Sources Sought PWS.pdf

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Performance Work Statement for Onsite Anesthesiology Physician Services

1. GENERAL:

1.1. Services Provided: The Contractor shall provide Board Certif ied Anesthesiology Physician Services on site in accordance with the specifications contained herein to benef iciaries of the Department of Veterans Af fairs (VA) and Minneapolis VA Health Care System.

1.1.1. Scope of Services: The contractor will provide one (1) Board-Certified Anesthesiologist for up to 2,080 on-site hours plus call coverage. Anesthesiologist shall provide direct patient care for the full range of anesthesiology services for operative procedures including: pre-procedure assessment with review of patient’s electronic medical record and focused physical exam; administration of anesthetic agents; insertion of invasive hemodynamic monitoring catheters with ultrasound guidance; management of dif f icult airways using alternative intubating devices and advanced techniques in both emergent and non-emergent situations; administration of multi-modal pre-emptive analgesics; placement of nerve blocks, including interscalene blocks for post-operative pain control; intra-procedure monitoring and management; and post-procedure follow-up as appropriate for both inpatients and outpatients. Anesthesiologists may personally administer anesthesia or may medically direct CRNAs or anesthesiology residents in the administration of anesthesia.

1.1.2. Period of Performance: Services are required for a Base Year and four (4) Option Years.

1.2. Place of Performance: Contractor shall furnish services at the Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417.

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

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

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

8153: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.2. VHA Directive 1003.04: VHA Patient Advocacy:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970

1.4.3. VHA Directive 1065: Productivity and Staf f ing Guidance for Specialty Provider Group Practice: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9130

1.4.4. VHA Directive 1088(1): Communicating Test Results to Providers and Patients:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

1.4.5. VHA Directive 1100.18: Reporting And Responding To State Licensing Boards:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9174

1.4.6. VHA Directive 1100.20 Credentialing of Health Care Providers:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9444

1.4.7. VHA Directive 1192.01: Seasonal Influenza Vaccination Program For VHA Health Care Personnel: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8948

1.4.8. VHA Directive 1220(1): Facility Procedure Complexity Designation Requirements To Perform Invasive Procedures In Any Clinical Setting:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8365

1.4.9. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8579

1.4.10. VHA Directive 1605.01: Privacy and Release of Information:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3233 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.va.gov%2Fvhapublications%2FViewPublication.asp%3Fpub_ID%3D9130&data=05%7C01%7C%7C8e30ab1c2724408fd8b908dabb69217a%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638028357445005912%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=nEyQZjaCRe9uO76Ysdmzbt%2B6eTSAaGHWlsT22NfQWJk%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.va.gov%2Fvhapublications%2FViewPublication.asp%3Fpub_ID%3D3148&data=05%7C01%7C%7C8e30ab1c2724408fd8b908dabb69217a%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638028357445005912%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=p2ndNOlW3Du6hynpHL%2BRvSKkW7ENCKS%2FUGtpw%2FEU44c%3D&reserved=0 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9174 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.va.gov%2Fvhapublications%2FViewPublication.asp%3Fpub_ID%3D9444&data=05%7C01%7C%7C8e30ab1c2724408fd8b908dabb69217a%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638028357445005912%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=ECQ42ixehYGe8phmwd3vjf%2BogtK%2Bp6dSlvpjzn7CI48%3D&reserved=0 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8948 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8365 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8579 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.va.gov%2Fvhapublications%2FViewPublication.asp%3Fpub_ID%3D3233&data=05%7C01%7C%7C8e30ab1c2724408fd8b908dabb69217a%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638028357445162578%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=OSgtlRX4Np9LQE16y8y3W8udw0ZEIgPykhxCoprX530%3D&reserved=0

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1.4.11. VHA Directive 1907.01: VHA Health Information Management and Health Records:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9235

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

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.13. VHA Handbook 1100.19: Credentialing and Privileging:

