Emergency Room Physician - PENDING AWARD

Service: Emergency Room Physicians (ER)
Location: Carl R. Darnall Army Medical Center, Fort Cavazos, TX
1.5.6. Recognized Holidays: Contract HCWs ?will ? will not be required to work on federally recognized holidays.
New Year’s Day, January 1st,
Martin Luther King’s Birthday, 3rd Monday in January,
President’s Day, 3rd Monday in February,
Memorial Day, Last Monday in May,
Juneteenth, 19 June
Independence Day, July 4th
Labor Day, 1st Monday in September,
Columbus Day, 2nd Monday in October,
Veteran’s Day, November 11th
Thanksgiving Day, 4th Thursday in November,
Christmas Day, December 25th
1.5.7.1. Hours of Performance (ER): The performance hours of the MTF are as follows: Sunday – Saturday, 8 or 12 hour rotating shifts with a 30-minute unpaid break given during the shift determined by the clinic. On occasion, other shift lengths may be specified. Hours scheduled for shifts do not include travel time involved in reaching the medical treatment facility and does not include a 30 minute unpaid lunch. The contractor shall provide full coverage for the hours of performance as follows: Emergency physician's duty hours will be for a predetermined scheduled period. All duty schedules
will be provided to the contractor 15 calendar days in advance. The government will only pay for the actual hours worked. Signing in prior to scheduled time will not be considered as hours worked. The contract emergency physician shall not leave the hospital during designated shift hours except in response to emergencies or as directed by the Chief, DEM or the COR. The Emergency Room
Physician shall remain on duty, if necessary, until the replacement physician arrives. He/she shall ensure that continuity of care is provided to the patient.
Possible shifts for the Emergency Department include the following: These are hours are not definitive and subject to change by the department. The COR will assist to define the needs of the department, as this is just an example.
0645-1515 w/30 min lunch
0645-1545 w/1-hr lunch
1445-2315 w/30 min lunch
1445-2345 w/1-hr lunch
2245-0715 w/30 min lunch
2245-0745 w/1-hr lunch
1045-1915 w/30 min lunch
1045-1945 w/1-hr lunch
1915-0345 w/30 min lunch
1915-0415 w/1-hr lunch
1045-2315 w/30 min lunch
1045-2345 w/1-hr lunch
0645-1915 w/30 min lunch
0645-1945 w/1-hr lunch
1845-0715 w/30 min lunch
1845-0745 w/1-hr lunch
1445-0315 w/30 min lunch
1445-0345 w/l-hr lunch

1.5.7.2. Scheduling (ER): The schedule or scheduling process is as follows: Contractor HCWs shall
perform services on a duty schedule established by the Chief, Department of Emergency Medicine of the MTF and/or his designee. Timeframes are subject to change by mutual agreement of the government and the contractor. Shift Change rounds will occur in the emergency department at 0645, 1445, and 2245 daily. Attendance at these is mandatory if scheduled on the corresponding emergency department shift.
• Compensatory time is not authorized. For instance, a HCW cannot come in early,
work through lunch, or stay late to accommodate for missed time.

