PWS - Onsite and On-call Orthopedic Physicians.pdf

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. Services Provided: The Contractor shall provide 1.5 FTE Board Certified /Board Eligible Orthopedic Physician Surgical Services on-site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center (VAMC) (also referred to as the “Memphis VAMC”).

1.2. Place of Performance – Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center (VAMC), 1030 Jefferson Ave., Memphis, TN 38104.

1.3. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority using FAR Parts 12 and 15.

1.4. Policy/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 Contracting - Buying http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

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 Handbook 1100.17: National Practitioner Data Bank Reports -http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.4. VHA Handbook 1100.18 Reporting and Responding to State Licensing Boards http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.5. VHA Handbook 1100.19 Credentialing and Privileging -

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.6. VHA Handbook 1907.01 Health Information Management and Health Records http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791

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

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

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. AAOS: American Academy of Orthopedic Surgery http://www.aaos.org/

1.5.2. ABOS: American Board of Orthopedic Surgery https://www.abos.org/

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACLS: Advanced Cardiac Life Support

1.5.5. AOD: Admitting Officer of the Day

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

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

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

1.5.19. DEA: Drug Enforcement Agency

1.5.20. ED: Emergency Department

1.5.21. FSMB: Federation of State Medical Boards

1.5.22. Full Time Equivalent (FTE): VA’s definition for full time- working the equivalent of 80 hours every two weeks, 2080 hours per year. In calculating FTE, any hours not worked on national holidays shall not be included.

1.5.23. HHS: Department of Health and Human Services

1.5.24. HIPAA: Health Insurance Portability and Accountability Act

1.5.25. HR: Human Resources

1.5.26. ISO: Information Security Officer

1.5.27. 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.

1.5.28. MOD: Medical Officer of the Day

1.5.29. 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).

http://www.aacn.nche.edu/accreditation

1.5.30. NLNAC: National League for Nursing Accrediting Commission.

www.nlnac.org

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

1.5.32. NP: Nurse Practitioner

1.5.33. NPPES: National Plan and Provider Enumeration System

1.5.34. PA: Physician Assistant

1.5.35. PALS: Pediatric Advanced Life Support

1.5.36. PECOS: Provider Enrollment, Chain, and Ownership System

1.5.37. POP: Period of Performance

1.5.38. PPD: Purified Protein Derivative

1.5.39. PWS: Performance Work Statement

1.5.40. 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.

1.5.41. QA/QI: Quality Assurance/Quality Improvement

1.5.42. QM/PI: Quality Management/Performance Improvement

1.5.43. QASP: Quality Assurance Surveillance Plan

1.5.44. 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.

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

1.5.46. 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.

1.5.47. Vet-Pro: a federal web-based credentialing program for healthcare providers.

1.5.48. 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 Memphis VA Medical Center.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. 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 on-site 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 - All contractor’s physician(s) shall be Board Certified /Board Eligible by the American Board of Orthopedic Surgery http://www.abos.org/,And be currently certified in Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) 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.

2.1.3. 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 VAMC Memphis Professional Standards Board, Medical Executive Board and Medical Center Director.

2.1.3.1. 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.

2.1.4. 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 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 physician(s) shall report CME http://www.abos.org/ 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).

2.1.6. Training (ACLS, BLS, CPRS and VA MANDATORY): Contractor physician(s) 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. All training requirements must be met prior to the Contractor physicians coming on board. Training certificates must be provided to the COR prior to coming on board. The contractor physician(s) will go to TMS website (www.tms.gov) to self-enroll for the following training listed below including VA Privacy and Information Security Awareness and Rules of Behavior Training #10176 and Privacy and HIPAA Training #10203.

2.1.6.1. All contractor physician(s) who require access to the Department of Veterans Affairs' computer systems shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement prior to contract performance. This requirement is applicable to all subcontractor personnel requiring the same access.

