draft_PWS_Physician Assistants_15 July 2022.docx

Performance Work Statement (PWS) Physician Assistant (PA) Services Department of Emergency Medicine Brooke Army Medical Center

1. GENERAL

1.1. This is a Personal Services contract (as defined by FAR Subpart 37.104) and is intended to create an employer-employee relationship between the Government and the individual Health Care Providers (HCP) only to the extent necessary for providing the health care services required under the contract. The performance of health care services by the individual HCPs under a personal services contract are subject to day-to-day supervision and control by health care facility personnel comparable to that exercised over military and civil service HCPs engaged in comparable health care services. Any personal injury claims alleging negligence by the individual HCPS within the scope of the HCP.s performance of the personal services contract shall be processed by DoD in the same manner as claims alleging negligence by DoD military or civil service HCPs. The contract does not create an employer- employee relationship between the Government and any corporation, partnership, business association or other party or legal entity with which the HCP may be associated. The authority for this contract is 10 United States Code 1089 and 10 United States Code 1091.

1.1.1. DESCRIPTION OF WORK.

The Contractor shall provide the services of three (3) CMEs Emergency Medicine Physician Assistants for the Rapid Treatment Area (PA-RTA) and two (2) CMEs Emergency Medicine Physician Assistants in support of the Emergency Medicine Physician Assistant Graduate Medical Education (PA-GME) for duty at the Brooke Army Medical Center as required by this Performance Work Statement (PWS) and in accordance with (IAW) the terms and conditions of this contract.

1.1.1.1. Background: The mission of the military healthcare system (MHS) is to enhance our Nation’s security by ensuring the nation has a healthy military force capable of providing the full range of military operations supported by a combat ready healthcare system sustaining the health of DoD beneficiaries. Health care services for eligible MHS beneficiaries are provided at Military Treatment Facilities (MTFs) located on or near military installations or posts. The MTF may be a clinic, hospital, or medical center. Clinics are outpatient facilities offering primary care or simple specialty care (routine exams, tests, treatments). The clinic may be a stand-alone site or a satellite of a larger clinic, hospital, or medical center. Hospitals offer more complex, resource-intensive secondary care (e.g. inpatient care, surgery under anesthesia) and primary care at outpatient clinics inside and outside the hospital. Medical Centers offer tertiary (sophisticated diagnosis/treatment of any ailment), secondary, and primary care, hospital services, preventive services, blood bank, and outpatient services. In addition, Medical Centers offer graduate medical education programs for physicians and other training programs for nursing and ancillary personnel.

1.1.1.2. Scope of Work: The purpose of this contract is to secure Physician Assistant-RTA services and Physician Assistant-GME services in support of Emergency Medicine Operation at the Brooke Army Medical Center (BAMC).

1.1.1.3. Constraints: This contract is subject to the availability of funds. No other none constraints exists

1.1.1.4. All persons performing work under this contract shall be and shall remain employees of the contractor and not employees of the government.

1.1.1.5. BAMC is a level one trauma center and currently provide trauma support for 50% of San Antonio’s trauma care. BAMC has the Institute of Surgical Research, the Burn Center, and the Center for the Intrepid to support America’s Wounded Warriors; as well as provides the maternal child services and neonatal intensive care unit.

BAMC provides the full spectrum of services associated with level one trauma centers and robust Graduate Medical

Education Programs. In addition, both sites provide training sites for multiple medical training programs for enlisted and officer medical specialties.

1.1.1.6. All services shall be provided in accordance with established standards, principles and ethics of the profession and applicable professional specialty organizations, The Joint Commission standards and Accreditation Association for Ambulatory Health Care (AAAHC), applicable Department of Defense (DoD), Army specific regulations, directives, and policies, and MTF specific policies, procedures, and job descriptions. The Physician Assistant (RTA/GME) shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association’s Bill of Rights for Patients.

1.1.2. PERFORMANCE MEASURES

1.1.2.1. Outcome. The contract Health Care Provider will provide Emergency Medicine Physician Assistant services at a standard enabling the MTF to provide such services at a high level of quality.

1.1.2.2. Acceptable measures include: shift fill rate - 95%; substantiated patient complaints- max 2 per year per provider; no provider initiated cancellations of treatments except as medically required by patient. Other performance evaluation factors will be monitored that are not qualified by numerical measurements which include: contactor providing personnel exceeding the minimum qualifications standards; patient customer service comments; provider and contactor relationship with hospital staff/government contacting personnel; compliance with hospital policies and procedures.

The Physician Assistant Graduate Medical Education (PA-GME) will function as a mentor and preceptor for the Emergency Medicine Physician Assistants (EMPA) students based on the needs of the program. As a preceptor, must not receive any complaints from students concerning educational matters. Additionally as a preceptor the PA (GME) will be required to complete student evaluation and provide educational feedback to both Emergency Medicine faculty and students. Assist EMPA residents with scholarly activities, and conduct liaison with Institutional Review Boards of each of the associated research institutions affiliated with the EMPA Fellowship.

