SOW - Hospitalist updated.pdf

STATEMENT OF WORK

PHYSICIAN SERVICES FOR THE

ROSEBUD IHS OUTPATIENT/INPATIENT DEPARTMENT

Rosebud Service Unit, Great Plains Area Indian Health Services

A. PURPOSE OF CONTRACT:

The mission of the Rosebud Comprehensive Healthcare Facility (Rosebud) is to provide the best possible health care services to the Native American population of the Rosebud Reservation in South Dakota. To meet this mission this requires contractor support to provide Hospitalist, Family Medicine and/or Internal Medicine Physician services on a temporary basis.

Many of the IHS patients receiving services may only speak a native language and/or reside on a Native American Reservation, therefore, the Contractor must demonstrate sensitivity to cross-cultural and language differences.

The Rosebud Comprehensive Healthcare Facility requires assistance in the recruitment and placement of Board Certified or Board Eligible physicians on the medical staff for a temporary duty assignment either for inpatient (hospitalist) or outpatient provider. The purpose of the contract is for the recruitment, credentialing and placement of a Physician as a hospitalist and an outpatient provider or both as need be; Family Medicine or Internal Medicine Physician for Rosebud.

B. SPECIFICATIONS OF SERVICES:

The contract is a non-personal health care services contract, as defined at Federal Acquisition Regulation (FAR) part 37.01 under which the contractor is an independent contractor and shall allow the Government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professionals’ aspects of the services rendered (e.g., professional judgments, diagnosis for specific medical treatment, or treatment plan). A Non-Personal Service Contract is established to provide 1) to provide direct patient care and 2) to manage and provide the service unit’s clinical training programs 3) There will be at least 3 different types of providers to be supplied by contractor.

Teaching physicians will provide clinical care in rotations. Outpatient rotations are preferred to be at least two weeks. Inpatient rotations are typically one or two weeks, with two weeks preferred.

Physicians who commit to more than two weeks per year are preferred. Physicians with active academic appointments are preferred. A teaching physician team with experience in IHS and with experience working in the Great Plains Area is preferred. A teaching physician team with experience in residency program development is required.

The academic institution is responsible for making arrangements with medical students and residents to participate clinically at Rosebud Service Unit. The academic institution provides full time on site internal medicine physicians who are able to see our patients in the above settings, and also provide academic professional oversight with mentorship of residents and students. The setting of Rosebud Service Unit provides the medical students and residents with a unique rural health learning experience which is an opportunity not available in urban settings.

Academic partners will also serve in the capacity of providing continuing medical education to our permanent clinicians and help serve in medical staff capacities such as chairs of hospital committees during times of low staffing. The coordination of resident rotations, learning sessions and medical staff administrative support responsibilities are documented by other professional services offered and are in addition to direct patient care services (outpatient/inpatient clinical care coverage).

The full-time presence of three teaching physicians, via rotations, are sought for outpatient and inpatient clinical and teaching services. At least one role is expected to be outpatient-focused and at least one role is expected to be inpatient-focused. All roles are expected to be focused on the care of adults as well as at times pediatric patients. Roles and duties for each physician position will be developed and assigned by the service unit. All three teaching physician roles will be assigned one hour per week at a convenient and appropriate time to meet virtually as a team with members who are not currently rotating.

Teaching physicians will be given appropriate time deliver high-quality teaching, which may include protected time prior to didactic teaching sessions. Teaching physicians will receive similar protected administrative time to non-teaching colleagues. Early-career outpatient teaching physicians are expected to be assigned additional administrative time as appropriate during their first rotations to adapt to the care system.

The faculty team will include one or more lead clinicians who ensure that high quality primary care and inpatient is delivered seamlessly across clinical rotations. The faculty team will identify the lead clinician(s) to the service unit.

Teaching physician teams commonly include fellows participating in rural or global health fellowships. These physicians will conduct similar duties to other staff physicians, but they will also be considered by the service unit to be learners and receive appropriate support. As above, they may require additional administrative time during their first outpatient rotations. The teaching faculty manager(s) (see below) will notify the service unit which providers, if any, are fellows

Faculty management of teaching activities at the service unit is required. The faculty manager(s) will work with the service unit to develop, implement, and maintain high-quality clinical rotations at the service unit. The faculty manager(s) will engage in quality improvement and medical staff support to assist with maintaining accreditation / certification and high quality of care at the site, which, in turn, will ensure that high-quality teaching rotations can be sustained. The duties and responsibilities of the faculty manager(s) will be determined by the service unit.

