Primary Care Physician PWS_Updated.docx

1. GENERAL:

1.1 Services Provided: The Contractor shall provide Board Certified (ABIM/ABFM) Primary Care Physician Services for the Battle Creek VA Medical Center (BCVAMC), 5500 Armstrong Road, Battle Creek, Michigan 49037. The 2.0 Full Time Equivalent (FTE) Primary Care Physicians shall be Board Certified in Family Practice or Internal Medicine. Primary Care Physicians services shall be provided at the BCVAMC Primary Care Clinic and at the following outlying VA Clinics locations: Lansing VA Clinic, Muskegon VA Clinic, Benton Harbor VA Clinic, Wyoming Health Care Center. Hours of Operation, 8:00am to 4:30pm, Monday thru Friday, excluding federal holidays. Every two weeks, the BCVAMC Primary Care Clinic and the Wyoming Health Care Center offer extended hours; Wednesday 10:00am to 6:30pm (Wyoming), Thursday 10:00am to 6:30pm (Battle Creek).

1.2 Place of Performance – Contractor to provide Primary Care Physicians services at the BCVAMC Primary Care Clinic, 5500 Armstrong Road, Battle Creek, Michigan 49037 and at the following outlying VA Clinics, Lansing VA Clinic; 2025 S. Washington Avenue, Lansing, MI 48910, Muskegon VA Clinic; 2734 Apple Ave, Muskegon, MI 49442, Benton Harbor VA Clinic, 115-B West Main Street, Benton, Harbor, MI 49022, Wyoming Health Care Center; 5838 Metro Way, Wyoming, MI 49519.

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

1.4 Policy/Handbooks- the contractor shall be subject to the following policies, including any subsequent updates during the period of performance:

1.4.1 VA Directive 1663: Health Care Resources Contracting - Buying https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.2 VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.4.3 VHA Directive 2010-018 “Facility Infrastructure”

www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2227

1.4.4 VHA Directive 1192 “Seasonal Influenza Prevention Program” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.4.5 VHA Handbook 1100.17: National Practitioner Data Bank Reports - https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.6 VHA Handbook 1100.18 Reporting and Responding to State Licensing Boards - https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.7 VHA Handbook 1100.19 Credentialing and Privileging - http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.8 VHA Handbook 1907.01 Health Information Management and Health Records: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

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

1.4.10 Bylaws and Rules of the Medical Staff, Battle Creek VA Medical Center – https://vaww.visn10.portal.va.gov/sites/Battle- Creek/Administration/ChiefOfStaff/Shared%20Documents/BYLAWS%2C%20PPEs%20AN D%20PRIVILEGES/BYLAWS/BYLAWS%20and%20Rules%20and%20Regulations%20Fin al%20June%202017%20signed.pdf

1.5 Definitions/Acronyms- 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 ABIM: American Board of Internal Medicine, https://www.abim.org/

1.5.2 ABFM: American Board of Family Medicine, https://www.theabfm.org/

1.5.3 ACGME: Accreditation Council for Graduate Medical Education

1.5.4 AOD: Admitting Officer of the Day

1.5.5 BLS: Basic Life Support

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

1.5.7 CDC: Centers for Disease Control and Prevention

1.5.8 CR: Contract Discrepancy Report

1.5.9 CEU: Certified Education Unit

1.5.10 CME: Continuing Medical Education

1.5.11 CMS: Centers for Medicare and Medicaid Services

1.5.12 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.

1.5.13 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.

1.5.14 COS: Chief of Staff

1.5.15 CPARS: Contractor Performance Assessment Reporting System

1.5.16 CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

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.

1.5.18 DEA: Drug Enforcement Agency

1.5.19 ED: Emergency Department

1.5.20 FSMB: Federation of State Medical Boards

1.5.21 HHS: Department of Health and Human Services

1.5.22 HIPAA: Health Insurance Portability and Accountability Act

1.5.23 HR: Human Resources

1.5.24 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

1.5.27 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 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 PWS: Performance Work Statement

1.5.37 Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for 8independent 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.

