SOW Orthopedic Services.pdf

Department of Health and Human Services Indian Health Service

Clinton Indian Health Center

Statement of Work (SOW) Orthopedic Services

1. PURPOSE OF THE PROJECT

The Clinton Service Unit (CSU) – Clinton/El Reno/Watonga Indian Health Center (C/E/WIHC) Indian Health Services (IHS) has a requirement/need for Orthopedic Services. Contracted Orthopedic Services are necessary to support and supplement health care within the Joint Commission accredited CSU facilities.

The Clinton Service Unit is a Joint Commission accredited federal facility. To meet the mission, Orthopedic care is a medical modality that has been deemed necessary to augment the services within the facility and as such are necessary to support and supplement health care.

The Indian Health Service, an agency within the Department of Health and Human Services (HHS), is responsible for providing federal health services to American Indians and Alaska Natives. The mission of IHS is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level and assure that comprehensive, culturally acceptable personal and public health services are available and accessible to members of the 566 federally recognized Tribes across the United States.

2. DETAILED DESCRIPTION OF THE TECHNICAL REQUIREMENTS

The care provided by the contractor shall be as comprehensive as the Indian Health Service supplied facilities;

equipment and support services permit. The contractor shall provide Orthopedic services for patients as required by this statement of work (SOW) and in accordance with the terms and conditions of this contract.

Contract Orthopedist shall provide services to eligible beneficiaries of the Indian Health Service who present themselves for treatment. Contractors shall provide diagnostic and treatment services including minor procedures as determined by evaluation and provide follow-up care as identified by treatment plan.

Services shall be fully coordinated and integrated with the patient’s primary care provider within the Clinton Service Unit with respect to services provided and professional relationships.

Contractor shall furnish services to include but not limited to the following:

• Contractor shall provide diagnostic and treatment services including minor procedures as determined by evaluation and provide follow-up care as identified by treatment plan as outlined within Oklahoma statutes governing orthopedic care.

• Contractor shall provide diagnostic procedures including orthopedic exams, range of motion exams, muscle strength testing; request diagnostic imaging procedures including MRI, CT, x-ray, and ultrasounds.

• Provide treatment modalities including exercise and rehabilitation, casting, strength and conditioning, oral and injection based medication therapy, passive stretch (independently or in conjunction with cryotherapy substance).

• Recommend proper therapeutic measures (exercise, stretches, etc.) for augmenting services.

• Recommend referred care for surgical intervention, augmentation for pain management strategies, and any other orthopedic related treatment strategy deemed medically necessary.

• Referrals shall be in conjunction with staff physician and shall utilize the Purchased Referred Care system.

• Provide and order medically indicated treatment.

• Prescribe medication.

• Chart, record and document in the Electronic Health Record (EHR) system provided by the facility or on any paper forms approved by the facility in case of EHR outage.

• Physician shall be proficient in electronically documenting services utilizing the appropriate electronic medical record system for patient encounters.

• Documentation of services shall be in accordance with clinic practice standards and applicable to all regulatory guidelines.

• Contractor shall participate in quality assurance activities that ensure quality patient care as well as efficient use of hospital resources. These activities may include, but not limited to, chart review and discussion with the Clinical Director of his designee.

• Contractor shall schedule in advance clinic based on facility needs and the vendor’s availability.

• The contractor shall advise the Clinical Director of designated representative of any problem encountered, in connection with meeting the patient care needs.

• Develop a working understanding of the Joint Commission standards, the Centers for Disease Control guidelines and Association of Infection Control guidelines.

• Services must be fully coordinated and integrated with the patient’s primary care provider within the

Service Unit with respect to services provided and professional relationships.

3. PERIOD OF PERFORMANCE

3.1. The Period of Performance will be 12 months from date of award.

3.2. Contractor shall provide 48 hours clinical hours each month as agreed upon between Contractor and the

Clinton Service Unit. The government reserves the right to negotiate the addition/reduction of hours, location, etc. as mutually agreed upon by contractor.