1.5.7.5. Closures: During a planned closure of the facility due to training, holiday or unplanned closure due to unusual and compelling circumstances (e.g., natural disasters, military emergencies, severe weather), the Contractor will only be compensated for the actual hours the HCW provided services.
1.5.8. Place of Performance: (ER) The work to be performed under this contract will be at Carl R. Darnall Army Medical Center, Fort Cavazos, TX. HCWs shall receive notification two weeks prior to the reassignment to another location.
1.5.9. Mission Essential: The following labor categories are designated as mission essential: ER Physicians
1.6.6. Contractor Travel: Reimbursement ?will ? will not be provided for travel within a 40-mile radius of the place of performance. HCW travel requirements are as follows:
N/A
1.6.7. Relocation Costs: The Government ?will ?will not pay the Contractor to relocate HCWs.
1.6.9.2. Computer Skill Competency: Each HCW shall demonstrate competency as required in the contract and as follows:
· Position requires access to Department of Defense computer systems,
therefore HCWs shall be a U.S. Citizen or otherwise meet the requirements of
AR 25-2 and any electronic record systems HCWs may be required to utilize in
the performance of assigned duties.
· Shall be able to type and have had experience using computers especially Microsoft
programs. CRDAMC will provide computer training for the CRDAMC computer system.
· Shall be able to read, write, and speak English well enough to
effectively communicate with patients and other healthcare providers.
1.6.10. MTF Training: Additional training requirements are as follows:
Computer Training. Contract providers who have any interaction with the MTF computer systems must receive training for the applicable system. All Contractor staff that access Government IT systems shall be trained in security awareness, protection of Government sensitive and privacy information, and their responsibility and consequences before access is authorized. The COR or appropriate Government designee will coordinate computer training. The training will be on-site and during normal duty hours. This training will be at no cost to the Contractor. Training is not reimbursable to the Contractor if completed off-site.
The Government may elect to provide unique Government training to contract personnel 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 personnel. When directed by the contracting officer, contract personnel 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 personnel fails to satisfy the performance commitment after the contract personnel receives the unique Government training.
1.6.12. MTF Standards: Specific policies, procedures, and instructions/regulations for the place of performance are as follows:
All services shall be provided in accordance with established standards, principles and ethics of the profession and applicable professional specialty organizations, The Joint Commission (TJC)
standards, applicable Department of Defense (DoD) and service specific regulations, directives and policies, as well as MTF policies, procedures and job descriptions. Contract HCWs shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association's Bill of Rights for Patients. Contract HCWs shall provide services in conjunction with other non-contract providers to include physicians, nurse practitioners, physician assistants, registered/licensed practical nurses and support personnel. All contract HCWs shall perform essentially the same functions, within the scope of acceptable practice, as those required by Army or government service health care professionals of similar experience and in similar duty assignments.
1.6.20.3. Occupational Health: The HCW ?shall ?shall not be required to obtain
documentation of required physical testing or a report of a physical examination. This list
may change at the direction of Occupational Health.
· MMR vaccine – 2 doses or Rubella, Rubeola and Mumps igG titers showing positive results (if
needed, must be taken no less than two (2) weeks prior to report date)
· PPD (TB skin test) - 2 tests within the past 12 months or a QFT Gold showing negative results within the past 12 months. A copy of a chest x-ray if you have a history of a positive TB test
· Varivax vaccine (chickenpox) – 2 doses or Varicella igG titer showing positive results
· Influenza vaccine (flu shot) - annually
· Hepatitis B vaccine - 3 doses or HBsAB showing positive results (health care providers only)
· BCLS, PALS, etc cards (if required)
· COVID-19 Certification (if required)

1.6.20.5. Tuberculosis Screening: The additional immunization/screening requirements for the risk of exposure to tuberculosis (TB) are as follows:
· Tdap vaccine within last 10 year
1.6.20.6. COVID-19 Vaccine, Exposure, and Positive Results: Per HCWs must adhere to any updated guidance as distributed by the Provost Marshals Office and Command as released on screening, vaccination, exposure, and positive results. CRDAMC/MEDCEN Command Policy 20-039, COVID-19 Healthcare Personnel Sustainment Policy, CRDAMC’s intent is to maintain a safe and healthy workforce to serve Ft. Cavazos’s beneficiary population, patient & staff safety, and support the III Corps mission. COVID- 19 statistics, data, and compliance is recorded and reported up the CRDAMC Chain of Command to MEDCOM, DHA, Department of Army, State of Texas, and Center for Disease Control (CDC). Due to the critical nature of the COVID-19 pandemic, adherence
to requirements are mandatory and require 100% compliance. It is critical that all personnel practice rigorous and regimented hand hygiene, cough and sneeze discipline, social distancing when applicable, the wear of face coverings and appropriate personal protective equipment (PPE), and vigilant assessment and reporting of personal health status. PPE will be provided by the Government for direct health care providers. Time away from the facility for screening, testing, vaccination, quarantine, or any COVID-19 related illness is not considered actual hours worked and is not billable.

