Performance Work Statement_MOD.docx

Performance Work Statement for Medical Officer of the Day Services

1. GENERAL:

1.1 Services Provided: The Contractor shall provide 2.95 FTE Medical Officer of Board Eligible in Internal Medicine or Family Practice and must have inpatient and outpatient experience. Physician Services on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Battle Creek Veterans Affairs Medical Center. Hours of operation 6:00 pm to 7:00 am Monday through Thursday and 6:00 pm Friday through 7:00 Am Monday (the entire Weekend) and all federal holidays. Period of performance, December 14, 2026 to December 13, 2031, base with four option years. The Contractor shall provide Credentialed Contractor Physicians with the NACI background check completed, to provide services starting December 14, 2026.

1.2 Place of Performance: Contractor shall furnish services at the Battle Creek VA Medical Center, 5500 Armstrong Road, Battle Creek, Michigan 49037.

1.3 Authority: Title 38 USC 8153, Health Care Resources (HCR) Sharing Authority

1.4 Policy/Directives/Handbooks. The contractor shall be subject to the following policies, including any subsequent updates during the period of performance. The policies listed below can be accessed electronically at the following: VA Publications VHA Publications

1.4.1 VA Directive 1663: Health Care Resources (HCR) Contracting – Buying Title 38 U.S.C. 8153

1.4.2. VHA Directive 1003 - VHA Veteran Patient Experience

1.4.3 VHA Directive 1230 - Outpatient Scheduling Management

1.4.4 VHA Directive 2010-018 “Facility Infrastructure

1.4.5 VHA Directive 1192 “Seasonal Influenza Prevention Program

1.4.6 VHA Handbook 1100.17: National Practitioner Data Bank Reports

1.4.7 VHA Handbook 1100.18 Reporting and Responding to State Licensing Boards

1.4.8 VHA Directive 1100.21(1) – Privileging

1.4.9 Credentialing of Health Care Providers

1.4.10 VHA Handbook 1907.01 Health Information Management and Health Records

1.4.11 Privacy Act of 1974 (5 U.S.C. 552a) as amended

1.4.12 Bylaws and Rules of the Medical Staff, Battle Creek VA Medical Center

1.4.13 VHA Handbook 1100.17: National Practitioner Data Bank (NPDB) Reports

1.4.14 VHA Handbook 1400.04: Supervision of Associated Health Trainees: (remove if not applicable)

1.4.15 Privacy Act of 1974 (5 U.S.C. 552a) as amended: http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.4.16 Acronyms/Definitions: Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.5.1 ABA: American Board of Anesthesiology http://www.theaba.org

1.5.2 ACGME: Accreditation Council for Graduate Medical Education

1.5.3 ACLS: Advanced Cardiac Life Support

1.5.4 AOD: Admitting Officer of the

1.5.5 ASA: American Society of Anesthesiologists

1.5.6 BLS: Basic Life Support

1.5.7 CCNE: Commission on Collegiate Nursing Education: www.aacn.nche.edu/accreditation

1.5.8 CDC: Centers for Disease Control and Prevention

1.5.9 CR: Contract Discrepancy Report

1.5.10 CEU: Certified Education Unit

1.5.11 CME: Continuing Medical Education

1.5.12 CMS: Centers for Medicare and Medicaid Services

1.5.13 Contracting Officer (CO) – The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings

1.5.14 Contracting Officer’s Representative (COR) – A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.15 COS: Chief of Staff

1.5.16 CPARS: Contractor Performance Assessment Reporting System

1.5.17 Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training, and experience and current competence and health status.

1.5.12 DEA: Drug Enforcement Agency

1.5.13 ED: Emergency Department

1.5.14 FSMB: Federation of State Medical Boards

1.5.15 FTE: Full Time Equivalent. VA’s standard definition is for full-time work, the equivalent of 80 hours every two weeks, 2080 hours per year. However, providers may propose using their standard FTE definition.