The teaching hospital team is expected to maintain sufficient administrative support to productively integrate its rotating clinicians and faculty manager(s) with the service unit’s administration and systems. The teaching team will also coordinate travel, housing, and training for its team. The service unit will provide training and onboarding, as appropriate.

The academic institution is responsible for making arrangements with medical students and residents to participate clinically at Rosebud Service Unit. The academic institution provides full time on site internal medicine physicians who are able to see our patients in the above settings, and also provide academic professional oversight with mentorship of residents and students. The academic teaching faculty coordinate the medical student and resident rotations. The academic institution also serves in the capacity of providing continuing medical education to our permanent clinicians and coordinates the learning sessions.

There is also specific administrative role that is to be provided by the faculty manager (s) as needed.

Academic faculty lead will help serve in medical staff capacities such as chairs of hospital committees during times of low permanent staffing. Medical staff administrative support responsibilities are documented by other professional services offered and are in addition to direct patient care services (outpatient/inpatient clinical care coverage).

The teaching hospital team is expected to maintain sufficient administrative support to productively integrate its rotating clinicians and faculty manager(s) with the service unit’s administration and systems. The teaching team will also coordinate travel, housing, and training for its team. The service unit will provide training and onboarding, as appropriate.

Specific role of inpatient provider:

85 hours per week in the Rosebud Service Unit (RSU) Inpatient Department (IPD); year-round coverage in 1- or 2-week rotations.

Role Goals:

• Provide high-quality, culturally aligned inpatient care to the Sicangu Oyate at the RSU o Support the RSU IPD team as it seeks to achieve the same goal o Serve as part of and model collegiality with the IPD team

• Function as a cohesive team without disruptions during rotation transitions

• Support clinical precepting of up to one learner per day

• Participate in quality & process improvement activities

• Should inpatient census be low this provider may be asked to help in outpatient clinic

The hospitalist will be anticipated to work 7 days/week consisting of call 24 hours per day for admissions or emergencies and 5 days weekly, Monday through Friday from 7:30 am to 4:30 pm (40 regular hours paid), with a 30-minute lunch break regarded as on call hour. Beyond 4:30 pm on weekdays it will be regarded as on call hours unless the provider is doing direct patient care related to hospitalized patients, Emergency Room Consultations and admissions. On weekends the inpatient provider is to arrive by 9:00 am (both Saturday and Sunday) to the hospital for rounding and completion of care for the inpatients. Then the rest of the hours are on call hours, Saturdays and Sundays except the time spent on inpatient rounds, attending Inpatient emergencies, Emergency Room consultations and new admissions which would be listed and paid as call back hours. Because of the nature of our hospital and the possibility of limited inpatient volume, the Contractor for Inpatient will agree on low volume days to report to the outpatient clinic and see walk in patients, i.e., the inpatient provider could provide inpatient rounding in the morning and work in the clinic in the afternoon.

Call may be nightly for inpatient provider, or may be divided among several providers to cover the inpatient call, depending on the volume of inpatients and the amount of calls and night admissions.

The contractor understands the Rosebud Facility shall set the on call schedule and it may vary from every day, to several days in a row with intermittent other coverage to alternating coverage days.

The Contractor understands they are to take 30 minutes for lunch during their Monday through Friday shift time. Should their lunch time be decreased it would need to be noted on their time sheet as to why (Consult/Admission). The contractor may be outside of the facility during on call time;

however they are to remain within the Rosebud area, being able to respond back to the hospital within 10-15 minutes if needed (for codes, patient evaluation, admissions). The contractor is to keep track of time inside the facility actively working, call back time for admissions or consults, and time being on call outside the facility. If the contractor is outside the facility it can only be listed as call time and does not get increased level of pay for phone calls. The contractor will perform according to this Statement of Work.

Depending on the needs of the facility the model for coverage of the inpatient services will either be as above or the model of a day hospitalist and nocturnist. Inpatient coverage hours or on call coverage may be subjected to change based on the needs of the facility.

