PBSOW__12_2014.pdf

5.0 PERFORMANCE-BASED SCOPE OF WORK (PBSOW)

5.1 The contractor shall provide Emergency Physician services to cover the Emergency Department at the Northern Navajo Medical Center in Shiprock, New Mexico on an ‘as needed’ basis for any combination of Day, Evening or Night shift of predominately 10 hours a day. There are possible 12 hour shifts if there is a staff shortage. There is no call back and/or pager carrying fee.

5.2 The contract shall be a non-personal health care services contract where the Contractor is an independent contractor and shall allow the Government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of the services rendered, (e.g., professional judgments, diagnosis for specific medical treatment). The

Contractor shall indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. The Contractor shall maintain medical liability insurance, in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

5.3 The Contractor shall provide physicians to perform the necessary medical procedures for patients in a variety of emergency room situations. The Contractor physicians shall provide immediate medical evaluation, examination, diagnosis, treatment, and/or referral of patients who present for care in the

NNMC emergency services area. “Present for care” includes patients referred to the Emergency

Department by other medical providers in the Northern Navajo Medical Center system (such as outpatient clinics, outlying clinics, urgent care, inpatient, etc.). The Contractor physician shall provide professional advice to emergency room personnel and ward personnel in emergency situations with regard to professional management of patients being treated and/or hospitalized. Contractor physician care shall cover the range of emergency room care typically provided in a rural civilian practice of similar size. The following list is an example of the types of cases, but is not all-inclusive:

5.3.1 Major trauma, including fractures of multiple extremities, stab wounds, open wounds of the chest and abdomen, head trauma, suspected spine injuries, lacerations, amputations;

5.3.2 Major medical emergencies such as cardiac arrest, myocardial infarction, respiratory failure, diabetic ketoacidosis, shock;

5.3.3 Obstetrical emergencies such as deliveries of single or multiple births, acute pregnancy complications, vaginal bleeding;

5.3.4 Pediatric emergencies

5.3.5 Acute psychiatric problems, including suicide attempts

5.3.6 Lower-acuity complaints including viral illnesses, ear infections, other infections, minor orthopedic problems, minor trauma, alcohol abuse (e.g., “urgent care” patients).

5.4 The physician shall be responsible providing Emergency Room coverage for the inpatient service until the inpatient doctor becomes available.

5.5 The contracted ER physician shall serve as medical control for the Navajo Nation Emergency Medical

Service stationed in Shiprock, New Mexico, and in accordance with NNMC policies and procedures.

5.6 The standards of medical practice and duties of the Contractor physicians shall be determined pursuant to Governing Board bylaws, medical staff bylaws, medical staff policies and procedures, Shiprock Health Care Facility clinical practice guidelines, other rules, and regulations of the appropriate

IHS facility, applicable provisions of law including but not limited to Centers for Medicare Medicaid

Services (CMS) compliance, rules and regulations of any and all governmental authorities relating to licensure and regulation of physicians and hospitals and standards and recommendations of The Joint

Commission (TJC).

5.7 The Contractor shall be required to maintain records that document the competence and performance level of Contractor employees working on this contract, consistent with current TJC, CMS, and other regulatory and/or accrediting body requirements. The Contractor shall provide a current copy of the competence and performance assessments to the Service Unit Clinical Director or Chief of

Emergency Medicine for each Contractor physician completing assignment in at Northern Navajo

Medical Center, Shiprock, New Mexico.

5.8 Contract physicians shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided in accordance with Indian Health Service (IHS), TJC, and CMS regulations.

The Contractor physician shall prepare all medical record documentation to meet or exceed the established standards of the IHS facility to include, but not limited to: timeliness, legibility, accuracy, content, and signatures. Contractor physicians shall complete all third party reimbursement forms. All medical record information and documentation generated in the performance of this contract must be completed at the time of departure and will remain the property of and subject to the exclusive control of the IHS. The Contractor physician is responsible for following up all ordered laboratory and x-ray tests. Contract physicians are be expected to use Electronic Health Records for entry of their documentation where applicable.

5.9 The contractor shall complete all medical record documentation for patients seen at the facility prior to leaving the facility. The Health Information Department shall be notified in advance of the contractor providers last workday. Failure to complete medical record documentation before leaving may result in a delay of the processing of all invoices from the contractor.

5.10 The Contractor shall establish a reporting system that includes significant findings, major problems encountered, and plans for their resolution.

5.11 Quality of Care by physicians: Contractor physicians shall practice in adherence to typical standards and guidelines as defined by, but not limited to NNMC Governing Board bylaws, NNMC Medical staff bylaws, rules, and procedures, NNMC ED Policies and procedures, Centers for Medicare Medicaid

Services (CMS), The Joint Commission (TJC), Applicable state licensure boards, and Applicable federal authorities (IHS, DEA, etc.)