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

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

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

1.5.2. ACGME: Accreditation Council for Graduate Medical Education

1.5.3. ACLS: Advanced Cardiac Life Support

1.5.4. ASA: American Society of Anesthesiologists

1.5.5. BLS: Basic Life Support

1.5.6. CDC: Centers for Disease Control and Prevention

1.5.7. CEU: Certif ied Education Unit

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

1.5.9. CME: Continuing Medical Education

1.5.10. CO: Contracting Officer: The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and f indings.

1.5.11. COR: Contracting Of f icer’s Representative: A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government.

The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.12. COS: Chief of Staf f

1.5.13. COVID-19: Coronavirus Disease 2019

1.5.14. CPARS: Contractor Performance Assessment Reporting System

1.5.15. Credentialing: Credentialing is the process of obtaining, verifying, and assessing the qualif ications of a health care provider to provide care of services in or for the VA health care system. Credentials are documented evidence of licensure, education, training, experience or other qualif ications .

1.5.16. CR: Contract Report

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9235 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm http://www.theaba.org/

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1.5.17. DEA: Drug Enforcement Agency

1.5.18. EHR: Electronic Health Record - electronic health record system used by the VA

1.5.19. FTE: Full Time Equivalent. 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.

1.5.20. HHS: Department of Health and Human Services

1.5.21. HIPAA: Health Insurance Portability and Accountability Act

1.5.22. Key Personnel: The individuals specif ied in this contract who are essential to work performance.

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

1.5.24. NPPES: National Plan and Provider Enumeration System

1.5.25. POP: Period of Performance

1.5.26. PPD: Purif ied Protein Derivative

1.5.27. PWS: Performance Work Statement

1.5.28. QA/QI: Quality Assurance/Quality Improvement

1.5.29. QASP: Quality Assurance Surveillance Plan

1.5.30. QM/PI: Quality Management/Performance Improvement

1.5.31. VetPro: is VHA’s mandatory credentialing sof tware platform to document the credentialing of VHA health care providers. This system facilitates completion of a uniform, accurate, and complete credentials f ile.

1.5.32. VHA: Veterans Health Administration

1.5.33. VISN: Veterans Integrated Services Network

1.5.34. VistA: Veterans Information Systems Technology Architecture

2. QUALIFICATIONS:

2.1. Staf f /Facility

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

All licenses held by the key personnel working on this contract shall be full and unrestricted licenses. Key Personnel 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 Certif ication: Key Personnel shall be Board Certif ied Anesthesiologists by the American Board of Anesthesiology (ABA), and be currently certified in Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) or equivalency. All continuing education courses required for maintaining certif ication must be kept up to date at all times.

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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. Experience – Anesthesiologist must have a minimum of two years recent experience providing anesthesiology services in a hospital operating room setting and must have recent cardiothoracic experience.

2.1.4. Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 and VHA Directive 1100.20 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 Key Personnel prior to obtaining approval by the Facility Professional Standards Board, Medical Executive Board and Medical Center Director.

2.1.4.1. If a Key Personnel 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.

2.1.5. Technical Proficiency: Key Personnel 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 verif iable evidence of all educational and training experiences including any gaps in educational history for all Key Personnel and Key Personnel shall be responsible for abiding by the Facility's Medical Staf f By-Laws, rules, and regulations (referenced herein) that govern medical staf f behavior.

2.1.6. Continuing Medical Education (CME)/ Certif ied Education Unit (CEU) Requirements:

Contractor shall provide the COR copies of current CMEs as required or requested by the VA facility. Key Personnel registered or certif ied by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for Key Personnel.

2.1.7. Training (ACLS, BLS, EHR and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements def ined herein; all training must be completed by the Key Personnel as required by the VA. Other training may become required. VA will communicate any changes to the training requirement to the contractor.

Training Frequency Annual Hours ACLS/BLS Every 24 months 4 hours

CPRS Once 4 hours

Mandatory Training for Transitory, Part-time and Intermittent Clinical Staff (20152) Once a Year 1 hour

VA Privacy and Information Security Awareness and Rules of Behavior (10176) Once a Year 1 hour

Additional training may be required per VHA or Medical Center directives Unknown Unknown

2.1.8. 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 f irst duty shif t to the COR and Contracting Of f icer. Tests shall be current within the past year.

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

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

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

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

2.1.8.5. 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 Inf luenza season. {This is applicable to all health care workers}.

2.1.8.6. 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.

