SOW-OBGYN.pdf

PERFORMANCE WORK STATEMENT

Cheyenne River Health Center (CRHC)

OB/GYN Physician

General

This performance based work statement describes the requirements for non-personal services for OB/GYN Physician to support the mission of the Indian Health Service (lHS)iCheyenne River Health Center (CRHC).

The mission of the Cheyenne River Indian Health Service Hospital in Eagle Butte, South Dakota is to provide the best possible health care services to Cheyenne River Reservation in South Dakota.

Backqround

The Indian Health Service (lHS) an agency within the Department of Health & Human Services is responsible for providing federal health services to Amencan lndians and Alaska Natives. The Indian Health Service provides a compreh}nsive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 567 federally recognized tribes, in 35 states. The Indian Health Service HeadquarteB is located in

Rockville, [/D and then divided into twelve physical areas: Alaska, Albuquerque, Bemidji, Billings, Califomia, Great

Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland and Tucson.

The Great plains Area Office (GPAO) works in conjunction with its 19 Indian Health Service Units and Tribal

Managed Service Units to provide health care to approximately 122,000 Native American located in North Dakota, SoutiiDakota, Nebraska, and lowa. The Area Office's service units include seven hospitals, eight health centers' and several smaller health stations and satellite clinics

Our facility, the Cheyenne River Health Center (CRHC), falls unde

(CRHC) provides medical care for approximately 9,000 tribal mem rural area, many of our patients travel 100 miles' round trip to rece signed to sical Ther

, Contract Health Services, Dietitians, Audiology, Eye oB/GYN, ENT, Audiology & Podiatry' The Cheyenne

River Sioux Tribe through a 638 contract with lHS, operates four satellite health stations which offer basic ambulatory services at Cherry Creek, Red Scaffold, Swiftbird, and Whitehorse communities'

0biective

To ensure unintenupted OB/GYN services, on an as needed basis, for the delivery of patient care in.the Outpatient olpartment at tne cheyenne River Health center. The qB/GYN Physician is ical and surgical care to women with particular expertise in pregnancy, childbirth, and disorders of the stem This includes oreventative'care, prenatal care, deteciion oi sexually transmitted diseases, p ing, famlly planning, etc

Period of Performance

Base Year: July 1,2021through June 30, 2022

Work Schedule

TheoBGYNPhysicianwil|workeveryTuesdayandS:00a.m'and8:00p.m.witha%hour lunch break. contract performance shall not be sche Holidays. The contractor rs expected to be

*.ii.Ui. Ouring th" ctinic aay. The Contractor may leav with the approval of the Project otficer' providing all scheduled patient care is completed. Hours are subject to change at the discretion of the Clinical Dhector or Deputy Clinical Director.

Place of Performance Cheyenne River Health Center Inpatient Department 24276 166rh Street Airport Road Eagle Butte, South Dakota 57625

9EICBIPIIOX QF SERVICES: The contractor shall provide OB/GYN Physician services required for the Cheyenne River lndian Health Service Hosoital.

This contract is a non-peBonal health care services contract, as deflned at Far Part 37.101 under which the Contractor is an independent contractor and which shall allow the Govemment to evaluate the quality of professional and.administrative services provided, but retarns no control over the medical, professional aspects oithe servrces rend^ered, (e.9., judgements, diagnos ment). The Coniractor shall indemnifythe,Governmen lity producing act or o its employees and agents occurnng dunng contract . The Contractor shal insurance, in the covirage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the" local community for the medical specialty concemed, typically provided in a rural civilian practice of similar size, care to women with particular expertise in pregnancy, includes preventative care, prenatal care, detection of planning, etc, These services shall be comprehensrve as n0 suppon servtces permit while complying with

Upon the receipt of an IHS purchase order, the Conkactor shall locate, credential, and have available sufficient stafiing to provide physician coverage for the OB/GYN Outpatient Department.

rmprovement program, which is consistent with current reo quality and appropriateness of care.

CONTRACTOR RESPONSIBILITY

utilizes RPMS/EHR compuler software/program for entenng and signing of medical orders such as laboratory studies, and directly signing and dating radiologicat studies:etc.

The Physicians actuar crinicar duties wiI be in accordance with his/her credentiared privireges.

pically provided in a rural civilian practice of simirar sEe.

re to women with particular expertise in pregnancy, ludes preventative care, prenatal care, detection of

These services shall be comprehensive as rvrces permit while complying with

The services provided the 0B/GYN Physician shall include but not limited to outpatient Care and procedures;

colposcopy with biopsy, endomehial biopsy, cryosurgery, vulvar biopsy and InpatienuER/UCC consuttatlon.

