OBGYN_SOW_edits.docx

DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

Obstetrics/Gynecology ON-CALL/CLINIC/OB/GYN SURGERY PHYSICIAN

Pine Ridge Service Un it, Great Plains Area Indian Health Service

PURPOSE OF CONTRACT.

The primary purpose of this non-personal service contract position is to provide direct patient care. The mission of the Pine Ridge IHS Hospital, Pine Ridge Service Unit, Great Plains Area Indian Health Service is to provide the best possible health care services to the Native American people on the Oglala Lakota (Sioux) Pine Ridge Reservation in South Dakota. To meet the mission, the Pine Ridge Hospital requires contracting support to assist the Service Unit in the recruitment of one (1) OB/GYN physician. This contract OB/GYN is expected to perform scheduled rotating shifts involving obstetrical and gynecologic services. Contracting support will hereafter be referred to as the Contractor. The care and prevent ion activities shall be as comprehensive as our Service Unit permits.

The Contractor is responsible for providing medically qualified physicians whom provide direct patient care meeting the requirements in the Statement of Work section of this document and adhering to the policies and procedures of the Pine Ridge Indian Health Service Hospital.

The contract resulting from this solicitation shall:

Be a non-personal health care service contract under which the Contractor is under the administrative supervision of the Pine Ridge Indian Health Service Hospital's Medical Director, or his/her designee.

Allow the government to evaluate the quality of professional and administrative services provided.

The contractor shall be fingerprinted prior to arrival to Pine Ridge IHS hospital in order to be cleared as a background check and cannot see patients until their fingerprints clear.

I t is strongly recommended that the provider have the Flu, MMR, TDAP, and Hepatitis. B vaccinations, in addition to TB testing.

**All Medicare B and other insurance provider enrollment documentation submitted to the contracted provider by Pine Ridge IHS Hospital credential & business office personnel shall be completed by the OB/GYN to the satisfaction of the Pine Ridge IHS billing department. Initial contract Physician's hospital orientation list is required to be signed off by the business office for insurance enrollment conformation. NO INITIAL TIME SHEETS OR INVOICES WILL BE APPROVED AND PROCESSED UNTIL THE RESPECTIVE PROVIDER HAS COMPLETED ALL INSURANCE FORMS DOCUMENTATION. The deciding authority for provider enrollment insurance documents will be the supervisor of the business department.

**All patient health record documentation initiated by the contract OB/GYN from patient encounters SHALL BE completed to the satisfaction of the supervisor, or designee, of the HIM (Health Information ·Management) Department & Business office supervisor or designee. The approving authority of the contract provider's time sheets will NOT sign off on the final time sheets unless the provider has successfully completed all required patient medical encounter documentation (medical records). If the provider has delinquent medical records as determined by the supervisor, or designee, of the HIM department. the approving authority will not sign off on any time sheets or process any invoices generated from "unauthorized'' time sheet signatures.

Time sheets shall be signed by the clinical director and reviewed by the Contracting Officers Representative (COR). No invoices will be processed unless properly signed. A record must be maintained in order to follow the budget of the contract.

The contractor will be required to utilize facility EHR (Electronic Health Record) for all patient encounter documentation. Experience is highly recommended. The contractor shall type all notes and complete all documentation required by the Health Information Management department (HIM). This includes completing all coding and purpose of visit diagnoses.

G OVE RNMENT FU R NISHED PROPERTY, FACILITI ES AND SERVICES

The Hospital shall provide a patient examination area and all medical and non-medical equipment and supplies used in the Indian Health Service facility for the care and maintenance of patients.

The Hospital shall provide an on-going monitoring and evaluation of the quality and appropriateness of patient care, and of identifying deficiencies in the qua li ty of services performed before the level of performance becomes unacceptable. This involves peer review on patient charting, peer evaluations, support personnel evaluations, documented complaints, incident reports, and monitors performed by Performance Improvement (Pl) processes.

The Physician shall be provided with an orientation. The Service Unit/Hospital personnel shall provide the initial orientation and any continuing orientation.

CONTRACTOR FURNISHED PROPERTY, FACILITI ES AND SERYICES

The Government does not anticipate any required Contractor furnished property, facilities, or services for the duration of this contract.