2.1.8.7. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

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

2.1.8.8. The facility shall notify the Contractor of any signif icant 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.

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

2.1.10. Conf lict of Interest: The Contractor and all Key Personnel are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services.

The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

Revision 03/09/2023 Page 6 of 30 provision 852.209-70 Organizational Conflicts of Interest and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.11. Citizenship related Requirements:

2.1.11.1. The Contractor certif ies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Af fairs 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 Af fairs 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 Af fairs; and shall form the basis for termination of this contract for breach.

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

2.1.11.5. The Contractor agrees to obtain a similar certif ication f rom its subcontractors. The certif ication shall be made as part of the of ferors response to the RFP using the subject attachment in Section D of the solicitation document.

2.1.12. Annual Of fice 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) Of f ice 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 https://oig.hhs.gov/exclusions/index.asp to ensure that the proposed Key Personnel 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 benef iciaries.

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

https://oig.hhs.gov/exclusions/index.asp

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2.2. Clinical/Professional Performance: The qualif ications of Contractor personnel are subject to review by VA Medical Facility COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19 and VHA Directive 1100.20.

Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the facility COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modif ication 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 Key Personnel shall not be considered VA employees for any purpose.

2.4. Indemnif ication: 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 f rom 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 f rom referring VA patients to contractor’s or their own practice(s)

2.6. Inherent Government Functions: Contractor and Key Personnel 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 Key Personnel furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staf f 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 Key Personnel. When a Contractor or Key Personnel have 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 f rom a Contractor’s (or Key Personnel) 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 (1.0) FTE or 2,080 hours. Call coverage will be 166 hours/month per FTE.

2.9.2. The minimum number of Board Certified Anesthesiologists. Anesthesiology physicians required to be on site on a daily basis is one (1) to be on site at the same time as defined in paragraph Hours of Operation in this section.

2.9.3. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations and additional coverage as required. In the event key personnel is out for an extended period, the contractor shall provide a replacement.

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2.9.4. Personnel Substitutions: During the f irst 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 fifteen (15) calendar day (s) after the occurrence of any of these events and provide the information required below. Af ter 90 days, the Contractor shall submit the information required below to the CO at least fifteen (15) 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 fifteen (15) calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modif ied to ref lect 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 (3) consecutive workdays or more, the Contractor shall provide a qualif ied 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 af ter 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, thef t, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staf f 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 Key Personnel, s/he may request, without cause, immediate replacement of said Key Personnel .The CO and COR shall deal with issues raised concerning Key Personnel conduct. The f inal arbiter on questions of acceptability is the CO.

2.9.4.4. Contingency Plan: Because continuity of care is an essential part of the Facility’s medical services, the Contractor shall have a contingency plan in place to be utilized if the Key Personnel 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 Minneapolis VA Medical Center is open 24 hours per day 7 days a week, 365 days per year. The services covered by this contract shall be furnished by the contractor as def ined in the work schedule below. The contractor shall also be required to furnish on-call coverage and provide emergency services on Federal Holidays, evenings and weekends.

Work Schedule: Anesthesiologist shall provide services to Minneapolis VAHCS an estimated 80 hours every two weeks with the exception of weeks with Federal Holidays. The schedule and tour of duty is defined by the Clinical Service Chief and may vary based on the nature of the workload, needs of the service, and patient care requirements. Work schedules will be provided by the Anesthesia Surgery Program Support Assistant a minimum of thirty (30) calendar days f rom beginning of the next month.

3.1.1. Patients must be seen by a Key Personnel on-site at the facility in a timely manner in accordance with VA Rules and Regulations. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

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3.1.2. Contractor’s physician(s) shall be available and physically present in the Minneapolis VAHCS during assigned tour of duty hours. Tour of duty is established, and may be revised, as deemed appropriate for patient care by the Chief of Staf f .

3.1.3. Tour of Duty: The normal Anesthesia Department tour of duty for weekdays, Monday through Friday, with the exception of Federal Holidays, is as follows:

• Start time is 6:30 a.m. – End time is 3:00 p.m.: or

• Start time is 6:30 a.m. – End time is 5:00 p.m.

Note: All daily tours will include a 30-minute non-paid lunch break.