1.1.2.3. CORE Duties

1.1.2.3.1. The PA- GME will provide a full range of Physician Assistant services in primary and specialty medical care within limits of training and privileges granted by the MTF (e.g. provide general screening and medical care and examinations of patients for routine, acute and chronic conditions involving any and all organ systems; provide immunizations; diagnose, treat and counsel patients as indicated)

1.1.2.3.2. Technically direct and provide care for a variety of diseases and types of injuries (i.e., acute, chronic, major and minor trauma), and the skills to recognize emergency conditions in order to diagnose, prescribe for and treat diseases, disorders, and injuries, and refer the more complex cases and serious conditions to qualified medical personnel and perform designated treatment

1.1.2.3.3. Technically direct and teach students, provide feedback on performance and evaluate techniques used by medical students.

1.1.2.3.4. Promote preventive care and health maintenance including annual physicals, positive health behaviors and self-care through both formal and individual education and counseling.

1.1.2.3.5. Prescribe in accordance with approved treatment protocols and Pharmacy and Therapeutics Committee approved medications and immunizations.

1.1.2.3.6.

1.1.2.3.7. Identify a medical problem and determine appropriate action to meet the problem, including referral to a physician.

1.1.2.3.8. Perform specific diagnostic and therapeutic practices and procedures in accordance with scope of practice.

1.1.2.3.9. Establish collaborative rapport with physician, nursing and others in order to promote and facilitate primary care services.

1.1.2.3.10. Teach patients and family member’s healthy regimen and responsibility for achieving wellness.

1.1.2.3.11. Attend staff meeting to provide case discussion, continuing education and continuous quality improvement.

1.1.2.4.1. The Physician Assistant Rapid Treatment Area (PA-RTA) will provide a full range of Physician Assistant services in primary and specialty medical care within limits of training and privileges granted by the MTF (e.g. provide general screening and medical care and examinations of patients for routine, acute and chronic conditions involving any and all organ systems; provide immunizations; diagnose, treat and counsel patients as indicated).

1.1.2.4.2. Technically direct and provide care for a variety of diseases and types of injuries (i.e., acute, chronic, and minor trauma), and the skills to recognize emergency conditions in order to diagnose, prescribe for and treat diseases, disorders, and injuries, and refer the more complex cases and serious conditions to qualified medical personnel and perform designated treatment.

1.1.2.4.3. Technically direct and teach other staff, provided educational lectures and participate in in-service training to staff members.

1.1.2.4.4. Promote preventive care and health maintenance including annual physicals, positive health behaviors and self-care through both formal and individual education and counseling.

1.1.2.4.5. Prescribe in accordance with approved treatment protocols and Pharmacy and Therapeutics Committee approved medications and immunizations.

1.1.2.4.6. Identify a medical problem and determine appropriate action to meet the problem, including referral to a physician.

1.1.2.4.7. Perform specific diagnostic and therapeutic practices and procedures in accordance with scope of practice.

1.1.2.4.8. Establish collaborative rapport with physician, nursing and others in order to promote and facilitate primary care services.

1.1.2.4.9. Teach patients and family member’s healthy regimen and responsibility for achieving wellness.

1.1.2.4.10. Attend staff meeting to provide case discussion, continuing education and continuous quality improvement.

1.1.2.3. How Measured. Department/clinic supervisory personnel will monitor provider performance through government information systems and records, patient records, customer service information, contractor reports, and time sheets.

1.1.2.4. Performance Requirements Summary. The following Performance Requirements Summary (PRS) will be utilized to assess the entire contract.

1.1.2.5.

1.1.3. Acceptable Quality Levels (AQLs)

1.1.3.1. The minimum level of metrics must be maintained to include a PAs (RTA/GME) overall fill rate, on-time fill percentage, turnover rate, and replenish rate. Acceptable Quality Levels (AQLs) on these metrics are listed below.

1.1.3.2. Clinical Documentation: Prepares medical records, reports, forms and required clinical documentation within 72 hours of the episode of care; defined as the date of clinical service to the patient. All clinical records shall be closed/completed for the purposes of continuity of care and clinical billing. A complete record is defined by all required provider entries are signed within MHS GENESIS for the patient encounter. Quality assessment reviews will be conducted as required.

1.1.3.3. Overall Fill Rate: The overall rate is the percentage of the total amount of required FTE-weighted days (i.e., purchased) filled in a reporting period. The overall fill rate is calculated by dividing the sum of FTE-weighted days PAs (RTA/GME) fill a position in a reporting period by the total number of required FTE-weighted days in the same reporting period.

1.1.3.4. On-Time Fill Percentage: Percentage of FTEs filled by the required start date during the reporting period. The on- time fill percentage is calculated by dividing the number of initial and replacement FTEs assigned with a required start date in a reporting period filled on time by the total number of initial and replacement FTEs assigned with a required start date in the same reporting period.

