Atch D - Statement of Work FP Physicians REV1.pdf

Statement of Work

Family Practice Physician Services for the Hopi HealthCare Center (HHCC)

OVERVIEW

Phoenix Area Indian Health Service has a requirement for non-personal Family Practice Physician

Services as described herein at the Hopi Health Care Center Indian Hospital located in Polacca, Arizona.

This will be for a one (1) year base period of performance with four (4) one (1) year option periods of performance. All responses to this solicitation shall contain a complete profile and current work history of the candidate(s) presented, including licensure and certifications.

Selected candidate shall undergo the Indian Health Service mandated security clearance requirement prior to commencement of services at the Hopi Health Care Center PHS Indian Hospital. The security pre-clearance requirement must be adhere to; the process includes a fingerprint check and a screen check of the physician through the office of the inspector general's exclusion list at http://exclusions.oig.hhs.gov/.

BACKGROUND:

The Hopi Healthcare Center is a 4-bed, The Joint Commission (TJC) accredited critical access hospital.

Hopi Healthcare Center Outpatient Services include general medical care to adults and pediatrics.

Outpatient visits for the HHCC totaled 68,000 for Fiscal Year 2015, including 14,000 Emergency

Department visits.

WORK SCHEDULE FOR PHYSICIAN SERVICES: Shift times and schedules are subject to change based on the medical needs of the patient populace and hospital operations.

A) Family Practice Physician shifts are routinely, (Mon – Fri) 5 days/week minus Federal holidays

8 hours/day (8A-4:30P with 30 minute lunch). Approximate number of shifts to be filled in

Family Practice are two (2) eight (8) hour shifts per day.

PRICING SCHEDULE – See Attachment A- Rate Schedule to Complete!!!

The unit price paid to the Contractor shall be considered as payment in full for services provided under this award. In no way, unless directed by the IHS, shall any provider attempt to bill or collect from any IHS patient, or from any alternate resource for which the patient may be eligible, any monies for services provided under this award.

Hourly fixed rate shall be inclusive of all other fees (holiday, overtime, nights, weekend or call services, etc), including travel expenses, per diem, lodging, all city, state, federal and local taxes, and all miscellaneous costs associated with the provision of services. The government will pay one flat rate.

Contractor shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate (one flat rate). There is no provision for holiday, overtime, nights, weekend or call services etc. *The government does not pay for time taken for lunch.

DUTIES AND RESPONSIBILITIES:

The contractor shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the department and personnel. The contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the contractor to meet these standards can result in cancellation of this contract. The contractor’s performance and abilities shall be http://exclusions.oig.hhs.gov/ evaluated based upon performance standards that are contained in this statement of work

The contractor shall prepare and complete in a timely fashion, the medical and other required records for all parties he/she admits or in any way provides care for the hospital or health care facility (Service Unit

Medical By Laws). All Electronic Health Records (EHR) notifications shall be addressed before contractor leaves the hospital care facility. During the performance of their duties, the contractor shall provide for the consistent performance of patient care processes according to the standards for the TJC accreditation program within IHS. These standards include: The Comprehensive Accreditation Manuals for the Hospitals, The Laboratory Standards and Ambulatory Care Standards as they represent the scope of services of this contract.

The contractor shall possess a professional medical education from a post-secondary academic institution or be licensed in a field of medical study. The contractor should be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications. The contractor shall have sufficient knowledge, competence and experience in providing these services on a regular schedule to the Hopi Healthcare Center. The contractor shall possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that the contractor can relate constructively to IHS employees, contractors, vendors and individuals from the

Native American community. Due to some limited driving requirements, the contractor should have a current, valid state driver’s license from any of the 50 United States or the Commonwealth of Puerto

Rico.

The contractor shall not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services as there will be some moderate lifting and moving of furniture as well as boxes of office supplies and equipment. The contractor shall maintain acceptable standards of personal hygiene and grooming such that their image as a Federal contract employee is compatible with the expectations of the IHS staff. Personal Service Contractors are covered under the Federal Tort Claims Act.

The contractor shall be required to utilize the electronic health record for chart documentation, after receiving training to enter all lab and x-ray requests. Once the emergency room is converted over to an

EHR system the provider must use the system for documentation.