Labor Category: Emergency Room Physician
HCW Qualifications (Contract PWS 5.2; 5.2.3; 5.2.4; 5.2.6.4.4):
· Degree/Education (5.2.4): A Doctor of Medicine (M.D.) or Osteopathy (D.O.) from an
accredited college approved by the Council of Medical Education and Hospitals of the American
Medical Association or Doctor of Osteopathy from a college accredited by the American Osteopathic Association.
· Certifications(5.2.3): Basic Life Support and Advanced Trauma Life Support (ATLS).
Contract workers shall maintain current certification in Basic Life Support (BLS) from the American Heart Association, or the American Red Cross. Certification cards must display the American Heart Association, the American Red Cross or other approved certifying body emblem. Web-based (on-line) classes are not acceptable by the Government.
· Experience: Be board eligible in Emergency Medicine (EM) under American Board of
Emergency Medicine, American Osteopathic Board of Emergency Medicine (AOBEM) or shall
have successfully completed an approved residency training program in emergency medicine
and be board eligible in emergency medicine at a minimum. Must have a minimum of one (1) year experience within the last two (2) years as a staff Emergency Medicine physician. The
MTF Emergency Room is identified as a Level III Trauma Center. Physicians shall meet the experience, training, and certification requirements for this level in accordance with regulations. The Contractor shall ensure that the Healthcare provider has sufficient training and experience
to effectively provide emergency medicine services for service members and family members. The MTF requires emergency physician with experience in all aspects of emergency medicine. This includes clinical education of residents and interns. The physician must have proven academic potential as demonstrated by teaching publications and specialty society membership. Graduates of foreign medical schools are required to possess both a medical license and other certification by the Educational Commission for Foreign Medical Graduates (ECFMG) or 5th Pathway.
· Board Certification (5.2.6.4.4): Board certified or board eligible. Certifications must be obtained through an American College of Surgeons approved training program. Current board
certification in Emergency Medicine (EM) by ABEM/AOBEM negates the need for ATLS, as long as the board certification was successfully passed.
· Licensure/Registration and DEA: Documentation demonstrating permission by an official
agency of a State, the District of Columbia, or a Commonwealth, territory, or possession of the
United States to provide health care within the scope of practice of a specified discipline. Licensure, certification, or registration is a qualification for employment as a healthcare
provider in the MHS. Healthcare providers must have one current, valid, active, and unrestricted license. Additional licenses held by a provider must be in good standing whether they are inactive, expired, or limit the provider’s practice to a military setting. Providers in the MHS may not have one active license and another currently suspended or probationary license. Contract workers under a personal services arrangement requiring licensure shall maintain a license in
any U.S. jurisdiction as outlined in DHAPM 6025-13, Volume 4. Contract workers under a non personal services arrangement requiring licensure shall have a license in the state that they are rendering care to their patients (no licensure portability) per 10 USC 1094 and DHAPM
6025.13, volume 4. Contract workers required to obtain a DEA registration number, shall have a current, valid DEA registration prior to performing on this contract in accordance with regulatory guidelines. The Contractor shall ensure DEA registrations are renewed throughout
the performance of the contract worker.

HCW Duties (5.1 Task 1): The duties for the HCW are as follows: Contract Emergency Physicians providing services under this contract shall perform the same clinical duties as those required of any military or government civil service physician of similar experience assigned to the same unit at the MTF. The quality of service shall meet or exceed reasonable standards of professional practice as determined by the same authority that governs physician services in the same discipline. Contract Emergency Physicians shall perform within the scope of clinical privileges granted by the MTF and the overall demand for Emergency services. Productivity is expected to be comparable to that of other providers with the same scope of practice. Workload will be scheduled by the treatment facility. Caseload includes scheduled and unscheduled requirements for care. Emergency Physicians shall have sufficient training/experience to be able to perform the required duties which include, but not limited to the following:
Responsible for providing emergency medical services to the patients in this Level III Trauma facility. It includes clinical supervision in the trauma room, the Urgent Care, and the Emergency Medicine area. These responsibilities include direct and indirect patient care, clinical supervision of personnel, educational activities, and the general clinical operations during the shift. The quality of Emergency Room Physician service shall meet or exceed reasonable standards of professional practice for the health care concerned as determined by the authority that governs military medical professionals in the same discipline. Emergency Medicine Physicians shall have sufficient training/experience to be able to perform the required duties which include, but not limited to the specific tasks that follow. Academic Duties: The contract emergency physician shall participate in the Emergency Medicine Residency Training Program at the MTF.
This clinical teaching will be directed at the residents in Emergency Medicine, other staff emergency physicians, residents in other departments, medical students, technologists, and other MTF staff members. Resident/Student Clinical Supervision: The contract emergency physician will follow all clinical supervisory requirements for ancillary personnel, medical students, interns, and residents in accordance with the MTF and Texas A&M University System Health Science Center College of Medicine guidelines and bylaws.

Be capable of performing the full range of emergency room services to include the ability and
experience to adequately diagnose and treat diseases and injuries to include, but not limited to, the following: Skin, Head, Eyes, Ears, Nose, Throat/Mouth, Neck, Cardiovascular System, Pulmonary System Gastrointestinal System, Lymphatic System, Musculoskeletal System, Genitourinary System, Reproductive System, Psychiatric Disease, Central Nervous System, Endocrine System, Peripheral Nervous System.

