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

What are Regional Referral Centers? 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

What are the benefits of Regional Centers? 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

Why was this concept proposed? 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

How was the concept developed? 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

How was the concept developed? 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

Recommended Regional Boundaries Demonstration Project 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

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

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

Recommended Participants* 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.

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

What's transpired? HQ-Area discussions generated 3 questions 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

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

Summary – the demonstration project will: 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.

Requesting a resolution adopted by ATNI: 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.

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