Outpatient teaching physician Role Description:

40 hours per week in the RSU OPD; year-round coverage in 2-week rotations; standard OPD schedule Role Goals:

• Provide high-quality, culturally aligned outpatient care to the Sicangu Oyate at the RSU o Support the RSU OPD team as it seeks to achieve the same goal o Serve as part of and model collegiality with the OPD team

• Function as a cohesive team without disruptions during rotation transitions

• Support clinical precepting of up to two learners per day in the outpatient clinic

• Participate in quality & process improvement activities

• There may be need of additional physicians to support the work of the outpatient and outlying clinics such as jail clinic via telehealth services when and if available.

Afternoon teaching physician Role Description:

45 hours per week split between

i) daily half-day in OPD and

ii) Overnight/weekend IPD coverage including overnight call >50% of nights.

iii) Should nocturnist model be best model for facility, it is understood that the afternoon teaching physician role would not be required.

Role Goals:

• Same as both “Outpatient” and “Inpatient” roles

• Onsite, as-needed backup for Inpatient role The contract physician as an outpatient provider will typically work Monday through Friday, with the potential for some evening or weekend clinics. The outpatient provider's shift will normally be 9:00 am - 6:00 pm CST; shifts may fluctuate to accommodate evening or weekend clinics. Times may also vary if there are meetings. Provider will begin seeing patients in the OPD at 8:30 am and work until 6:00 pm CST with a minimum of a 30 minute lunch break required. The contract provider, on occasion, may need to work for short periods of time beyond their respective shift hours, at times when such extra time is necessary to finish a patient visit, increased number of patients that need to be seen. The normal work day would not be more than 9 hours, not including lunch. If the provider is needed to work more than 9 hours per day, approval of such hours must be obtained by the Clinical Director or designee prior to working the extended hours.

Work assignments will be defined by the Clinical Director or designee to include shifts within the hours of operation of the facility including inpatient and outpatient clinic. The contract physician's regular work duties may include the clinical supervision of mid-levels, students and residents.

Teaching is considered a vital role in providing good patient care. Regular work schedules for contractors may include Federal holidays. The work hours/shifts cannot be changed/traded/switched without prior approval from the Clinical Director or designee.

The contractor shall be paid a fixed flat rate per hour as stated on the issued contract for inpatient services, outpatient clinic services and for call as outlined. All charts and records should be completed during the day shifts or call back time for admission H & P and orders. No differential pay for government holidays, compensation time, and overtime will be approved.

Administrative Duties of Faculty Lead teaching physician (s) Role Description:

i. Serve as chair of medical committees when needed by facility

ii. Perform chart reviews of hospitalists and telemedicine specialists when needed by facility

iii. Preparation of academic teaching/training for facility’s medical staff

iv. Coordination of medical students/residents schedules during rotation at the facility

v. Attendance of medical staff meetings as determined by the facility such as Med

Staff, P&T, Inpatient QAPI.

vi. Coordination and/or set up of specialized clinics if and when requested by the facility for example jail clinic, hepatitis clinic etc.

vii. Completion of quarterly reports as requested by facility

viii. Other duties if agreed upon by facility

The Contractor shall indemnify the Government for any liability producing act or omission by the contractor its employee and agents occurring during contract performance. The Contractor shall maintain medical liability insurance in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

The facility at times may need coverage 365 days per year, or may only need intermittent coverage.

Contract physician care shall cover the range of primary care typically provided in a rural civilian practice of similar size. The Contractor shall provide a skilled physician to perform the necessary medical diagnostics, management, procedures, and treatments.

Upon the receipt of contract, the contractor shall locate, credential, and have available sufficient staffing to provide “seamless” physician coverage on a regular work schedule. Physician primary care work schedules are inclusive of weekends and all federally established holidays. Failure to provide “seamless” coverage will result in the contract going into default.

The standards of medical practice and duties of the contractor through its physicians shall be determined pursuant to the governing body bylaws, medical staff bylaws, rules and regulations of the Indian Health Service (IHS), applicable provisions of law including but not limited to The Joint Commission, Centers for Medicare, Medicaid Services (CMS) compliance, rules and regulations of any and all governmental authorities related to licensure and regulations of physicians in health care and standards and recommendations of the Accreditation Association for Ambulatory Health Care

(‘AAAHC’).

In accordance with the Indian Health Service credentialing policy, the contractor shall complete primary source verification for the contract physician performing services under the contract. Upon the placement of a physician at Rosebud the physician shall timely complete a credentials packet, background clearance forms and be credentialed by the Rosebud Governing Body. Compliance with IHS privileging requirements is essential in the performance of the contract.

