SOW.pdf

Statement of Work (SOW)

IDIQ

Emergency Medicine Physician Services

1. GENERAL:

1.1. Services Provided: This is a Fixed Price Award Fee, indefinite delivery/indefinite quantity (ID/IQ), non-personal service type contract. Task Orders shall be issued as needs arise in accordance with Statement of Work (SOW). The Indian Health Service reserves the discretionary authority to exercise any one of the 4 option years. This is an all-inclusive monthly price. The Contractor shall provide Emergency Medicine (EM) physicians for direct patient care EM services for the Indian Health Service (IHS) at the Fort Yates Hospital (FYH), Fort Yates, ND. The Emergency Department is comprised of an isolation room, a trauma room and 2 bays. FYH is a Level IV Trauma center,12-bed critical access hospital, located in rural ND. These physicians will provide EM Physician Services on site in accordance with the specifications contained herein to beneficiaries of the IHS. A contractor providing onsite EM physician services shall follow the American Board of Emergency Medicine Physician Guidelines http://www.abem.org.

Contractor employees shall not be considered government employees for any purpose under this contract.

1.2. Place of Performance - Contractor shall furnish services at the FYH:

1.2.1. 10 Standing Rock Ave, Fort Yates, ND 58538.

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

1.3.1. – IHS Manual – “Health Care Service Standards”

1.3.2. - National Practitioner Data Bank Reports

1.3.3. - Credentialing and Privileging

1.3.4. - Health Information Management and Health Records

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

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

1.4.1. ABEM: American Board Emergency Medicine (http://www.abem.org)

1.4.2. ACLS: Advanced Cardiac Life Support

1.4.3. ALSO: Advanced Life Support in Obstetrics

1.4.4. ATLS: Advanced Trauma Life Support

http://www.abem.org/ http://www.abem.org/

1.4.5. BLS: Basic Life Support

1.4.6. CCNE: Commission on Collegiate Nursing Education:

www.aacn.nche.edu/accreditation

1.4.7. CDC: Centers for Disease Control and Prevention

1.4.8. CDR: Contract Discrepancy Report

1.4.9. CEU: Certified Education Unit

1.4.10. CME: Continuing Medical Education

1.4.11. CMS: Centers for Medicare and Medicaid Services

1.4.12. Contracting Officer (CO) – The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.4.12.1. Contract Specialist (CS) – The person who is administering the contract on behalf of the Contracting Officer.

1.4.13. Contracting Officer’s Representative (COR) – A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.4.14. COS: Chief of Staff

1.4.15. CPARS: Contractor Performance Assessment Reporting System

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

1.4.17. DEA: Drug Enforcement Agency

1.4.18. FSMB: Federation of State Medical Boards

1.4.19. HHS: Department of Health and Human Services

1.4.20. HIPAA: Health Insurance Portability and Accountability Act

1.4.21. HR: Human Resources

1.4.22. ISO: Information Security Officer

1.4.23. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs http://www.aacn.nche.edu/accreditation in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.4.24. NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org

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

1.4.26. NP: Nurse Practitioner

1.4.27. NPPES: National Plan and Provider Enumeration System

1.4.28. NRP: Neonatal Resuscitation Program

1.4.29. PA: Physician Assistant

1.4.30. PALS: Pediatric Advanced Life Support

1.4.31. POP: Period of Performance

1.4.32. PPD: Purified Protein Derivative

1.4.33. Privileging (Clinical Privileging): 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-specific and provider-specific.

1.4.34. QASP: Quality Assurance Surveillance Plan

1.4.35. SOW: Statement of Work

1.4.36. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License/Certification/Registration - Contract physician(s) assigned by the

Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia. SPECIAL NOTE: For procurements that require a Drug Enforcement Agency (DEA) registration, contract providers must have a medical license and be individually registered with the DEA (schedule types I-V). All licenses held by the personnel working on this contract shall be full http://www.nlnac.org/ and unrestricted licenses. Contract physician(s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2. Board Certification - All contract physician(s) shall be Board Certified/Board Eligible Emergency Medicine physicians. Other specialties will be considered, such as Internal Medicine (IM) and Family Practice (FP) physicians, if Board Certified/Eligible in their given specialty (must have completed a recognized advanced training program (residency/fellowship) in their specialty where applicable) on a case by case basis. If not trained in Emergency Medicine, significant experience, as determined by the FYH ,Clinical Director, ED Manager or designee, working in Emergency Departments is required. All physicians must be currently certified in, ACLS, ATLS, PALS and BLS. Pending provider experience, Clinical Director or ED Manager may require candidates to have additional certificates including but not limited to ALSO, NRP. All continuing education courses required for maintaining certification must be kept up to date at all times. Documentation verifying current certification shall be provided by the Contractor to the IHS Credentialing Coordinator on an annual basis for each year of contract performance.