STATEMENT OF WOR K

The contracting company shall provide one-two (I-2) OB/GYN Physicians for the entire duration of the contracted period of performance. Each contracted OB/GYN physician shall be referred as "OB/GYN'' here after for the purposes of this Statement of Work (SOW) document.

***The rotation of the OB/GYN may be incorporated into a rotating OB/GYN schedule that includes one (1) permanent full time Indian Health Services OB/GYN physician. In this scenario, the contract OB/GYN will overlap rotations with 1-2 permanent IS OB/GYNs. The schedule shall be 14 consecutive days on the schedule and 14 consecutive days off the schedule.

The primary function of the Physician (MD or DO) OB/GYN shall include the following:

OB/GYN shall work an eight-(8) hour daily shift physically based on the inpatient ward and outpatient clinic (OB U nit/ Women's Health Clinic/Operating Room). These eight-(8) hour daily shifts shall be scheduled for a period of fourteen (14) consecutive days.

The OB/GYN on occasion ma y need to work for short periods of time beyond their respective shift hours, at times when such extra time is necessary to finish a patient care, admission, inter-hospital transfer, or OB/GYN change of shift transfer of care. The OB/GYN will work under the direct supervision of the Pine Ridge IHS Hospital OB/GYN Supervisor, Clinical Director, or designee.

The OB/GYN shall remain physically within the confines of the hospital at all times during their eight-(8) hour duty shift. Responsibilities include providing direct patient medical care to obstetric and gynecologic patients currently admitted on the ward, admitting OB/GYN patients to the OB Unit, delivering vaginal births or performing caesarian sections and other obstetric and gynecologic surgeries as privileges delineated, discharging patients from hospital, accepting as well as performing inter-hospital transfers, being "on-call" to the Pine Ridge IHS Hospital Emergency Department (including ED OB) and other Pine Ridge IHS hospital outpatient clinics for OB/GYN consultations which includes the responsibility of performing the admission orders, and history and physical. The OB/GYN shall attend discharge planning every day.

*The OB/GYN shall be on call to the Emergency Department, to include the ED OB department, to evaluate and treat OB/GYN patients. Certified Nurse Midwives will consult the OB/GYN for telephone consults and in person consults at their discretion, this includes coverage by the OB/GYN physician for the ED OB. Regarding ED consults of the OB/GYN, the decision to call the OB/GYN is determined by the attending ED physician's assessment of the current ED situation and any potential safety hazard to the waiting triaged ED patients. The OB/GYN will under no circumstances be expected to function as an Emergency Department physician and will only perform medical evaluations and treatments he/she is trained, experienced, credentialed, and privileged as an OB/GYN.

The OB/GYN will provide physician consultation to outpatient providers involved with evaluating and treating patients in the adult medicine clinic.

The OB/GYN will provide diagnostic, preventive, and therapeutic health services to patients and family members within the Pine Ridge IHS Hospital’s Inpatient ward, Emergency Department, and Women's Health Outpatient clinic. The OB/GYN occasionally maybe called upon by the general surgeon to assist in emergency surgery ie appendectomy or cholecystectomy.The OB/GYN may be consulted to outpatient specialty clinics in cases where the specialist provider feels a need to initiate a same day OB/GYN consultation. This consultation may sim ply involve an exchange of information over the telephone or having the need for the OB/GYN to physically present to the respective specialty clinic for consultation. This consultation may merely require information from the OB/GYN to the consulting provider to act upon, or the OB/GYN to admit the patient or even transfer the patient to the ED. Specialty clinics include yet are not limited to the Surgery, Dental, Optometry, Podiatry, Pediatrics, Ophthalmology, ENT, PT, and Orthopedic clinics.

The physician shall be required to be cleared and fingerprinted through the Indian Health Services Suitability Office fingerprinting process if they have not previously been cleared.

The OB/GYN shall meet all Pine Ridge IHS Hospital credentialing requirements as dictated by the Medical Staff By-Laws. All requisite credentialing and application documents shall be in the Pine Ridge IHS Hospital's credential coordinator's office no later than ten (10) business days before the OB/GYN is expected to report to duty. Submitting the documents earlier is preferred to allow issues to be resolved timely.

