regional referral centers pilot study affiliated tribes of nw indians airway heights, wa september...

Regional Referral Regional Referral Centers Pilot Study Centers Pilot Study

Affiliated Tribes of NW IndiansAffiliated Tribes of NW Indians

Airway Heights, WAAirway Heights, WA

September 21, 2010September 21, 2010

Portland Area Facilities Advisory Portland Area Facilities Advisory CommitteeCommittee

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What are Regional Referral Centers?– A facility where specialty care services are

provided on a referral basis by surrounding health programs.

– A facility that might provide colonoscopy, endoscopic, cardiac stress tests, etc. (Priority 2 types of services)

– A program that does not have the high costs of maintaining a hospital

– Culturally competent care – Does not fit within current IHS facility structure

PAFAC 2010 – Regional Referral Center Pilot Study Status PAFAC 2010 – Regional Referral Center Pilot Study Status ReportReport

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What are the benefits of Regional Centers?– Address CHS Dependency and equity concerns

– Provide some level of specialty care service for the Portland Area

– Provide a vehicle for telemedicine services

– Improve access to care and improve quality of care

– Cost savings for Tribal CHS programs

– Generate third party reimbursements that can be used to provide additional services

– Provide culturally competent care

– Reduce the amount of construction funding required


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Why was this concept proposed?– Healthcare Facilities Construction Priority System

• No Portland Area representation since early ‘90s• Regional Referral Centers cannot be prioritized

– Facilities funding received is inadequate• Limited to Small Ambulatory and Dental Programs

– Rarely has fully funded any projects (requiring tribal contributions)

– No funding for staffing or operations

– Recurring funding increases favor new facilities • Recurring Pay Act and Inflation increases are greater• More staff, more patient visits generate more 3rd-party collections


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How was the concept developed?IHS Areas directed to develop master plans– Memo, Acting Director, IHS, Feb. 11, 2003

• Define the healthcare needs for the Area– Identify healthcare needs of the Area Service Population– Identify type and location of facilities needed– $150,000 provided to each Area Office to assist in completing

master plans

• All PAO Tribes given 2 options for completing master plans– 26 PSAs (21 Tribes) master plans completed by contract– 22 Tribes provided partial funding to complete individually

PAFAC 2010 – Regional Referral Center Pilot Study PAFAC 2010 – Regional Referral Center Pilot Study Status ReportStatus Report

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How was the concept developed?– Criteria defined by Tribes participating in master

planning contract• Primary Care will remain a local service• Share referrals to justify specialty services• Facilities recommended

– 55 Primary Service Areas (includes 3 urban, 4 new)– 3 outpatient specialty Regional Referral Centers– 1 Area-wide Medical Center (hospital)

– Concept presented to NPAIHB, ATNI• Supporting resolutions passed• Portland Area Health Services Master Plan Final Report

– Completed and submitted October 1, 2005


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NorthwestNorthwest

NortheastNortheast

SouthwestSouthwest

PSAPSA – Tribal (Typ.)– Tribal (Typ.)

PSA – Federal (Typ.)PSA – Federal (Typ.)

Demonstration Demonstration ProjectProject

PAFACPAFAC (Typ.)(Typ.)


Recommended Recommended Regional Regional

BoundariesBoundaries

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• Recommended Participating Tribes by Region

1Region to be selected by Tribe.

Northeast Northwest Southwest

1. Coeur D’Alene Chehalis Samish Burns Paiute

2. Colville Hoh River Sauk-Suiattle Chemawa

3. Kalispel Jamestown Shoalwater CLUSTI

4. Kootenai Lower Elwha Skokomish Coquille

5. Nez Perce Lummi Snoqualmie Cow Creek

6. NW Band of Shoshone1 Makah Squaxin Island Cowlitz

7. Shoshone-Bannock1 Muckleshoot Stillaguamish Grand Ronde

8. Spokane Nisqually Suquamish Klamath

9. Umatilla Nooksack Swinomish Siletz

10. Port Gamble Tulalip Warm Springs

11. Puyallup Upper Skagit

12. Quileute Yakama

13. Quinault


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PSA – Tribal (Typ.)PSA – Tribal (Typ.)

PSA – Federal (Typ.)PSA – Federal (Typ.)

Demonstration Demonstration Project Project

BoundaryBoundary

PAFAC (Typ.)PAFAC (Typ.)

PAFAC 2010 – Regional Referral Center Pilot Study PAFAC 2010 – Regional Referral Center Pilot Study Status ReportStatus Report

Recommended Recommended Demonstration Demonstration

ProjectProject

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• Recommended Demonstration Project


Recommended Participants* Possible Services

1. Stillaguamish Audiology

2. Tulalip Medical Specialties

3. Snoqualmie Surgical Specialties

4. Muckleshoot Ambulatory Surgery

5. Puyallup Advanced Imaging (Fluor, Mammo, CT, MRI)

6. Nisqually Occupational Therapy

7. Port Gamble S’Klallam Speech Therapy

Telemedicine

*Initial workload will be based on a 60-minute drive time resulting in 24,000 primary care users in the NW region.

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What's transpired?Proposed regional facilities were entered into current priority system

– Regional referral centers could not be prioritized

•Needs can be defined for large, centralized populations•Smaller, geographically dispersed populations left out

– A Pilot Study was proposed to•Develop preliminary planning criteria to size

regional referral centers for small, dispersed populations


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What's transpired?– HQ-Area discussions generated 3 questions

• Specialty referral rates• Distance patients are willing to travel• Impacts of alternative care sources

– HQ agreed to fund the Pilot Study• To provide recommendations on the modification of

planning criteria for geographically dispersed, multi-tribal populations.

– For National application (CA, OK, NS, BE Areas are interested)– Allow referral centers to be prioritized– Overseen by the PAFAC


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What's transpired?– The Pilot Study determined insufficient data

is available for preliminary planning• Recommended a demonstration project to:

– Gather data to establish planning thresholds

– Focus on specialty care only

– Test assumptions on the viability of Regional Referral Centers

• PAFAC requested funding for a demonstration project November 2009

– Awaiting Headquarters response


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Summary – the demonstration project will:

1. be new funding for the Area with a recurring staffing package.

2. not diminish current funding or services for tribes.

3. provide only specialty care; primary care will continue to be provided at local sites.

4. is the first of a 3-phase master plan.

5. be available to ALL Tribes for referral to the facility.

6. reduce Tribes dependency on CHS, allowing CHS funding to be stretched further.

7. result in better continuity of care.

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Requesting a resolution adopted by ATNI:to support the planning and design of the Portland Area Regional Referral Center demonstration project.


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Questions…?Questions…?

To review full study you can access at NPAIHB’s websiteTo review full study you can access at NPAIHB’s websitewww.npaihb/XXXXXwww.npaihb/XXXXX


regional referral centers pilot study affiliated tribes of nw indians airway heights, wa september...

Documents

referral basis

benefits of regional

sregional referral centers

specialty care services

tribes master plans

area office

participating tribes

master plansmemo