1.5.38 QA/QI: Quality Assurance/Quality Improvement

1.5.39 QM/PI: Quality Management/Performance Improvement

1.5.40 QASP: Quality Assurance Surveillance Plan

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

1.5.42 Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers.

1.5.43 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.

1.5.44 VetPro: a federal web-based credentialing program for healthcare providers.

1.5.45 Veterans Affairs Medical Center (VAMC): 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

2.1.1 Board Certification - Contractor’s physician (s) shall be Board Certified or Board Eligible in Internal Medicine or Family Practice and be currently certified in Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) or equivalency. 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.

2.1.2 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 Professional Standards Board, Medical Executive Board and Medical Center Director.

2.1.3 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.

2.1.4 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 centers). 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) and shall be provided to the Contracting Officer during the onboarding process.

2.1.5 DEA Certificate - Contractor shall provide copy of current DEA certificate.

2.1.6 If a Contractor’s physician(s)is 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.

2.2 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.

2.3 Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the VAMC. 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 credentialing office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for Contractor’s physician (s).

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2.3.

2.3.1. Training BLS, CPRS and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor’s physician(s) as required by the VA. Other training may become required. VA will communicate any changes to the training requirement to the contractor.

VA Privacy and Information Security Awareness and Rules of Behavior

Suicide Prevention: Suicide Risk Management Training for Clinicians

3. Duties and Responsibilities: The Primary Care Physicians are clinical representatives of the Medical Center Director and Chief of Staff and responsible for Primary Care clinical operations.

3.1 Contractor’s employee services to be performed include:

3.1.1 Outpatient/Primary Care. Evaluation of new and returning outpatients as assigned for the Battle Creek VA Medical Center and all sites to include Battle Creek, Lansing, Muskegon, Benton Harbor and Wyoming, MI. Patient care: approximately 8-15 outpatients – ½ hour allotted for follow-up and ½ hour/1 hour for new patients during regular work week schedule.

3.1.2 Patient medical history and physical exams appropriate to the care setting and documented in accordance with Battle Creek VA Medical Center Staff Bylaws. Contract physician shall complete appropriate evaluation and paperwork for special incidents such as medication errors, falls, injuries, adverse drug reactions.

3.1.3 Contract physician shall, at all times 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.

3.1.4 Preventive health and goal-oriented treatment.

3.1.5 Refers patient to other specialty care as required according to service agreements and current legislation.

3.1.6 Prescribing Medications: The contracted physicians shall be responsible for prescribing medications as needed and will be required to utilize the VA formulary. When the contract physician identities a need to prescribe non-formulary medication, the physician shall submit the appropriate non-formulary request with all required information. The contract physician will be required to have a DEA controlled substance registration certificate issued in their name only (not restricted for use at only one agency, institution or location) for prescribing Schedule II through Schedule V controlled substances. Medication reconciliation shall be completed during each patient encounter in the Clinic. Allergy assessment shall be documented when medication is prescribed.

3.1.7 Order labs, imaging and other pertinent tests.

3.1.8 Initial screening of patients to determine eligibility.

3.1.9 Documentation: Clinical records shall be completed and signed in a timely manner. The contract physician shall be trained on the proper use of various VA systems including Vista and CPRS. Contract physicians are expected to comply with Medical Center requirements to use the Emergency Department Integration System (EDIS) when working in urgent care. The performance metrics as outlined in the Emergency Medicine Management Tool (EMMTT) will be utilized in tracking compliance. Findings from an assessment or a reassessment shall be clearly documented in the medical record, which is used by all members of the interdisciplinary care team in care planning and treatment. Assessment for invasive procedures shall include all elements as explicitly outlined in the Battle Creek VA Medical Center Staff Bylaws and applicable policies. All required documentation shall be fully completed within Battle Creek VA Medical Center required timeframes.

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

3.1.11 Furnish technical and/or professional support for residents, physicians, nurse practitioners and physician assistants employed by the VA.

