropriate delegation of tasks and duties in the direction and coordination of health care team members, patient care, and clinic activities.

C.5.4.7. Demonstrate awareness of legal issues in all aspects of patient care and unit function and strive to manage situations in a reduced risk manner.

C.5.4.8. Maintain an awareness of responsibility and accountability for own professional practice; participate in continuing education to meet own professional growth.

C.5.4.9. Participate in monthly meetings to review and evaluate the care provided to patients, identify opportunities to improve the care delivered, and recommend corrective action when problems exist. Should a meeting occur outside of the HCW’s regular working hours, the HCW shall be required to read and initial the minutes of the meeting.

C.5.4.10. Participate in unit and Command Improvement activities. Assist with the development of programs that comply with all regulatory agencies and JCAHO requirements with a focus on Quality Assurance (QA), professional practice, and patient care/teaching.

C.5.4.11. Perform administrative duties which include maintaining statistical records of the HCW’s workload, operate and manipulate automated systems such as Composite Health Care Systems (CHCS), and participate in clinical staff quality assurance functions and Process Action Teams, as prescribed by the MTF.

C.5.4.12. Perform technical duties including, but not limited to, aiding in the clinical input for evaluation of MTF equipment and software updates.

C.5.4.13. Serve as patient advocate, maintain each patient’s right to confidentiality, and provide effective patient education.

C.5.4.14. Support the development of academic and research activities within the department including mentoring residents in research projects.

C.5.4.15. Be assigned, on occasion, to assist in directing the thorough instruction of residents and/or students in a specialty area in accordance with the Accreditation Council for Graduate Medical Education (ACGME) and appropriate certifying board and/or subspecialty board guidelines. This would include assuring the up-to-date practice of that specialty within the department, adherence to applicable professional practice standards and the development of appropriate protocols.

C.6. FAILURE AND/OR INABILITY TO PERFORM.

C.6.1. If clinical privileges or duties of a HCW have been summarily suspended or are being held in abeyance (per DoD Manual 6025.13 (or latest version)), pending an investigation into questions of professional ethics or conduct, performance under the contract may be suspended until clinical privileges are reinstated. No reimbursement shall be made and no other compensation shall accrue to the Contractor for the affected HCW so long as performance is suspended or clinical privileges are held in abeyance. The denial, suspension, limitation, or revocation of clinical privileges based upon practitioner impairment or misconduct will be reported to the appropriate licensing authorities of the state in which the license is held, in accordance with DoD Manual 6025.13.

C.6.2. Any HCW demonstrating impaired judgment will be removed from providing health care services. The Government reserves the right to remove any employee who, in the judgment of a licensed physician, is impaired by drugs or alcohol.

C.6.3. Any HCW with alcohol or drug abuse problems may be allowed to return to work under the terms of this contract only with prior written approval from the Commanding Officer.

C.6.4. This contract may be terminated by the Government if the contractor fails to provide the physical certifications as outlined herein and/or if the HCWs fail to secure clinical privileges as outlined herein.

C.7. CREDENTIALING AND QUALIFICATION REQUIREMENTS.

C.7.1. For all credentialed HCWs: Following award of the contract, the HCW shall complete a Credentials Record (CR) prior to performance of services. Completed CR must be forwarded no less than 30 days prior to performance of duties to the COR. The CR, maintained at the MTF, contains specific information with regard to qualifying degrees and licenses, past professional experience and performance, education and training, health status, and current competency (i.e. within 2 years) as compared to specialty-specific criteria regarding eligibility for defined scopes of health care services. For those HCWs who currently have a CR on file, an updated Personal and Professional Information Sheet (PPIS) for Privileged Providers, with notation that a complete up-to-date CR is on file, shall be submitted no less than 15 days prior to commencement of services. BUMED Instruction 6010.30, enclosure 6 details the CR requirements. BUMEDINST 6010.30 is available from the COR or at http://www.med.navy.mil/directives/Pages/ExternalDirectives.aspx. Click BUMED Directives and page to the appropriate instruction number.