This OB/GYN shall perform all Inpatient medical documentation, OB ED MSE/consults/evaluations, and Out-Patient clinic visits/consults in Pine Ridge IHS Hospital's Electronic Health records (EHR). The OB/GYN shall be provided EHR orientation and practice with the EHR Clinical Application Coordinator (CAC). Complete documentation must be annotated in the patient's EHR medical record chart per PRSU policy within 24 hours. All medical records must meet acceptable standards as determined by the hospital's Performance Improvement (PI) department and the Health Information Management (HIM) Department. All OB/GYNs are expected to complete all EHR patient encounter notes, Purposes of Visits (POV) and medical levels on every patient in a timely manner. Medical records personnel will monitor any deficiencies and inform the OB/GYN, OB/GYN Supervisor, and Clinical Director or designee. Medical record deficiencies can seriously impact the ability of the hospital to bill alternate resources. Therefore, any significant medical deficiencies will prevent processing of final purchase orders.

The OB/GYN's medical records will be reviewed to determine if the OB/GYN is providing acceptable medical care. These reviews will be in the form of Utilization Review and peer review. The OB/GYN shall secure health history from the patient or family member and record any findings. Physical examination shall be performed and will be consistent with the patient's presenting complaints and/or presenting signs and symptoms. Appropriate diagnostic testing shall be ordered, reviewed, interpreted, and acted upon to address and treat the patients' complaints, signs, symptoms, and in the patient's best medical interests. The OB/GYN will discriminate between normal and abnormal findings to recognize early stages of serious physical, emotional, or mental problems. The OB/GYN will make decisions with available physicians, surgeons, or specialists that may be available concerning medical care needs of patients. The OB/GYN will consult available in-house medical services when indicated and available. If consulting services are not available in-house the OB/GYN will perform diagnostic and therapeutic consultations with surrounding health care facilities.

Chronic pain patients presenting to the OB/GYN will be assessed for new specific chief complaints or general health evaluations and assessments. Any treatment involving chronic pain issues, including controlled substances, shall be referred to the Chronic Pain Medical Management Team (CPMMT) for assessment and recommendations. All patients currently holding signed pain contracts shall be honored as the contract has dictated. The OB/GYN will abide to the agreements of all signed and current (less than one year old) chronic pain contracts.

The OB/GYN will Participate with other health professionals and agencies involved in providing health care and services required to include immunization and disease control, environmental health and health education.

Provides full range of emergency services or intervention including life-saving emergency procedures in order to sufficiently stabilize a patient for transport to a higher - level facility.

Evaluates the medical aspects of treatment plans, periodically recognizing the need for reassessment by a physician or other health professional.

Provides medical care and preventive services to healthy individuals, including guidance in nutrition, common illnesses, and accidents.

Evaluates total health care needs of patient s and develops or initiates plans to meet these needs.

Maintains records and reports on patients, personal activities and other required information for use in program operation, quality control and other purposes. All medical record information generated in the performance of this contract will remain the property and subject to the exclusive control of the Indian Health Service.

The OB/GYN shall comply with all IHS facility infection control and safety procedures, practices and standards.

The OB/GYN shall meet all applicable Joint Commission and Centers for Medicare/Medicaid Services (CMS) standards during the performance of this contract, and must be in compliance with the Service Unit’s Medical Staff Bylaws.

This individual must be eligible for enrollment in the Service Unit's Medicare Part B program, so as to enable the hospital to bill for the OB/GYN's services.

The OB/GYN shall respect and maintain the basic rights of patients, to include but not be limited to personal dignity.

EHR/Health Records

The contractor will be required to utilize the facility Electronic Health Record (EHR) for all patient encounter documentation. Experience is highly recommended. The contractor shall type all their notes and complete all documentation required by the Health Information management department (HIM). This includes completing all coding and purpose of visit diagnoses.

All patient health record documentation initiated by the contract OB/GYN from patient encounters shall be completed to the satisfaction of the supervisor, or designee, and to the satisfaction of the Health Information Management Department & Business Office supervisor or designee. The approving authority of the contractor's timesheets will not sign off on the timesheets unless the provider has successfully completed all required patient medical encounter documentation (health records). Further, if the contractor has delinquent records as determined by the supervisor or designee of the HIM department, the approving authority will not sign off on any time sheets.

KNOWLEDGE REQUIRED

Skill and knowledge of established concepts, principles, and practices related to health care assignments requiring training equivalent to a Medical Doctorate or Osteopathic Doctorate degree and successful completion of an Obstetrics/Gynecology residency.