1.5.16 HHS: Department of Health and Human Services

1.5.17 HIPAA: Health Insurance Portability and Accountability Act

1.5.18 HR: Human Resources

1.5.19 ISO: Information Security Officer

1.5.25 Medical Emergency: A sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.5.26 MOD: Medical Officer of the Day - Contracted Physician

1.5.27 NPI: National Provider Identifier. NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.5.28 NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org

1.5.29 Non-Contract Provider - any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.5.30 NP: Nurse Practitioner

1.5.31 NPPES: National Plan and Provider Enumeration System

1.5.32 PA: Physician Assistant

1.5.33 PALS: Pediatric Advanced Life Support

1.5.34 POP: Period of Performance

1.5.35 PPD: Purified Protein Derivative

1.5.36 Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific.

1.5.37 POD: Psychiatrist of the Day

1.5.38 PWS: Performance Work Statement

1.5.39 QA/QI: Quality Assurance/Quality Improvement

1.5.40 QASP: Quality Assurance Surveillance Plan

1.5.41 QM/PI: Quality Management/Performance Improvement

1.5.42 VetPro: is VHA’s mandatory credentialing software platform to document the credentialing of VHA health care providers. This system facilitates completion of a uniform, accurate, and complete credentials file.

1.5.43 VHA: Veterans Health Administration: The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.5.44 VISN: Veterans Integrated Services Network

1.5.45 VistA: Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

1.5.46 (VAMC): Veterans Affairs Medical Center Unless identified with the name of a different VA Medical Center, for purposes of this contract, this term shall mean the Battle Creek VA Medical Center.

2. QUALIFICATIONS:

2.1 Staff/Facility: The Medical Officer of the Day (MOD) is directly responsible for the care of patients in Community Living Center (CLC), and urgent care. He/she will not leave the medical center grounds during the tour of duty or after completion of tour of duty, unless relieved by another physician, working as MOD. The MOD physicians will carry a pager at all times during the assigned tour of duty and wear the Government furnished picture ID badge. The ID badge shall be returned to VA at contract completion.

The Psychiatrist on Duty (POD) may request consultation from the MOD when the POD is rounding on Inpatient Mental Health patients on weekends or holidays regarding these patients and the MOD is expected to provide timely consultation.

The MOD will complete the First Clinical Certification if Psychiatric care is indicated with the POD available for consultation by phone.

The MOD will complete entry level admission orders in phone consultation with the POD. The POD will provide a video assessment of the Veteran if an Inpatient Mental Health admission is indicated.

The Administrative Officer of the Day (AOD) will assist the MOD with administrative functions not requiring professional decisions. The duties consist of receiving admission calls, making and receiving telephone contacts with other VA facilities and private hospitals, arranging conference calls between physicians and other hospitals, determining legal eligibility of applicants, assisting next-of-kin with funeral arrangements, arranging transportation and any other duties as assigned.

A patient activity report will be maintained and shall consist of the name and last four of social security number for new admissions; patients placed on 23-hour observation; death; patients placed on seriously ill list; medical emergencies; inpatients treated; outpatients treated; bioterrorism cases; employees treated for on-the-job injury and any other noteworthy event that took place on the MOD’s tour of duty.

Upon arrival the MOD shall report to urgent care, obtain pager, keys and report from the off going physician and will follow-up on any patients identified during the report. The MOD is responsible for assuming the care of all patients remaining in urgent care at the beginning of their tour of duty.

The MOD lounge is located in building 82. This is the work site where the MOD will normally be located unless called by the AOD or RN to see a patient in another area of the Medical Center.

Only in emergencies will oral or telephone orders be accepted. The disciplines that can accept verbal orders are registered nurses for all aspects of patient care, pharmacists for medications, and respiratory therapist for respiratory treatments and EKG’s. In these instances, the orders will be written, dated, timed, and signed as soon as the MOD can see the patient, and in any case prior to the completion of the tour of duty.