C.7.2. If, during the Government's evaluation of the CR a negative current clinical competency assessment is determined; it will bring the MTF’s consideration of the HCW’s application for credentials review and privileging to an immediate close. Since meeting credentialing requirements and, as applicable, being granted privileges is required as a condition of employment under this contract; a negative current clinical assessment may result in the issuance of a termination notice by the contracting officer under the clause at FAR 52.249-12.

C.7.3. Upon receipt of a complete CR, the COR will forward the package to the MTF’s Medical Staff Services Office (MSSO) for credentials review of the individual HCW. The MSSO shall ensure the CR is complete in accordance with BUMEDINST 6010.30 (and subsequent revisions). The Contractor shall not assign an individual to work at the MTF until the HCW’s CR has been approved by the designated Privileging Authority.

C.7.4. The contractor is responsible for performing verification of all licenses and certifications prior to their submission to the MTF. The contractor shall provide written documentation from the verifying agency that includes the agency POC, their position and contact information, the agency name, and the date of verification. The contractor shall also include a copy of their outgoing letter to the primary issuing agency requesting written verification. Upon receipt by the contractor, the issuing agency's original letterhead verification response shall be provided to the MTF Medical Services Professional, via the Contracting Officer's Representative.

C.7.5. The contractor shall ensure that all documentation necessary to keep each individual CR current is submitted to the MSSO, via the COR, for inclusion in each file. The contractor shall maintain a complete credential file for each employee during the life of this contract. It is emphasized that the file and the documents therein shall be kept current and shall be made available for Government inspection upon request if needed for further credential review.

C.7.6. The government reserves the right to transfer to the gaining Contractor the credentials of a HCW who has been granted delineated clinical privileges on a predecessor contract without a new or additional credentialing action. This extension may occur only: a) within the same command; b) when there is no increased clinical competency requirement of the HCW; c) when there is no significant change in the scope of clinical practice of the HCW; d) when there is no gap in performance between the contracts; and e) when the HCW has had acceptable performance evaluations.

C.6.7. If clinical privileges have been summarily suspended or are being held in abeyance, pending an investigation into questions of professional ethics or conduct, performance under this contract may be suspended until clinical privileges are reinstated. No reimbursement shall be made and no other compensation shall accrue to the contractor so long as performance is suspended or clinical privileges are held in abeyance. The denial, suspension, limitation, or revocation of clinical privileges based upon practitioner impairment or misconduct may be reported to the appropriate licensing authorities of the state in which the license is held IAW DoD Manual 6025.13.

C.7.8. Permanent revocation of clinical privileges and permanent adverse administrative actions due to professional misconduct against licensed or certified practitioners may be reported to the appropriate professional licensure clearinghouse and/or to the licensing authorities of the state in which the services are performed in compliance with SECNAVINST 6401.2. In addition, contract providers are advised that the Department of Defense participates in the national reporting system established under Part B of the Health Care Quality Improvement Act of 1986, Public Law 99 660. Reports, naming individual practitioners, shall be submitted to the National Practitioner Data Bank in accordance with this Act.

C.7.9. The privileging authority per BUMEDINST 6010.30 will grant clinical privileges where appropriate to those HCWs requiring privileges to perform services. If a HCW’s employment with the contractor ends for any reason, all clinical privileges and medical staff appointments shall be terminated without recourse to the fair hearing and appeals procedures specified by the medical staff bylaws and DoD Manual 6025.13 and BUMEDINST 6320.67A (and subsequent revisions).