The contractor shall provide at least 3 physicians for the professional management of patients being treated at the Rosebud Hospital. The contract physicians shall provide medical support for the outpatient department as described above.

The Contractor health care providers shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contractor shall ensure strict compliance to the release of Protected Health Information in accordance with the Coder of Federal Regulation, Title 45, Public Welfare, Subtitle A, Department of Health and Human Services, Part 164, Security and Privacy (45 CFR 164) and AFI 41-210, “Patient Administration Functions” paragraph 2.2.3, “Health Insurance Portability and Accountability Act (HIPPA)” and paragraph 2.3, “General Guidelines on Releasing Medical Information”.

The Contractor shall ensure contract providers maintain open and professional communication with members of the Medical Staff. Complaints validated by the Quality Assurance Personnel (QAP) and Clinical Director shall be reported in writing to the Contracting Officer (CO) and the Contractor for action.

Contract providers shall perform procedures compatible with their privileging and the medical facility’s operating capacity and equipment. New medical procedures/services/or personal medical equipment (other than stethoscope) shall not be introduced without prior recommendation and approval of the Rosebud I.H.S Clinical Director or authorized representative.

The contract physician shall generate and maintain proper medical record information on beneficiaries to who treatment is provided in accordance with Indian Health Service, AAAHC and CMS regulations. The contract physician shall prepare all medical record documentation exclusively on the Electronic Health Record (EHR) to meet or exceed the established standards of the IHS facility to include but not limited to: timeliness, legibility, accuracy, content and signature.

An orientation to the EHR will be given by the Clinical Applications Coordinator (CAC) prior to any patient care. All medical recording information and documentation generated in the performance of this contract must be completed by the time of departure and will remain the property of and subject to the exclusive control of IHS. All medical records must include proper documentation to allow for coding and billing of all inpatient and outpatient visits based on current standards.

The Rosebud Hospital will provide support personnel to assist with clinic to equivalent of a licensed practical nurse and registration staff. Exam rooms equipped with standard supplies including computers for completing electronic medical records.

The contractor shall document all patient encounters legibly on all medical records. All documentation shall be timed and dated. The Contractor must place in the EHR all of their orders in a timely fashion and verbal ordered are to be used in an emergency basis only. All Medical records are to be completed by the end of the provider’s scheduled shift and must be verified by the HIM department. All documentation shall meet the current CMS guidelines.

Inpatient duties include but are not limited to: Reporting to morning rounds by 7:40 am every morning to give inpatient report, review patient plans, and review any special needs for patient care.

The inpatient provider is required to perform a daily, in-person evaluation of each inpatient which includes but not limited to appropriate examination, review of laboratory test results, and medications. New orders and daily progress notes are to be completed daily. If needed, a reevaluation is conducted later in the day with addendum added to the morning note. Notes from ER consultations and admission History and Physicals must be completed immediately at the time of service per hospital policy. EHR items will include the review of outpatient medications, order of proper inpatient medications including DVT prophylaxis if warranted (or reasons why not), and EHR order entry required with minimal to no verbal orders. Necessary duties include review and signing of laboratory investigations, orders, review and sign off radiographic studies, interpretation and sign off of all EKG tracings and placing a note in the EHR with EKG interpretation. Discharge orders must be written early in the day to allow for arrangement of transportation. Medication reconciliation must be completed for all patients on admission and discharge. At discharge, discharge medications must be ordered along with discharge instructions and home supplies.

Consultations (ER or outpatient) and discharge summaries must be completed the day of discharge and Nutrition Guidelines per requirements. All records of transfer will need to be completed prior to transfer of patients, this includes transfer note, Purchased/Referred Care (PRC), and all appropriate records must be ready for the transfer team. All consults must be placed and PRC completed for any outside treatment or testing needed upon discharge or transfer.

Final payment will be withheld until all medical records are completed by the contract physician.

The contractor will be required to create a time work record by utilizing a contractor provided timecard. The contractor is to be honest with arrival and departure times and to only include times actively working. No “padding” of hours is allowed and will be considered fraud, waste and abuse of government funds. Once inpatient work is completed, the contract provider should report to outpatient, complete medical records or report to the Clinical Director for direction. If the contract provider should need to re-evaluate inpatients prior to leaving work, an addendum on the daily note should be placed. Daily charge sheet must be completed to include the correct diagnosis on the front sheet and the appropriate level of charges for admission, daily note, and discharge. This must be completed on all charts on a daily basis.