2.1.3. Credentialing and Privileging –Credentialing and privileging is to be done in accordance with the provisions of IHS Credentialing and Privileging standards.

The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. All required credential documentation shall be provided to the FYH credentialing office a minimum of fourteen-14 days before an MD/DO can start treating patients. IF any required credentialing documents have not been provided to the Fort Yates Hospital credentialing office the terms of this contract will not have been satisfied. No services shall be provided by any contract physician(s) prior to obtaining approval by the Great Plains Area Credentialing and Privileging Committee and the FYH Medical Executive Committee.

2.1.3.1. If a contract physician(s) is unable to be credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.4. Technical Proficiency - Contract physician(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed. Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contract physician(s) and contract physician(s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations that govern medical staff behavior.

2.1.5. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide copies of current CMEs as required or requested by the IHS. Contract physician(s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for contract physician(s).

2.1.6. Training: Contractor shall meet all IHS trainings, educational requirements and mandatory course requirements defined herein; all training must be completed by the contract physician(s) as required by the IHS. ATLS, PALS, ACLS, BLS, Opioid, EHR, IHS Privacy and Information Security Awareness and Rules of Behavior, IHS Privacy and HIPPA, EMTALA and Prevention of Workplace Harassment/No Fear. And others as assigned or deemed appropriate. All trainings must be completed prior to the employees first scheduled shift.

Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for physicians within five (5) calendar days after contract award and prior to the first duty shift. Tests shall be current within the past year.

2.1.6.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to PPD testing for all contract physician(s). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually.

2.1.6.2. RUBELLA TESTING: Contractor shall provide proof of immunization for all contract physician(s) for measles, mumps, rubella or a rubella titer of 1.8 or greater.

2.1.6.3. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all contract physician(s); provide their own Hepatitis B vaccination series at no cost to the IHS if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. The IHS shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control.

Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

2.1.7. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The IHS must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.8. All Medicare B and other insurance provider enrollment documentation submitted to the contracted provider by FYH credential and business office personnel SHALL BE completed by the EM Physician to the satisfaction of the FYH billing department. Initial contract Physician’s hospital orientation list is required to be signed off by the business office for insurance enrollment confirmation. NO

INITIAL TIME SHEETS OR INVOICES WILL BE APPROVED AND PROCESSED

UNTIL THE RESPECTIVE PROVIDER HAS COMPLETED ALL INSURANCE

FORM DOCUMENTATION. The deciding authority for provider enrollment insurance documents will be the supervisor, or acting, of the business department.

2.1.9. DEA License) - Contractor shall have a valid DEA license and provide copy of current licensure to Credentialing Specialist (Schedule 1-V).

2.1.10. Conflict of Interest: The Contractor and all contract physician(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest.

2.1.11. Citizenship related Requirements:

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

2.1.11.2. While performing services for the IHS, 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 IHS may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.11.4. This certification concerns a matter within the jurisdiction of an agency of the

United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.11.5. The Contractor agrees to obtain a similar certification from its subcontractors.

The certification shall be made as part of the offerors response to the RFP.

2.1.12. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.12.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contract physician(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

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

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

2.2. Clinical/Professional Direction: The qualifications of Contractor personnel are subject to review by FYH Emergency Department Manager, Clinical Director, COS or his/her clinical designee and approval by the Great Plains Area Office. Clinical/Professional direction of all clinical personnel covered by this contract will be provided by the FYH Emergency Department Manager, Clinical Director, COS and/or her designee. Only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non-Personal Healthcare Services: The parties agree that the Contractor and all contract physician(s) shall not be considered IHS employees for any purpose.

2.4. Inherent Government Functions: Contractor and Contract physician(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.5. No Employee status: The Contractor shall be responsible for protecting Contract physician(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.5.1. Workers’ compensation

2.5.2. Professional liability insurance

2.5.3. Health examinations

2.5.4. Income tax withholding, and

2.5.5. Social security payments.

2.6. Contractor Travel: The contractor shall be responsible for arranging travel and all associated costs related to the performance of this contract.