During his/her tour of duty, the MOD shall see and write notes on all Veterans treated by the MOD during the shift.

When the nursing staff contacts the MOD regarding patient, it shall be the MOD’s responsibility to determine whether the patient needs to be seen or not. A progress note shall be written that includes specially what the RN Reported regarding the patient, if orders were entered without seeing the patient or if the MOD is going to be delayed seeing the patient. In general, patients will be seen by MOD when requested by a nurse or if there are any changes in clinical status.

MOD shall see every patient who has a fall and/or injury and document the history, physical findings, and the care that was given. If an incident report was generated the MOD shall complete all aspects of the incident report and the severity level.

When there are significant changes in an inpatient’s condition, the physician has an obligation to inform the patient’s next of kin or guardian and document this in a progress note.

The Chief of Psychiatry Service and the Associate Chief of Staff for Medical Service or designee will provide orientation to contract MOD related to all responsibilities during their tour of duty.

The MOD shall she/he responsible for the examination and disposition of all veterans presenting for care, including established outpatient and veterans who walk-in for the first time and those referred by other VA facilities, private physicians or private hospitals.

The MOD has the authority to admit, treat, discharge or refer patients in accordance with his/her clinical privileges. A patient having a life-threatening condition will be referred for admission to a local hospital, provided the Veteran cannot be adequately cared for at VAMC Battle Creek or is not stable for transfer to another VA Medical Center. When care at a local hospital is indicated, the MOD shall contact the AOD who will set up a three-way call with the Professional Back -Up. Hospitalization will continue until the emergency ends, or the patient can be safely transferred to the VAMC Battle Creek or VAMC Ann Arbor. The referring physician’s statement that a case is an emergency will be accepted. Before accepting transfer patients, the MOD should determine the stability of the patient by discussion with the referring physician or evaluation of faxed information.

MOD shall complete history and physician (H&P) examination including mental status examination and medication reconciliation on all new admissions within 24 hours of admission or before end of their tour of duty, if less than 24 hours.

Initial plan of care shall be developed in collaboration with nursing staff and documented within the History & Physical (H&P).

MOD shall complete discharge summaries and medication reconciliation on patients admitted and discharged over a weekend or holiday.

MOD shall complete clinical reminders for performance measures as appropriate.

Emergency Medical Care of Employees and Visitors: The MOD shall be responsible for emergency care and treatment of on-the-job illnesses and injuries of employees or visitors occurring after regular working hours. The MOD shall refrain from relieving an employee from duty. Instead, MOD shall provide employee’s supervisor and documentation of recommended physical restrictions, and the supervisor will determine disposition of the employee.

Treatment of minor ailments, which may interfere with an employee’s immediate ability to perform duty (such as colds, headaches, etc.), may also be treated to keep the employee on duty. Treatment and care are not intended to provide full medical care for employees.

Dead on Arrival Cases: Veterans proceeding under PRIOR AUTHORITY of the VA who dies while in route to the Medical Center shall be accepted for admission. The MOD shall complete examination of the remains and arrive at a tentative cause of death and enter I in a progress note. The MOD shall have the body removed to the morgue, and the AOD will be notified.

Veterans arriving WITHOUT PRIOR AUTHORITY, who die in route, should be reported to the local coroner immediately. The chief of Staff or designee should also be contacted immediately, for all deaths. The coroner will make disposition of the remains.

Occasionally, a death may occur that appears to be accidental, suicidal or homicidal. The coroner or the deputy coroner is the proper official to make such determinations and should be notified immediately in any of the following cases:

Death resulting from violence, accident, or suspected felony.

Death of any patient who died at a subsequent date who was admitted as a result of trauma or violence.

Death of an inpatient during MOD’s tour of duty: MOD shall be notified by nursing staff regarding death of a patient. MOD shall pronounce the death, document the incident in the medical record and release the body to the morgue. The patient’s next of kin or family member shall be contacted into inform them regarding the death and to ask them about an autopsy. The AOD can be asked to set up the telephone call. MOD shall sign the death certificate prior to leaving the Medical Center an discuss with professional back up.