On a weekly basis, or per the Contractor policy, timecards and timesheets will be turned in to the Clinical Director or his designee for verification and signature prior to submitting to the Contractor’s timekeeper. No invoices shall be processed for payment until a complete, signed, and verified work record is submitted along with the medical records documentation completion verification.

**All patient health record documentation initiated by the contract physician from patient encounters must 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).

The contract will be provide two or more MD staffed for the described Outpatient and Inpatient duty shift as well as a combined position when possible for the entire contract period providing “seamless coverage” AKA “continuous coverage”. It is imperative that the contracting agency ensures qualified and credentialed MDs will be physically present in the Rosebud inpatient and/or outpatient clinic every day as needed throughout the entirety of this contract.

Skills and knowledge of established concepts, principles, and practices related to health care assignments requiring training equivalent to an educational program leading to a Degree of Medicine (MD/DO) and additional training or experience in assessing the conditions of patients, in providing medical care and in advising on health care needs, all with full consideration of mental, emotional, and physical factors. Extensive knowledge of disease entities.

Knowledge of diagnostic, preventive and therapeutic procedures related to a variety of medical and health care fields.

Ability to collect, organize, record and communicate, in a meaningful way, data relevant to primary health assessments including detailed family and medical history, physical examinations and selective laboratory tests.

Skill in making diagnoses and in choosing, initiating, and modifying selected therapies, and ability to provide emergency treatments. Skill in simple laceration repair, casting/ splinting, and in other ER or urgent care- related procedures. Skill in the management of simple fractures.

Ability to assess the physical-psychosocial health status of patients and family based upon the knowledge of growth and development patterns and health conditions that require medical management. Knowledge of human behavior during stressful situations in order to exercise emotional control, tact, patience and reliability in providing emergency/ urgent patient care.

Knowledge of pharmaceuticals to be able to determine proper medications to order, including dosages and able recognize the desired effects, side effects and complications of their use and interactions.

Ability to provide individual and family counseling, guidance, and health instruction to help patients to understand how to prevent disease and maintain good physical and mental health. The ability to work closely with families with death and dying issues related to end of life care. The ability to understand and work within the culture of the patients we serve.

The Contractor will provide diagnostic, preventive, and therapeutic health services to patients and family members in the Emergency Department, or an urgent care setting affiliated with the Emergency Department.

The Contract physicians’ medical documentation will undergo peer review to ensure acceptable medical care is being provided. The Contract physician shall secure a thorough health history from the patient or patient’s parent and record findings. A thorough history and 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 Contractor will discriminate between normal and abnormal findings to recognize early stages of serious physical, emotional, or mental problems. The Contactor will consult available in-house medical services when indicated and available. If consulting services are not available in-house the Contractor will consult with the shift OPD physician or clinical director about appropriate referrals.

Provides direct medical care in the presence of illness or disability in order to maintain life, provide comfort, reduce distress and enhance coping ability.

Provides surveillance over medical practices applied to stabilize chronically ill persons; adjusts treatment within established standing orders, recognizing when to refer the patient to another physician, another hospital or other health team members.

Works collaboratively with physicians in management of selected complex medical problems.

When clinically engaged with a medically complex patient the Contractor will present the case to the physician clinic consultant for the day for proper follow up and disposition.

The physician will have knowledge of how to look up hospital policies and procedures and will abide by the outlined policies and procedures.

C. GOVERNMENT FURNISHED EQUIPMENT, FACILITIES AND PROPERTY:

The Hospital shall provide a patient examination area and all medical and non-medical equipment and supplies used in the Indian Health Service facility for the care and maintenance of patients either on inpatient or outpatients. The contract physician will be authorized to use all areas of the medical treatment facility available to civil service and Commission Corps personnel in similar positions.

The same restrictions apply to the Contractor as any other Indian Health Service personnel to use these areas for official business activities only.

The contract physician will be authorized to use all administrative and professional support available to Indian Health Service personnel. This will include but not limited to copy machines, fax machines, medical library, and telephone services. The same restrictions to use these items for official Indian Health Service business apply. All equipment is for the use of patient care only and personal use is not authorized. The contractor shall not use hospital electronics for personal use including searching the web for anything other than non-clinical purposes.

The facility shall provide all medical and non-medical equipment and supplies used in the Rosebud Hospital for the care and management of patients.