3.1.12 Responsible for coordination, evaluation, treatment, and overall medical management for eligible Veterans evaluated and treated within the clinic. Appropriate referral transfer of the Veteran shall be arranged by the Contractor for care that cannot be delivered in Battle Creek VA Medical Center clinical setting.

3.1.13 The contracted physician(s) ensures that medical record documentation contains the minimum information in congruence with the Health Care Financing Administration/ Medicare guidelines, supporting patient care.

3.1.14 When the Government directs, the Contractor shall remove from performance on the contract any physician who is identified as a potential threat to the health, safety, security, general well-being, or operational mission of the Battle Creek VA Medical Center and its population.

3.1.15 In addition, perform other work within the scope of their clinical privileges in the Battle Creek VA Medical Center Clinic.

3.2 Emergency/Disaster Procedures: In case of fire or other Medical Center disaster, the contract Physician shall assist in the evacuation of patients. The contract physician 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.

3.3 The good conduct of medical practice includes the proper and timely use of consultation. Consultation shall be made when necessary with the VA medical backup physician, surgeon, psychiatrist and/or social worker.

3.4 All Physicians shall have current Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) Certification.

3.5 Battle Creek VA Medical Center Staff will provide orientation and training to new contract physician 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 Battle Creek VA Medical Center. Payment for orientation and training will be at regular hourly rate. Maximum of 16 hours provided for training/orientation.

3.6 Following the 16 hour orientation, new contract physician staff members will shadow with a Battle Creek VA Medical Center staff Licensed Independent Provider (LIP). The new contract physician staff member will begin seeing a minimum of 4 Veterans/ day within 3 weeks of their first day on duty. Availability will be incrementally added to the new contract physician schedule such that within 90 days of their start date, the contract staff physician will have full availability to see 14 or more Veterans/ day. Contract physician will notify Medical Service and Contract Holder immediately if there are concerns over being able to reach full availability within 90 days. Battle Creek VA Medical Center reserves the right to replace any contract physician who fails to reach full availability within 90 days.

3.7 Documentation and clinical records shall be completed and signed in a timely manner. “Timely” is defined within the Medical Center Policies and Medical Service Standard Operating Procedures. The Contractor’s employees shall be trained on the proper use of various VA systems including VISTA and CPRS.

3.8 Contractor shall be required to wear the Government furnished picture ID badge during the entire time he/she is on VA grounds. The ID badge shall be returned to VA at contract completion. All contracted physicians shall be required to maintain current PIV badges at all times.

3.9 Contractor shall provide the same professional level of care to VAMC patients and/or beneficiaries as to any other patient under his/her care. Contractor shall provide all services specified in this contract for any person, 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.

4. Other Requirements

4.1. Standard Personnel Testing: Contractor shall provide proof of the following tests 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.

4.1.1.1. 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) {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. The TST or IGRA testing shall be repeated annually.

4.1.1.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

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

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

4.1.1.5. 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}.

4.2. 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.

4.2.1. The VAMC 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 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

4.3. 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 (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document.

4.4. Citizenship related Requirements:

4.4.1.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non- immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

4.4.1.2. 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.

4.4.1.3. 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.

4.4.1.4. 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.

4.4.1.5. 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.

4.5. 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 program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

4.5.1.1. 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 contracts with excluded individuals to provide items or services to Federal program beneficiaries.

4.5.1.2. 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.

4.6. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC 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. All physicians will be evaluated through Focused Professional Practice Evaluations and Ongoing Professional Practice Evaluations and presented to the Executive Committee for Medical Staff for continued credentialing and privileging.

4.6.1. When the government directs, the contractor shall remove from performance under the task order any physician who is identified a potential threat to the health, safety, security, general well-being, or operation mission of the Battle Creek VA Medical Center and its population.

4.7. 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.

4.8. 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.

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

4.10. 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.

4.11. 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:

4.11.1. Workers’ compensation

4.11.2. Professional liability insurance

4.11.3. Health examinations

4.11.4. Income tax withholding, and

4.11.5. Social security payments.

4.12. Tort Liability: The Federal Tort Claims Act does not cover Contractor or Contractor’s 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 Contractor’s physician (s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

4.13. Key Personnel:

4.13.1. The VA Full Time Equivalency (FTE) for the services required is 2.0 FTE (2,080 hours = 1.0 FTE; 2,080 hours x 3 physicians = 4,160 hours of service coverage annually).