Emergency/Disaster Procedures: In case of fire or other Medical Center disaster, the AOD will immediately take charge of the evacuation of patients in accordance with published regulations. H/she will also notify the Director of the nature of the emergency or disaster and report what action has been taken. The MOD shall ensure that he/she is familiar with fire and disaster instructions and will attend all fire and disaster drills conducted during his/her tour of duty.

Restraints/Seclusion: The MOD shall become fully familiar with the Medical Center policy on Restraints and seclusion and shall comply with requirements therein. If a patient needs a restraint which may include a chest posey, wrist restraint, or mitts to prevent an injury or maintain a medical device, the clinician must enter an order for restraining. Patients with restraints for medical reasons must be evaluated every 24 hours. Patients with restraints for behavioral reasons must be evaluated every four hours. The evaluation shall be documented, and new orders shall be written if restraints are to be continued.

Release of Information: Any requests for release of information concerning a veteran’s beneficiary will be referred to the AOD on duty.

Prescribing Medication: MOD shall be responsible for prescribing medications as needed and will be required to utilize the VA formulary. When the MOD identifies a need to nonformulary medication, the MOD shall submit the appropriate non-formulary request with all required information. Also, will be required to have DEA License number of prescribing Class II-V controlled substances. Medication reconciliation shall be completed during each patient encounter in Outpatient/Inpatient Clinic. Allergy assessment needs to be documented when medication is prescribed.

Documentation: Clinical records shall be completed and signed in a timely manner

The MOD shall be trained on the proper use of various VA systems including the Federal Electronic Health Record.

MODs are expected to comply with Medical Center requirements to use the Medical Emergency Policy.

Department Integration System (EDIS) when working in urgent care. The performance metrics as outlined in the Emergency Medicine Management Tool (EMMT) will be utilized in tracking compliance.

When a prescription is needed if the Outpatient Pharmacy is closed, the MOD should utilize the First Fill Urgent Fill contract as outlined in Standard Operating Procedure 119-35 Pharmacy Operations. prescribing controlled substances from the after-hours stock, a handwritten green narcotic prescription blank shall be filled out and deposited in the med-select machine at the time the medication is dispensed by the MOD.

Informed Consent: In accordance with Medical Center policy, when written informed consent is required, the MOD shall explain procedure and risks/benefits to the patient/guardian and obtain informed consent from patient/guardian.

When the MOD is the only practitioner involved in the care of the patient during a hospital stay: he/she shall be responsible for completing all required medical record documentation, including the discharge summary and patient instructions.

Reporting at the Beginning of Tour of Duty: At the beginning of the tour of duty, the MOD shall collect the keys and pager from the outgoing MOD. The outgoing MOD will provide a sign-out report to the oncoming MOD. The MOD shall communicate any significant issues throughout all tours of duty including weekdays, weekends and holidays, as noted to the AOD for documentation on the AOD log. At this time the oncoming MOD will be responsible for all patients still needing to be seen in the urgent care area.

Reporting at End of Tour of Duty: At the end of the tour of duty, the MOD shall turn over the keys and pager to relieve MOD and provide a sign-out report to the oncoming MOD. The sign-out report shall consist of new admission; deaths; patients placed on seriously ill list; medical emergencies: inpatients treated: outpatients treated significant patient care issues; patients in restraints; pending transfers; inter-ward transfers; significant phone calls from the wards; outside phone contact; bioterrorism: and employees treated for on-the-job injury. The AOD will have the schedule of oncoming MOD’s and staff physicians, including home phone numbers, and pager number if needed.

In the event of an emergency which prevents the on-duty MOD from continuing duty, the AOD will notify the contractor. The contractor is responsible for providing backup coverage for the provider on duty if backup coverage is not provided, the contractor shall be responsible to provide compensation to the Battle Creek VA Medical Center under FAR clause 52.211-11, Liquidated Damages – Supplies, Services, or Research and Development.

