Regional Referral Centers Pilot Study: Status Report

1. Portland Area Facilities Advisory Committee Regional Referral Centers Pilot Study Affiliated Tribes of NW Indians Airway Heights, WA September 21, 2010

2. PAFAC 2010 – Regional Referral Center Pilot Study Status Report 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

3. PAFAC 2010 – Regional Referral Center Pilot Study Status Report 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

4. PAFAC 2010 – Regional Referral Center Pilot Study Status Report 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

5. PAFAC 2010 – Regional Referral Center Pilot Study Status Report 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

6. PAFAC 2010 – Regional Referral Center Pilot Study Status Report 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

7. PAFAC 2010 – Regional Referral Center Pilot Study Status Report Northeast Recommended Regional Boundaries Demonstration Project PSA– Tribal (Typ.) Northwest PAFAC(Typ.) PSA – Federal (Typ.) Southwest

8. PAFAC 2010 – Regional Referral Center Pilot Study Status Report • Recommended Participating Tribes by Region 1Region to be selected by Tribe.

9. PAFAC 2010 – Regional Referral Center Pilot Study Status Report Recommended Demonstration Project PSA – Tribal (Typ.) Demonstration Project Boundary PAFAC (Typ.) PSA – Federal (Typ.)

10. PAFAC 2010 – Regional Referral Center Pilot Study Status Report • Recommended Demonstration Project *Initial workload will be based on a 60-minute drive time resulting in 24,000 primary care users in the NW region.

11. PAFAC 2010 – Regional Referral Center Pilot Study Status Report 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

12. PAFAC 2010 – Regional Referral Center Pilot Study Status Report 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

13. PAFAC 2010 – Regional Referral Center Pilot Study Status Report 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

14. PAFAC 2010 – Regional Referral Center Pilot Study Status Report Summary – the demonstration project will: • be new funding for the Area with a recurring staffing package. • not diminish current funding or services for tribes. • provide only specialty care; primary care will continue to be provided at local sites. • is the first of a 3-phase master plan. • be available to ALL Tribes for referral to the facility. • reduce Tribes dependency on CHS, allowing CHS funding to be stretched further. • result in better continuity of care.

15. PAFAC 2010 – Regional Referral Center Pilot Study Status Report Requesting a resolution adopted by ATNI: to support the planning and design of the Portland Area Regional Referral Center demonstration project.

16. PAFAC 2010 – Regional Referral Center Pilot Study Status Report Questions…? To review full study you can access at NPAIHB’s website www.npaihb/XXXXX