1.1.3.5. Turnover Rate: The number of FTEs that turned over during a reporting period. The turnover rate is calculated by dividing the number of assigned FTEs turned over in a reporting period (for any reason unless the KO informs the PMO not to count the turnover) by the total number of assigned FTEs in the same reporting period. Turnovers occurring less than 30 calendar days before the end of the TO will not be counted as a turnover for this metric.

1.1.3.6. Replenish Rate: The replenish rate is a measure of how well assigned positions remain filled in a reporting period. The replenish rate is calculated by dividing the sum of FTE-weighted assigned PAs (RTA/GME) days in a reporting period by the sum of FTE-weighted days available subsequent to initial PA (RTA/GME) assignment start dates in the same reporting period.

1.2. QUALIFICATIONS.

1.2.1. The PA-GME shall have sufficient experience and skills to be able to adequately perform the tasks identified in the work statement as stated below.

1.2.2. The PA-GME is required to have and maintain a current, valid, unrestricted license to legally Practice in one of the 50 states in the United States, or the District of Columbia, the Commonwealth of Puerto Rico, or a U.S. Territory.

1.2.3. License and or Certification requirements. BAMC requires a PA to possess certification by the National Commission on Certification of Physician Assistants (NCCPA). PA must have and maintain a valid, unrestricted license to practice medicine in one of the 50 states in the U.S., the District of Columbia, the Commonwealth of Puerto Rico, Guam, or the U.S. Virgin Islands, IAW AR40-68. Candidates must have ACLS, ATLS, and PALS certification. Candidates must possess and maintain a valid Basic Cardiac Life Support (BCLS) certification during the contract period of performance.

1.2.4. The PA-GME shall be a graduate of an Emergency Medicine Physician Assistant (EMPA) Fellowship training program, shall have a minimum of two years as a practicing EMPA in the last four years. The PA-GME shall have at least one year's experience as teaching faculty at an EMPA Fellowship Program.

1.2.5. The PA-GME must have proven academic potential demonstrated by an established history of teaching and specialty society membership.

1.2.6. All contract HCPs shall be able to read, write, and speak English well enough to effectively communicate with patients and other HCPs.

1.2.7. Contract HCPs shall be required to meet Continuing Medical Education (CME) requirements. The government will not reimburse for these costs.

1.2.8. The PA-RTA shall have sufficient experience and skills to be able to adequately perform the tasks identified in the work statement as stated below.

1.2.9.

1.2.10. The contact HCP is required to have and maintain a current, valid, unrestricted license to legally Practice in one of the 50 states in the United States, or the District of Columbia, the Commonwealth of Puerto Rico, or a U.S. Territory.

1.2.11. License and or Certification requirements. BAMC requires a PA to possess certification by the National Commission on Certification of Physician Assistants (NCCPA). PA must have and maintain a valid, unrestricted license to practice medicine in one of the 50 states in the U.S., the District of Columbia, the Commonwealth of Puerto Rico, Guam, or the U.S. Virgin Islands, IAW AR40-68. Candidates must have ACLS, ATLS, and PALS certification. Candidates must possess and maintain a valid Basic Cardiac Life Support (BCLS) certification during the contract period of performance.

1.2.12. The contractor HCP shall have a minimum two years as a practicing PA in an Urgent Care Center or Emergency Department in the last four years.

1.2.13. All contract HCPs shall be able to read, write, and speak English well enough to effectively communicate with patients and other HCPs.

1.2.14. Contract HCPs shall be required to meet Continuing Medical Education (CME) requirements. The government will not reimburse for these costs.

1.3. ADMINISTRATIVE

1.3.1. Neither uniformed personnel nor Government civilian employees shall be employed to perform services under this contract.

1.3.2 MHS-GENESIS (automated documentation). MHS GENESIS, an electronic health record for the Military Health System (MHS) and charting system for Physician Assistants at BAMC. It provides enhanced, secure technology to manage health information; a single health record for service members, veterans, and their families; Navigates the MTF’s appointment scheduling program, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the MTF. The Government will provide training to contract HCPs in the MHS Genesis and/or other procedures that the medical activity's staff is required to use. Access to such patient data systems is an "Automated Data Processing Sensitive" position requiring compliance with AR 380-19 and AR 380-67.

1.3.2.1. The Government may elect to provide unique government training to contract HCPs who are performing services under this contract. If the government elects to provide such training, the government will provide such training at no additional expense to the contractor or to the contract HCPs. When directed by the contracting officer, contract HCPs shall attend all such training in a paid status as part of the normal services required and billed under the contract. If determined by the contracting officer, such training may require a performance commitment by the contractor and the contractor shall reimburse the government (by means of a reduction in an invoice) if a contract HCP fails to satisfy the performance commitment after the HCP receives the unique government training. The amount of the reimbursement shall be the prorated cost of the training, calculated based on the total cost of the training and the number of months by which the contract HCP fails to complete the performance commitment. The length of the performance commitment shall be 12 months or until the end of all performance under this contract, whichever occurs first.