The OB/GYN Physician shall provide patrents with a full explanation of diagnosis, procedures and treatments.

The OB/GYN Physicians may be involved in health promotion and disease prevention activities by advising patients about the advantages of healthy lifestyles and specific measurers that may prevent recunences of ill health.

Ensures a safe work environment and employee safe work habits.

Demonstrates com0etent and effective oral and wntten communication.

Computer efficiency required. Prefened 5 years of Electronic Health Record experience.

Maintain certification in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS).

The Contractor shall provide adequate credentialed staff during the regular scheduled services dates and cover the salary for an ancillary staff brought to the service unit. Ancillary staff must have licensure/certification and competencies on file with the Contracting officer.

REFERMLS AND C0NSUSLTS. The provider shall follow IHS Purchased Refened Care regulations and policies wphen arranging for a refenal or consult, The 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 refenal or consult by indicating the specialty involved.

PRESCRIPTIoNS. The provider shall use and lollow the IHS formulary for prescnptions for all patients. The formulary list is approved and maintained by the Cheyenne River Health Center Pharmacy and Therapeutics

Committee. Any drug not listed on the formulary must be approved by the Pharmacy and Therapeutics Committee.

C0NTRACTOR Tll\4ESHEETS. The Physician will be responsible for obtaining Medical Records (Hllvl) signature prior to CD or representative signature lor the completion of their timesheet. Invoices submitted without the signed timesheet including Medical Records (HlM) and CEO signatures will not be paid.

PROCEDURE GUIDANCE. Contractor providers shall perform procedures compatible with the medical facility's operating capacity and equipment.

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATI0N. The Contnct health care providers shall provide patients with the utmost care and attention. All patients shall be assured ol their privacy and personal dignity. The Contractor shall ensure strict compliance to the release of Protected Health Information in accordance with the Code 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" pa.ayaph 2.2.3, "Health Insurance Portability and Accountability Act (HIPM)" and paragraph 2.3, "General Guidelines on Releasing

Medical Information".

COMMUNICATIONS. The Contractorshall ensure contract providers maintain open and professional communication with memben of the Medical Staff, Complaints validated by the Hospital Accreditation Specialist and

Clinical Director or shall be reported in writing to the Contracting Officer (CO) and the Contractor for action.

ENGLISH LANGUAGE REQUIREMENT. The Contractor provide(s) shall read, understand, speak and write English fluently.

DOCUMENTATIONS. Contractor personnel shall prepare all documentation to meet or exceed established CMS standards and Cheyenne River IHS Medical Staff Bylaws, AVAILABILITY:

HOURS OF OPERATION: The OB GYN Physician will work every Tuesday and Wednesday between 8:00 a.m, and

8:00 p,m. with a % hour lunch break. Contract performance shall not be scheduled during Federal Holidays. The contractor is expected to be available dunng the clinic day, The Contractor may leave before 4:00 p.m. with the approval of the Project Officer, providing all scheduled patient care is completed. Hours are subject to change at the discretion of the Clinical Director or Deputy Clinical Director.

CoNTINUITY OF SERVICES/REPLACEMENT STAFF. The Contractor point of contact shall ensure qualified personnel are available to provide coverage at all times and will provide makeup days if unable to provide services.

The OB/GYN services are considered vital to the Govemment and must be continued with the minimal intenuption, In order to minimize intenupted services, the incumbent contractor shall exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor.

PERFORMANCE OF SERVICES DURING CRISIS DECLARED BY THE NATIONAL COMMAND AUTHORITY. On occasion, services may be required to support an activation or exercise of contingency plan outside the normal duty hours. Emergency situations (i.e. accident and rescue opentions, civil disturbances, natural disasters) may necessitate the contractor provide increased or reduced with the contractor for the cost of these emergency requrremenls.

RECORDS. The contractor shall document all patient encounters legibly in the patient medical record. All documentation shall be timed and dated. Verbal orders are to be used as infrequently as possible, In the event of a major disaster or code all verbal orders are to be signed off immediately following the code or disaster. All Medical Records must be signed by the providers and charge ticket completed at the end of the visit. All [iledical Records are to be completed within 24 hours of the provideds scheduled shift. All documentation shall meet the cunent Cl\4S guidelines.

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

PERSONNEL REQUIREMENTS

CONTINUING i/EDICAL EDUCATION (CME) / CERTIFIED EDUCATION UNITS (CEU) REQUIREMENTS, Maintain CME and review pertinent joumals, books and publications. Health care providers registered or certified by the national/medical associations shall continue to meet the minimum standards for CME to remain cunent. ClvlE hours shall be repo(ed to the credentials office for tracking by the CD.