2.1.6.2. Contractor physician(s) must complete the "VA Privacy and Information Security Awareness and Rules of Behavior," and “Privacy and HIPAA Focused Training.” This training is a web-based course that may be accessed on the https://www. https:

www.tms.va.gov/SecureAuth35/. A copy of the training certificate must be forwarded to the Surgical Service COR who will in turn forward to VA Information Security Officers and Privacy Officer. Rules of Behavior training is an annual mandatory requirement for all employees. The Rules of Behavior Automated Information Systems (AIS) Security Policy describes the security operations of the information system and delineates security responsibilities and expected behavior of contractor physician(s) (see Attachment 11). The rules include the consequences of inconsistent behavior and non-compliance and all significant aspects of information system use, including policy on the usage of electronic mail. A signed acknowledgment of these rules is a condition for access to the VA Information systems. All contractors must ensure that each contractor physician has completed the VA System Access Agreements. Violations may be cause for termination of the contract.

2.1.6.3. Submission of the access request form to VA Information Security Officers (See Attachment 12). Access shall be granted to non-VA users only if the purpose for access meets the criteria of the Privacy Act and VA Confidentiality regulations and transfer.

Compliance & Business Integrity Annually http://www.tms.gov/

Annual Government Ethics Annually

Prevention/Management of Disruptive Annually

Behavior/Violence Prevention Level I Annually

VA Privacy and HIPAA Annually

Mandatory Training for Transient Clinical Staff

Annually

Suicide Prevention: Suicide Risk Management Training

Annually for Clinicians Annually

ACLS/BLS Annually

Privacy & Information Awareness & Rules of Behavior

Annually

2.1.7. Standard Personnel Testing (PPD, etc.): 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.

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). 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 test shall be repeated annually.

2.1.7.2. MEASLES, MUMPS, AND RUBELLA TESTING: Contractor shall Provide proof of immunization for all Contractor’s physician(s). This is applicable to all healthcare workers.

2.1.7.3. VARICELLA: Contractor shall provide proof of immunity for all physicians. This is applicable to all healthcare workers.

2.1.7.4. ACELLULAR PERTUSSIS: Contractor 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. COVID-19: Contractors shall comply with VHA Supplemental Contract Requirements for Combatting COVID-19 {This is applicable to all health Care workers}. – See Section D attachment.

2.1.7.7. OSHA REGULATION CONCERNING OCCUPATIONAL

EXPOSURE TO BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all contractors’ physician(s); provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. 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.

2.1.7.8. 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.

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 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) be provided to the Contracting Officer with the proposal.

2.1.9. DEA - Contractor physician(s) shall provide copy of current DEA certificate.

2.1.10. Conflict of Interest: The Contractor and all contractors’ 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 that 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.

2.1.11. Citizenship related Requirements:

2.1.11.1. The Contractor certifies that the contractor physician(s) 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;

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 program 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 physicians (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 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.

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

2.7.3. 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 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.

2.9. Key Personnel:

2.9.1. The VA Full-Time Equivalency (FTE) for the services required is 1.5 FTE (3,040 hours per year). One 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 Orthopedic Physicians required to be on-site daily is 1 FTE as defined in paragraph Hours of Operation In section 3.0. 2 FTE are required on Mondays and Tuesdays. 1 FTE is required on Wednesdays, Thursdays, and Fridays.

2.9.3. The Contractor shall assign to this contract the following key personnel.

The contractor shall provide a complete list of all contract physician(s) that will be assigned to this contract at the time of the award. This shall include a sufficient number of contract physicians(s) so that there is coverage at all times. Provide the name of each contract physician(s) and the number of hours worked weekly by each contract physician(s) identified to work under this contract. This information may be provided in a table format as shown below. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel and VA providers due to sick leave, personal leave, vacations, and additional coverage as required. If the contractor is unable to schedule a contract physician(s) at any time, it must be brought to the attention of the COR immediately. The contractor is to have a provider at the VA on the designated days required. In the event a scheduled contract physician(s) is unable to provide coverage, the contractor shall provide replacement contract physician coverage within 2 hours and notify the Contracting Office Representative (COR) at the Memphis VA Medical Center immediately of the schedule change. If no replacement contract physician coverage is provided, the contract price will be decreased accordingly during each billing cycle.

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 1 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 _7_ 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 for 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 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.