4. LEVEL OF EFFORT

4.1. The contractor shall provide orthopedic care as outlined within scope noted above.

4.1.1. Provide a minimum of eighteen (18) patient encounters per 8 hours. Additional provider encounters shall be allowed and will be coordinated by specialty clinic manager.

4.1.2. Communicate, in a timely fashion, to the referring primary care provider all clinical information necessary for continuity of care and documentation of quality of performance.

4.1.3. Observe and assess patient’s clinical condition; recognizing, identifying and interpreting situation and immediately deciding proper action and therapeutic care plan.

4.1.4. Formulate proper diagnosis and develop plan of care for individual patients as indicated.

4.1.5. Recommend proper therapeutic measures (exercise, stretches, etc.) for augmenting services.

4.1.6. Document all patient encounters in the patient’s electronic health record within 24 hours of clinic completion.

4.2. The Clinton Service Unit shall have the right to provide continual review of all patient encounters and ensure all required documentation is provided.

4.3. Failure, on the part of the Contractor, to provide care as identified may result in the suspension of contract for services.

4.4. The Clinton Service Unit shall retain the right to implement additional contractor responsibilities if, during the course of the contract, additional responsibilities become necessary to maintain continuity of care and quality of performance, however, these additional responsibilities, if implemented, do not alter nor effect negotiated and contracted rate fees.

4.5. Training: Contractor shall maintain proper licensure at all times and provide copy of license credentials as required.

4.6. Rates of Payment: Contracted rates shall be established as identified within the attached quote for services and shall be invoiced on a total completed clinic hourly rate based invoice and submitted in accordance of this Statement of Work.

5. SPECIAL REQUIREMENTS

5.1. In accordance with HHSAR 304.1300(b) non-routine contractor employees shall comply with OPDIV

DHHS/SE Region – Human Resources, Security Clearance Guidance – Visitors (3/29/12) policy for contract performance period. Contractor employees will be required to obtain a visitor’s pass upon arrival for services from Facilities Management.- (Security Clearance for on-site human services)

5.2. The US PHS Clinton Indian Health Center is a tobacco/smoke free environment (buildings and grounds).

No tobacco/smoking use will be tolerated during service.

5.3. Security Requirements: Contractor personnel will be required to contact the government designated point of contact upon arrival when reporting for service calls or delivery supplies. The contractor shall be responsible for the security of all organizational information. Current rules and regulations applicable to the premises, where the work shall be performed shall apply to the contractor and its employees while working on the premises. These regulations include but are not limited to, escort by Clinton Indian Health Center official, presenting valid identification, smoking restriction and any safety procedures.

5.4. The contractor shall not disclose or cause to disseminate any information concerning operations of Clinton

Indian Health Center. Such action(s) could result in violation of the contract and possible legal actions.

5.4.1. All inquiries, comments, or complaints arising from any matter observed, experienced or learned of as a result of or in connection with the performance of the contract, the resolution of which may require the dissemination of official information, shall be directed to the government’s designated representative.

5.5. Contractor must comply with the Stark Law that prohibit physician self-referral if the physician (or an immediate family member) has a financial relationship with that entity.

5.5.1. Contractor shall possess the following requirements:

5.5.2. Rubella immunity must be documented either by serologic test or proof of immunization

5.5.3. A yearly PPD is required for all persons who have had no previous positive tuberculin skin test

5.5.4. A series of three (3) Hepatitis B immunizations or serologic proof of past infection is required

5.5.5. A yearly influenza vaccination

5.5.6. COVID-19 vaccination and necessary boosters to maintain vaccinated status

6. DELIVERABLES AND REPORTING REQUIREMENTS

6.1. Delivery: The contractor will coordinate the appointment and schedule with the designated government employee.

6.2. Contractor Point of Contact: The contractor shall furnish one designated point of contact (POC) to the government’s designated representative for coordination of supplies, delivery, and/or maintenance. The POC will be empowered to make daily decisions to ensure that the contract implementation and day-to-day maintenance meets the terms and conditions of this contract.