Contract Physician shall obtain, read, and follow Standard Operating Procedures (SOPs) or established guidelines for all reusable medical equipment (RME) in use in their clinical area prior to use.

Contact Physician shall participate in fire drills, disaster drills and medical mock codes, while on MOD duty.

Contract physician shall complete appropriate evaluation and paperwork for special incidents such as medication errors, falls, injuries, adverse drug reactions, etc.

Contract physicians shall, always, conduct themselves in a professional and ethical manner treating patients’ visitors, and staff in a courteous manner. Sustained allegations of patient abuse, either verbally or physically, shall result in immediate termination. Patient rights shall not be violated.

Battle Creek VA Medical Center staff will provide orientation and training to new MOD staff members. Normally, the orientation shall be accomplished at the earliest possible date, prior to the first day of scheduled duty. All contracted providers must complete applicable TMS modules, training, and orientation prior to providing any services at the Battle Creek VA Medical Center.

Payment for orientation and training will be at regular hourly rate. Maximum of 40 hours provided for training/orientation.

MOD shall be required to wear the government furnished picture ID badge during the entire time she/she is on VA grounds. The ID badge shall be returned to the VA at task order completion. All MOD shall always be required to maintain current PIV badges.

MOD shall provide the same professional level of care to VAMC patients and/or beneficiaries as to any other patient under his/her care. MOD shall provide all services specified in this contract for any person deemed eligible by the ACOS for Medical Service, regardless of the race, color, religion, sex, , or national origin of the person for whom such services are ordered. No services provided under this contract shall be performed outside of the United States.

2.2 License: The Contractor’s physician (s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia) when services are performed onsite on VA property.

All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contractor’s physician (s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2 Board Certification and Experience: All contractor’s physician (s) shall be Board Certified/Board Eligible in internal medicine or family practice and be currently certified in Basic Life Support (BLS) through the American Heart Association Advanced Cardiac Life Support (ACLS) through the American Heart Association (AHA). All continuing education courses required for maintaining certification must be kept up to date at all times.

Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance.

2.1.3 Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any Contractor’s physician (s) prior to obtaining approval by the Battle Creek VA Medical Center Executive Committee of the Medical Staff and Medical Center Director.

If a Contractor’s physician(s) and/or other contract provider(s) are not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.4 Technical Proficiency: Contractor’s physician (s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contractor’s physician(s) and contractor’s physician (s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5 Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the facility. Contractor’s physician (s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for contract physician(s).

2.1.6 Training (ACLS, BLS, and VA MANDATORY): . All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems:

Training (The following training is mandatory per VHACO for Contracted Physicians) Frequency (once a year, etc.)

Annual Hours

Suicide prevention: Suicide Risk Management Training for Clinicians

List other training per local facility

2.1.7 STANDARD INFECTION CONTROL MEASURES (PPD, IMMUNIZATIONS, ETC.):

Contractor shall provide proof of the following for physicians within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer.

Tests shall be current within the past year.

2.1.7.1 TUBERCULOSIS TESTING: Contractor shall provide proof of a negative Tuberculosis Skin Test (TST) or interferon-gamma release assays (IGRA) for all Contractor’s physician(s) upon hire in accordance with CDC guidance. (This is applicable to all health care workers). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results.

2.1.7.2 MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor physicians

2.1.7.3 VARICELLA: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers.

2.1.7.4 ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor physicians (This is applicable to all health care workers.

2.1.7.5 INFLUENZA: Contractors shall provide proof that all Contractor physicians have received the annual Influenza vaccine unless it is contraindicated. If the Contractor physician has a medical contraindication to the vaccine they shall be required to wear a mask during the Influenza season. (This is applicable to all health care workers).