3. VA HOURS OF OPERATION/SCHEDULING:

3.1. VA Business Hours: The Orthopedic Clinic is open Monday through Friday from 8:00 am - 4:30 pm. Orthopedic Clinic Days/Hours required are Monday, Tuesday, and Wednesday from 8:00 am - 4:30 pm. Surgery Days/Hours required are Monday, Tuesday, Thursday and Friday from 8:00 am - 4:30 pm. Clinic and surgery hours may vary during the term of the contract.

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

3.1.2. Contractor’s physician(s) shall be available and present in clinic during normal VAMC Memphis clinic hours, VAMC Memphis clinic hours which will be established, and may be revised, as deemed appropriate for patient care by the Chief of Staff. Currently, normal clinic hours are Monday through Friday from 8:00 am – 4:30 pm, however as stated in paragraph 3.1, the Contractor’s physician(s) is only required to cover clinic Monday, Tuesday, and Wednesday from 8:00 am – 4:30 pm.

3.1.2.1. Contractor’s physician(s) will provide coverage for VA staff physicians when they are on leave. A thirty-day notice will be given to the contractor physician(s) of the date VA staff will be on leave. VA staff work full-time and parttime scheduled. Annual leave days will also be covered.

3.1.3. Off-hours Coverage: Contractor must make the contractor’s physicians available on-call during after-hours when VAMC Memphis orthopedic clinic is closed, including evenings, weekends, and holidays. The historic number of after-hours surgeries performed on an annual basis is 5. Physician Assistants will take the first call and perform initial evaluations. Contractor physician(s) will only be called if emergency surgery is necessary and cannot wait until the next day.

3.1.3.1. On-call contractor’s physician(s) must be available at all times for phone consultations with VA residents and physicians.

3.1.3.2. Patients must be seen within 40 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

• Labor Day

• Columbus Day

• Veterans Day

• Thanksgiving

• Christmas

• Any day specifically declared by the President of the United States to be a national holiday.

If the holiday falls on a Saturday or Sunday, it is recognized either the previous Friday or following Monday by the Department of Veterans Affairs and the VA will be close

3.3. Cancellations: Contractor must provide a replacement provider with comparable qualifications to perform in the physician’s stead if he/she wishes to cancel a clinic or unable to report to duty. Otherwise, a 45-day notice must be given in writing if a provider wants his/her clinic cancelation request to be considered.

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

4. 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.

4.1.1. Contractor’s physician(s) shall be responsible for completing and forwarding weekly timesheets for approval. Contractor’s physician will forward approved timesheets to Contractor. COR will confirm hours/day and services provided against the contractor physician’s invoices.

4.1.2. The Department of Veterans Affairs reserves the right to refuse employment under this contract or require dismissal from contract work of any contract physician(s) for unsatisfactory performance at the VAMC, Memphis, TN or any other objectionable reason considered by the Contracting Officer. The contract physician(s) shall receive a ninety (90) day written notification of unsatisfactory performance with ninety (90) days to cure the problem. If a disagreement about performance still exists at the end of the ninety (90) day period, the Contracting Officer will make a final determination with the input of the VAMC, Director within a reasonable period of time.

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

4.2.1. American Academy of Orthopedic Guidelines:

http://www.aaos.org/research/guidelines/guide.asp

4.2.2. VA Standards: 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

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

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

4.3. Resident Supervision and Teaching: RESIDENT SUPERVISION WILL NOT BE

APPLICABLE TO THIS REQUIREMENT.

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 U.S.C.551a (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 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 Contractor physician(s) by the VA are covered by the VA system of records entitled ‘Patient Medical Records-VA’ (24VA19). 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 physician(s) shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense.

Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

4.4.3. Disclosure: Contractor’s physician(s)may have access to patient medical records: however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA ‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records.

The VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 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 Handbook 1907.01 Health Information Management and Health Records:

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 and all guidelines provided by the VAMC.