LICENSURE/REGISTRATION. Contractor must maintain a cunent active and unrestncted license in at least one of the 50 United States or US tenitodes.

CERTIFICATION. The Contractor shall be board certified, or board eligible by the Amencan College of Obstetrics and Gynecology, lt is a condition of this conhact that all required certification in this statement of work remain cunenr during the life of this contract.

F0RMAL EDUCATION. The Physician must have a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited college or university in the specialty area required to complete the FTE, EXPERIENCE. The Physician must have a minimum of 3 years of expenence in field of primary care, preferably residency trained in Obstetrics and Gynecology to include residency and/or fellowship and show evidence of expenence employed as a OB/GYN Physician during this time, prior to beginning performance at Cheyenne River Health Center.

PERFORMANCE'BASED SERVICE DELIVERY SUMMARY. The contracto/s performance will be measureo based on the following Performance Requirements, The Performance Requirements will be measured against Govemment Perfonnance Standards and monitored in accordance with the following Methods of Govemment Surveillance or what is known as a Quality Assurance Surveillance Plan (MSP) to determine compliance. A 5% deduction will be assigned to each Performance Requirements not met. Deductions shall be assessed against individual invoices when services are not performed or do not meet contract requirements. Deductions will be done by the category that was deficient, Performance Standards

Perlormance TasKRequirement lndicator Standard/(AQL) Acceptable Quality

Level

Surveillance (QA)

Quality Assurance lncentive

Completion of documentation of patient record

All patient records must be documented accurately, correctly, and completely within

24 hours of patient visit

100Y0 Random observation and

HIM Report

5% deduction from weekly rnv0ice.

Deductions will increase by 1% in subsequent months.

Prompt and continuous coverage

Agency must provroe a competent Mid-

Level to ensure no gaps in c0verage.

100% Provider Schedule For every shift not covered by

Agency, the shift rate will be deducted Irom next submitted invoice

Credentialing Agency is allowed 3 business to submit required credentialing documentation

100% Credential Report 5olo deduction from weekly tnvoice.

Deductions will increase by 1% in su0sequent monms.

performance Evaluation. lf the contractor fails to perform required services at the acceptable quality level, payment may be withheld until the contractor makes coneciions. ln the event that the contractor falls to perform any required

,.ti,i.rr, ti.rr con *ill provide wntten notice of such to the contracting Specialist and cco and the contractor' The

Contracting Office will tssue fhe contractor a Contract Discrepancy Report (CDR) The contractor shall have seven tZi JenAJr Oavs to provide the Contracting Office with their response to the CDR. Upon evaluation of the i.'.tn.i.ii "i'p*se to the cDR for tasksiurveilled, the contractor's payment for the month in which the oerformance is question occuned will be calculated as outlined above'

Contractor payment. lfthe contractor fails to perform required services at the acceptable quality level, payment may be withheld until contractor makes corrections.

Contractinq Oflicer's Representative Desiqnation

The contracting Officer Representative (COR) designated for this Prolect is:

Cheyenne River Health Center

24276 166tr Street, Airport Road

Eagle Butte, SD 57625 office: 605-964-7724

Fax: 605-964-0522

The COR is resPonsible for:

Monitoring the Contractois technical progress;

lnterpreting the statement of work;

Technical evaluation as required:

Technical inspections and acceptance required by this contract; and' n.ii.irg thr'ao.t"ctor in the resolution o{ technicat probtems encountered during performance of this contract n c.

d

The contractor shall be paid a fixed flat rate of per hour. No differential pay for govemment holidays, compensation time, and night differential. Holidays and weekends shall be included as part of the work period and considered regular hou|s.

Quality Assurance Surveillance Plan (MSP). The purpose of the QASP is to provide a government developed system to assure the use of quality assurance methods in the administration of the performance based acquisition standards. The intent is to ensure that the Conhactor performs services for the Cheyenne River Health Centerthat are provided in accordance with performance requirements set forth in the contract documents, that the govemment receives the quality of services called for in the contract and that the government only pays for the acceptable level of services received.

The plan provides the basis forthe COR to evaluate the quality ofthe contractor's performance. The oversight provided for in the contract and in this plan will help ensure that service levels reach and maintain the reouired levels throughout the contract term. Further, this plan provides the COR with a proacttve way to avoid unaccepiaore or deficient performance and provides venfiable input for the required past performance ivaluations.

GOVERNMENT FURNISHED PROPERTY AND SERVICES.

