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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
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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.)
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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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