4.4.5. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Quin Denton VAMC Memphis 1030 Jefferson Ave. Memphis, TN 38104 (901) 523-8990 x7087

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:

4.5.1.1. Board Certified/Board Eligible Orthopedic Surgeon

4.5.2. The Contractor shall furnish the services of Orthopedic Surgeon. In addition, the Contractor physician(s) must be present at the VA facility and must perform the required services as specified in the contract. At least one surgeon should be available during off duty hours in case of emergencies. Historically the average number of emergency cases performed annually are five. Emergency cases would be such as but not limited to: compartment syndrome, irrigation & debridement procedures, arthroplasty, closed vs open reduction, intermedullary nailing, right intertrochanteric femur fracture, and CRPP femoral neck fractures.

The Contractor shall be responsible for providing replacement staff at all times to ensure complete coverage.

4.5.3. The Contractor physician(s) shall supervise designated VA employees and will only perform authorized contract work at the Memphis VA Medical Center in strict accordance with the schedule of costs shown in the contract. Contractor physician(s) may work with current VA full or part time surgeons that are not provided by the contractor. Contractor physician(s) will provide, as needed, professional guidance to support personnel employed by the VAMC, Memphis, TN.

4.5.4. Contractor physician(s) will actively support the VAMC Memphis' efforts to purchase all orthopedic surgical supplies or implants from contracted vendors.

Only when clinically indicated will such purchases be considered from noncontracted Vendors. Non-contract requests must include documentation demonstrating why the contract appliance/implant, when available, is not clinically acceptable and each purchase request must be approved by the Chief of Staff or designee.

4.5.5. Upon request of the VA the Contractor shall be responsible for providing any or all of the following services:

4.5.5.1. Contractor shall ensure that physicians provide educational training sessions for orthopedic surgery section house staff and orthopedic surgery physician assistants. The surgeons must be experienced in teaching Orthopedic Staff and trainees assigned to Surgical Service. This would primarily be Orthopedic PA’s, nurses, and techs.

4.5.5.2. Contractor shall provide orthopedic surgeon(s) to support the orthopedic surgery clinic. The contracted orthopedic surgeon will be required to operate the clinic, examine patients, and interpret reports as required by the VA. The Contractor physician(s) will be required to work with VA staff. Should clinic hours need to be changed, VA will provide the contractor a four (4) month advanced notice of the change.

4.5.5.3. Contractor and VA Chief of Surgery shall prepare monthly call schedules for coverage of orthopedic surgery emergencies. A draft schedule shall be submitted to the office of the VA Chief, Surgical Service/Administrative Officer within five (5) working days prior to the end of each month.

4.5.5.4. When required, in case of a patient death, the contractor physician responsible for treating that patient, shall attend the Morbidity and Mortality meetings to discuss lessons learned. If the particular contractor physician is not available, another contractor physician shall attend the meeting to discuss the case.

4.5.5.5. In addition, the services to be performed by the Contractor physician(s) will be done so in accordance with compliance with VA mandates, policies and procedures, Joint Commission, Federal and State laws, and regulations of the Medical Staff by-laws of the VA Medical Center.

4.5.5.6. All surgeons will be required to work in collaboration with surgeons who are part-time or full-time salaried by the VA including but not limited to seeing patients and operating and collaborating physicians’ patients. In general, the responsibilities for inpatient care include but are not limited to:

4.5.5.6.1. See Orthopedic Surgery Ward Patients/Surgical Intensive Care Unit Patients

4.5.5.6.2. Admit

4.5.5.6.3. Diagnosis

4.5.5.6.4. Develop Treatment Plan

4.5.5.6.5. Manage, including the performance of surgery, timely ordering of surgical supplies prior to date of surgery

4.5.5.6.6. Discharge/Transfer

4.5.5.6.7. Include all needed medical record documentation

4.5.5.6.8. Outpatient Care

4.5.5.6.9. Seeing all new patient referrals with accompanying medical records

4.5.5.6.10. Seeing patients with new surgical complications

4.5.5.6.11. Approving proposed surgeries

4.5.5.6.12. Post-operative visits

4.5.5.6.13. Patients must be seen by a provider in 15 days

4.5.5.7. Orthopedic operations are to be performed either by the attending physician or with the attending physician providing professional direction and supervision to the house staff at levels defined in the Veterans

Healthcare Administration (VHA) Manual, M-2, Part 1, and Chapter 26.

