Presentation to Medicaid Opportunities and Challenges Task Force May 14, 2013 Primary Care in South Dakota 1

Presentation Overview 2  General demographics  Location of primary care providers in South Dakota  Current efforts

General Demographics 3

2010 – 814, to

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South Dakota Working Age Population Change

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Location of Primary Care Providers 8

South Dakota Physicians: Percentage of Primary Care Providers* 9

* Primary care defined as family medicine, internal medicine, pediatrics, and OB / GYN Percentage of Primary Care Physicians* by Community Population (as of December 31, 2011) 10

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* Due to a technical issues, Faulk county should be shaded light yellow. 20

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Current Efforts 27

Governor’s Primary Care Task Force  Governor appointed a Primary Care Task Force in 2012 to consider and make recommendations to ensure accessibility to primary care for all South Dakotans – particularly in rural areas of the state  Members included primary care physicians, nurse practitioners, physician assistants, health systems, hospital administrators, School of Medicine, Board of Regents, IHS, medical students, legislators, consumers, and state agencies  Developed recommendations around five specific areas :  Capacity of healthcare educational programs  Quality rural health experiences  Recruitment and retention  Innovative primary care models  Accountability and oversight  Task Force also developed metrics within each area to measure progress and success in maintaining and strengthening the state ’ s primary care system  Governor ’ s Primary Care Task Force website : doh. sd. gov / PrimaryCare / 28

Primary Care Education Programs 29  Expansion of Medical School  FY 13 budget provided for the expansion of the USD Sanford School of Medicine class size by four students per year.  Frontier and Rural Medicine ( FARM )  FY 2013 budget funded establishment of the FARM program which is a rural track program to provide 3 rd year medical students with a 9- month clinical training in a rural community.  Physician Assistant Program Expansion  FY 2013 budget provided for the expansion of the PA program class size by five students (20 to 25) and converted 5 of the existing non - resident slots to resident slots.  PA / NP Preceptors  FY 14 budget provides for payments to SD providers serving as preceptors for PA students ; Oversight Committee looking at need to extend payments for NP preceptors in FY 15 budget

Healthcare Workforce Pipeline  Health Occupations for Today and Tomorrow ( HOTT )  A K -12 health career awareness curriculum. HOTT is a web - based tool with lesson plans, activities, resources, etc. designed to increase students ’ knowledge of health careers.  Scrubs Camps / Camp Meds  One - day health career educational opportunities to allow high school students ( Scrubs ) and middle school students ( Camp Med ) to experience a wide variety of health careers through hands - on activities and discussions with healthcare providers.  Rural Experiences for Health Profession Students ( REHPS )  REHPS provides 1 st and 2 nd year medical, PA, NP, and pharmacy students with experience in a rural setting with the ultimate goal of increasing the number of medical professionals practicing in rural and frontier communities in South Dakota. 30

Recruitment Assistance Programs for Health Professionals and Communities Program NameRecruitment Assistance Program – Physician/Dentist Recruitment Assistance Program – Physician Assistant, Nurse Practitioner, Nurse Midwife Rural Healthcare Facility Recruitment Assistance Program Description Recruitment assistance program available to eligible physicians and dentists licensed in South Dakota who agree to practice in a community with a population of 10,000 or less that has been assessed by the Department of Health and determined to both need and be able to sustain a physician or dentist. Recruitment assistance program available for physician assistants, nurse practitioners, and nurse midwives licensed in South Dakota who agree to practice in a community with a population of 10,000 or less. Recruitment assistance program in which the eligible health professional must enter into a three - way contract with the employing facility and the state. The employing facility must reside in a community with a population of 10,000 or less. Benefits The amount reimbursable is equal to double the USD School of Medicine ’ s resident tuition for the most recent four year period. The current amount is approximately $138,328. The amount reimbursable is equal to double the USD resident tuition for physician assistant studies for the three most recently completed academic years. The current amount is currently $31,345. $10,000 payment at the end of the service commitment. Commitment Agree to practice full - time in an eligible community for at least three consecutive years. Agree to practice full - time in an eligible community and eligible facility for at least three consecutive years. Eligible Disciplines Family medicine, pediatrics, internal medicine, and OB / GYN General and Pediatric Dentistry Physician assistant, nurse practitioner, and nurse midwife Dietitian / nutritionist, nurse ( RN or LPN ), occupational therapist, respiratory therapist, pharmacist, physical therapist, paramedic, certified medical laboratory professional, & radiologic technologist More Information http :// doh. sd. gov / RuralHealth / RAP. a spx http :// doh. sd. gov / RuralHealth / RAP. a spx or Contact the Office of Rural Health at (800) or (605) http :// doh. sd. gov / RuralHealth / RAP. a spx http :// doh. sd. gov / RuralHealth / RAP. a spx or Contact the Office of Rural Health at (800) or (605) http :// doh. sd. gov / RuralHealth / Faci lityRecruitment. aspx http :// doh. sd. gov / RuralHealth / Faci lityRecruitment. aspx or contact the Office of Rural Health at (800) or (605)

32 Communities Participating in Tuition Reimbursement Programs Physician Communities Belle Fourche Chamberlain Custer Flandreau Freeman Gregory Hot Springs Madison Martin Miller Mobridge Parkston Phillip Platte Redfield Scotland Tyndall Viborg Wagner Webster Winner Dentist Communities Deadwood DeSmet Gettysburg Gregory Howard Martin Platte Redfield Sisseton Springfield PA / NP Communities Armour Britton Canton Chamberlain Elk Point Faulkton Freeman Howard Mission Phillip Redfield Salem Scotland Sisseton Viborg

Facilities Participating in Rural Recruitment Assistance Program 33

Accountability and Oversight 34  Oversight Committee has been established to monitor implementation of the recommendations of the Primary Care Task Force  Oversight Committee will also be looking at the metrics established by the Task Force to measure progress  Members include :  Deb Bowman, Governor ’ s Office, Chair  Rob Allison, MD, SD State Medical Association  Senator Corey Brown  Gail Gray, Ed. D., Rapid City  Doneen Hollingsworth, Secretary of Health  Mary Nettleman, MD, Dean, USD Sanford School of Medicine  Senator Billie Sutton  Gale Walker, Avera St. Benedict Health Center  Jack Warner, Ed. D., Executive Director, SD Board of Regents  Oversight committee will meet 3 times a year and provide an annual report to the Governor, Board of Regents, and Legislature by November 1 st of each year

Questions? 35  For more information contact : Doneen Hollingsworth, Secretary South Dakota Department of Health Halley Lee, Office of Rural Health South Dakota Department of Health