C.7.10. For non-credentialed HCWs: The Contractor shall submit a qualifications package to the COR for each HCW who is not required to submit a CR. Prior to Contractor employees providing services under this contract, the COR will verify the compliance of each HCW with the qualification requirements appropriate to their employment category. For HCWs who do not currently have a qualification package on file at the facility, the contractor shall submit a package at least 30 days prior to commencement of services. For those HCWs who currently have a qualification package on file, an updated qualification package shall be submitted no less than 15 days prior to commencement of services.

C.7.11. The contractor shall inform the COR of any terminations of employment within 24 hours of the action.

C.8. GENERAL PROVISIONS FOR HCWs.

C.8.1. The HCWs shall comply with Executive Order 12731, October 17, 1990, (55 Fed. Reg. 42547), Principles of Ethical Conduct for Government Officers and Employees, and shall also comply with Department of Defense (DOD) and other government regulations implementing this Executive Order.

C.8.2. The HCWs shall become acquainted with and obey all station regulations, shall perform in a manner to preclude the waste of utilities, and shall not use Government resources (i.e. copiers, telephone, and computers, etc) for personal business. All motor vehicles operated on these installations by HCWs shall be registered with the base security service according to applicable directives. Eating by HCWs is prohibited in patient care areas/clinics and is restricted to designated areas. Smoking is prohibited in all clinic facilities.

C.8.3. The contractor and all HCWs shall comply with all MTF checkout processes. These processes include returning government property, i.e., identification badges, pagers, cellular phones, etc., to the MTF upon a HCW’s last day of service. Failure to do so promptly may result in delay of payment to the contractor.

C.8.4. Except as provided in this clause and in Section H, HCWs are not prohibited from conducting a private practice of their professions or from engaging in other employment. However, the HCWs shall not, simultaneously with performance under the contract, engage in other employment that creates a conflict of interest, violates federal law (see Section H), or potentially compromises the quality of their work under the contract. Further, such private practice or other employment shall not be conducted during those hours in which the HCW is required to render services under the contract. HCWs shall make no use of the Government facilities or property provided under the contract in connection with other employment. (NAVMED P-117, Chapter 1, Article 1-22 applies (http://www.med.navy.mil/directives/Pages/NAVMEDP-MANMED.ASPX).

C.8.5. The HCWs providing services under the contract shall arrive for each scheduled shift in a well-rested condition and shall have had at least 6 hours of rest from all other medical duties immediately prior to reporting for the shift.

C.8.6. While on duty, HCWs shall not advise, recommend, or suggest to individuals authorized to receive services at Government expense that such individuals should receive services from the HCWs when they are not on duty, or from a partner or group associated in practice with the contractor, except with the express written consent of the Commanding Officer. The contractor shall not bill individuals entitled to those services rendered pursuant to the contract.

C.8.7. HCWs shall be neat, clean, well groomed, and in appropriate clothing when in patient care and public areas. All clothing shall be free of visible dirt and stains and shall fit correctly. Fingernails shall be clean and free from dirt, and hair shall be neatly trimmed and combed. Each HCW shall display an identification badge, which includes the HCW’s full name and professional status (furnished by the Government) on the right breast of the outer clothing. Security badges provided by the Government shall be worn when on duty. In addition to the identification badge, the HCWs shall identify themselves as contract personnel in all meetings, telephone conversations, and formal and informal written correspondence with the government personnel.

C.8.8. The Secretary of the Navy has determined that the illegal possession or use of drugs and paraphernalia in a military setting contributes directly to military drug abuse and undermines Command efforts to eliminate drug abuse among military personnel. The policy of the Department of the Navy (including the Marine Corps) is to deter and detect drug offenses on military installations. Measures to be taken to identify drug offenses on military installations, and to prevent introduction of illegal drugs and paraphernalia, include routine random inspection of vehicles while entering or leaving, with drug detection dogs when available, and random inspection of personal possessions on entry or exit. If there is probable cause to believe that an HCW has been engaged in use, possession, or trafficking of drugs, the HCW may be detained for a limited period of time until he/she can be removed from the installation or turned over to local law enforcement personnel having jurisdiction. When illegal drugs are discovered in the course of an inspection or search of a vehicle operated by an HCW, the HCW and vehicle may be detained for a reasonable period of time necessary to surrender the individual and vehicle to appropriate civil law enforcement personnel. Action may be taken to suspend, revoke, or deny clinical privileges as well as installation driving privileges. Implicit with the acceptance of the contract is the agreement by the HCWs to comply with all Federal and State laws as well as regulations issued by the Commanding Officer of the military installation concerning illegal drugs and paraphernalia.