The facility shall provide all blank government forms applicable to the Indian Health Service. The facility personnel will provide an appropriate orientation to the necessity of such forms.

The facility shall provide an ongoing method of monitoring and evaluation of the quality and appropriateness of patient care and identifying deficiencies in the quality service performed before the level of performance becomes acceptable.

The facility shall provide to the contract physician and support staff a contractor orientation to the facility, of which must be completed timely.

D. CONTRACTOR FURNISHED EQUIPMENT, FACILITIES, AND PROPERTY:

The Rosebud Hospital does not anticipate a need for contractor furnished equipment beyond a stethoscope. Hospital Accreditation does require any equipment brought in to a facility to be assessed and approved by Biomed and Administration.

The contract physician and support staff shall provide his or her own uniforms which must be clean and tidy.

E. WORK SCHEDULE/PAYMENT SCHEDULE:

The MD’s work schedule is as follows: Each work day per provider will consist of one 8½-9 hour tour of duty in the Rosebud IHS hospital Inpatient and/or Outpatient, typically weekdays, Monday through Friday (potentially with evening or weekend outpatient clinics). Weekends for inpatient is only actual rounding time required to see the patients on the inpatient service unit usually 2-4 hours, depending on the number of patients hospitalized. On the weekend rounding must be completed in the morning hours, with arrival around 9:00 am on Saturday and Sunday and will resume call after rounding completed. Inpatient on call weekend hours will be from on the weekends begins at 8:00 am and will resume after rounding until 8:00 am the following day. The on call schedule is listed in the inpatient area, administration and in the ER. The inpatient provider will start their weekday work shift at 7:40 am CST with morning report and Inpatient Rounds. During the week days the inpatient provider may leave the facility by 4:30 to 5:00 pm when records and charting is completed.

Outpatient providers will report to clinic at 8:00 am and begin seeing patients at 8:30 am and work until 4:30-5:00 pm CST with a 30 minute lunch break as allowed. The outpatient provider will provide care one afternoon a week via telehealth to those patients at our correctional facilities as needed for the duration of this contract or until notified differently by the clinical director. The outpatient contract MD, on occasion may need to work for short periods of time beyond their respective shift hours, at times when such extra time is necessary to finish a patient visit and charting. The outpatient physician may also be scheduled to provide call after clinic to the next morning. Actual call hours will be on the schedule. Note there is time allotted within the scheduled day to allow for charting to be completed and additional overtime hours must be approved prior to happening should there be extenuating circumstances.

The Contractor will adhere to work duties and schedule for shifts in accordance with the SOW with no more than one unplanned absence per quarter. Any changes more than that on the side of the contractor, resulting in any open shifts on the schedule will result in the contract going into default.

Invoices will be line itemed as hospitalist hours, outpatient hours and administrative hours.

F. QUALITY ASSURANCE:

Is under the administrative supervision of the Clinical Director of the Rosebud Service Unit or his/her designee. Will participate with the Rosebud Hospital medical staff Chart Review Processes for the providers of this contract as well as participate in Corrective Actions, if needed. Incumbent performs assignments under general supervision, and will work directly under the clinical director.

In addition, the Supervisor will monitor the contractors work and provide feedback to the contractor.

Performance objectives will include a written summary provided to the Contract Provider as well as the Contractor summarizing the provider’s performance while on duty at the Rosebud Hospital.

Criteria for evaluation will be as follows:

• Medical practice must be within the standards of their credentialed specialty.

• Documents medical assessments, History and Physicals, observations, discharge summaries and daily progress notes all must be consisted with current standards and meet billing requirements.

• Utilizes EHR/RPMS computer system to enter and sign off lab results, pharmacy orders, notes; must be signed off at the end of each shift.

• Complies with safety policies.

• Complies with all required trainings within the scheduled timeline.

• Consults with other specialty practitioners when needed.

• Maintains patient privacy/confidentiality and meets all HIPPA compliance standards.

• Adheres to work duties and scheduled shifts consistently without tardiness or absences.

• Understands that we have an FPPE and OPPE process and process improvement needs will be reviewed with the provider. Failure to improve may result in removal of the provider.

• Complaints on quality of care and/or conduct will be not more than 4 per quarter. There is zero tolerance for negligence or incompetence resulting in morbidity or mortality. Zero tolerance for violence or sexual harassment in the work place.