EQUIPMENT/OFFICE. I have ervjces required by this contrac e offic This wilj also include, but not lim lejax hysician will be authonzed to use all areas of the medical treatment fac in similar positions. Tne sameieitrictions apply to the c0ntractor as any other Indian Health s.r,.. o.ojnt#lllt' use these areas for official business activities only.

PERSONAL PROTECTIVE EQUIPMENT (PPE). The Government willfurnish the contract provide(s) with appropriate PPE. The Government will be responsible for any repair, cleaning and inventory requireJio1. itrr ppg This does not include any type of unilorm or laboratory coat.

lDENT|FlcAlToN cREDENTlALs. The Cheyenne River Health Center will provide each contract provider wth the required identification card.

FoRMS. The Cheyenne River Health Center will provide required Govemment forms used in the performance of servces.

9UlPllESt The Cheyenne River Health Center will provide medical and non-medical supplies commonly used in the facility for the care and management of patients and the performance of the requirements or tnis coniiaa

HouslNG. contractor shafi be responsibre for a[ appricabre Federar, state, and Locar Taxes, Mears, Travel/Transportation, lodging, and per diem, Lodging is available in govemment housing at prevaili able, ano must tor. There are limited fumished units available for cont and prevailing rates range from Single _$34.72 daily, Shared 916,59 daily and Trailer pads _ im Jr..uo1..t to change).

Local Hotel: Cheyenne River Motel (605) 964_gggg.

SERVTCES

ntract provjders participate in the Cheyenne River Health ude one additionalday. provideB must arrive on a tation, which must be completed in the Monday_

Adminstrative Support. cheyenne River Health center will provide normal office administrative support services, toinclude telephone and utilities.

Patient Scheduling, Facility personnel willassistin patient scheduling. Complete administrative control ofthe patient shall remain with the facility.

Cheyenne River Health Center will provide all other ancillary personnel services required, including personnel to move patients or equipment.

CONTRACTOR FURNISHED ITEMS AND SERVICES

GENEML. Except for those items or services specifically stated in Section lll to be Govemment fumished, the

Contractor shall furnish eveMhing required to perform this contract in accordance with all of its terms. The

Contractor shall provide adequate credentialed staff during the regular scheduled services dates and cover the salary for an ancillary staff brought to the service unit. Ancillary staff must have licensure/certification and competencies on file with the Contracting Officer.

coNTRACTOR OWNED EQUIPMENT. The provider will provide his/her own stethoscope, pen lights, etc., and white physician coat.

lNlTlAL INSpECTION. Contractor owned equipment will be inspected and approved by the biomedical equipment maintenance sectton prior to use in the facility.

GENEML INFORMATION

PERSONNEL.

potNT oF coNTACL The Contractor shall provide a point of contact who shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this iontract. The Contractor shall designate this individual, in writing, to the Contracting Officer before the contract start date. An altemate may be designated, br t the Contract shall identify those times when the altemate shall be the primary point of contact.

cRIMINAL BACKGROUND tNVESTIGATI0N. The Govemment will conduct at government expense, a state criminat nstory cneck on individuals providing direct, unsupervised -child care services under this contract Asa

,niniru. the bontractor shall contact the Chlyenne River Health Center Contracting Officer for obtaining all necessary forms and dlrections for fil hired at the beginning of the contract award date. Contractor shall submit days after award date to the Contracting Offlcers for fingerprinted. Requests for personnel hired subsequ

Government no later than five (5) working days from substitute contract personnel fulfilling contingency situatio s of substitutes and credentials shall be provided 15 calend

Contractor personnel receiving an unfavorable background

Center may employ an individual pending completion of successful background checks'

Background checks will be based on fingerprints oJ indlvidual obtarned by a Govemment law enforcement officer and ririir. ..ror.i.o through the FederaiBureau of lnvestigation (FBl) and state cnminal history repositones lndividuals shall have the right to obtain a copy of any background check pertaining to themselves and to challenge the accuracy and completeness of the information contained in the report

Individuals who have prevtously received a background check shall provide proof of the check to the cEo or obtain a new one.

coNFLlcT oF INTEREST. The contractor shall not employ any person who is an employee of the united states

Governmen eate a conflict of interest The Contractor shall not employ any personWnonServices),un|esssuchapersonseeksandreceives approval In

APPEARANCE. Employees are expected to comply with reasonable dress, grooming and hygiene standards based on comfort, productivity, health and type of position occupied, Employee attire will be in good repair, and should not be considered offensive, disruDtive or unsafe.

Contract providers shall display their identification badge on their outer clothing.

