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ATNI Presentation - September 21_ 2010

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									Portland Area Facilities Advisory Committee


         Regional Referral Centers
                       Pilot Study




               Affiliated Tribes of NW Indians
                           Airway Heights, WA
                             September 21, 2010
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
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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
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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



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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



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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




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PAFAC 2010 – Regional Referral Center Pilot Study Status Report


                                           Northeast
                                                             Recommended
                 Demonstration
                    Project                                    Regional
                                                PSA – Tribal (Typ.)
                                                              Boundaries
            Northwest                              PAFAC (Typ.)




                    PSA – Federal (Typ.)




                 Southwest

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PAFAC 2010 – Regional Referral Center Pilot Study Status Report

• Recommended Participating Tribes by Region
                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

1
 Region to be selected by Tribe.


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PAFAC 2010 – Regional Referral Center Pilot Study Status Report


     Recommended
     Demonstration
        Project                           PSA – Tribal (Typ.)



                                            PAFAC (Typ.)
                                                                Demonstration
                                                                   Project
                                                                  Boundary

                   PSA – Federal (Typ.)




                                                                                9
PAFAC 2010 – Regional Referral Center Pilot Study Status Report


• 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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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



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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

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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




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PAFAC 2010 – Regional Referral Center Pilot Study Status Report

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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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.




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PAFAC 2010 – Regional Referral Center Pilot Study Status Report




                   Questions…?


To review full study you can access at NPAIHB’s website
www.npaihb/XXXXX


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