Rosebud Hospital’s Clinical Director or designee will conduct an exit interview with the provider to obtain any feedback from the contract provider regarding the work conducted. If the contract provider is unable to meet with the Clinical Director in person, the Rosebud Hospital requests feedback to be provided in writing within 2 days prior to departure from the Rosebud facility.

Due to the nature of this contract being with a teaching affiliate, contractor will also provide a faculty teaching administrator:

Role Description:

13.5 hours per week 46 weeks per year Role goals:

• Assist, at Clinical Director discretion, the RSU medical staff in achieving quality and accreditation standards (e.g., TJC, CMS, OIG), to allow the RSU to continue to serve as an appropriate training site.

• Develop and support processes to ensure teaching providers in OPD and IPD achieve goals, as above.

• Develop and support learner rotations . • Develop and support continuing medical education to enhance knowledge & retention of non-teaching staff.

• Identify and communicate regarding educational opportunities (e.g., a full-time internal medicine residency) that could improve care quality and access, strengthen the physician workforce, and create financial efficiencies for the RSU

G. REPORTING REQUIREMENTS:

The Contractor shall ensure that all new contract providers participate in the Rosebud I.H.S. Facility Orientation with an overlap of services to include one additional day. All providers must arrive on a Monday – Friday excluding holiday and participate in the orientation prior to providing services at the Rosebud I.H.S. Hospital and shall be scheduled for a minimum of a 2 week increment.

Credentialing and background evaluation must be completed timely to allow individuals to be orientated and ready for their shifts. Please allow 4-6 weeks to complete background and credentialing. Orientation is offered every two weeks starting on Mondays and that is the best time for new contractors to begin.

H. PROFESSIONAL QUALIFICATIONS CRITERIA:

The Contractor must hold an active, current, and unrestricted state Medical Doctor or Doctor of Osteopathy license from any of the 50 United States or the Commonwealth of Puerto Rico.

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

The Contractor must have a Medical Doctor (MD) or Doctor of Osteopathy (DO) degree from an accredited college or university in the specialty area required to provide medical services.

The Contractor must fulfill all the requirements for appointment to the Rosebud IHS Medical Staff and for the granting of privileges, in accordance with IHS policies and with the Service Unit Medical Staff Bylaws.

The Contractor must have current BLS, ACLS certification for adult patient care, and PALS and/or NALS certification for pediatric care prior to starting work at Rosebud.

The provider shall have basic core privileges granted upon verification of all credentialing processes. The provider shall have the onus of supplying documentation supporting any requested privilege that is deemed outside the normal basic scope of a Medical Doctor or Doctor of Osteopathy. Requested privileges shall be denied by the medical director if the provider is unable to prove sufficient training, and State law citing specific allowance to perform requested privileges.

Required credential and appointment documents needed to allow initial provisional and subsequent active privileges and appointment shall include but not limited to the following items.

1) Unrestricted active State license photocopied, primary source verification will be completed at the service unit.

2) Photo of Individual that is recognizable, example driver’s license or passport work well.

3) Evidence of a two-step PPD skin test with annual TB testing evidence that followed or Interferon

Gold with results not less than one-(1) year old:

*If TB positive then chest radiograph reading results must be submitted.

*If TB positive then record of treatment must be submitted.

*If TB skin test is positive secondary to BCG shots, do IFG blood test.

4) Immunization Required Prior to Arrival:

Rosebud Service Unit Health Requirements

1. 2 documented MMR vaccines OR positive antibody titers on each Measles, Mumps, and Rubella.

2. 2 documented varicella vaccines OR a positive antibody titer OR paperwork indicating by a physician diagnosis of the disease (must be complete documentation).

3. TDAP documented in past history AND at least a tetanus vaccine within the past 10 years.

4. 3 documented hepatitis B vaccines OR a positive hepatitis B antibody titer OR a signed declination of refusal.

5. 2 negative TB skin tests within the last 12 months OR a negative IGRA within the last 12 months.

a. If history of a positive reaction to either TB skin testing (secondary to BCG then do

IGRA, if exposure need CXR and dates treated) or to an IGRA we will need the last chest x-ray, and dates of treatment (if treated).

6. Proof of both Covid Vaccinations

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

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

5) Complete Curriculum Vitae with complete and current medical provider work history listing months and years. All gaps of medical employment eight-(8) weeks or greater must include an explanation by the applicant to the reason of this prolonged period of unemployment.