Patients receiving services under this agreement may only speak a native language and/or reside on a

Native American Reservation. The Contractor’s employee(s) shall be sensitive to the unique culture factors of the people they treat, which may include use of an interpreter as necessary in communication of services being rendered. Unique cultural factors that may contribute to the patient’s treatment include: use of their language communications; village and tribal customs; use of traditional healers; isolation;

housing conditions and lack of resources.

In the event the Contractor’s employee is unable to render service on a previously agreed schedule, the

Contractor shall provide a minimum seventy-two (72) hour notification to the Contracting Officers

Representative (COR), Clinical Director or designee thereof. The Contractor shall then make a full, good-faith effort to provide coverage with a replacement.

In the event that the contractor fails to provide 72 hours’ notice of their inability to meet the schedule, excepting unforeseen emergencies, the contract with this individual provider will be terminated and the contractor will no longer be scheduled to work in the Hopi Healthcare Center since failure to show up for the scheduled shift causes an undue burden on the hospital.

E.D. Physicians will admit patients to inpatient and must complete a History & Physicial. E.D. Physicians must provide cross coverage of inpatient as the in-house physician, and must complete assessments required for identified “changes in patient condition” and condition of such patients and all aspects of treatment regimen shall be documented.

Accommodations/Lodging – The IHS Hopi Health Care Center Service Unit may be able provide accommodations on-site for the selected physicians for the estimated period of performance.

Transient housing will be provided (at a daily rate) when available. If no transient housing, then the local hotel or housing in Winslow, Arizona. CURRENTLY and for the forecasted remainder of 2022 there is NO transient housing available.

CONTRACTOR EXPERIENCE/QUALIFICATIONS:

It is preferred but not required that Medical staff have experience of services performed in a rural community. It is essential that medical staff must be willing to accept a position in a rural community. The contractor shall provide the Government with the qualifications of Physicians presented as candidates for assignments, including resume (detail experience in months and years), and references.

REQUIREMENTS - (Family Physician):

(a) QUALIFICATION/CERTIFICATION – FAMILY PRACTICE PHYSICIAN:

1) Contractor shall provide staff physician with recent outpatient medical experience.

2) Physicians shall be either board certified in Family Practice or Internal Medicine.

3) Recent outpatient work experience is acceptable in lieu of board certification.

4) Current certification is required in BLS (Basic Life Support).

5) ACLS (Advanced Cardiac Life Support and

6) PALS (Pediatric Advanced Life Support).

STATEMENT OF WORK:

The contractor will be expected to have the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the department

Contractor shall speak, understand, read and write the English language fluently. The contractor should be proficient in typing and have a basic working knowledge and understanding of computer hardware and software applications.

Government shall allow only qualified, appropriately licensed or credentialed individuals, practicing within the scope of their license or credentials, to provide healthcare services on behalf of the government.

Contractor agrees to the terms and conditions of the contract, acknowledges that performance shall be provided in a professional manner and shall demonstrate a level of competence in work that meets and/or exceeds the government’s requirements.

The Government shall periodically assess and evaluate medical and health services programs to ensure consistency with current standards of practice.

The Contractor shall perform services with respect to patient’s right to receive appropriate and quality healthcare services without discrimination due to race, creed, gender, national origin, sexual orientation, disability, age, physical or mental handicap or disability, type of illness or condition, and need for health services.

Contractor(s) acceptance of the government contract shall ensure that Contractor adheres to all terms and conditions of the contract. A Contractor shall be free of any non- prescribed substance in performance of the contractual requirements. However, if the government has suspicion and/or observation of

Contractor's performance possibly being under the influence of non-prescribed substance (ie, alcohol, etc.) the government reserves the right to terminate contract without further explanation.

The Contractor or individual performing services shall comply with all applicable Federal and State workers compensation, health examinations, income tax withholdings, social security withholding and occupational disease statues.

The Contractor shall ensure confidentiality of all patient medical records. Information contained in these records may not be disclosed to any person or agency, except pursuant to a written request and with prior written consent of the individual to whom the records pertain. However, this obligation shall not prevent the disclosure of patient medical records to officials and employees of departments and agencies of the

United States Government acting in performance of official duties pursuant to laws and regulations governing local control of communicable diseases, preventive medicine, and safety programs; to official representative authorized surveying bodies during the conduct of certification and accreditation reviews, or to third party payers to whom the patient has authorized release of information.