Be able to adequately perform medical procedures to include, but not limited to, the following:
incision and drainage, nail trephination, sling or swath injuries, bandage, reduce dislocations and
fractures when appropriate, stabilize and evaluate cervical spine injuries as appropriate, lumbar
puncture, periocardiocenthesis, removal of foreign bodies as appropriate, deliver
babies/emergency vaginal deliveries, perform venous punctures for lab studies and interpret
results, draw arterial blood gases for evaluation and interpret results, suture simple lacerations,
remove sutures, tube thoracostomy, open thoracotomy, secure and maintain an adequate airway,
by such means as:
oral airways;
oral tracheal intubation;
nasal/tracheal intubation;
crico-thyrotomy (needle and surgical)
Splint and stabilize traumatic injuries to extremities; Administer intravenous, intramuscular and subcutaneous medications as appropriate; secure and maintain adequate intravenous access by peripheral and by central routes; Diagnostic Peritoneal Lavage (DPL); bladder catheterization; NG/OG tube; local anesthesia; restraints; and conscious sedation. Be able to perform tasks to include, but not limited to, the following: Coordinate with accepting facility & other ER Departments; consult with consultants appropriately; provide medical advice over the telephone; complete all required paperwork; obtain an adequate history, physical, assessment and plan in a timely and appropriate manner on each patient and develop treatment plan; utilize paraprofessional staff as appropriate; respond to cardiopulmonary arrest as appropriate and arrange appropriate backup from the EMS Interpret electrocardiograms; preliminary interpret radiographs to include CAT scans; direct medical care through radio communication with an ambulance and provide discharge instructions.

Examine patient, render a medical assessment of their conditions, and take appropriate action. Provide immediate evaluation and management of emergency patients. Required to perform and supervise bedside ultrasound. Provide definitive medical care to reduce the emergency situation and enable the patient to safely continue care as an outpatient with follow-up care as required. Follow-up of abnormal reports is the responsibility of the ordering physician. However, to assure correct medical follow-up for these patients, all abnormal x-ray and lab reports received on patients seen by the contractor’s Physicians shall be reviewed by the contract physician on duty at the time these reports are available for review. Review each report in accordance with established MTF procedures.

Provide emergency medical care to both inpatients and outpatients, summon appropriate on-call specialist when deemed necessary, and continue medical management until the arrival of the appropriate specialist. Reassure and treat non-acute conditions in priority as established by medical triage. When necessary, provide emergency care to patients in the holding area. Prepare appropriate narrative summaries and patient profile changes. Prepare and document appropriate history, physical examinations, and preoperative diagnosis. Maintain documentation of all treatment provided in accordance with MTF directives.

