Starting Medication Abortion Services in a FQHC Residency Clinic: You Can Do It! Lealah Pollock, MD, MS Isabel Lee, MD UCSF Family and Community Medicine Residency Program Kohar Der Simonian, MD Maine Family Medicine Residency Program

Disclosures None

Learning Objectives After this session, participants will be able to: Identify three key stakeholders in their institution List five components of the planning process Name two national organizations providing key resources for preparation and support

But First… Who are you and why are you here? Pull out your phones Text “Lealah” to Now you will text your responses to the following questions

Our Site: Background Hospital campus-based family medicine clinic Federally Qualified Health Center (FQHC) Residency outpatient training site

Our Site: Background CA: State Medicaid funds cover abortion RHEDI grant recipient Abortion services available in OB/Gyn- run hospital unit

So, Why Bother? Enhance patient-centered abortion care Reduce barriers to services Train and model for residents how medication abortion can be integrated into primary care Model for patients that abortion care is a part of comprehensive women’s health care and a common part of reproductive life cycle

Step 1: Build a Team Build an inter-disciplinary committee Set up structure and expectations Delegate to make project manageable! Our team: –Two faculty co-chairs –3-4 residents –Nurse manager –Clinic director –FP Family Planning fellow

Step 2A: Identifying Stakeholders Who has skin in the game? Whose buy-in will give you needed leverage or access? What are their priorities and how do you frame your interests to overlap with theirs?

Step 2B: Identifying Our Stakeholders Family medicine clinic director Chief of service Residency director Chair of OB/Gyn Department Director of hospital’s abortion clinic  Start internal: frame around patient access, patient centered care, resident education  Move external: take advantage of leadership’s relationships and history to strategize and seek buy-in

Step 3A: Addressing FQHC Status You can’t do that at an FQHC: the Hyde Amendment restrictions 18 states allow use of state Medicaid funds Options: –Co-location services, but separate staffing time, supplies, and services documented and pro-rated –Creation separate corporation (to facilitate above) –Development separate accounts for billing procedures ¹ ¹Administrative Billing Guide, Abortion Access Project

Step 3B: Addressing Our FQHC Status Meeting with hospital billing and accounting leadership Provided administrative billing guide in advance They developed new encounter form with common billing codes (separation funds) Training for billing/registration staff

Step 4A: Clarify Hospital Approval Process Identify leadership and allies who can guide you through necessary steps Consider consultation: OB/Gyn department and Pharmacy

Step 4B: Our Hospital Hurdles Key Ally: OB Pharmacist Development of medication abortion protocol for clinic (none existed for hospital service) Approval by formulary committee (for mife) Protocol submitted and reviewed by three additional regulatory committees Clinical concession: universal ultrasounds

Step 5A: Collaborating with Clinic and Residency Where/when in clinic (specific clinic vs full integration) Staffing: residents and faculty Curriculum development –Faculty –Residents Staff training

Step 5B: Our Implementation Plan MAB Service: separate clinic once/week with goal of eventual wider integration Resident: on women’s health rotation; carry after-hours pager Faculty: US-credentialed pool, all with abortion training experience Training: faculty development session, resident modules, RN options counseling, staff-wide values clarification

BREAKOUT!! Go around the group and briefly share where you are in the process and where you anticipate your biggest barrier Choose one barrier to focus on Strategize ways to overcome this barrier Come up with one next step for your site: Make it SMART

Steps in Review Step 1: Build a Team Step 2: Identify Stakeholders Step 3: Address FQHC Status (if relevant) Step 4: Clarify Hospital Approval Process Step 5: Collaborate with Clinic and Residency Note: Steps 3-5 may be worked on simultaneously or in different order

SMART Goals Specific Measurable Attainable Realistic Timely

Resources The person sitting next to you! Reproductive Health Access Project reproductiveaccess.org Reproductive Health EDucation In Family Medicine (RHEDI), ACOG National Abortion Federation (NAF)

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