3.1.4. Call Coverage Tour: On-call hours are estimated not to exceed 166 hours per month.

Current on-call hours are:

• Weekday Call: Monday – Thursday coverage is 7:00 a.m. – 7:00 a.m. next day

• Weekend Call: starts Friday at 7:00 a.m. and goes to 7:00 a.m. on Monday

• Holiday Call: coverage is f rom 7:00 a.m. – 7:00 a.m. next day

3.1.5. Late Shif t tour with Day Off: On days when Anesthesiologist is scheduled to be on-call, the provider will work an extended day/evening shift. The extended shift will be f rom 7:00 a.m.

until the end of the day’s surgical cases, usually between 8:00 p.m. to 10:00 p.m. Call coverage begins when the Anesthesiologist leaves the hospital to go home after the end of the extended shift and lasts until 7:00 a.m. the following morning. The day following the working of an extended “late shif t tour” will be considered a workday.

3.1.6. All daily work schedule tours will not end until all patient care has been completed.

3.1.7. The contract physician may not work at another facility during normal VA tour of duty.

3.1.8. Of f -hours Coverage: Contractor must make the contract physician available on-call during all hours when the Minneapolis VAHCS clinics and operating room are generally closed, including evenings, weekends and holidays. The anesthesiology call-coverage rotates with seven (7) to nine (9) anesthesiologists. Current rotation is one (1) out of every seven (7) days and every seventh weekend.

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

3.1.8.2. On-call providers must be available within 15 minutes by phone and on-site, within 60 minutes.

3.1.8.3. When Anesthesiologist is on-call, the anesthesiologist will have the next weekday of f .

3.1.8.4. Concurrent call is not acceptable.

3.1.8.5. Contract physician will not be paid a fee for carrying a pager. If call results in on-site services, physician will be paid at the contract hourly rate.

3.2. Federal Holidays: The following holidays are observed by the Department of Veterans Af fairs:

• New Year’s Day

• President’s Day

• Martin Luther King’s Birthday

• Memorial Day

• Juneteenth

• Independence Day

• Labor Day

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• Columbus Day

• Veterans Day

• Thanksgiving

• Christmas

• Any day specif ically declared to be a national holiday.

3.3. Cancellations: Unless a state of emergency has been declared, the contractor shall be responsible for providing services unless contractor’s provider is excused per the procedure list above.

4. CONTRACTOR RESPONSIBILITIES

4.1. Clinical Personnel Required: The Contractor shall provide Key Personnel who are competent, qualif ied per this performance work statement and adequately trained to perform assigned duties. Key personnel must have a Cardiovascular background and completed a Cardiovascular Fellowship.

4.1.1. Key Personnel shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to conf irm hours/day and services provided against the contractor’s invoices.

4.2. Standards of Care: The Key Personnel’ care shall cover the range of Anesthesiology services as would be provided in a state-of-the-art health care facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.2.1. American Society of Anesthesiology (ASA) Guidelines:

https://www.asahq.org/standards-and-guidelines

4.2.2. The professional standards of the Joint Commission (TJC):

http://www.jointcommission.org/standards_information/standards.aspx

4.2.3. The standards of the American Hospital Association (AHA):

http://www.hpoe.org/resources?show=100&type=8 and;

4.2.4. The requirements contained in this PWS

4.3. Resident Supervision and Teaching: Reserved

4.4. MEDICAL RECORDS

4.4.1. Authorities: Key Personnel providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the 5 U.S.C.552a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Conf identiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Conf identiality 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 of VA patients. Based on this exception, a BAA is not required for this contract. Health records generated by this contract or provided to the Contractors by the VA are covered by the VA Privacy Act system of records entitled ‘Patient Medical Records-VA’ (24VA10A7). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services provided to VA patients are captured in the VA electronic health record system as required by VA policy as discussed in 4.4.4.

https://www.asahq.org/standards-and-guidelines http://www.jointcommission.org/standards_information/standards.aspx http://www.hpoe.org/resources?show=100&type=8

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

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

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

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

4.5. Direct Patient Care: estimated 98% of the time involved in direct patient care. Per the qualif ication section of this PWS, the contractor shall provide 1.0 FTE Board Certif ied Anesthesiologist.