1.3.2.2. The government will furnish up to 4 hours of paid training in the use of the MSH GENESIS systems. The COR or department representative will schedule training. The contract Physician Assistant (PA) or Nurse Practitioner (NP) shall have received training on MHS GENESIS and all applicable computer systems prior to commencing services under this contract. Required training will be paid by the government. Training on the following systems is a condition of employment, MUSE: EMS System; CIS, and any future charting changes. The training will be performed by the Government.

1.3.2.3.

1.3.4. The Contract HCP shall comply with the local installation requirements for vehicle registration and operation on the military facility. Any vehicle operated by the contractor or its employees in performance of this contract must have the minimum liability coverage required by the state in which the installation is located.

1.3.5. Health. All contract HCPs performing services under this contract shall comply with the health and immunization requirements as stated in Supplement to PWS, entitled “Health and Immunization Requirements”, at the time of initial request for clinical privileges and annually thereafter. Backup/replacement contract HCPs shall be required to provide equally current certification of health at the time of initial request for clinical privileges, and annually thereafter. The expense for all physical examinations to comply with the health requirements shall be borne by the contractor at no additional cost to the government.

1.3.6. REPORTS. The contractor shall submit additional reports to the Contracting Officer (KO) and Contracting Officer Representative (COR) upon request for use in monitoring contractor performance. Such reports include, but are not limited to, personnel recruitment, credential status, projected losses, PA assignments, and projected time off.

1.3.6.1 The contractor shall provide a monthly report to the COR by the 15th working day of each month which provides a consolidated status of profile packets (e.g., number of packets submitted, packets pending approval, accepted packets, rejected packets per category).

1.3.6.2 The contractor shall submit a monthly report to the COR by the 15th working day of each month that identifies compliance with annual and mandatory requirements, to include health, ocular and immunization (PPD) requirements, fit testing requirements (as needed), licensure renewals, certification renewals, life support training renewals, annual competency requirements and annual training requirements. This monthly report shall detail status of licensure, certifications, and health and immunization status and shall include expiration dates and projected renewal of mandatory requirements such as licensure, certifications, life support courses, annual training requirements, and health requirements (e.g., TB, influenza).

1.3.6.3 The contractor shall provide a monthly report to the COR by the 5th working day of each month identifying fill and turnover rates by specialty and work unit.

1.3.6.4 The contractor shall provide a quarterly report to the COR by the 5th working day of the month immediately following the end of the quarter (i.e., January, April, July, October) of all mandatory and unique training completed and pending per Physician Assistant.

1.3.6.5 The contractor shall provide with each invoice cycle as an attachment to the WAWF invoice, a report which details work hours per task order by work unit, to include the Physician Assistant name, hours and work unit for all billed hours.

1.3.6.6 Sexual Assault Reporting. The contractor will immediately (within 24 hours after gaining knowledge) report an incident of sexual assault to the COR.

1.3.6.7 Sexual Harassment Reporting. The contractor will immediately (within 24 hours after gaining knowledge) report an incident of sexual harassment to the COR.

1.3.7. ORIENTATION AND TRAINING.

1.3.7.1. MTF, Department, and Unit Orientation. The government will provide the contract HCPs with a Government orientation during hours of operation to familiarize them with the policies and procedures of the MTF, assigned department and specific unit. Orientation attendance will be required of all contract HCPs and will be scheduled by the Contracting Officer’s Representative (COR) or Department Chief during normal duty hours.

1.3.7.2. The contract HCP shall be knowledgeable of the policies and procedures of their specific place of duty and of the medical activity. The contract HCP shall receive any staff training required by the MTF as a 1.3.7.3.

precondition/condition to performance. Such training may include instruction on automation processing, quality assurance policies and local in-service and safety briefings. This training shall be conducted during the scheduled shift of the contract HCP.

1.3.7.3 MTF In-processing Checklist. When commencing work under this contract, the PA (RTA/GME) shall obtain in-processing checklist(s) from the COR or designated office. All PAs (RTA/GME) are required to complete the applicable items on the checklist and turn it in to the designated office. Upon completion of the contract, resignation or termination, the PAs (RTA/GME) shall complete an out-processing checklist and return it to the designated office.

1.3.7.4 The unit orientation consists of but is not limited to familiarization with the work-unit, uses of MHS Genesis (automated documentation), military time, military hospital protocol, BAMC quality assurance program, and location of emergency equipment. If the supervisors, department COR, or the agency deem additional orientation is necessary it will be provided by the government.

1.3.7.5 Annual Training Requirements. The contractor shall ensure that HCPs complete any mandatory annual Government or medically unique training requirements in accordance with MTF procedures. All HCPs shall meet Continuing Medical Education (CME) and Continuing Nursing Education (CNE) requirements for licensure at their own expense. The COR may approve HCPs to attend, in an unpaid status, MTF continuing education classes on a space available basis.