Complete administrative control of patient remains with the Government. All records produced in the performance of the contract and all evaluations of patients are the property of, and subject to the exclusive control of, the Government. All records shall be maintained in accordance with medical treatment facility guidelines.

OTHER CONTRACTOR RESPONSIBILITIES

All financial, statistical, personnel, and technical data which is furnished produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. Such data or information shall not be released nor legal rights claimed by the Contractor without prior written consent of the Contracting Officer. Any presentation of any statistical or analytical materials, or any reports based on information obtained from performance by this contract will be subject to review and approval of the Contracting Officer.

Safety or protective clothing or equipment shall be provided and maintained by the Contractor at the

Contractor’s own expense.

No interpretation of any provision of this contract, including applicable specifications shall be binding on the Government unless furnished or agreed to in writing by the Contracting Officer.

HEALTH REQUIREMENT/SCREENING:

Immunizations:

The contractor agrees to furnish the following documentation of immunization records prior to the performance of work. (Reference Indian Health Service Circular 95-9A).

(1) Tuberculosis: Annual PPD or Chest X-ray, if there is a history of positive skin test.

(2) Documentation of two (2) MMR (Measles, Mumps & Rubella) vaccinations or proof of immunity. Employees born before 1957 do not need MMR or proof of immunity.

(3) Documentation of two (2) varicella (chicken pox) vaccinations or proof of immunity or history of having disease. Documentation of Hepatitis B series vaccination and influenza vaccination during flu season.

Personal Hygiene – Contractor personnel shall be clean and neat in appearance.

Contractor’s personnel who acquire a communicable illness shall not perform services under the contract and must be free of illness before returning to work. The Contractor shall notify the COR of any situation that may arise immediately.

Contractor’s personnel shall not use commercial tobacco products while on the IHS campus.

The Contractor is responsible for compliance with all appropriate TJC, IHS, IHS facility policies/procedures and other regulatory agency record keeping requirements.

INDIAN CHILD PROTECTION AND FAMILY VIOLENCE PREVENTION ACT

No performance under the contract shall be allowed without full compliance with the Indian child protection and family violence prevention act, public law 101-630 and the Indian health service memo dated February 3, 1997 investigations of child-care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

CRIME CONTROL ACT OF 1990

No performance under this contract shall be allowed without full compliance with the Crime Control Act

Of 1990, Public Law 101-647 and the Indian Health Service memo dated February 3, 1997 Investigations on Child Care Workers. Contractor shall ensure that proposed providers cooperate with and assist the government in condition of any necessary background checks.

ORIENTATION:

Contractors shall participate in facility orientation program prior to physician and nurse practitioner services starting. Orientation is usually accomplished within one (1) week. The Contractor shall be required to complete all necessary documentation required for background checks as applicable.

No Contractor or Contractor’s personnel may be assigned to work under the contract until initial

Orientation has been completed. Documentation verifying the content of the orientation and a list of the Contractor’s personnel who attended shall be maintained by the Contractor and a copy provided to the Contracting Officer’s Representative (COR). When the Government exercises one or more of the option years to the contract, the Contractor shall provide updated listing to the COR, documenting personnel have had refresher orientation.

IHS on site orientation must be met within thirty (30) days of award. This requirement includes any

“new Contractor personnel.”

Contractors shall complete IHS Computer Security Awareness Training within thirty (30) days.

CREDENTIALING AND PRIVILEGING:

The Contractor shall participate in the Credentialing and Privileging process in accordance with facility procedure. The Contractor will be provided copies of current requirements as applicable and updates as they are published.

CONTRACTOR CREDENTIALS

The Contractor shall provide a list of qualified physicians and the following documents for each provider for the Solicitation Phase Items A thru F ONLY! Other items are for after Award for credentialing.

a) Current Resume or C.V

b) College Transcripts; conferred degrees and certified training in the field

c) Copy of active unrestricted License to Practice Medicine

d) License Certification Statement

e) Two (2) letters of references from current or previous employers

f) Past Work Performance Statement, applicants must describe their present and previous experiences in this field

After Award for credentialing.