4.5.1. Scope of Care: Key Personnel (as appropriate and within scope of practice/privileging) shall be responsible for providing Anesthesiology care. Contract Anesthesiologist shall be responsible for providing anesthesiology care at the MVAHCS in operating rooms and procedure rooms. On average, the MVAHCS has thirteen (13) operating rooms and two -three out of OR procedure rooms (GI, Cardiac Cath Lab and Interventional Radiology), that are staffed daily for surgical and procedure cases. The average annual case load consists of approximately 6085 cases performed in operating room surgical suites and approximately 700 procedures requiring anesthesia support in procedure room in the Medical Center.

All small cases, lumps, bumps, biopsies, etc. are conducted in clinics. All cases conducted in anesthetizing locations required anesthesia attendance. The Medical Center conducts numerous cardiac cases, large vascular cases (aneurysms) and extensive cancer surgeries with over 66% of cases classif ied as major surgery. The predominate age of surgical patients is 65 – 75 years and the average America Society for Anesthesiologist (ASA) physical classif ication status is 3 – 5.

4.5.1.1. Clinic and Surgical Care: Key Personnel shall provide clinical Anesthesiology services. Key Personnel 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.

4.5.1.1.1. Operative Services: Key Personnel shall provide comprehensive clinical anesthesiology services including patients undergoing cardiac surgery, orthopedic joint replacement, and major vascular, thoracic, neurosurgical, plastic, ENT, urologic and ophthalmologic operations.

4.5.1.1.2. Key Personnel shall provide clinical care of patients undergoing electroconvulsive therapy and diagnostic and therapeutic procedures in the

Revision 03/09/2023 Page 12 of 30 cardiac catheterization laboratory, electrophysiology, gastrointestinal and radiological suites.

4.5.1.1.3. Key Personnel shall provide primary coverage for all patients in the surgical intensive care, short stay unit, acute and chronic pain management services, diagnostic trans esophageal echocardiography for medical and surgical patients, and emergency airway management.

4.5.1.1.4. Key Personnel 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.

4.5.1.2. Medications: Key Personnel shall follow all established medication policies and procedures. No sample medications shall be provided to patients.

4.5.1.3. Discharge education: Key Personnel shall provide discharge education and follow up instructions that are coordinated with the next care setting for all Anesthesiology clinical or surgical patients.

4.5.1.4. Communication of Test Results: Mechanisms must be in-place to provide notif ication of test results for patients receiving care in accordance with VHA Directive 1088, Communicating Test Results to Providers and Patients.

4.5.2. ADMINISTRATIVE: estimated 2% of time not involved in direct patient care.

Contract Anesthesiologist shall participate in appropriate conferences and meetings related to anesthesiology and patient care as requested and deemed appropriate by the MVAHCS Chief of Staff, Surgery Specialty Care Service Line Director or the Anesthesiology Chief of Service or Designee. Contract physician may participate in in the Focus Peer Review Program and shall assist in maintaining QA procedures for anesthesia services and ensure compliance with service performance monitors. Administrative duties include:

4.5.2.1. Quality Improvement Meetings: The Key Personnel shall participate in continuous quality improvement activities and meetings with committee participation as required by the VA facility Chief of Service, Chief of Staf f , or designee.

Meeting Frequency Annual Hours

Department Quality Ad Hoc

10 – 12

4.5.2.2. Staf f Meetings: The Key Personnel shall attend staff meetings as required by the VA facility Chief of Service, Chief of Staff, or designee. Contractor to communicate with COR on this requirement and report any conflicts that may interfere with compliance with this requirement.

Meeting Frequency Annual Hours

Staf f Meetings Weekly, every Wednesday @ 7:15am – 8:15am

Estimated @ 42

4.5.2.3. QA/QI documentation: The Key Personnel shall complete the appropriate QM/PI documentation pertaining to all procedures, complications and outcome of examinations.

4.5.2.4. Patient Safety Compliance and Reporting: Key Personnel shall follow all established patient safety and infection control standards of care. Key Personnel shall make every ef fort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be documented in the medical record of those impacted and disclosed to the patient or surrogate. As soon as practicable (but within 24 hours) Contractors shall notify COR of incident and

Revision 03/09/2023 Page 13 of 30 submit an entry in the VA Patient Safety Reporting System, following up with COR as required or requested.

