Transcript Improving Access to Specialty Care”

Regional Referral Centers:
“Improving Access to
Specialty Care”
Portland Area Facilities Advisory Committee (PAFAC)
Presentation Outline





PAFAC Charge & Recommendation
Benefits of a regional referral center in
Portland Area
Guiding Principles
Pilot Study overview and findings
Address questions/concerns on moving
forward
2
PAFAC Charge

…to provide recommendations to the
Director, PAIHS, on issues related to
healthcare facilities and staffing.

Initial Task:
Make recommendations to allow regional
healthcare facilities and Area-wide medical
centers to be ranked under the revised IHS
Healthcare Facilities Construction Priority
System (HFCPS).
3
The PAFAC’s Recommendation

Fund a “Demonstration Project” or
projects


A multi-tribal specialty care referral facility
 At least one in the Portland Area
st of 3 to be built in the Portland Area
 The 1
To include planning, design, construction, and
staffing of regional referral center(s) that will
provide secondary care referral services to
Portland Area Tribes.*
*NPAIHB passed Resolution No. 10-01-04 on 10/22/09
4
What is a
Regional Referral Specialty Center?
A healthcare facility that provides
culturally sensitive access to specialty
care through referrals from primary
care facilities operated by the
participating tribes.
5
Benefits of a Regional Referral Center



Decrease dependence on CHS resulting in
cost savings
Increase access to all levels of specialty care
More timely access to care



Reduce waiting period for contract health
Culturally-relevant healthcare
Primary Care remains at, and is best
delivered at the local level
6
Why this approach?
INNOVATION, CHANGE..
The Demonstration Project would




Provide improved access to more comprehensive care for
dispersed Tribal populations.
Have a “specialty care” focus that compliments
community-based primary care.
Be based on multi-tribal partnerships.
Make use of telemedicine when possible.
“…in order for us to get the support that is so desperately needed,
we need to demonstrate a willingness to change and improve.”
-- Dr. Yvette Roubideaux, Director
Indian Health Service
Open Letter to Tribal Leaders, June 2, 2009
7
The Influence of Portland Area Tribes
Portland Tribes:
 Have a unique ability to collaborate
 Share common goal: provide culturallysensitive care to patients


This sense of partnership guided the
Master Planning Process of 2005.
These attributes carry over to the PAFAC
and their recommendations.
8
Partnerships
Portland Area Tribes = Collective Power
Examples of successful partnerships that have
resulted in better services for users:




Healing Lodge of the Seven Nations
SDPI Consortiums (i.e., Southern Oregon)
Northwest Washington Indian Health Board
Northwest Portland Area Indian Health Board
9
Guiding Principles
Such a facility will bring new resources:
 Additional services on a direct care basis.
 Current local resources and services remain
unchanged.
 Full consultation among all involved Tribes
before any advancement of the facility.
 Governance will be with the consent of the
governed – the participating Tribes.
 Concept will be self-sufficient (revenue-stream)
 Range and scope of services provided will be
determined based on the need of the
participating Tribes and communities.

Size, staffing, location, other pertinent aspects
10
Why a Demonstration Project?

Current IHS healthcare resources do not fully
address the needs of small, geographically
dispersed Tribes.



CHS is inadequate.
Small, isolated populations do not justify direct
service Specialty Care.
Current IHS methodologies for healthcare
facilities construction funding are inequitable.

Areas that service predominantly small Tribes
have been left out.
11
Terminology of the Pilot Study




CHSDA – Counties defined all or in part as the
Contract Health Service Delivery Area for a particular
Tribe.
Primary Service Area (PSA) – A group of communities
and its population for which, at a minimum primary
care is planned and resourced.
User Population – The number of Active Registrants
in the healthcare system that have used the system
in the last 3 years.
Workload – The number of annual Indian patient
visits for primary care and/or specialty care at a
service unit or Tribal clinic.
12
Pilot Study Findings
Portland Area Regional Specialty Care Referral Centers
must:
 Rely on existing Primary Care at Tribal clinics and
service units
 Be near a population center that supports hospitals


Be near a transportation hub


For recruitment/retention of high skilled Specialists
Facilitate Tribes’ access to the facility
Demonstrate prelim. planning criteria for use by IHS


Sufficient to adapt the IHS facility planning process
Determine facility workload and size