5.12 Contractor physicians shall complete all third party reimbursement documentation required. All medical record information and documentation generated in the performance of this contract must be completed for each patient at the time of (shift) departure and will remain the property of and subject to the exclusive control of Northern Navajo Medical Center. All medical record information and documentation generated in the performance of this contract must be completed for each patient at the time of (shift) departure and will remain the property of and subject to the exclusive control of

Northern Navajo Medical Center.

5.13 Physician Qualification, credentials, and competencies: The Contactor physician shall meet the following requirements throughout the term of the contract.

5.13.1 Experience: The Contractor shall ensure that all Contract physicians are trained and licensed to perform Emergency Physician Services.

5.13.2 Licensure: The Contractor shall ensure that all Contract physicians hold a valid, active, and unrestricted physician license in at least one state.

5.13.3 Certifications: The Contractor’s personnel performing services under this contract shall be certified in ATLS, ACLS, PALS and BLS; NRP and ALSO are strongly recommended.

5.13.4 The Contractor’s personnel performing services under this contract shall be qualified by at least one of the following routes: (Note: Only accept residency training from a program certified by the

ACGME and board certification through specialty boards approved by the American Board of Medical

Specialties are acceptable).

MINIMAL FORMAL TRAINING/CERTIFICATION:

1) Must have current and unrestricted medical license for a U.S. State.

2) Board certified in Emergency Medicine or Board Eligible due to having completed a Emergency

Medicine Residency or if certification has lapsed, and arrangements are to recertify by ABEM.

3) OR: Is Board-certified in Internal Medicine or Family Medicine by ABMS or AOA &/or AAPS

BCEM with long-term (MINIMUM of 2-3 years with at least half time dedicated EM work in busy EDs) ED experience and Current ATLS, PALS, ACLS certifications.

4) Must possess a current DEA license in a state.

Providers with lapsed board certification in one of the above categories may be considered, subject to

Credentialing Committee review, if they are currently eligible for board certification according to the standards defined by the relevant ABMS board for their specialty

5.13.5. Competencies: The Contractor’s personnel performing services under this contract shall be proficient in essential emergency medicine skills demonstrable by one of the following:

Completion of an emergency medicine residency within the last 4 years Presentation of a log documenting skill performance during the last 2 years.

Copies of privileges at other facilities(s) within the last 2 years along with a signed attestation by a supervisor from that facility indicating the contractor’s competency to perform the granted privileges.

Presentation of CME documentation from courses providing hands‐on training and evaluation of skill performance within the last year.

The Contractor is responsible for providing the above documentation, and the COR will have the authority to determine whether the documentation provided is adequate to support proficiency.

5.13.6 CME: Documentation of continuing medical education (CME) is not required if within one year after graduating from an Emergency Medicine residency. Otherwise, a report documenting an average of 30 hours of CME per year in Emergency Medicine for the past three years is required.

5.13.7 The Contractor shall provide, to the COR, and the NNMC Credentialing Staff, a roster that provides employees and stand-by staff names, certification number and certification expiration date.

The Contractor shall furnish, to the COR and the Shiprock Credentialing Staff, copies of renewals of any licenses and certifications for all employees providing services under this contract.

5. 13.8 Background Checks: The contractor shall complete required SF-85 background check form identifying the character (background checks) of each employee performing services under this contract.

The contractor shall ensure that physician have their fingerprints and preliminary background cleared prior to beginning work. Also, the contract physician shall complete OF-306 for compliance with the

Public Law 102-573, Indian Child Welfare Protection Act. Fingerprinting will be performed by the IHS

Human Resource Department. Finger printing will be completed prior to embarking on duty.

5.13.9 Immunizations: The contractor shall provide proof of employee immunizations for: Measles, mumps, rubella, influenza, Hepatitis, and Tuberculosis or provide declination statements.

5.14 Reports: The Contractor shall establish a reporting system that includes significant findings, major problems encountered, and plans for their resolution, including:

Number of copies Due date

-Error Reports One (1) Quarterly -Morbidity/Mortality Review Reports One (1) Quarterly -Reports of Provider reviews to demonstrate One (1) Quarterly compliance with standards of care and Shiprock Service Unit Clinical Practice Guidelines

-Reports of provider certifications/expiration One (1) Quarterly dates for ATLS, ACLS, PALS, and BLS as required.

5.15 Conduct: Contractor physicians shall interact in a professional manner with patients, colleagues and co-workers.

6.0 GOVERNMENT FURNISHED INFORMATION, PROPERTY, AND SERVICES

6.1 Information: Government unique information related to this requirement, which is necessary for

Contractor performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the

Government.

6.2 Joint Use by the Government and the Contractor: The Government will provide, for joint use by the

Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

6.3 Protection of Government Buildings, Equipment, and Vegetation: The Contractor shall use reasonable care to avoid damaging existing buildings, equipment, and vegetation on the Government installation. If the Contractor’s failure to use reasonable care causes damage to any of this property, the

Contractor shall replace or repair the damage at no expense to the Government as the Contracting

Officer directs. If the Contractor fails or refuses to make such repair or replacement, the Contractor shall be liable for the cost, which may be deducted from the contract price.