4.13.2. The Contractor shall ask 60 days in advance for vacation or personal leave days.

4.13.3. 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.

4.13.3.1. 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.

4.13.3.2. For temporary substitutions where the key person shall not be reporting to work for 5 consecutive work days 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.

4.13.3.3. 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.

4.13.3.4. Contingency Plan: Because continuity of care is an essential part of VAMC’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.

5. VA HOURS OF OPERATION/SCHEDULING:

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

5.2 Schedule: Primary Care Hours of Operation, 8:00am to 4:30pm, Monday thru Friday, excluding federal holidays. Every two weeks, the BCVAMC Primary Care Clinic and the Wyoming Health Care Center offer extended hours, Wednesday 8:00am to 6:30pm (Wyoming). Thursday 8:00am to 6:30pm (Battle Creek).

5.2.1 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.

5.2.2 Contractor’s Physician(s) shall be available to be scheduled to work during all hours of operation of the facility or as required by the facility Chief of Staff or designee.

6. CONTRACTOR RESPONSIBILITIES:

6.1 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.

6.2 Standards of Care: The contractor’s physician (s)’ care shall cover the range of Primary Care 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:

6.2.1 The American Board of Internal Medicine http://www.abim.org/ 6.2

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

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

6.2.5 The requirements contained in this PWS

6.3 EDUCATION AND SUPERVISION OF HEALTH PROFESSIONS TRAINEES (HPTS):

Contractor shall not supervise or educate any Health Professions Trainees (HPTS).

6.4 Medical Records:

6.4.1 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 claimant’s 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).

6.4.2 HIPAA: This contract and its requirements meet exception 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.

6.4.3 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.

6.4.4 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.

6.4.5 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 all such requests to the Release of Information Department at the VA facility were assigned.

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

6.5 Direct Patient Care: estimated 90% of the time involved in direct patient care and documentation.

6.5.1 Scope of Care: Contractor’s physician (s) (as appropriate and within scope of practice/privileging) shall be responsible for providing Primary Care Physician services, including, but not limited to:

Chronic disease management Complete history and physical examinations Evaluation and treatment, including the ordering and interpretation of diagnostic studies, including laboratory, diagnostic imaging, and electrocardiographic examinations, and the ordering and administration of medications normally considered part of the practice of primary care medicine.

Discussion of end-of-life preferences/advanced care planning Consultations with sub-specialists Timely and proactive discharge planning Coordination of care with specialty care services

6.5.2 Clinical Duties and Responsibilities:

6.5.2.1 Contract physician shall keyboard a pertinent progress note into the computerized patient record system (CPRS) at the time of each outpatient visit. This progress note will generally include the following elements: Patient's chief complaint and/or the purpose of the visit; Pertinent physical findings; Studies ordered (laboratory, radiology, etc.); Provisional or confirmed diagnosis; Therapies administered; and Disposition of the patient at the end of the visit, recommendations for follow-up care, and instructions given to the patient or significant other.

6.5.2.2 Contract physician shall address the clinical reminders due at the time of each outpatient visit which support the clinical practice guidelines in prevention and chronic disease management as outlined by the VHA. The clinical reminder notes will be utilized as the documentation tool. All VHA performance measures shall be met.

6.5.2.3 Contract physician shall electronically enter all doctor’s orders, consultation referrals, requests for x-rays and lab work using CPRS. Approved order sets shall be used, as appropriate, for disease specific conditions, e.g. pneumonia, ACS, etc.

6.5.2.4 Contract physician shall electronically complete a VA encounter form on each patient seen; listing the diagnosis for the visit and all procedures performed based on current VA requirements.

6.5.2.5 Contract physician shall address all telephone calls from patients assigned to the cohort of patients the contract physician is covering within twenty-four hours. A pertinent progress note shall be entered into the CPRS. Failed attempts to contact the patient shall also be documented.