4.6. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY

IMPROVEMENT(QI)

4.6.1. Quality Management/Quality Assurance Surveillance: Key Personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, and Peer Reviews. Methods of Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE). Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall def ine the methods and f requency of surveillance conducted.

4.6.2. Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is f inal authority on validating complaints.

In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.6.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time af ter performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The f inal arbiter on questions of acceptability is the CO.

4.6.4. Performance Standards: The contract provider shall comply with the required standards as outlined in the Performance Work Statement (PWS) and the Quality Assurance Surveillance Plan (QASP). The QASP outlines required standards, defines the methods and frequency of surveillance, and will be a part of the resultant contract.

4.6.4.1. Measure: Provider Quality Performance

Performance Requirement: All Key Personnel shall perform in accordance with clinical standards of care.

Standard: OPPE documentation for all (100%) staf f providing services under the contract. All staf f (100%) meet clinical standards of care.

Acceptable Quality Level: 100% meet Standards Surveillance Method: Periodic Inspection or Random Sampling. OPPE data pertinent to care performed for each provider working under this contract. OPPE data will review the following elements:

A. Patient Care Performance B. Medical/Clinical knowledge C. Updated Licensing, registration and certif ication D. Practiced Based Learning and Improvement E. Interpersonal and Communication Skills F. Professionalism G. System Based Practice

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Frequency: OPPE monitoring reports are every eight (8) months.

4.6.4.2. Measure: Qualif ications of Key Personnel

Performance Requirement: All Key Personnel shall be Board Certif ied Anesthesiologists in accordance with American Board of Anesthesiology Standards.

Standard: All (100%) Key Personnel are Board Certif ied Anesthesiologists Acceptable Quality Level: 100% Surveillance Method: Annual review of qualif ication documents Frequency: Reviewed annually

4.6.4.3. Measure: Time and Attendance

Performance Requirement: The Contractor shall provide Key Personnel in accordance with the operating hours and VA clinical schedule outlined in this PWS.

Standard: All (100%) Key Personnel are on time and available to perform services.

Acceptable Quality Level: Key Personnel is on-time and available to perform services 98% of the time Surveillance Method: Inspection of Time and Attendance Sheets Frequency: Monthly

4.6.4.4. Measure: Patient Safety

Performance Requirement: Patient safety incidents shall be reported using VA Patient Safety Reporting System. All incidents reported immediately (within 24 hours).

Standard: All (100%) of patient safety incidents are reported using VA Patient Safety Reporting System within 24 hours of incident.

Acceptable Quality Level: 100% of patient safety incidents are reported using VA Patient Safety Reporting System within 24 hours of incident.

Surveillance Method: Periodic inspections or random sampling Frequency: Reviewed every three (3) months

4.6.4.5. Measure: Mandatory Training

Performance Requirement: Contractor shall complete all required training on time per facility policy Standard: All (100%) of required training is complete on time by Key Personnel.

Acceptable Quality Level: 90% completions Surveillance Method: Periodic Inspection Frequency: Reviewed every three (3) months

4.6.4.6. Measure: Privacy, Conf identiality and HIPAA

Performance Requirement: Contractor is aware of all laws, regulations, policies and procedures relating to Privacy, Conf identiality and HIPAA and complies with all standards Zero breaches of privacy or conf identiality Standard: All (100%) Key Personnel comply with all laws, regulations, policies and procedures relating to Privacy, Conf identiality and HIPAA Acceptable Quality Level: 100% compliance Surveillance Method: Random Sampling. Contractor shall provide evidence of annual training required by facility, reports violations per VA Handbook 6500.6.

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Frequency: Reviewed annually

4.6.4.7. Measure: Clinical Information Documentation

Performance Requirement: Contract physician shall comply with all clinical documentation regulations, policies and procedures for complete and timely clinical documentation.

Standard: Contractor’s physician shall comply with all laws, regulations, policies and procedures relating to patient clinical information documentation.

Acceptable Quality Level: 95% compliance Surveillance Method: Random Sampling…