2.1.7.6 OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all Contractor’s physician(s) {This is applicable to all health care workers}; provide their own Hepatitis B vaccination series and hepatitis B surface antigen test results following the hepatitis B vaccination series; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.1.7.7 The facility shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998; 26:289-354 (https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/index.html) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.8 National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical facilities). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.9 DEA: Contractor shall provide copy of current DEA certificate.

2.1.10 Conflict of Interest: The Contractor and all contractor’s physician (s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.11 Citizenship related Requirements:

2.1.11.1.1 If required by the contract, each affected contractor employee as shall be a United States (U.S.) citizen. Otherwise, each affected contractor employee as described in paragraph shall be:

a) A United States (U.S.) citizen; or

b) A national of the United States (see 8 U.S.C. 1408); or

c) An alien lawfully admitted into the United States for permanent residence as evidenced by an Alien Registration Receipt Card Form I-151.

2.1.11.2 While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.11.3 If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.11.4 This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.11.5 The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.1.12 Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.12.1 Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contractor’s physician (s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.12.2 By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2 Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Facility COS or his/her clinical designee and approval by the Medical Facility Director as provided in VHA Directive 1100.20 and VHA Directive 1100.21. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the facility COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3 Non-Personal Healthcare Services: The parties agree that the Contractor and all contractor’s physician(s) shall not be considered VA employees for any purpose.

2.4 Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5 Prohibition Against Self-Referral: Contractor’s physicians are prohibited from referring VA patients to contractor’s or their own practice(s).

2.6 Inherent Government Functions: Contractor and Contractor’s physician (s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.7 No Employee status: The Contractor shall be responsible for protecting Contractor’s physician

(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.7.1 Workers’ compensation

2.7.2 Professional liability insurance

2.7.4 Health examinations

2.7.4 Income tax withholding, and

2.7.5 Social security payments.

2.8 Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract physician(s). When a Contractor or contractor’s physician (s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract physician(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.9 Key Personnel:

2.9.1 The VA Full Time Equivalency (FTE) for the services required is 2.95 to provide 6,130 hours annually of service for off-tour duties. FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays.

2.9.2 The minimum number of Board Certified /Board Eligible Medical Officer of the Day physicians required to be on site daily is 1 as defined in paragraph Hours of Operation in this section.

The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations and additional coverage as required. In the event a scheduled physician is unable to complete an assigned shift, the contractor shall provide replacement physician coverage within 2 hours and notify the Contracting Office Representative (COR) Carrie Sedlacek at the Battle Creek VA Medical Center immediately of the schedule change.

2.9.3 It is essential that continuity of services is maintained to the maximum degree possible, hence, substitution of contractor provided Physicians shall be limited to urgent/emergent absences of approved, assigned providers. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations and additional coverage as required. In the event a scheduled physician is unable to begin or complete an assigned shift, the contractor shall provide replacement physician coverage within 2 hours and notify the Contracting Office Representative (COR) immediately of the schedule change.

2.9.4 Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 2 calendar day (s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 45 calendar days prior to making any permanent substitutions.

2.9.4.1 The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 7 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.9.4.2 For temporary substitutions where the key person shall not be reporting to work or three consecutive workdays or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.9.4.3 The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor’s physician (s), s/he may request, without cause, immediate replacement of said Contractor’s physician (s). The CO and COR shall deal with issues raised concerning Contractor’s physician (s) conduct. The final arbiter on questions of acceptability is the CO.

2.9.4.4 Contingency Plan: Because continuity of care is an essential part of the facility’s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor’s physician (s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3 VA HOURS OF OPERATION/SCHEDULING:

3.1 VA Business Hours: The hospital operates 24 hours a day, 7 days a week, 365 days a year including Federal Holidays

3.1.1 Schedule: Monday through Thursday 6:00 PM to 7:00 AM and 6:00 PM Friday through 7:00 AM Monday (the entire Weekend) and 24 hours for all federal holidays

3.1.2 Patients must be seen by a contractor’s physician (s) on-site at the facility in a timely manner in accordance with VA Rules and Regulations on clinic wait times and consult completion. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