Board Certification in Obstetrics and Gynecology, or Board Eligible and graduated from an accredited residency program within the past four-(4) years, preferred.

Ability to collect, organize, record and communicate, in a meaningful way , data relevant to primary health assessments including detailed family and medical history, physical examinations and selective laboratory tests in order to evaluate and treat OB/GYN patients in an inpatient/outpatient facility. Able to identify medical conditions that warrant medical and surgical treatment available at the local hospital facility and when/how to transfer patient to higher level of care hospital facility for indicated medical care. Pine Ridge does not have an ICU. There are 24/7 Surgery and CRNA on-call services. There is a general surgeon with surgical privileges on staff. Generally there is limited evening and weekend general surgical on call services; provider is on call during the normal duty hours.

Closest higher level of care hospital is 35 minutes away by life flight and 1 hour and 30 minutes by ground ambulance. Transfer weather conditions at times can be in climate precluding air or even ground transfer.

Skill in typing all inpatient and outpatient clinical patient encounter notes.

Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health conditions that require medical management.

Knowledge of pharmaceuticals in order to recognize the desired effects, side effects and complications of their use.

Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience and reliability in providing emergency/ urgent patient care.

Ability to provide individual and family counseling, guidance, and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health.

Qualifications

The OB/GYN must be a graduate of an accredited school of allopathic or osteopathic medicine.

The OB/GYN must hold an active, current, and unrestricted state medical license with a medical doctor or doctor of osteopathy degree from any of the 50 United States or the Commonwealth of Puerto Rico.

Must be Board eligible or certified in Obstetrics and Gynecology.

Must have served as a credentialed full-time OB/GYN for a minimum of six-(6) consecutive months without a hiatus of longer than six consecutive weeks, an d must have provided a portion of these OB/GYN duties within the last three months unless just recently graduating from OB/GYN residency training.

The OB/GYN cannot be under any exclusions or sanctions from the Medicare/Medicaid programs.

The OB/GYN must fulfill all the requirements for appointment to the Pine Ridge IHS Medical Staff and for the granting of privileges as OB/GYN, in accordance with IHS policies and with the Service Unit Medical Staff Bylaws.

The OB/GYN must have, at minimum, current BLS, ACLS and NRP certification.

The Contractor must have three-(3) written letters of professional recommendation less than one year old; recommendations are written by physicians.

The Contractor must have had a PPD performed and read in the past year. Documentation of PPD is required. If positive, treatment type and dates must be provided along with a statement if applicant is symptomatic or not. If positive PPD and previously symptomatic a chest radiograph is required.

Pine Ridge Indian Health Service hospital policy requires all staff with direct patient contact, be able to provide proof of TDAP (Tetanus, Diphtheria, acellular Pertussis). This includes all permanent employees, volunteers, and contractors (for all contractors in this category, acceptable proof can be in the form of an immunization record or written documentation from a physician). This proof must be provided as part of the application submission process prior to being accepted for a position. Contractor personnel currently serving in a contract position can receive these immunizations from the facility. In addition, all contractors must have a current Basic Life Support (BLS), Advance Cardiac Life Support (ACLS) and Neonatal Resuscitation (NRP) certificate prior to arrival at Pi ne Ridge hospital. Provider must have Hepatitis B vaccine and MMR vaccines or titers documenting immunity to hepatitis B and MMR.

All Civil Service employees, contract staff, temporary employees, students, and volunteers, who work in an IHS health care facility, must receive a seasonal influenza vaccination by October 31 of each year or have on file a valid medical exemption for vaccination signed by a licensed independent practitioner.

1. Individuals with a valid medical exemption for vaccination will be required to wear a mask provided by IHS during the influenza season (November 1 through March 31) and during other periods of increased influenza activity as defined by the Centers for Disease Control and Prevention and/or State public health authorities.

2. All employees, contract staff, temporary employees, students, and volunteers, must be provided access to influenza vacci nations at no charge.

Quality Assurance/Supervisory Control

Quality Assurance and Supervisory Control is under the OB/GYN Supervisor and Clinical Director of the Pine Ridge Service Unit or his/her designee. The Pine Ridge Hospital medical staff will perform peer reviews of the incumbents' work. Incumbent performs assignments under general supervision and will work directly under the OB/GYN Supervisor and Clinical Director. In addition, the Supervisor will monitor the contractors work and provide feedback to the contractor.