PROTECTIVE CLOTHING. When required and supplied by the Govemment, the provider shall wear special protective clothing and shoe coven. When duties will be performed in specified areas, a disposable protective hood shall be wom to ensure infection control standards are met. The Govemment will provide this hood. These items shall remain the property of the Government and shall not be removed from the facility. After use, protective clothing shall be tumed tn or destroyed as directed by the Infection Control policy.

PRIVILEGING REQUIREMENTS. The contract providers' credentials shall be reviewed by the Credentialing Specialist and the Credentialing Committee. The Contractor is responsible for ensuring that proposed providers possess the requisite credentials to enable granting of privileges by the Cheyenne River Healtn benterMedical Staff sufficient to allow for pertormance of al tasks identified. Medical Services cannot be performed by a contract Physician until professional staff membership and the Great Plains lndian Health Service Goveming aoOy tlis granted clinical privileges in writing.

Initial applrcatjons for clinical privileges, to include credentials action history, malpractice history, and certified true copies of the documents listed below, shall be submitted to the Cheyenne iiiver ilealth c.nt.rtreornii.iinf Committee, through the credentialing Specialist, no later than 3 caiendir days after receipt or notrcL oiconiract award.

a Copy of valid, cunent unrestricted state license and applicable Board certification, (Submission of required with proposal).

b. Documentation of continuing education and trainino.c Cunent Basic Life Support (BLS), and Advances Cirdiac Life Support (ACLS). (Submission required with pr0posat).

A signed consent for release of information.

ificate.

olds or has held a license to practice related services.

sst0nal resume.

examinins phvsician statins thar the emprovee is rre"*:1f:*il:::t iJ"ltlltiLl'nlil,iJ,*' examination shall be cunent as of 12 months prior to application foi privireges.

t.

I h.

Applications for privileges will be screened through the National practitioneB Data Bank.

Re-appointment shall occur no less than every two years, in accordance with cheyenne River Health center MedicalBylaws.

DENIAUTERMINAT|0N 0F pRtVtLEGES. Actions to timi

REVIEW oF cREDENTIALS PACKAGES The Govemment reserves the right to limit the number of credentiaringpackages it will evaluate.

HEALTH REQUIREMENTS

The contract provider shafl provide oroof of cunent immunizations (Hep B, MMR, Varice[a, Tdap, Fru) status ano a ::rilr-lyillil .he past vear. The_contractor shir .;;tt;riri;iHs inrection lonlioirerpi.vrr'r,rrir, ,rosarety procedures, practices,, and standards.

EMERGENCY HEALTH CARE. Cheyenne River Health Center will provide emergency health care for the contract providers for injuries incuned while on duty in the facility. These services will be billed to the Contractor at the cunent full reimbursement rate.

MEDICAL QUALITY IMPROVEMENT/RISK MANAGMENET (QI/RM),

The contract provide(s) shall participate in Ql/RM activities to the extent required by Section 2C, AFI 44-119 and the individual Cheyenne River Health Center Ql/RM plan or regulation.

The Government will evaluate the provider's professional, as differentiated from administrative, performance under this contract using Quality lmprovement standards specified in paragraphs 2.1 and 2.2. Nothing in this paragraph precludes the Government from also conducting inspections under the Inspection/Acceptance requirement of FAR clause 52.212-4.

PERFORMACE EVALUATION

The Cheyenne River Health Center will evaluate the contractors' performance under this contract. Evaluations will be provided to the contactor, in writing. These evaluations may be used by as a record of contract performance history for the purpose of evaluation in other competitive or non-competitive acquisttions.

FREEDOM OF INFORMATION ACT (F0lA) PROGRAM. All FOIA request shall be delivered immediately to the

Medical Records Supervisor.

PHYSICAL ACCESS. The Contractor shall retum identification badge to the lT Department and house keys to the

Housing Officer, upon completion/termination of the contract.

Physical Security. The contractor shall safeguard all government property, including controlled forms provided for contractor use. At the close of each work period, government equipment, facilities, and other valuable materials shall be secured.

WeaDons, Firearms, And Ammunition. Conkactor employees are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their contractor-owned vehicle or privately-owned vehicle while on the

Cheyenne River IHS compound.

Reporting Requirements. Contractor personnel shall report to an appropriate authonty any information or circumstances of which they are aware may pose a threat to the security of IHS personnel, contractor personnel or patients.

The contractor shall prohibit their use of keys, issued by the govemment, by any persons other than the contractor's employees and the opening of locked areas by contractor employees to permit entrance of person other than contractor employees engaged in performed of contract work requirement in those areas