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A GP for Meand

In-Patient Care Program Overviews

April 2013

Revised: April 9, 2013

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A GP for Me(or the Attachment Initiative)

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A GP for Me: Background

• Number of unattached patients in BC uncertain

• Using Canadian Community Health Survey data, it is estimated:– 13.8% of British Columbians (~615,000 people)

have no regular family physician; and

– 3.96% (~176,000) are looking for a family physician, but cannot find one.

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A GP for Me: Background• Hollander's BC data indicates better

outcomes at lower costs for patients attached to a FP

• Care through walk-in clinics or Emergency Departments– fragmented & expensive

– poorer outcomes

• Lack of access = health inequities

• 2010 Government commitment to provide a family physician for any BC resident who wants one, by 2015

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A GP for Me: Goals

• Confirm and strengthen the FP-patient continuous relationship

• Better support the needs of vulnerable patients• Enable patients that want a family doctor to find

one• Increase the capacity of the primary health care

system

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A GP for Me: Consultation

• Nearly 400 FPs involved in creation of initiative:– as members of the GPSC shaping the high-level framework; – as members of both BCMA and SGP boards of directors, reviewing

and approving the GPSC’s work ;– as members of the provincial attachment working group from the

prototype communities; – Approx. 300 physicians tested and implemented the prototype plans

across three communities;– through workshops to define patient attachment and outline the

responsibilities of both physicians and patients in this relationship; and

– through addressing elements of attachment through CSCs:• collecting and analyzing data to better understand unattached patient numbers and

priority areas for improving the health of vulnerable populations.• Co-designing community supports with Health Authority Partners

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A GP for Me: Prototype Results

• Two-year prototype – White Rock/South Surrey, Prince George, Cowichan Valley

– Approx. 9,400 unattached patients connected to FPs or primary care clinics

– Many complex patients being served in primary care clinics and/or through Division of Family Practice / Health Authority collaborative initiatives

– Currently, patients can find a FP immediately in White Rock/South Surrey.

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A GP for Me: Expansion

• Components of Patient Attachment:

1. Practice Fee Supports

2. Divisional Supports

3. Alignment of existing Health Authority, Ministry and Physician Committee initiatives and programs

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A GP for Me: Fee Supports

• Attachment Participation Code G14070: – Zero-Sum MSP code to indicate commitment– Once per physician per calendar year– Submission indicates the FP will:

• provide continuous full service family practice services • confirm their primary care relationship with their patients• register with and work with local Division of Family

Practice and/or community to develop community-specific supports as they are able

– Participation opens access to Attachment fees

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A GP for Me: Fee Supports

• Attachment Participation Code G14070:• Submit with “Patient” Identifiers

– PHN#: 9753 035 697– Patient Surname: “Participation”– Patient First Name: “Attachment”– Date of Birth: January 1, 2013– ICD-9 code: 780

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A GP for Me: Fee Supports

Physician-Patient ‘Compact’:•As your family doctor I, along with my practice team, agree to:– Provide you with the best care that I can– Coordinate any specialty care you may need– Offer you timely access to care, to the best of my ability– Maintain an ongoing record of your health– Keep you updated on any changes to services offered at my clinic– Communicate with you honestly and openly so we can best address your health care needs

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A GP for Me: Fee SupportsPhysician-Patient ‘Compact’:

•As my patient I ask that you:– Seek your health care from me and my team whenever possible and, in my absence, through my colleague(s), xxxxxx– Name me as your family doctor if you have to visit an emergency facility or another provider– Communicate with me honestly and openly so we can best address your health care needs

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A GP for Me: Fee Supports

Physician-Patient ‘Compact’:

•NO need to call in each patient•Can be done face-to-face, by letter or other communication, or by posting this standardized ‘Compact’ in office and examination rooms•Supportive materials (posters, brochures) are available from the GPSC website (www.gpscbc.ca)

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A GP for Me: Fee Supports

• Attachment Fees1. G14076 GP Attachment Telephone

Management fee2. G14075 GP Attachment Complex Care

Management fee3. G14077 GP Attachment Patient Conference

fee4. G14074 GP Unattached Complex/High Needs

Patient Attachment fee5. Non-Complex Unattached Patient Intake

(future incentive)

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A GP for Me: Fee Supports1. G14076 GP Attachment Telephone Management Fee

• Requires submission of Attachment participation code by FP• $15 per 'visit'• All patients for whom that FP is community MRP• 500 per physician per calendar year• Intent is to use to avert need for a visit; in practice, WIC, ER• Requires clinical discussion. NOT for:

• notification of appointments, referrals• prescription renewals

• May be delegated to another College-certified healthcare professional• Patients who are eligible for the GP Patient Telephone/e-mail Follow-up

Management fee (G14079) are also eligible for the new Attachment telephone fee (not on same day)

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A GP for Me: Fee Supports2. G14075 GP Attachment Complex Care Management

fee• Access requires submission of Attachment Participation

Code• Includes diagnosis of 'Frailty' • Use Diagnostic Code V15• Canadian Study of Health and Aging Scale; Level 6 & 7

• Moderately Frail: Help is needed with both instrumental and non-instrumental activities of daily living

• Severely Frail: Completely dependent on others for the activities of daily living, or terminally ill

• FPs participating in the Attachment initiative still have access to the original Complex Care incentive (G14033) for qualifying patients.