6.4 Contractor Exclusive Use:

6.4.1 Personal Protective Equipment (PPE): The Government will furnish the Contractor with appropriate

PPE other than specified in paragraph 4 of the contract. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

6.4.2 ID Badge: The Government will provide facility specific contractor identification badges for each contractor. A minimum fee of $10.00 will be charged for lost or destroyed badges.

6.5 Government Housing: There is no government housing available. Nearby towns consist of

Farmington, NM and Cortez, CO. Both are about 45 minute commutes one way.

7.0 Performance Based MATRIX:

PERFORMANCE

OBJECTIVES

INDICATOR STANDARDS SURVEILLANCE

PLAN

CONTRACTOR

INCENTIVE

The Contractor shall provide physicians to cover the Northern Navajo Medical Centers Emergency Room on an ‘as needed’ basis.

This will include the

1) Quality of Care:

●The Contractor physician shall provide immediate medical evaluation, treatment, and/or referral of patients who present

1) Contractor Physicians shall provide medical care according to the standards of medical practice adopted by the Northern Navajo

1) Surveillance systems will include:

- periodic chart reviews

- review of morbidity & mortality reports

- review of error reports

1) Payment of Contract for Satisfactor y Performan full spectrum of emergency care and urgent care. The physicians shall also be responsible for transfers (as medically indicated), and provision of care to inpatients as needed. The location of facility is in Shiprock, NM.

● The Contract physician shall also provide medically appropriate care to the inpatient service. The physician shall be responsible for admitting patients and providing coverage for the inpatient service when the inpatient doctor is not available.

for care or are transferred to in the Northern Navajo Medical Center Emergency Services area. The emergency medical care provided shall cover the range of emergency room care typically provided in a rural civilian practice of similar size and remoteness.

●The contractor shall serve as medical control for the Navajo Nation Emergency Medical Service stationed in Shiprock, NM

● Contractor physicians shall be expected to use Electronic Health Records (EHR) for their medical records documentation.

Medical Center pursuant to :

-Governing Board bylaws

- Medical staff bylaws, rules, and regulations, and policies

- Centers for Medicare Medicaid Services

(CMS)

- The Joint Commission (TJC)

- Applicable state licensure boards

- Applicable federal authorities (I.H.S., DEA, etc.)

- Other applicable regulatory agencies

- substantiated complaints

- random sampling

a) No more than 3 failures per quarter to comply with documentation standards:

- Signing off on lab reports

- Signing off on X-Ray (and other imaging) reports

- Correcting charting errors

- Chart completions

b) No greater than three (3) valid complaints by patients or by staff of deficiencies regarding patient care, contractor behavior and/or professional demeanor/ performance per 6 month period.

c) No more than one failure per quarter to respond to professional improvement/quality assurance and periodic review reports.

ce.

2) Successful evaluation s using

CPARS

2)Reports:

● Errors reports ●Quarterly reports of provider certifications/expirati on dates for ATLS, ACLS, PALS, BLS; NRP and ALSO are recommended ●Medical records documentation

2) Complete 100% of required reports by deadlines.

2) No more than 3 failures per quarter to comply with documentation standards:

●Signing off on lab report ●Signing off on x-ray (and other imaging)reports

●Correcting charting errors ●Chart completions

3) Adequate staffing and on-call support to meet performance requirements

3) 100% of the time without reliance on Northern Navajo Medical Center physician staff.

8.0 APPLICABLE DOCUMENTS:

8.1 Section 231 of Public Law 101-647, the Crime Control Act of 1990.

8.2 Section 4087 of Public Law 101-630, the Indian Child Protection and Family Violence Act.

8.3 Health Insurance Portability and Accountability Act (HIPAA) of 1996 http://www.cms.hhs.gov.hippa

8.4 Privacy Act of 1974.

8.5 Service Unit and Health Center Policies, Procedures, and Protocols.

8.6 The Joint Commission http://www.jointcommission.org

8.7 Centers for Medicare and Medicaid Services (CMS) Standards http://www.cms.hhs.gov

8.8 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act.

9.0 PERIOD OF PERFORMANCE: The tentative effective date of this contract is from Date of Award

(tentatively January 1, 2015) through December 31, 2015.

10.0 CONTRACTING OFFICER RESPONSIBILITY: Authority to negotiate changes in terms, conditions, or amounts cited in this contract is reserved for the Contracting Officer.

11.0 PRIVACY ACT NOTIFICATION: This contract requires the Contractor, on behalf of the Indian Health

Service (IHS), to provide health care to American Indians and Alaskan Natives and report selected medical record as required. The Snyder Act (25 U.S.C. 2001) authorizes the collection of this information.