6) Current and active BLS, ACLS, and PALS as listed above with recommendation of NALS, NRP or any other certifications which will remain active throughout the provider’s tour while seeing patients in Rosebud Hospital.

7) Three letters of professional reference from supervisors or peers not less than 3 months old.

8) Active DEA license including prescription privileges of Schedule 2 & 2N.

9) Current Liability Insurance of not less than $300,000/$1,000,000.

10) Record of recent (2 years) continuing education units (CEUs) or (CMEs). Must possess

CME/CEUs that satisfies state licensing requirements if credentialing is to be beyond a 120-day Temporary medical staff appointment.

Providers must furnish adequate number of CMEs new residency graduates are exempt from 30 hours CME/CEUs as they have just successfully completed their training. However; fully credentialed new graduates with active medical staff membership will be required to provide an adequate number of CME/CEUs before they can be re-credentialed in 2 years with active medical staff membership.

I. CHARACTER INVESTIGATION FOR CONTRACTORS WHO WILL HAVE CONTACT

WITH INDIAN CHILDREN:

The contractor is prohibited from having any unsupervised contact with Indian Children in the performance of this contract unless:

1. They act under the direct supervision and within the sight of a Government employee who has obtained a satisfactory “Criminal History Check” in accordance with the “Indian Child Protection and Family Violence Prevention” P.L. 101-630 and “Crime Control Act” P.L.

101-647.

Prospective contractors who duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by P.L. 101-630, the Indian Child Protection and Family Violence Prevention Act. IHS personnel offices will conduct these investigations following award of a contract. The character investigations may be waived if, in judgment of the Contracting Officer, in consultation with the Personnel Officer, and investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified or the results, the Contractor must not have unsupervised contact with Indian Children.

2. The Physician has obtained a satisfactory “Criminal History Check” which satisfies the requirements for the “Indian Child Protection and Family Violence and Prevention Act” P.L.

101-630 and “Crime Control Act” P. L. 101-647.

J. REQUIRED MALPRACTICE INSURANCE:

Current Liability Insurance of not less than $300,000/$1,000,000 covering the duration of the contract.

A Certificate of Insurance evidencing the required coverage shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on claims-made basis, evidence of an extended reporting endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended endorsement is provided to the Contracting Officer.

K. COMPLIANCE WITH IHS RULES AND REGULATIONS:

Medical Practices must be within the standards of their established credentialed specialty and maintains continuing medical education, licensing, registration and certifications 100% of the time.

Complies with all policies, By-laws, Safety, Infection Control, and rules and regulations of HHS/IHS/Rosebud Hospital with zero violations.

Maintains patient privacy/confidentiality/HIPAA with zero breaches of privacy.

The contract physician shall follow IHS Purchase Referred Care (PRC) regulations and policies when arranging for a referral or consult. The contract physician shall be required to consult with other specialty practitioners for consultative opinions and continuation of care. The provider shall inform patients of the required referral or consult by indicating the specialty involved. The contract physician will be required to facilitate transportation arrangements for patients referred to facilities for a higher level of care.

The contract physician shall use and follow the Rosebud IHS formulary list which is approved and maintained by the Rosebud IHS Pharmacy and Therapeutics Committee. Any drug not listed on the formulary must be approved by the Pharmacy and Therapeutics Committee.

Timely documentation that is completed 100% of the time which is to be completed prior to the end of the daily shift and prior to signing an invoice for payment.

Complaints on quality of care and/or conduct should be minimal and no more than three per quarter (all issues will be addressed in writing to the contractor so that action can be taken).

The standards of medical practice and duties of the Contractor through its Physician(s) shall be determined pursuant to the bylaws of the Service Unit. The regulations of the hospital, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of physicians and hospitals must be followed. Also the standards and recommendations of The Joint Commission, Centers for Medicare and Medicaid Services (CMS) or the Accreditation Organization must be adhered to. The Contract Physician(s) shall be required to participate in a quality improvement program, which is consistent with current requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

L. ANY SPECIAL REQUIREMENTS:

Utilizes EHR and RPMS computer system to enter and sign off on laboratory orders (90% of orders must be signed off at the end of each shift).

M. CONTRACTING OFFICER REPRESENTATIVE (COR):

For the purpose of this contract, the Laboratory Director or designee will act as the COR and the Clinical Director will serve as the contractor’s supervisor.