VHA Manual M-2 is available for viewing in the Department of Veterans Affairs Medical Center, Chief, and Surgical Service’s Office or upon request from the Contracting Officer.

4.5.5.8. Services are required to provide professional supervision to the house staff, with documentation in compliance with VA mandates, regulations, and policies.

4.5.5.9. The Contractor physician(s) shall respond to peer reviews completed by Risk Management and the Peer Review Committee. The Contractor physician(s) will provide an answer on why they took a certain course of action for their patient.

4.5.6. CONTINUITY OF CARE:

4.5.6.1. The Contractor shall be responsible for the management of medical care and continuity of care for all patients through the following minimum functions

4.5.6.2. The Contractor shall provide case management services by orthopedic surgery providers who functions as staff, consultant, and attending physician, including in collaboration with other members of the orthopedic surgery staff, as appropriate.

4.5.6.3. The Contractor shall provide services which meet the standards as established by Federal and State Regulations and other review bodies, e.g., Joint Commission (JC).

4.5.6.4. Clinical duties include direct patient care.

4.5.6.5. The Contractor physician(s) shall perform emergency procedures after normal working hours as needed. Emergency procedure procedures are rare. Contractor physician(s) will be scheduled to provide services of boardeligible/certified orthopedic surgeons to fill a need created due to the absence of some or all Government orthopedic surgeons on leave, training or unforeseen emergencies. Contractor and VA Chief of Surgery, by mutual agreement, may schedule additional shifts for specialized procedures where government staff may lack specific expertise.

4.5.6.6. The Contractor physician(s) shall be responsible for the completion of all orthopedic surgery medical records documentation, including admission notes, operative notes, brief operation notes, consultation notes, discharge summaries, clinical notes, ICU transfer notes, and ICU daily care notes, and shall use the clinical reminder system in the VA Memphis CPRS in accordance with current Department of Veterans Affairs, VISN 9 and facility policy.

4.5.6.7. Contractor physician(s) will make orthopedic inpatient rounds on a daily basis. These can be in-person rounds with the Physician Assistants or phone call rounds with the Physician Assistants who have already seen and examined the patients.

4.5.7. Scope of Care: Contractor’s physician(s) (as appropriate and within the scope of practice/privileging) shall be responsible for providing Orthopedic care, including, but not limited to:

4.5.7.1. Clinic and Surgical Care: Contractor’s physician(s)shall provide clinical orthopedic services. The contractor’s physician(s) shall be present on time for any scheduled clinics/surgeries as documented by physical presence in the clinic or operating room at the scheduled start time.

4.5.7.1.1. Approximate case load is as follows:

# of patients per clinic: 20___ # of procedures per surgical session:_4__

4.5.7.1.2. Operative Services: Contractor’s physician(s) shall provide comprehensive clinical Orthopedic services.

4.5.7.1.3. Intraoperative Follow-up: the Contractor’s physician(s) shall be present in the operating suite for all orthopedic procedures.

4.5.7.1.4. Postoperative Follow-Up. Contractor’s physician(s) rounds shall be conducted on postoperative patients in the Surgical Intensive Care Unit (SICU) and on the wards. All cases will be discussed in morbidity and mortality conferences, and the contractor’s physician(s) (s) will provide appropriate information to the COR for inclusion in departmental reports.

4.5.7.1.5. Contractor’s physician(s) shall provide consultative services at the patient’s bedside if the patient is not ambulatory and in the clinic setting if the patient is able to report to the outpatient clinic. Consultations shall be scheduled for completion within 30 days of the date of the consult.

4.5.7.2. Medications: Contractor’s physician(s) shall follow all established medication policies and procedures. No sample medications shall be provided to patients.

4.5.7.3. Discharge education: Contractor’s physician(s) shall provide discharge education and follow up instructions that are coordinated with the next care setting for all orthopedic clinical or surgical patients.

4.5.8. ADMINISTRATIVE: estimated 5 % of time not involved in direct patient care

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

4.5.8.2. Staff Meetings: The contractor’s physician(s) shall attend staff meetings as required by the VAMC 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.

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

4.5.8.4. Patient Safety…