C.8.9. All financial, statistical, personnel, and technical data which are furnished, produced, or otherwise available to the contractor during the performance of the contract are considered confidential business information and shall not be used for purposes other than performance of work under the contract. Such data shall not be released by the contractor without prior written consent of the COR. Any presentation of any statistical or analytical materials, or any reports based on information obtained from studies covered by the contract, will be subject to review and approval by the COR before publication or dissemination.

C.8.10. The Contractor shall comply with all applicable federal, state, and local laws, Department of Defense, Department of Navy, Bureau of Medicine and Surgery, and MTF instructions and policies.

C.8.11. HCWs shall participate in executing the Emergency Preparedness Plan (drills and actual emergencies) as scheduled by the MTF (typically semiannually). The MTF personnel re-call list with personal contact information for all military, civil service and contractor staff is required to prepare in advance for an actual emergency. Upon commencement of performance, the contractor shall provide the COR with a list of personal contact information for a designated contractor representative as well as all contractor staff performing services. The contractor shall provide an updated list to the COR bimonthly (every two months). Should an emergency occur that will affect the HCWs’ shifts, the designated contractor representative and the HCWs will be contacted.

C.8.12. For unusual and compelling circumstances (e.g., weather emergencies) in which the Commanding Officer either excuses all facility personnel from reporting to work or dismisses all personnel early, the Commanding Officer is authorized to grant administrative leave to the HCWs.

C.8.13. A HCW with a bona fide medical emergency occurring while on duty, or with an on-the-job injury, will be provided stabilizing medical care according to the procedures of the MTF. The contractor shall reimburse the Government for all medical services provided unless the HCW is otherwise entitled to Government medical services.

C.8.14. HCWs may receive one compensated work break in the morning and one in the afternoon, workload permitting, at the discretion of the Government. Neither break shall exceed 15 minutes or be taken with the intention of extending the lunch break.

C.8.15. Possess basic computer skills. The contractor shall provide a completed Computer Skills Competency Form for each Healthcare Worker (Attachment AC). The Computer Skills Competency Form shall be provided with the candidate’s credentials or qualification package.

C.8.16. Healthcare Workers who demonstrate a health or safety risk to patients or staff may be immediately removed from service. In the event of such a removal, the Contracting Officer will request a corrective plan of action from the contractor and may issue a stop work order while the contractor's response, contractor's implementation of the plan, and/or any government investigation is pending. Removal of a HCW for the reasons above does not mitigate the contractor's obligations under this contract.

C.8.17. Furlough. Unless otherwise authorized by a defense appropriations bill, contractors shall not be reimbursed by the Government for services not rendered during a Government furlough. In the event of a Government furlough, the Commanding Officer will determine which HCWs are considered critical and therefore must report to work. Contract employees deemed critical shall be compensated for services rendered during a furlough. All other HCWs shall be furloughed until the Government shutdown ends or they are notified by the COR that they have become critical employees.

C.9. REGULATORY COMPLIANCE REQUIREMENTS. The HCWs shall:

C.9.1. Within 30 days prior to performance of services by the HCW, the HCW shall obtain, at Contractor expense, documentation of required immunizations and physical testing, and a statement from the HCW's licensed medical practitioner or a report of a physical examination. The physical examination and immunization documentation shall indicate that the HCW is free from mental or physical impairments that would restrict the HCW from providing the services described herein.