1.3.7.6 Government Unique Training. The government may elect to provide unique government training to HCPs who are performing services under this contract, approximately 8 hours annually. When directed by the KO, the HCPs shall attend all such training in a paid status as part of the normal services required and billed under the contract. Such training shall require a performance commitment by the contractor and the contractor’s HCP. If a contractor HCP fails to satisfy the performance commitment after the HCP receives the unique government training. The amount of the reimbursement shall be the prorated cost of training, calculated based on the total cost of the training and the number of months by which the HCP fails to complete the performance commitment. The length of the performance commitment will be stated in the task order or determined by the KO.

1.3.7.7 SHARP Training. The contractor shall ensure all service providers receive Sexual Harassment/Assault Response and Prevention (SHARP) training not later than 60 calendar days after contractor personnel begin performance under this contract. Training can be obtained either online or in person. Contractor personnel can attend SHARP training provided by MEDCOM on an every other month basis by contacting (210) 221-8361 for class date/time and availability. If the employee has an AKO account, they can access online the Team Bound Self Study course through Army Learning Management System (ALMS) at http://www.atsc.army.mil/tadlp/delivery/alms.asp

1.3.7.8 Computer Training. HCPs who have any interaction with the MTF computer systems must receive training for the applicable system(s). The COR or assigned unit’s shift supervisor will coordinate the necessary computer training. The training will be on-site and during normal duty hours. This training will be at no cost to the contractor. These systems include but are not limited to:

1.3.7.8.1 MHS GENESIS, an electronic health record for the Military Health System (MHS) and charting system for HCPs at BAMC. It provides enhanced, secure technology to manage health information; a single health record for service members, veterans, and their families; Navigates the MTF’s appointment scheduling program, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the MTF.

1.3.7.8.2 Ambulatory Data System (ADS). This computer system produces forms on which the providers identify the appropriate billing codes for diagnoses and procedures for each patient. In addition, HCPs working in Labor and Delivery will be trained on the Labor and Delivery Statistics System (LADS).

1.3.7.8.3 Quality Assurance. Contract surveillance will be conducted by the designated COR for each task order. Contractor performance for quality of services rendered, and any documentation or written material in support of 1.3.7.8.4 same, will be subject to continuous inspection, surveillance and review for acceptance by the KO or COR and in accordance with Performance Requirement Summary (PRS).

1.3.7.8.5 The government will monitor contractor compliance through observations and feedback from Nurse Managers/Department Chiefs/Clinic supervisory personnel who will monitor the contractor PAs (RTA/GME) clinical competence through observation, government information systems and records, customer service information and competency assessment checklists to assist the designated CORs with their surveillance responsibilities.

1.3.7.8.6 The government will evaluate the quality of the contractor's professional and administrative services for purposes of contract inspection and acceptance. The government will immediately notify the contractor when overall clinical quality fails to meet Joint Commission standards and the expectations of established MTF policy standardization.

1.3.7.8.7 At no time will a government representative perform merit evaluations, or officially rate the contractor PA’s (RTA/GME) performance.

1.3.8. SECURITY.

1.3.8.1. The contract Physician Assistant (PA) shall produce photographic identification when initially reporting for duty (e.g., a driver’s license). Physician Assistant (PA) will register their private vehicle at the Fort Sam Houston ID Section.

1.3.8.2. Contract HCPs shall comply with installation and MTF personnel identification and access requirements. The contractor is responsible for absences of contract HCPs due to expired identification and access documents.

1.3.8.2.1. The contract Physician Assistant (PA) shall not be permitted on the installation when their presence is considered detrimental to the security of the installation. The Government reserves the right to require removal from the job site any contract HCP whose continued employment is inconsistent with the interest of military security or who is found to be otherwise impaired. For Example: Intoxication or debilitation resulting from drug or alcohol use, insubordination, theft, or patient abuse will result in removal of the contract HCP.

1.3.8.3. The contract HCP shall be responsible for any keys issued by the government for use in the MTF. The keys shall not be duplicated. The contract HCP shall be financially responsible for the replacement of any lost keys and any associated locks. Lost keys and/or locks shall be reported to the issuing party, Department Chief, or COR immediately upon recognition of the loss. No unauthorized personnel shall be allowed entry into the locked area. Contract HCPs shall lock all areas for which they possess a key when they are not using the area and at the close of the work period.

1.3.8.4. Safeguarding Material. The contractor shall be responsible for safeguarding all government property provided for contractor use. The contract HCP shall safeguard information of a confidential or sensitive nature. The contract HCP shall not disclose or cause to be disseminated any information concerning the operation of the MTF that could result in or increase the likelihood of the possibility of breach of security or interrupt the continuity of operations or which breach the requirements of the Federal Privacy Act of 1974. However, the contractor may be required to provide testimony or disposition in cases of due process action.

1.3.8. Safety. Contract HCPs shall comply with all installation safety regulations. Such regulations include, but are not limited to, general safety, fire prevention, and waste disposal. Copies of these regulations are on file in the medical activity safety office or may be obtained through the COR.