2.7. Other Direct Costs: The contractor shall be responsible for arranging travel, lodging, per diem, labor, fringe benefits, and any applicable Federal, State, and Local taxes, plus and other costs pertinent to the performance of this contract.

2.8. Housing: Local Government furnished housing is not guaranteed and cannot be assumed available.

2.9. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract physician(s). When a Contractor or contract physician(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a

Contractor’s (or contract physician(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.10. Security Clearance: The contract EM Physicians shall be fingerprinted prior to arrival to FYH in order to be cleared as a background check and cannot see patients until their fingerprints clear.

2.11. Key Personnel:

2.11.1. The IHS Full Time Equivalency (FTE) for the services required is 4.5 FTE for a total of 9,360 hours for 1 year. FTE is defined by IHS as a minimum of 80 hours every two weeks and does not include holidays. It is estimated that the contractor will need 3x the amount of credentialed providers than FTE’s to achieve proper full-time staffing.

2.11.2. The number of Board Certified/Board Eligible Physicians that are required to be on-site on a 24/7 basis is 1.0 FTE minimum, for the FYH.

2.11.3. It is essential that continuity of services is maintained to the maximum degree possible, hence, substitution of contractor provided Physicians shall be limited to urgent/emergent absences of approved, assigned providers. The Contractor shall be responsible for providing coverage to the IHS during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations and additional coverage as required. In the event that a scheduled physician is unable to come in for or complete an assigned shift, the contractor shall provide a replacement physician coverage within 2 hours and notify the clinical director and Contracting Office Representative (COR) at the IHS immediately of schedule change.

2.12. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar days after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitutions.

2.12.1. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives.

Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the IHS FYH Emergency Department Manager Clinical Director, COS or designee show documented clinical problems or continual unprofessional behavior/actions with any contract physician(s), s/he may request, without cause, immediate replacement of said contract physician(s).

2.12.2. The CO and COR shall deal with issues raised concerning Contract physician(s) conduct. The final arbiter on questions of acceptability is the CO.

2.13. Contingency Plan: Because continuity of care is an essential part of IHS FYH’s medical services, the Contractor shall have a contingency plan in place to be utilized if the contract physician(s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

Service is for 24/7 coverage and any drop in coverage of providers is deemed not acceptable. The provider will maintain credentialed provider in the local (90 miles) area to provide coverage in short notice situations.

3. HOURS OF OPERATION

3.1. IHS Business Hours: Emergency Department Services are provided 24/7, 52 weeks per year.

3.2. Work Schedule: Coverage for the FYH shall be, up to, for 24/7, 52 weeks per year.

3.2.1. Patients must be seen by a contract physician(s) on-site at FYH in a timely manner in accordance with IHS Rules and Regulations. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

3.2.1.1. Time will vary based on ESI triage determinations.

3.2.2. The contracting company shall provide one-(1) Emergency Medicine Physician(s) functioning as an ED Provider at all hours of operations 24/7/365. Overall scheduling model can be flexible, but will need to be predetermined and approved by clinical director, or ED manager or Chief of Staff. Preference is an alternating rotational schedule seven-(7) day to ten-(10) day work week schedule. ED Physician shall work a twelve-(12) hour daily shift physically based in the ED.

Shifts shall not extend greater than 10 consecutive days for the safety of the provider and their patients. Schedules shall include adequate time for shift change between providers on patients. Contractor will schedule and publish schedule with 1 month in advanced.

3.2.3. Base Year 14 months – 4-1-25 to 5-31-26

3.2.3.1. Transition Period 2 months (4-1-25 to 5-31-25)

3.2.3.1.1. The transition period will allow contract to onboard, credential, and orient staff prior to a full transition from previous vendor. Prior to 5-31-25 contract must provide 8 credentialed and onboarded physicians who have rotated onsite for orientation to include hands-on training with EHR system. It is required that a soft-hand off/trial vendor switch period will happen at minimum 2 days prior to the official transition date with the current vendor onsite as backup only.

3.2.3.2. Emergency Medicine Physician Services12 months: (6-1-25 to 5-31-26) The service component, is minimum of 8760 hours for continuous ED coverage. It is anticipated that providers may/will need additional time for chart completion and provider debriefing during shift changes. The Contractor shall at minimum staff 1 physician on site for the entirely of the contraction duration.

The government shall request through task orders the months required with minimum 2 month order at a time. It is anticipated the government will request task orders for services 2-3 months on a task order on a rolling basis for the Services period

3.2.3.3. IDIQ Minimum 2 month transition and 2 month Service

3.2.3.4. Exercising Option Periods- Due to the historical recruiting difficulties and unpredictable staffing patterns, the expected Notice of Intent to Exercise Option Periods is thirty (30) days prior to the start of the next option period.