6.5.2.6 Contract physician shall arrange urgent appointments and/or transfer of patients to other VA or private facilities, as appropriate.

6.5.2.7 Contract physician shall follow the VA drug formulary and follow approval procedures of non-formulary drugs in accordance with VA policy.

6.5.2.8 Contract physician shall address all patient alerts in the CPRS prior to the end of each workday.

6.5.2.9 Contract physician may be assigned as the surrogate for an absent physician’s patient alerts and shall complete these patient alerts prior to the end of the workday. This would not be considered a routine duty and if completion of these alerts depended upon working beyond the normal 8-hour workday, overtime may be approved.

6.5.2.10 Contract physician shall address all written correspondence regarding patients assigned to the cohort that the physician is covering. This shall be done in collaboration with the Release of Information office or other appropriate staff.

6.5.2.11 Contract physician shall be issued VA owned keys to permit access to secure areas of the Medical Center, e.g. physician workroom, exam rooms, staff restrooms, etc. These keys must be turned in upon conclusion of the assignment.

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

6.5.2.13 Contract physician shall participate in fire and disaster drills.

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

6.5.2.15 Contract physician shall, at all times, 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 will result in immediate termination. Patient rights will not be violated.

6.5.2.16 Contractor’s physician (s) shall be present on time for any scheduled clinics as documented by physical presence in the clinic at the scheduled start time.

6.5.2.17 Contractor physician will provide notification of test results for patients receiving care in accordance with VHA Directive 1088, Communicating Test Results to Providers and Patients

6.5.3 Administrative: estimated 10% of time not involved in direct patient. This time shall be utilized to attend various staff meetings, participate in quality improvement initiatives, and ensure documentation of patient care services is comprehensive and timely.

6.5.4 Quality Improvement Meetings: The contractor’s physician (s) shall participate in continuous quality improvement activities and meetings with committee participation as required by the facility Chief of Service, Chief of Staff, or designee.

6.5.5 Staff Meetings: The contractor’s physician (s) shall attend staff meetings as required by the facility Chief of Service, Chief of Staff, or designee. Contractor to communicate with COR on this requirement and report any conflicts that may interfere with compliance with this requirement. A list of required meetings will be supplied to Contractor and Contract Physician during orientation/ onboarding.

6.5.6 QA/QI documentation: The contractor’s physician (s) shall complete the appropriate QM/PI documentation pertaining to all procedures, complications and outcome of examinations.

6.5.7 Specialized EHR Documentation Procedures: Patient documentation is completed using the current Electronic Health Record (EHR).

6.5.8 Procedure Documentation: Contractor’s physician (s) shall document care given and select appropriate Evaluation and Management (E&M) procedure codes in CPRS as required by the VAMC Chief of Service, Chief of Staff, or designee. Documentation must be sufficient to support both the E&M and procedure codes. Documentation and coding functions must be completed by the end of each patient care encounter.

6.5.9 Patient Safety Compliance and Reporting: Contractor’s physician (s) shall follow all established patient safety and infection control standards of care. Contractor’s physician(s) shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be documented in the medical record of those impacted and disclosed to the patient or surrogate. As soon as practicable (but within 24 hours) Contractors shall notify COR of incident and submit an entry in the Patient Safety Reporting System, following up with COR as required or requested.

6.5.10 Customer Service: Contractor’s physician (s) shall refer all patient/customer service issues to the Supervisory Physician and/or Nurse Manager or designee.

6.6 Performance Standards, Quality Assurance (QA) And Quality Improvement (QI):

6.6.1 Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, proper utilization of the VAMC Software used for patient tracking and Peer Reviews. Methods of Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE). Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

6.6.2 Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

6.6.3 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. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

6.6.4 Performance Standards:

6.6.4.1 Measure: Provider Quality Performance

Performance Requirement: All Contractor’s physician(s) shall perform in accordance with clinical standards.

Standard: OPPE documentation for all (100%) staff providing services under the…