Guidelines

Guidelines include standing orders, protocols and agency procedures. Guidelines are not completely applicable. Uses judgment in interpreting guidelines.

COMPLEXITY

The work consists of providing a range of health services from assessment through intervention, counseling, teaching, treating illnesses, and performing surgical procedures as indicated. Health care services are being delivered to the patients of the Pine Ridge Service Unit where the rate of Diabetes Mellitus (DM) is prevalent along with the usual DM co-morbidities.

Reporting to Work

Contractor is required to report to work on time and will notify the supervisor if he/she will be late for any reason. Contractor must wear the appropriate IHS badge at all time while working in the IHS facility.

Scope and Effect

The purpose of the work is to deliver health care to Native American individuals and families, and eligible members of the USPHS Uniformed Services. The work affects the physical well-being of persons in the community.

IRS Reporting Requirements Contractor is required to pay all Federal, State, and local taxes. The Indian Health Service will not withhold taxes for the Contractor.

Personal Contacts The Contractor shall communicate with patients, families, and various staff members in all departments in the facility.

Purpose of Contact

To provide health care, and to collaborate with the Medical Director of the Pine Ridge Service Unit or his/her designee on review of work.

Physical Demands

Must be able to work at least eight (8) consecutive hour shifts for a period of seven (7) to fourteen (14) consecutive days. Prolonged standing and bending is required in treating patients. Be able to be called back for emergency support during non-scheduled hours during scheduled working days.

Meals

Breakfast, lunch & dinner are available in the Pine Ridge IHS hospital cafeteria with the purchase of a meal ticket. Meal tickets may be purchased in the hospital administration department between the hours of 10:00 AM to 11:45AM and 12:45PM to 2:00PM on Monday through Fridays. Cash and checks are accepted. The hospital is not equipped to perform credit or debit cards transactions.

Work Environment

Exposure to contagious diseases is possible in the Inpatient Unit, Outpatient clinic, field clinics, and Emergency Room settings. Also, possible exposure to bodily fluids may occur in the course of caring for patients.

Pine Ridge, South Dakota is a geographic area with a wide temperature span. The winters can be very cold and windy. Summer conditions can be very warm. Contract providers should expect to drive in these weather conditions.

The sole authority to close the hospital or clinics rests with the CEO. This decision is based on National and regional weather reports. If the hospital remains open the contract provider shall be expected to report to work on time as all other hospital employees will be required.

Housing may be available on the Pine Ridge Hospital housing compounds based on current vacancies. The decision to house the contract provider in the Staff Quarters is the decision of the CEO and the Quarters Committee. Area hotels are available ranging from 35 minutes to 1-1/2 hours away by motor vehicle.

Hotels

Prairie Winds Casino, 35 miles west of Pine Ridge, 605-867-6300

Jefco Inn - Gordon, NE 308-282-2935

Nebraska Land - Rushville, NE 308-327-2487

Antlers Motel - Rushville, NE 308-327-2444

Lakota Prairie Ranch Resort – Kyle, SD 605-455-2555

Crossroads Inn Highway 18 & 73, Martin, SD 57551 605-685-1070

Famco Inc PO Box 251, Martin, SD 57551 605-685-6156

Hacienda 605 W US Highway 20, Gordon, NE 308-282-0075

Western Sands Motel I 07 W US Highway 20, Gordon, NE 308-282-1795

Nebraskala nd 508 E 2nd St, Rushville, NE 308-327-2487

Best Western 1100 W 10th St, Chadron, NE 69337 308-432-3305

Super 8 5840 W Highway 20, Chadron, NE 308-432-4471

Motel 6 755 Microtel Dr, Chadron, NE 308-432-3000

Westerner Motel 300 Oak St, Chadron, NE 308-432-5577

Bunk House Motel 901 E 3rd St, Chadron, NE 308-432-5591

Economy 9 Motel 1201 W Highway 20, Chadron, NE 308-432-3119

Olde Main Street In n 115 Main St, Chadron, NE 308-432-3380

Driving Distances

Gordon Ne 34 miles

Chadron Ne 54 miles

Rushville Ne 24 miles

Martin SD 45miles

Kyle SD 50 miles