3.1.2.1 Contractor’s physician (s) shall be available on station during scheduled hours as determined by the Battle Creek VA Medical Center which will be established, and may be revised, as deemed appropriate for patient care by the Chief of Staff. Currently, scheduled hours include off hours, weekends and holidays

3.1.2.2 Patients must be seen within 10 minutes of the page when medically indicated.

3.2 Federal Holidays: The following holidays are observed by the Department of Veterans Affairs: New Year’s Day President’s Day Martin Luther King’s Birthday Memorial Day Juneteenth Independence Day Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Christmas Any day specifically declared to be a national holiday.

Any day where the federal agencies and departments are closed by executive order of the President of the United States

3.3. Cancellations:

3.3.1 Unless a state of emergency has been declared, the Contractor shall be responsible for providing services.

CONTRACTOR RESPONSIBILITIES:

4.1 Clinical Personnel Required: The Contractor shall provide contractor’s physician (s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

Contractor’s physician (s) shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to confirm hours/day and services provided against the contractor’s invoices.

4.2 Standards of Care: The contractor’s physician (s)’ care shall cover the range of Hospital Medicine Physician services as would be provided in a state-of-the-art health care treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.2.1 The Society of Hospital Medicine (http://www.hospitalmedicine.org ) would be the most reasonable replacements.

4.2.3 The American Board of Internal Medicine http://www.abim.org/

4.2.3 The professional standards of The Joint Commission (TJC) http://www.jointcommission.org/

4.2.4 The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.2.5 The requirements contained in this PWS

4.4 Medical Records:

4.4.1 Authorities: Contractor’s physician (s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the 5 U.S.C.552a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.4.2 HIPAA: This contract and its requirements meet exceptions in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical Records-VA’ (24VA10A7 ). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services provided to VA patients are captured in the VA electronic health record system as required by VA policy as discussed in 4.4.4.

4.4.3 Disclosure: Contractor’s physician(s) may have access to patient medical records for the purpose of providing medical care and services to VA patients and performing services under the contract; however, Contractor shall obtain permission from the VA before disclosing any patient information outside VA. VA authorizes the Contractor to discuss patient health information for coordination of care with community health care providers in compliance with VA regulations, HIPAA and VHA Directive 1605.01, Privacy and Release of Information. The VA will provide the Contractor with a copy of VHA Directive 1907.01, Health Information Management and Health Records and VHA Directive 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.4.4 Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Directive 1907.01 Health Information Management and Health Records and all guidelines provided by the facility.

4.4.5 Release of Information: The VA shall maintain control of releasing any copies of patient health information or health records and will follow policies and standards as defined, but not limited to Privacy Act requirements. Contractor will not release or disclose copies of records and will refer to all such requests to the Release of Information Department at the VA facility were assigned.

4.4.6 Management for Medical Records: National Archives and Records Administration record disposition requirements are found in RCS 10-1 Chapter 6, 6000 series.

4.5 Direct Patient Care: estimated 95% of the time involved in direct patient care.

4.5.1 Per the qualification section of this PWS, the Contractor shall provide the following staff:

4.5.2 Board Certified /Board Eligible in Internal Medicine or Family Practice

4.5.2.1 Scope of Care: Contractor’s physician (s) (as appropriate and within scope of practice/privileging shall be responsible for providing with a framework that is clinically relevant and scientifically valid. Provision of care shall be based on clinical standards of practice and scientifically based clinical practice guidelines, which have been approved for use by the VHA, VISN or facility executive medical staff. Contract physicians shall sign and agree to adhere to Medical Staff Bylaws, Rules and Regulations. The contracted physician shall provide input as requested by the VAMC in regard to budge, scope of services provided, and resource allocation.

4.5.3 Evaluation, Treatment and Management:

4.5.3.1 Contractor’s physicians shall admit and coordinate all aspects of care for hospitalized medical patients including:

Admission, including history…