Respond to a staff nurse's request for assistance to the emergency needs of hospitalized patients, to carry out procedures, and for writing orders, until the patient's staff physician arrives. Dispatch and provide medical control for ambulances in accordance with MTF procedures. Accompany emergency room technicians on ambulance runs when indicated by the nature of the emergency and in accordance with MTF procedures. Perform emergency room procedures compatible with the MTF operating capacity and equipment. As workload permits during scheduled duty, attend the Emergency Medical Service's monthly staff meetings and the Quality Improvement and Risk Management committee meetings as required by the individual MTF. Contract physicians may also attend such meetings scheduled during other than their assigned duty shift.
Provide house-staff teaching, prepare and deliver resident lectures, attend department grand rounds and other scheduled academic activities. The contract HCW shall be present for any case being presented for review that involves the contract provider. Become familiar with the hospital formulary. Contract physicians authorized to prescribe pharmaceuticals shall do so according to the availability of drugs listed therein. The pharmacy service will provide instructions to all prescribing practitioners regarding substitutions of generic drugs for prescribed drugs. Complete medical documentation using the approved electronic medical record (EMR) system within a reasonable required time, such as the current hospital policy by 72 hours after the patient visit.
Responsible for the completion of individual workload accountability in accordance with clinic, medical treatment facility and program requirements. Maintains inpatient and outpatient medical records IAW DoDM 6025.18. Medical records will be subject to review by the Medical Care evaluation Committee, Quality Assurance Committee, and designated representatives of the Commander, DHA. Only approved medical abbreviations will be used. Charting will be in compliance with Army, MTF, or clinic requirements as directed by the provider’s immediate supervisor. The contract service provider is responsible for the content and correctness of all prepared and transcribed reports and shall verify the content and correctness of all prepared and transcribed reports by affixing signature and stamp to all copies of the document and validating its contents the same day as documents are provided by the U.S. Government. All evaluations and other records of patients will remain the property of, and subject to the exclusive control of, the U.S. Government. All reports and documents prepared by the Contactor in fulfillment of this contract will become the property of the U.S. Government. Take part in clinic Quality Assurance Program as required to meet the standards of the Joint Commission on Accreditation of Healthcare Organizations. Responsible for maintenance of the highest standards of professional care. Prepare and document appropriate history and diagnosis. Maintain documentation of all treatment
provided in accordance with hospital directives and prepare such records and reports as may be required by the contract. Ensure all documentation and reports are legible. Coordination with other departments of the medical facility staff to provide complete care to patients. Consult with supervisor and/or colleagues, which are normally available, regarding problems either professional or administrative. Responsible for the quality and the timeliness of treatment records and reports required to document procedures performed and care provided. Participates in clinical education programs and in clinical staff quality improvement
functions as prescribed by Chief, Emergency Medicine. Comply with the MTF quality control program and the standing operating procedures of the MTF. Participate in clinical and quality review processes as determined by hospital policy. Provide screenings, clinical assessments, treatment, case management, consultation, referral and education according to their professional discipline, Army Medical Departments standards, and the DoD-directed Clinical Practice Guidelines (CPGs). Services shall be provided in accordance with the established principles, practices and ethics of both (1) the contract service provider’s professional (2) Department of the Army (DA) regulations. Services shall be provided in accordance with MTF rules, regulations, bylaws, privileging and within the contract service provider’s scope of practice. Shall be able to read, write, and speak English well enough to effectively communicate with patients and other healthcare providers.

5.4.4.1. Schedule Management for Non-Personal Services (ER Physicians): The work schedule for each labor category is as follows:
The work schedule for each labor category is as follows: Emergency Physicians will normally work 40 hours per week to include Federal holidays and weekend coverage Sunday through Saturday. Each HCW will be required to work 1,912 regular hours per year. The Government maintains the right to make changes to meet operational needs. A 30-minute unpaid break will be given during the shift as determined by the clinic. HCWs shall be rested (physically and mentally) and fully capable of performing the duties required under this contract. Scheduled absences shall be provided no less than 60 days in advance for review/approval by the DEM Chief and/or his designee. Unscheduled absences shall be called-in to the on- site supervisor by HCWs at least two (2) hours prior to the scheduled shift in which they are unable to report to work. May be required to work at the different locations due to transitioning services, staff shortages, or peak/surge workloads within their skill set. The Contractor shall only be paid for actual hours worked. Hours scheduled for shifts do not include travel time involved in reaching the medical treatment facility or work site.

5.4.4.2. Schedule Management for Non-Personal Services: Hours of service and roster submission requirements are as follows:
N/A
5.4.4.4. On-Call Hours: On-call requirements for each labor category are as follows: N/A
5.4.4.4.1 Call-Back Hours: HCWs ? will ? will not be required to report in-person to the MTF during on-call hours if needed. The number if call-back hours and timeframe is as follows:

5.4.4.5. Overage Hours: Overage hours for the Optometrists are as follows: In addition to regular hours worked, HCWs may be scheduled to work Overtime (OT). OT hours are worked in excess of 40 hours per week. ER Physicians will not be authorized OT.
5.5.3. Scope of Work: HCWs will be able to bill the Government for participation in administrative functions (i.e., orientation, quality improvement programs, clinical/administrative data collection, meetings, and training). Specific tasks associated with administrative duties beyond the tasks outlined in the contract PWS include:
The Contractor HCW shall complete any mandatory annual medical/government required training. Must possess the competencies to enter/retrieve medical information in various government database systems.
The providers shall be able to type and have had experience using computers, but will not be required to type a certain amount of words per minute. The government will provide computer training on the hospital computer systems. Failure to learn the computer systems within a reasonable time period shall be grounds for immediate removal of the provider. All contract HCWs shall be able to read, write, and speak English well enough to effectively communicate with patients and other HCWs. Must accurately enter actual work hours into the Defense Medical Human Resources System Intranet (DMHRSi) every other week on the date specified by the COR or designated Government representative