1.3.9. Contracting Officer’s Representative (COR). The COR will be appointed in writing by the Contracting Officer after the contract is awarded. The Contracting Officer will provide a copy of this designation and COR - contact information to the Contractor.

1.3.10.

1.3.10.1. The contractor Physician Assistant (PA) shall meet with the COR a minimum of every three (3) months to discuss any problems that he/she may be experiencing during the performance of this contract. Problems experienced by the Government with the contractor’s performance of services under this contract will also be discussed.

1.3.11. SUBMITTALS. The contractor shall ensure all contract specific requirements paragraphs such as Education and Training Requirements, Privileging Requirements, National Agency Check Requirements, Health and Immunizations Requirements, and viewing MTF Facility Safety Orientation material are accomplished prior to performance.

1.3.11.1. The information provided may be used for input into the MTFs Consolidated Personnel Database (CPDB). All information given by the HCP will be protected by the Privacy Act of 1974 (PL 93-579). This information is necessary to assure hospital records can be maintained correctly, therefore complying with Joint Commission (JC), Occupational Safety and Health Association (OSHA) and Center for Disease Control (CDC).

1.3.11.2. Point of Contact: The contractor, within seven calendar days of award of contract, shall provide both the Contracting Officer, and the Contracting Officer’s Representative (COR) his/her name and local telephone number. He/she shall be responsible for coordination of the contract with the COR. The administrative duties shall not interfere with clinical duties.

1.3.12. POLICIES, PROCEDURES and REGULATION COMPLIANCE. The contractor will be responsible for following all MTF policies, procedures, and regulations in support of Occupational Safety Health Alliance (OSHA), Joint Commission (JC), and other national, state, and local policies that regulate the health care industry. Policies and procedures may be obtained by contacting the COR.

1.3.13. PERFORMANCE: The contractor shall begin full performance of the contract requirements on the first day of the period of performance specified in the contract award. It is critical that privileges be granted the contract Physician Assistant (PA) prior to the period of performance to meet the contract requirements by the commencement date. Therefore, no later than 15 days after receiving the award, the contractor shall submit completed credentials application to the COR for submission to the Credentials Committee. Under no circumstances will the contract HCP leave the Anesthesia Department before his/her duty hours are complete and any pending patients are transferred to another provider to complete the patient care.

1.4. HOURS OF PERFORMANCE.

1.4.1. Duty Hours: PA-GME duty hours will consist of 8-12 hour shifts to include a 30 minute unpaid break. Full- time contractors shall work at least 40 hours a week. Sufficient time will be allowed for student evaluations, mentor session and minor administrative tasks. Shifts will be worked over days, evenings, nights and include weekends and holidays. Hours scheduled for shifts do not include travel time involved in reaching the medical treatment facility. The contractor will arrive early enough to begin operations at the start of the paid shift. The duty hours may change at the discretion of the Chief, Department of Emergency Medicine (DEM) or his/her designee.

1.4.1.2. PA-RTA duty hours: Duty hours will consist of 8-12 hour shifts to include a 30 minute unpaid break. Full- time contractors shall work at least 40 hours a week. Shifts will be worked over days, evenings, nights and include weekends and holidays. Hours scheduled for shifts do not include travel time involved in reaching the medical treatment facility. The contractor will arrive early enough to begin operations at the start of the paid shift. The duty hours may change at the discretion of the Chief, Department of Emergency Medicine (DEM) or his/her designee.

1.4.1.3. Contractor duty hours will be for a pre-determined scheduled period, seven (7) days a week. No provisions are made for a lunch hour. The total number of hours worked will not exceed the maximum per year set forth in the contract. All duty schedules will be provided to the contractor 15 calendar days in advance if possible. The government will pay only for the actual hours worked. Signing in prior to scheduled time will not be considered as 1.4.1.4.

hours worked. Overtime is not authorized. The above timeframes are subject to change by mutual agreement of the government and the contractor. The contract Emergency Physician Assistant shall not leave the hospital during designated shifts hours except in response to emergencies or as directed by the Chief, DEM or COR.

1.4.1.5. During training or excused absences, contract employees may use personal time off in accordance with the contractor’s personnel policy, or report to work and may be required to work in a different department/or clinic of the hospital. Excused absences are subject to workload and mission requirements.

1.4.1.6. Continuity of Services: The contractor shall provide full coverage for the hours of performance shown in the schedule.

1.4.2 ABSENCES

1.4.2.1. Scheduled Absences. Scheduled absences as defined in section 2.1 such as vacations, continuing education units, personal time off, or meetings that could impact on patient scheduling, shall be scheduled at least 30 calendar days in advance and mutually agreed upon by the COR or designated Government Representative, the Department Chief, and the contractor. A combined total of 160 hours (20 days) of leave time can be used for combined annual/sick leave. If an approved Federal Holiday is worked as directed by the COR, an alternate date will be given as a day off for the holiday.