1. Current resume

2. OF-306 – Declaration for Federal Employment (all questions must answered and signature with date in 17a is required)

3. OF-306 Addendum – Addendum to the OF-306 (Declaration for Federal Employment)

4. IHS Provisional Access Memo

5. Protecting Children from Sexual Abuse in Health Care Settings; complete the Certificate of Completion

6. NoFEAR Act Training; complete the Certificate of Completion

7. OFI-86C form along with two fingerprint cards and applicable state forms

8. HHS-745, Section A

9. Two IDs (driver’s license and social security card – names must match and be unexpired)

NOTE: No photo submission of forms, please have the forms scanned. Wet signature and date is highly recommended. No PDF signatures will be accepted

CONTRACTOR QUALITY CONTROL PROGRAM:

(a) The Contractor shall have a Quality Control program to assure compliance with contract.

Quality Control program shall minimally have the following elements:

(1) A method for identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

(2) A file of all quality control inspections, inspection results, and any corrective action required shall be maintained by the Contractor throughout the duration of this contract. This file shall be the property of the Government and shall be available to the COR during normal working hours. The file shall be turned over to the Government within 14 days of completion or termination of the contract.

PERIODIC PERFORMANCE EVALUATION MEETINGS:

The Contractor shall meet, via in-person or teleconference meeting, with the Contracting Officer’s Representative

(COR) at the Hopi Healthcare Center a minimum of every six months according to availability.

The issuance of a Contract Discrepancy Report (CDR) may be cause for the scheduling of additional meeting(s) between the Contractor and COR. A mutual effort will be made to resolve all problems identified. The COR will prepare written minutes of these meetings. Should the Contractor not concur with the minutes, a written statement will be presented to the Contracting Officer (CO), and the Contractor will be notified of the decision in writing by the CO.

GOVERNMENT FURNISHED PROPERTY AND SERVICES:

(a) All tasks accomplished by Contractor’s personnel shall be performed to preclude damage or

Disfigurement of Government-owned furnishings, fixtures, equipment, and architectural or building structures. The Contractor shall verbally report immediately to the COR, any damage or disfigurement to these items when caused by Contractor’s personnel. A follow-up written report will be given to the COR and a copy forwarded to CO.

(b) When the Contractor has caused damage or loss of government property, or performance is determined to be unsatisfactory; the COR will issue a CDR. The Contractor will reply in writing, to the PO within ten (10) working days, stating the reason for the unsatisfactory condition, the corrective measures which have been taken, and preventive procedures initiated.

CONTRACTOR FURNISHED PROPERTY AND/OR ITEMS:

Contractor shall furnish qualified and experienced physicians and hospitalist for the purpose of performing services at the Hopi Healthcare Center. The Contractor shall secure all certifications and licenses to comply with Local, State and Federal laws.

Contractor shall perform all health screening of all medical staff to ensure that they meet IHS

Guidelines.

Miscellaneous: The Contractor shall furnish other items as identified within this contract, such as, orientation and training, medical exams, procedures manual, quality control program, required data.

ACCOUNTABILITY

Time and attendance logs or sign-in/sign-out sheets shall be kept on file and verified by the Clinical

Director, Hopi Healthcare Center or designee (e.g. ANE) to ensure that services called for under the contract have been rendered.

PERFORMANCE BASED ASSESSMENT:

(a) Introduction – Performance Requirements:

(1) A Quality Assurance Surveillance Plan (QASP) has been developed for in-house operations or to implement a service contract. It is designed to aid the COR in providing effective and systematic surveillance of all aspects of professional nursing services. This plan provides for monitoring the contract requirements

(b) The objective of this surveillance plan is to evaluate how the Contractor is performing in key areas. The government is primarily interested in the final service being provided and not in the details of accomplishment.

(c) The principal method of surveillance will be daily in some cases or by use or periodic inspections. Appropriate indicators are provided for recording observations in this type of surveillance.

(d) Quality Assurance Surveillance Plan (QASP):

(i) The Government shall monitor the Contractors’ performance through a Quality

Assurance Surveillance Plan (QASP). The QASP is for informational purposes only and not considered part of the contract.