3.2.4. Option Year 1 12 months (6-1-26 to 5-31-27) – The service component, is minimum of 8760 hours for continuous ED coverage. It is anticipated that providers may/will need additional time for chart completion and provider debriefing during shift changes. The Contractor shall at minimum staff 1 physician on site for the entirely of the contraction duration. The government shall request through task orders the months required with minimum 2 month order at a time. It is anticipated the government will request task orders for services 2-3 months on a task order on a rolling basis for the Services period

3.2.5. Option Year 2 12 months (6-1-27 to 5-31-28) The service component, is minimum of 8760 hours for continuous ED coverage. It is anticipated that providers may/will need additional time for chart completion and provider debriefing during shift changes. The Contractor shall at minimum staff 1 physician on site for the entirely of the contraction duration. The government shall request through task orders the months required with minimum 2 month order at a time. It is anticipated the government will request task orders for services 2-3 months on a task order on a rolling basis for the Services period

3.2.6. Option Year 3 12 months (6-1-28 to 5-31-29)– The service component, is minimum of 8760 hours for continuous ED coverage. It is anticipated that providers may/will need additional time for chart completion and provider debriefing during shift changes. The Contractor shall at minimum staff 1 physician on site for the entirely of the contraction duration. The government shall request through task orders the months required with minimum 2 month order at a time. It is anticipated the government will request task orders for services 2-3 months on a task order on a rolling basis for the Services period

3.2.7. Option Year 4 12 months (6-1-29 to 5-31-30) – The service component, is minimum of 8760 hours for continuous ED coverage. It is anticipated that providers may/will need additional time for chart completion and provider debriefing during shift changes. The Contractor shall at minimum staff 1 physician on site for the entirely of the contraction duration. The government shall request through task orders the months required with minimum 2 month order at a time. It is anticipated the government will request task orders for services 2-3 months on a task order on a rolling basis for the Services period

3.2.8. Transition Period: The government reserves the right not exercise any or all option periods including due to providing services with a new vendor. It is anticipated that any contracting change with require a transitional period and multiple vendors may be onsite training new contract staff. Contractor must still provide services until end of contract period during this transitional period.

4. CONTRACTOR RESPONSIBILITIES

4.1. ED Services: The Contractor shall provide contract physician(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.2. The EM Physician will provide full scope emergency medicine services within facility capabilities including diagnostic, preventive, and therapeutic health services to all patients. The EM physicians must be familiar with rural medicine with no-in house specialty consults. The EM will consult with inpatient and admission providers to provide a seamless admission process. The EM Physician may be consulted to outpatient and specialty clinics in cases where the specialist provider feels a need to initiate a same day consultation. This consultation may merely require information from the EM Physician to the consulting provider to act upon, or the EM Physician to transfer the patient to the ED.

4.3. The contractor shall make preliminary diagnosis, directs, prescribes or provides treatment, or arranges for specialized care of patient referral as required. Evaluates patients who come to the emergency room.

4.4. The contractor shall provide emergency care on a regular and ongoing basis to patients seen in the emergency room. This includes stabilization and transfer of major trauma (penetrating wounds, hemorrhage, traumatic brain injury, significant blunt trauma etc.).

Contractor must be competent in the management, stabilization and transfer of pediatric trauma, pediatric advanced life support, adult cardiac life support, advanced trauma life support, psychiatric emergencies such as suicide, precipitous deliveries, and complex/critical medical conditions (septic shock, cardiopulmonary shock, end stage renal disease etc.)

4.5. This EM Physician shall perform all medical documentation in the Hospital’s Electronic Health records (EHR). Contractor shall be provided adequate time to receive EHR orientation and practice with the EHR Clinical Application Coordinator (CAC), ED Manager, Clinical Director, or delegate prior to being scheduled for patient care with competency signed by ED Manger, Clinical Director, or delegate. Complete and proper documentation must be annotated in the patient’s EHR medical record chart. All medical records must meet acceptable standards as determined by the hospital’s Health Information Management (HIM) Department. All EM Physicians are expected to complete all EHR patient encounter notes, Purposes of Visits (POV) and medical levels on every patient as soon as reasonably possibly, but not later than 24 hours. Charts should be completed prior to leaving for end of shift. HIM personnel will monitor any deficiencies and inform the EM Physician, ED Manager, Clinical Director or designee.