1.4.2.2. Unscheduled Absences. As defined by 2.1.22, he contract emergency physician assistant shall notify the Chief, DEM or designee, eight (8) hours prior to scheduled reporting duty time, if he/she is sick and cannot report to work as scheduled or cannot report to work as scheduled due to an emergency absence.

1.4.3. The Government reserves the right to verify the hours worked by the Contract HCP by implementing sign- in/sign-out procedures or by any other means including the use of a time clock. The Government will pay only for hours actually worked. These time sheets are for the sole use of government officials to ensure compliance with FTE hours and will not be provided to the contractor for any reason and/or purpose. In addition, under no circumstances will the government employees sign or verify the contractor’s time sheets for the contractor’s health care providers.

1.4.4. The HCP will be required to sign-in/sign-out daily on a monthly sign-in/sign-out timesheet. The timesheet will be approved by the Chief of the Department of Emergency Medicine and turned in to the COR by COB on the first working day of the following month.

1.4.5. Closures. During anticipated closure of the facility due to Command or Presidential declared training holidays or unplanned closures due to natural disasters, military emergencies, severe weather, or otherwise, the contractor will only be paid for actual hours worked.

1.4.5.1. In the event of unplanned facility closure due to natural disaster, military emergency, severe weather, or facility-related problem that prevents the contractor’s personnel from performing under this contract, these contract HCP shall follow the same departure and reporting directions given to government personnel. The contractor shall not submit an invoice or otherwise seek additional payment from the Government for any expenses incurred by the contractor as a result of any such unplanned closure.

1.5. CONDUCT.

1.5.1. The contract HCP shall record the time worked according to procedures determined by the MTF.

1.5.2. The chief of the department where services are being performed, or his/her representative, will define the scope of practice. Contract HCPs shall not introduce new procedures or services without prior approval of the Department Chief or representative. In disagreements or deviations from established or new protocols, the Department Chief, or representative, will be the deciding authority.

1.5.3.

1.5.4. Contract HCPs shall comply with MTF policies regarding personal appearance and conduct.

1.5.5. Contract HCPs shall abide by federal and local MTF regulations and requirements concerning the nature of limited privileged communication between patients and the HCP as may be necessary for security and personnel reliability programs. They shall also abide by federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability & Accountability Act of 1996. All regulations referenced are available for review from the COR, MTF, or the Contracting Officer. All medical records and reports will remain the property of the government.

1.5.6. Contract HCPs shall abide by MTF by laws, Joint Commission, DOD and Medical Department regulations with regard to Utilization Review and Quality Assurance directives, including, but not limited to, in-service training, maintenance of records, performance evaluation, and release of medical information.

1.5.7. Contract HCPs shall make use of all appropriate equipment; supplies and services made available by the government and shall make referrals and seek consultations, as deemed necessary, for the optimal care of the patients.

1.5.8. Media and Other Inquiries. The contractor or contract service provider shall not respond to any media inquiries. Any inquiries from the media, third parties, or public agencies shall be immediately relayed to the COR, who will relay them to the MTF Public Affairs Officer or, after duty hours, to the Administrative Officer of the Day (AOD). There shall be no interviews, comments, or any other response without the prior knowledge and approval of the MTF Commander. Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the COR and the KO.

1.5.9. Impaired Contract HCPs.

1.5.9.1. At any time during the performance of this contract, the Contracting Officer, COR, or the department Chief may direct the contractor to immediately remove any contract HCPs whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other contract HCPs, government personnel or to the impaired individual. This provision will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the contractor.

1.5.9.2. If a removal occurs, the COR will contact the contractor's point of contact within 24 hours, who will formally meet with the COR and/or other hospital management personnel to discuss further action in accordance with the MTF Quality Assurance and Inspection (QA&I) Plan. A review of the basis for removal will be made by the Contracting Officer and the COR within 3 working days.

1.5.9.3. Upon conclusion of the investigation if the KO concludes that the contract PA’s (RTA/GME) impairment requires permanent removal from the contract, the contractor will be notified. During the period of time between the removal and the final decision of the KO, the contractor shall provide a backup/replacement contract PA (RTA/GME) in accordance with the terms and conditions of this contract. The KO will notify the Contractor if and when permanent removal is required. In the event of a disagreement between the Government and the Contractor, the decision of the KO will be final. During the period of time between the removal and the final decision of the CO, the Contractor agrees to provide a backup/replacement PA (RTA/GME) in accordance with the terms of this contract.

1.5.9.4. The contractor shall not use that individual to perform any health care services required under this contract until the issue has been resolved by the KO or COR (as authorized by the KO). The contractor shall formally meet with the COR to discuss further action in accordance with the MTF, Inspection (QA&I) Plan and AR 40-68, A review of the basis for removal will be made by the KO within 3 working days after the Government directed removal of the PA (RTA/GME).

1.5.9.5.

1.5.9.6. When there is a reasonable cause to doubt the PAs (RTA/GME) competence to practice or for any cause affecting the safety of patients or others, the MTF Commander has the prerogative to hold in abeyance, to deny, or to summarily suspend clinical privileges in accordance with AR 40-68, which outline the adverse clinical practice actions for privileged personnel and adverse practice actions and peer review for non-privileged providers.