(ii) Surveillance systems will include periodic inspection and acceptance of all deliverables as cited in the contract.

Performance Standards: The Quality Assurance Surveillance Plan (QASP) outlines required standards and will be a part of the contract.

Measures Performance

Requirement

Standards Acceptable

Quality

Level

Negative

Incentive

Positive

Incentive

1. Key Personnel Provide required

Specialty FP

Physicians &

Nurse

Practitioner as specified

In the statement of work.

Qualified personnel are available within

10 days of notice to

Contractor and in location as needed to properly

95% 5% (the maximum negative incentive combined will not exceed 10% per month for not meeting the

Acceptable Quality

Level)

Government will exercise the next option year if the contactor performs satisfactory.

2. Patient Safety Immediate reporting of any

Potential or actual patient risk

Management incidents to the

Department

Manager

All incidents reported immediately

100% 5% (the maximum negative incentive combined will not exceed 10% per month for not meeting the

Acceptable Quality

Level)

Government will exercise the next option year if the contactor performs satisfactory.

3. Maintaining licensing registration, and certification

Updated

Licensing and certifications, BLS, ACLS, PALS will be provided as they are renewed

Licensing and certification information kept current.

Contract provider records will be kept 100% up-to-date

5% (the maximum negative incentive combined will not exceed 10% per month for not meeting the

Acceptable Quality

Level)

Government will exercise the next option year if the contactor performs satisfactory.

4. Privacy, Confidentiality and HIPPA

Contractor is aware of all laws, regulations, policies, and procedures relating to

Privacy

Confidentiality and HIPPA and

Complies with all standards

Zero breaches of privacy or confidentiality

100% 5% (the maximum negative incentive combined will not exceed 10% per month for not meeting the

Acceptable Quality

Level)

Government will exercise the next option year if the contactor performs satisfactory.

CONDITIONS FOR REMOVAL/REPLACEMENT OF PHYSICIAN(S)

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a Physician. The Contractor’s employee shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this award, and/or the Contractor’s

VA/FSS contract.

CONTRACTOR REQUIREMENTS

For Medical & Professional Contractors, the contractor shall comply with all IHS facility infection control and safety procedures, and standards. During the performance of this contract, the Contractor shall provide for the consistent performance of patient care process according to the standards of the JTC and/or Centers for Medicare Services (CMS) who supplies accreditation to the Phoenix Area Indian

Health Service hospitals and health centers. These standards shall include: The Comprehensive

Accreditation Manual for Hospitals, the Laboratory Standards, and Ambulatory Care Standards as they represent the scope of services of this contract.

For Medical & Dental Professional Contractors, the contractor shall complete in a timely fashion, the medical and other required records for patients he/she admits or in any way provides treatment. The contractor shall abide by the Service Unit Medical By-laws and rules and regulations and meet all credentialing requirements in accordance with the Service Unit Medical Staff By-laws.

Upon award, the selected physician(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site at the Hopi Healthcare Center.

SUPERVISORY CONTROLS

The Chief Medical Officer, or designee, provides primarily administrative supervision. The supervising physician sets overall health care objectives and specifies resources available. The supervising physician provides for clinical supervision on a 24-hour, media and tour of duty coverage. The supervising physician reviews work performance on a periodic basis in order to evaluate proficiency in providing health care, discuss deficiencies and problems encountered, outline and/or approve new or changed practices to be employed, and provides consultation on specific cases and related problems. Work which involves out-of-the-ordinary diagnostic decisions or treatment is discussed with supervisor or supervising emergency department physician who keeps aware of the condition of such patients and all aspects of treatment regimen. Work performance is reviewed for conformance to IHS policy, procedures and accepted professional practices; and the Quality Assurance improvement Program of the Medical staff of the Service Unit.

E.D. physicians will provide guidance and instruction to the nurse practitioners providing services during each shift worked. Within established guidelines, contractor(s) exercise latitude in planning and carrying out health care assignments and in undertaking new procedures, practices and approaches to extend both services provided and increase individual proficiency. Overall work performance is reviewed jointly by the clinical director/supervising physician for effectiveness in meeting requirements for healthcare services.

END OF STATEMENT OF WORK