FPs choosing not to participate will only have access current FP complex care dual-diagnosis fee item G14033

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A GP for Me: Fee Supports3. G14077 GP Attachment Patient Conference

fee• Access requires submission of Attachment Participation

Code• Less restrictive; replaces G14015, G14016, G14017• Removes requirement for onsite attendance• Removes need to conference with 2+ other healthcare

professionals• Initiation by facility not required; either side can trigger• Any patient for whom FP is community MRP – no

diagnostic restrictions• Any time either side feels is clinically warranted• $40 per 15 minutes or greater portion thereof• Max 2/calendar day, up to max 18/calendar year per

patient• Non-participants still have access to current

fees

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A GP for Me: Fee Supports4. G14074 Unattached Complex/High Needs Patient Attachment fee• $200 in addition to visits• providing care for new patients who do not have a FP • Commit to provide ongoing, longitudinal FSFP care for at least one year• Target Populations

• Complex/high needs populations» Frail in community and in residential care» High needs chronic conditions» Cancer patients» Severe disability » Mental health and substance use

• Mother/Baby dyad is counted as one» May be accepted into longitudinal practice at any time during pregnancy up to

child aged 18 months

• Patient must be referred.

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A GP for Me: Fee Supports4. G14074 Unattached Complex/High Needs Patient Attachment fee (continued)• Referral Sources

• Acute Care: ER and Admitted• Mental Health/Substance Use Workers/Clinics• Home and Community Care• BC Cancer Agency or regional centres• Public Health• Colleagues• Local Division• Patients cannot self-identify

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A GP for Me: Fee Supports5. Non-Complex Unattached Patient Intake• Future incentive• Lower priority• Placeholder for future consideration as funding is identified

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A GP for Me: Divisional Supports32 Divisions, including new provincial Rural and Remote

DivisionOver 95% of FPs have a Division available$40M one-time funding to support the Attachment work of

Divisions $24M Discretionary MoH support for non-physician

expenditures;$16M GPSC allocation for physician-related costs In areas where there is no Division an alternate mechanism

will be made availableAllows:

Engagement with and expansion of membership;Assessment of community makeup, local primary care system;Collaboration with local HA through the CSC to identify

problems, develop local solutions and provide community-specific supports for Attachment; and

Implementation of agreed-upon plan.Not to be used for:

Long term (ongoing) Leases Long term (ongoing) Contracts with Allied Health Professionals or

Physicians Solutions will vary – community-specific

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Divisional Phases of ‘A GP for Me’

 CommunicationIntroduce and

explain Attachment

Fee component:All Family

Practitioners providing

continuous care

Dr. informs Division they have billed Attachment participation

code

 Division

Component

Local approvals

and provincial approval

Access to portal fees

 Tools and

resources to share

 Tools and

resources to share

 Tools and

resources to share

ASSESS 

PLAN 

IMPLEMENT

 Approval and funding Agreement

 Approval and funding Agreement

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Divisional Supports: Overview Summary

Plan to be reviewed by Committee

Pre Planning Phase: 

Work with PEL: Checklist Plan design Letter of Intent

CONTRACT

Planning Phase:($xxx,xxx)

   Data Analysis Operation Plan Approach Metrics  

Plan to be reviewed by Committee

CONTRACT

Implementation Phase

ACTIVATE

Year 1Year 2Year 3

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A GP for Me: Alignment of Existing HA, Ministry and Physician Committee Initiatives• Programs currently under way:

• Integrated Primary and Community Care Strategy

• NP4BC• Practice Support Program/Physician Information

Technology Office IT alignment• Better at Home Program• Home Health Monitoring• After-hours Palliative Nursing Services• Seniors’ Action Plan• Partnerships with non-governmental

organizations providing patient self-management supports

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In-Patient Care Initiative

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In-Patient Care: Background• 48% of "MSOC-50" FPs providing In-patient Care• Attrition of ~3%/Yr FPs leaving in-patient care service delivery

0%

10%

20%

30%

40%

50%

60%

70%

80%

31%

Percen

tage of com

mun

ity based

 GPs

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In-Patient Care: Supports

G14086 GP Assigned In-patient Care Network Initiative:

“Assigned In-patient”: a patient whose family physician has:

• Accepted Most Responsible Physician status for their care while resident in the community, and

• Admitting privileges at the acute care facility in which the patient has been admitted.

The Assigned In-patient Care Network Fee is designed to support the provision of in-hospital care to ‘Assigned’ inpatients by their own family physicians. This includes the costs of group/network activities for their shared provision of care to their Assigned hospital in-patients.

Funding Level:• $8,400 per annum paid at $2,100 at the beginning of each quarter;

and• Payable in addition to visits.