Medical record deficiencies can seriously impact the ability of the hospital to bill alternate resources. Therefore, any significant medical deficiencies may prevent processing of final purchase orders. If this situation occurs the Area Office contracting office and contracting company shall be promptly notified in order to quickly rectify.

4.6. The EM Physician’s medical records will be reviewed to determine if the EM Physician is providing acceptable medical care. This review will be in the form of Utilization Review and FPPE/OPPE. The EM Physician shall secure a thorough health history from the patient or family member and record findings. Physical examination shall be performed which is consist 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 EM Physician will discriminate between normal and abnormal findings to recognize early stages of serious physical, emotional, or mental problems. The EM Physician will make decisions with available physicians, surgeons, or specialists that may be available concerning medical care needs of patients. The EM Physician will consult available in-house medical services when indicated and available. If consulting services are not available in-house the EM Physician will perform diagnostic and therapeutic consultations with surrounding health care facilities.

4.6.1. Contract physician(s) shall remain onsite in building for duration of scheduled shift. It is not acceptable for scheduled physician to be out of the hospital on campus during shift.

4.7. Background Checks: The contractor shall be subject to character investigation as required by Public Law 101‐360, the Indian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) system and this shall include all fingerprinting procedures and clearances. The contractor shall provide all requested information necessary to perform Level II background checks. The contractor shall comply with the requirement to obtain security investigations. The contractor shall work with the IHS to ensure that the pre‐ employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the contractor and forwarded to the government personnel. The contractor will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known

4.8. Standards of Care: The contract physician(s)’ care shall cover the range of EM services as the health care treatment facility allows and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.8.1. American Board of Emergency Medicine http://www.abem.org

4.8.2. IHS Manual https://www.ihs.gov/IHM/

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

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

4.8.5. The requirements contained in this SOW

http://www.abem.org/ https://www.ihs.gov/IHM/ http://www.jointcommission.org/ http://www.hpoe.org/resources?show=100&type=8

4.9. MEDICAL RECORDS

4.9.1. Authorities: Contract physician(s) providing healthcare services to IHS patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.9.2. Disclosure: Contract physician(s) may have access to patient medical records:

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

The penalties and liabilities for the unauthorized disclosure of IHS patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.9.3. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by IHS Manual and all guidelines provided by the IHS.

All patient health record documentation initiated by the contract physician 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). Further, 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. This is a condition of the Statement of Work (SOW).

4.9.4. Release of Information: The IHS shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the IHS authorizing the Contractor to release patient information, the Contractor in compliance with IHS regulations, and at his/her own expense, shall use IHS Form, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The IHS’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use IHS Form, Request for and http://www4.va.gov/vaforms/va/pdf/VA3288.pdf http://www4.va.gov/vaforms/va/pdf/VA3288.pdf http://www4.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf

Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form.

4.10. Direct Patient Care: 90% of the time involved in direct patient care.

4.10.1. Per the qualification section of this SOW, the Contractor shall provide the following staff:

4.10.2. Scope of Care: Contract physician(s) (as appropriate and within scope of practice/privileging) shall be responsible for providing EM care, including, but not limited to :

4.10.2.1. Evaluation, Treatment and Management: Employment of the principles of EM care.

4.10.2.1.1. Initial and follow-up evaluation, treatment and management for EM surgical and non-surgical care.

4.10.2.2. Inpatient Services: Contractor physician(s) shall be available for inpatient consults and emergency codes. The providers will work closely with inpatient provider to facilitate appropriate work-ups and admissions to facility.

4.10.2.3. Consultation and Referral Responsibilities: Contractor physician(s) shall provide consultation with and instruction to referring physicians regarding appropriate indications for procedures so that the most expeditious and clinically appropriate work-up can be done. Contractor physician(s) shall determine the appropriate course of treatment and communicate in person or by phone with the referring clinicians.

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

4.10.3. ADMINISTRATIVE: 10% administrative time.

4.10.3.1. Quality Improvement Meetings: The contract physician(s) shall participate in continuous quality improvement activities and meetings with committee participation as required by the IHS ED Manager, Clinical Director, Chief of Staff, or designee.

4.10.3.2. Staff Meetings: The contract physician(s) shall attend staff meetings as required by the IHS ED Manager, Clinical Director, Chief of Staff, or designee.

Contractor to communicate with COR on this requirement and report any conflicts that may interfere with compliance with this requirement.