6.3. Contractor’s Phone Numbers: The contractor shall provide a toll-free telephone number for service calls, which must be answered during at least eight working hours, between 8:00 am and 4:30 pm, Monday through Friday.

6.4. Personnel Qualifications: The qualifying Orthopedic physician:

• Must possess a current MD or DO unrestricted license.

• Must be residency trained in their specialty.

• Must be Oklahoma Medical Board Certified in Orthopedic Services.

• Physician shall apply and be accepted as clinic/hospital associate member of on-site Medical

Staff.

• Shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to patients of the Native American/Alaska Native communities.

• Shall have a current DEA license.

6.5. Credentials:

6.5.1. Physicians shall be credentialed and have privileges as active members of the medical staff. The physician shall be required to provide completed applications for Medical Staff appointments and privileges, as specified in the By-laws, for all providers to the Clinical Director and at least 30 (thirty) days prior to assignment for periods of coverage.

6.5.2. Credentialing activities shall require a minimum of thirty (30) calendar days to insure (1) that written or printed information is received at the on-site Hospital Quality Assurance Department from the National Physicians Data Bank, (2) that three letters of reference for each sub-contractor are received in the Credentials Office and are recent within the last year, and (3) the credentialing package (application for appointment and request for privileges) is completed and received by the Medical Executive Committee and OCA IHS Governing Board.

7. GOVERNMENT FURNISHED PROPERTY, FACILITIES AND SERVICES

7.1. The Government shall supply all records of consultation, examination, surgeries/procedures and services of patients’ required in the performance of this contract will remain the property of and subject to the exclusive control of the Clinton Service Unit. The Clinton Service Unit will provide materials, support staff and equipment necessary for the performance of this contract. The Contractor shall provide all services within the Clinton Service Unit facilities.

8. CONTRACTOR FURNISHED PROPERTY, FACILITIES AND SERVICES

8.1. The government assumes no responsibility of negligent acts of the Contractor. Therefore, the Contractor is responsible for personal insurance if the Contractor indicates that it is necessary. The Contractor will hold harmless and indemnify the government against any or all loss, cost, damage, claims, expense or liability whatsoever as a result from the performance of the Contractor. The Contractor will hold the Federal Government and its agents including the Clinical Director and the Governing Body immune from civil or professional liability for all acts related to quality care management and enforcement of this contract.

9. CHANGES TO THE STATEMENT OF WORK (SOW)

Any changes to this SOW shall be authorized and approved only through written correspondence from the Contracting Officer. Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor.

10. DELIVERABLES/PERFORMANCE MATRIX

10.1. (A narrative of deliverables to satisfy your request should be provied in section 10.)

Measureables to be evaluated at the conclusion of awarded contract:

Performance is acceptable ☐YES ☐NO ☐N/A

Responsibilites of contractor have been fulfilled, including reports submitted on time.

☐YES ☐NO ☐N/A

Upheld Standards & Guidelines of accrediting organizations, national, state, and local regulating agencies, and CSU Policy and Procedures

Quality Control met and provided when required ☐YES ☐NO ☐N/A

Quality Improvement information provided when required. ☐YES ☐NO ☐N/A

Customer Service was provided to CSU Vision “Exceed the Need”.

Additional Measureables to be evaluated for awarded contract providing temporary employees (excluding medical staff).

License / BLS were maintained, current at all times and provided to CSU Human Resources prior to expiration

Evidence of staff competency provided when requested & required prior to expiration (Q3 years).

Staff competency conducted by contractor is acceptable and submitted prior to expiration (Q3 years).

Comments:

Department Supervisor Signature:___ ______________________

Administrative Officer Signature:_________________________