 

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In-Patient Care: SupportsG14086 GP Assigned Inpatient Care Network Initiative• For date of service use: April 1, 2013, July 1, 2013,

October 1, 2013, January 1, 2014• Billing Schedule: First day of the month, per calendar

quarter• Once your registration in the network has been

confirmed, submit fee item G14086 GP Assigned in-patient care network fee using the demographic patient information on the following slide. Your location will determine which PHN# to use.

• Use Diagnostic Code 780

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In-Patient Care: Supports

GP Assigned Inpatient Care NetworkParticipant Location Specific “patient” demographics for billingFraser Health Authority:

PHN# 9752 590 548Patient Surname: Assigned First Name: FHADate of birth: January 1, 2013

Interior Health Authority:PHN# 9752 590 587Patient Surname: Assigned First Name: IHADate of birth: January 1, 2013

Northern Health Authority:PHN# 9752 590 509Patient Surname: Assigned First Name: NHADate of birth: January 1, 2013

Vancouver Coastal Health Authority:PHN# 9752 590 523Patient Surname: Assigned First Name: CVHA (note first name starts with ‘C’)Date of birth: January 1, 2013

Vancouver Island Health Authority:PHN# 9752 590 516Patient Surname: Assigned First Name: VIHADate of birth: January 1, 2013

 

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In-Patient Care: SupportsEligibility for the Assigned In-patient care Network Incentive:

• Be a family physician in active practice in B.C.;

• Have active hospital privileges;

• Be associated and registered with a minimum of three other network members (special consideration will be given in those hospital communities with fewer than four doctors providing inpatient care);

• Submit a completed Assigned In-patient Care Agreement Form;

• Submit a completed Assigned In-patient Care Network Registration Form;

• Co-operate with other members of the network so that one member is always available to care for patients of the Assigned In-patient Care Network; and

• Must provide MRP care to at least 24 admitted patients over the course of a year; networks may average out this number across the number of members.

• Exemptions can be made through the GPSC In-patient Care working group.

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In-Patient Care: SupportsUnassigned In-patient Care Network Incentive:

• “Unassigned In-patient”: a patient whose family physician does not have admitting privileges in the acute care facility in which the patient has been admitted

• Quarterly incentive based on the annual volume of unassigned in-patients admitted to the acute-care facility, and is available for most hospitals with a community GP run unassigned inpatient care model

• Incentive for Unassigned In-patient Care is not available for hospitals which have a Hospitalist model

• Payment will be made to participating Divisions of Family Practice, or where there is no Division or the local Division decides not to provide the oversight, to the Network group.

Funding Level:

• Funding varies across hospital sizes from $8,213/qtr to $54,750/qtr.

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In-Patient Care: SupportsUnassigned In-patient Care Network Incentive:

Funding varies across hospital dependent upon volume of unassigned

Annual Volume

Daily payment

Annual Rate

>1,000 $600 $219,000

800-999 $500 $182.500

600-799 $400 $146,000

400-599 $310 $113,150

200-399 $220 $80,300

100-199 $130 $47,450

<100 $90 $32,850

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In-Patient Care: SupportsEligibility for claiming the Unassigned In-patient Care Network

Incentive:

• Be a family physician in active practice in B.C.;

• Have active hospital privileges;

• Submit a completed Unassigned In-patient Care Service Verification Form;

• Submit a completed Unassigned In-patient Care Network Registration Form;

• Also be a member of the Assigned In-patient Care Network unless an exemption is granted by the Division or the GPSC In-patient Care Working Group as indicated under the specifics of the Assigned In-patient Care Network Incentive; and

• Cooperate with other members of the network so that one member is always available to care for patients of the unassigned in-patient network.

• Exemptions can be made through the GPSC In-patient Care working group.

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In-Patient Care: SupportsG14088 GP Unassigned In-patient Care fee:• $150 per patient for MRP care for duration of hospital stay

Eligibility

• Must be member of a Unassigned In-patient Care Network and/or a Maternity Network;

• Payable once per unassigned in-patient per in-hospital admission;

• Payable only to the FP who is the Most Responsible Physician (MRP) for the patient during the in-hospital admission or is providing shared MRP responsibilities with a specialist due to a significant medical issue unrelated to the purpose of admission;

• Payable in addition to the hospital visits for care;

• Not payable to physicians who are employed by or who are under contract to a facility and whose duties would otherwise include provision of this care; and

• Not payable to physicians working under salary, service contract or sessional arrangements whose duties would otherwise include provision of this care.

• Exemptions can be made through the GPSC In-patient Care working group.

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In-Patient Care: Supports

Clinical Service Fee Bonus– 25% lift to community FP MRP visit fees (13008, 00127)– Payable to all FPs performing this service

Telephone Visits, Attachment Patient Conference

– expanded conference with healthcare professionals, patients– all patients for whom FP has community MRP responsibility– initiated by either FP or patient/healthcare professional– any time during care as clinically indicated– expanded number per year

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Questions?

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Thank you