Travel Distance
Alternate Resources
13
30+ Hospitals
8 Universities/colleges
1 Major Medical School
SeaTac International Airport
I-5 Corridor
8 Hospitals
5 Universities/colleges
Spokane International Airport
I-90 Corridor
15+ Hospitals
8 Universities/colleges
1 Major Medical School
Portland International Airport
I-5 Corridor
14
Possible Referral Services




Cardiology
Orthopedic
procedures
Endo/Colonoscopy
Rheumatology





Dermatology
ENT
Pulmonology
GYN
“Scope” Surgery
• Final range of services for the Referral Center will be
determined during planning phase
**These services would be provided on a direct care basis within
IHS system instead of utilizing CHS resources.
15
Why Telemedicine?

Improved Access


Cost Efficiencies





It brings healthcare to patients in remote location
Better management of chronic diseases
Shared health professional staffing
Reduces/eliminates travel
Fewer or shorter hospital stays
Improved Care

Reduces travel and related stress to patients
16
Telemedicine





Dermatology
Ophthalmology
Mental Health
Imaging




Specialty/Primary Care
Radiology
Pathology
Cardiology



Cardiology
Pathology
Education/Information



Continuing Education
Education Seminars
Peer-to-peer support
Remote Monitoring


Blood Glucose
EKG
• Final range of services for the Referral Center will be
determined during planning phase
17
Initial Task Timeline

January 2008


February – April 2008


Initial charge/task from Director, PAIHS
Develop Pilot Study Concept
November 2008

Met w/ IHS Director Bob McSwain


Pilot Study approved and funded by IHS
March – October 2009




Pilot Study contract finalized - Mar
First Draft Pilot Study completed - Aug
NPAIHB Supporting Resolution passed - Oct 22, 2009
Pilot Study Final Report completed - Oct 30, 2009
18
Initial Task Timeline

November 2009


March – Sept 2010




Tribal-IHS Director listening Session - Mar
 PAFAC participated
PAFAC sent follow-up letter - Aug
 requested $300K for initial planning
ATNI supporting resolution passed - Sept
January 2011


Met with IHS Director Dr. Roubideaux
Follow-up letter on planning funds to IHS Director
April 2011

Tribal Leader - PAFAC Forum, Ocean Shores, WA
19
Why a Demonstration Project Now?

IHS HQ acknowledgement

The current system does not address all
healthcare needs




Smaller individual Tribes ≠ Specialty Care
IHS Priorities for innovation and increased
access to care
National focus on healthcare reform and
Affordable Care Act
Other Areas are eager to act on regional
referral concept. (California, Nashville, Bemidji,
Oklahoma)
20
PAFAC Membership - 2012
Member
Affiliation
Status
Andy Joseph
Colville Tribal Council, NPAIHB Chair
DST
Pearl Capoeman-Baller
Quinault, NPAIHB Vice-Chair
T-5
Julia Davis-Wheeler
Nez Perce Tribal Council
T-5
Dan Gleason
Chehalis Tribal Council
T-1
Mark Johnston
Grand Ronde, Health Director
T-5
Steve Kutz
Cowlitz Tribal Council
T-5
Marcus Martinez
Spokane, CEO, Wellpinit Service Unit
Fed
Angela Mendez – Alt.
Shoshone-Bannock, Tribal Health Director
T-1
Sharon Stanphill
Cow Creek, Director, CCH&WC
T-1
John Stephens
Swinomish, Director, Social Services
T-5
Ron Suppah
Warm Springs Tribal Council
DST
21
“Health Care Funding for Pacific Northwest Tribes
Is Seriously Inadequate
IHS funding is appropriated annually at the discretion of Congress and is not
adequate to meet the health care need of Native American people. This
ongoing funding deficit is a major factor in cancer-related and other
disparities experienced by Native populations. The Institute of Medicine
(IOM) has stated that closing the gap on health disparities for this population
will require a national recommitment; especially in the form of increased
Federal funding that would allow patients timely access to specialty care.”1
Cancer in Indian Country: The Yakama Nation and Pacific Northwest Tribes; President’s Cancer Panel,
2002 Report; U. S. Department of Health and Human Services, National Institute of Health, National Cancer
Institute
1Facing
22
Discussion?
For more information visit the NPAIHB web site under “Indian Health Policy” page
http://www.npaihb.org/policy/portland_area_facilities_advisory_committee/