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

http://www4.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf

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

4.10.3.4.1. Contract physician(s) shall document care given and select appropriate Evaluation and Management (E&M) procedure codes in EHR. Documentation must be sufficient to support both the E&M and procedure codes. Documentation and coding functions must be completed by the end of each patient care encounter.

4.10.3.4.2. Medical Referrals: Contract physician(s) shall enter appropriate referrals into EHR PRC system with adequate supporting information and utilizing the IHS PRC priority levels.

4.10.3.5. Patient Safety Compliance and Reporting: Contract physician(s) shall follow all established patient safety and infection control standards of care. Contract physician(s) shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be reported to the COR, per IHS Safety Policy. As soon as practicable (but within 24 hours) Contractors shall notify COR of incident and submit to the COR the Patient Safety Report, following up with COR as required or requested.

4.10.3.6. Customer Service: Contract physician(s) shall refer all patient/customer service issues to the Ambulatory Care Supervisory Physician and/or Ambulatory Care Nurse Manager or designee.

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

IMPROVEMENT(QI)

4.11.1. Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, proper utilization of the EHR used for patient tracking and Peer Reviews. Methods of Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE).

Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (SOW) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

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

4.11.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives.

Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

4.11.4. Acceptable Fixed Price Performance Base Standards:

4.11.4.1. Measure: Provider Quality Performance

Performance Requirement:

Standard: FPPE/OPPE documentation for all (100%) staff providing services under the contract. All staff (100%) meets Standards.

Acceptable Quality Level: 80 % meet Standards

Surveillance Method: Focused/Ongoing Provider Performance Evaluation (FPPE/OPPE) data pertinent to care performed for each provider working under this contract. FPPE/OPPE data will review the following elements:

A. Patient Care Performance

B. Medical/Clinical knowledge

C. Practiced Based Learning and Improvement

D. Interpersonal and Communication Skills

E. Professionalism

F. System Based Practice

Frequency: Will be completed within 3 months of beginning work at the IHS or if specified triggers occur. The following applies: POTENTIAL TRIGGERS FOR

FOCUSED REVIEW (PLEASE INDICATE IF RELEVANT)

• New Provider (generally at 3 months; no later than 6 months if insufficient clinical info)

• Request for New Privileges

• Sentinel Events

• Substantiated Practitioner-Specific Complaint

• Provider-Specific Tort Settlement

• Significant Safety Violations

• Repeated/Egregious Unprofessional Behavior

• Other

Incentive: Positive Past Performance

Disincentive: Negative Past Performance, (should there be deductions for this standard)

4.11.4.2. Measure: Qualifications of Key Personnel

Performance Requirement: All contract physician(s) shall be board certified/board eligible in accordance with ABEM or respective specialty.

Standard: All (100%) contract physicians must have completed a recognized advanced training program, (residency/fellowship) in the specialty, where applicable.

Acceptable Quality Level: 100% No deviations accepted.

Surveillance Method: Inspection of qualification documents

Frequency: At the time of selection and during re-credentialing.

Incentive: Favorable contactor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation. Removal from contract until such time the contract physician(s) meet qualification standard:

4.11.4.3. Measure: Scope of Practice/Privileging

Performance Requirement: Contract physician(s) performs within their individual scopes of practice/privileging.

Standard: All (100%) contract physician(s) perform within their scope of practice/privileges 100% of the time.

Acceptable Quality Level: All (100%) contract physician(s) perform within their scope of practice/privileges 100% of the time. No deviations accepted.

Surveillance Method: Random Inspection of records during OPPE/FPPE.

Frequency: Up to two (2) times per year.

Incentive: Favorable contactor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation. Removal from contract until such time the contract physician(s) meet qualification standard.

4.11.4.4. Measure: Patient Access

Performance Requirement: The Contractor shall provide contract physician(s) in accordance with the operating hours and IHS schedule outlined in this SOW.

Standard: All (100%) contract physician(s) are on time and available to perform services.

Acceptable Quality Level: Contract physician(s) is on-time and available to perform services 100% of the time

Surveillance Method: Periodic Sampling of Time and Attendance Sheets

Frequency: Quarterly review by Clinical Director, ED Manager, or delegate at

FYH.

Incentive: Favorable contactor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation.

4.11.4.5. Measure: Patient Safety

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

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

Acceptable Quality Level: All (90%) of patient safety incidents are reported using Patient Safety Report within 24 hours of incident. No acceptable deviation.

Surveillance Method: Direct Observation

Frequency: As needed

Incentive: Favorable…