1.5.10. Sexual Assault and Sexual Harassment under the Sexual Assault Prevention and Response Program (SHARP)

1.5.10.1. The contractor shall comply with OTSG/MEDCOM Policy Memo 13-062, Policy for Reporting Incidents of Sexual Assault and Sexual Harassment under the Sexual Assault Prevention and Response Program (SHARP), 12 Nov 2013. The SHARP reporting requirements apply only to knowledge obtained by contractor personnel while performing services under this contract.

1.5.10.2. The contractor shall require all PAs (RTA/GME) with knowledge of an incident of sexual assault occurring on a Government facility, to include a Government leased facility, where the contractor is providing services under this contract, to report the incident to the contractor who shall immediately (within 24 hours after gaining knowledge) report the incident in writing to the government's COR. All incidents shall be reported whether they involve contractor personnel or Government personnel, or other individuals.

1.5.10.3. The contractor shall require all PAs (RTA/GME) with knowledge of an incident of sexual harassment occurring on a Government facility, to include a Government leased facility, where the contractor is providing services under this contract, to report the incident to the contractor who shall immediately (within 24 hours after gaining knowledge) report the incident in writing to the government's COR. All incidents shall be reported whether they involve contractor personnel or Government personnel, or other individuals.

1.6. CONFLICT OF INTEREST.

1.6.1. The Contract HCP shall not bill the patient for services rendered under this contract. The Contract HCP shall be prohibited from receiving compensation of any kind for patients treated, procedures performed, or any other actions performed, except under the terms and conditions of this contract, at the rate specified.

1.6.2. The contract HCP shall not, while performing services under this contract, advice, recommend, or suggest to persons eligible to receive medical care at Government expense that such persons should receive care from the contract HCP at any place other than as designated under this contract.

1.6.3. Confidentiality of Information. Unless otherwise specified, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. The contractor shall not release any of the above information without prior written consent of the Contracting Officer. The contract HCP shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication.

1.6.4. Contract HCP are not prohibited by reason of their employment under this contract from conducting private practice provided there is no conflict with the performance of services under this contract. The contracting officer will unilaterally resolve any issues concerning potential conflicts.

1.6.5. The contract HCP shall not use Government facilities or other Government property in connection with conducting a private practice.

1.6.6. Confidentiality of Medical Records: The contract Physician Assistant (PA) shall ensure that the confidentiality of medical records is maintained at all times and that information is disclosed only as permitted by the Privacy Act and Army Regulations in AR 340-21. Diagnostic images and records required or generated in the performance of this contract will be maintained under the control of the Department of Emergency Medicine, BAMC.

1.6.7.

1.6.8. All films, evaluations, and other records of patients will remain property of and subject to the exclusive control of the U.S. Government. All reports and documents prepared by the contractor in fulfillment of this contract will become the property of the U.S. Government.

1.7. LICENSE AND CREDENTIALS REVIEW OR PRIVILEGING.

1.7.1. The MTF Commander must grant privileges to contract HCPs for which credentialing is required prior to HCPs providing any services. The privileging process shall be in accordance with all requirements in ARs 40-66 and 40-68, as amended. The privileges granted by the MTF will be sufficient to allow for performance of all specific tasks identified in this contract. Information on the credentialing/privileging process is contained in chapter 4 of AR 40-68. Any failure to meet these requirements is considered nonperformance and the basis for termination for cause.

1.7.1.1. The Physician Assistant (PA) providing service under the provisions of this contract must be approved by the BAMC Credentials Committee, unless already credentialed, and be granted hospital privileges by the BAMC Commander in accordance with Army Regulation (AR) 40-68. The BAMC Commander is the final authority for approving/denying clinical privileges to the contract Physician Assistant (PA). Actions to limit, suspend, or revoke clinical privileges shall be in accordance with the procedures of AR 40-68 as pertaining to notice, hearing, and the Commander’s decision, except that the contractor does not have the right to appeal the BAMC Commander’s decision to the next higher headquarters. The Commander is the final authority for approving, denying or otherwise restricting the clinical privileges of the contract Physician Assistant (PA).

1.7.2. The contractor HCP shall request from the COR documentation requirements for privileging. Required documentation shall be completed and returned within the time specified in the contract. The contractor shall perform all primary source verifications and include all verifications with the credentials. The Contractor shall obtain all paperwork, letters of reference, approvals, work history, etc. required by the MTF credentialing process. MTFs will not assist the contractor in obtaining any needed information.

1.7.2.1. Professional staff appointments and clinical privileges are specific to the facility and the provider. Initial appointment is for one year and reappointment shall occur and not to exceed two years.

1.7.2.2. The Contract HCP shall submit a complete credentials application for processing. Incomplete applications (those that do not fully comply with the requirements) will not be accepted by the Government and will be returned without action.