1. Specialty Care needs For Denver Safety Net Clinics
Steven Krager, MD
1/19/16

2. Key Findings
The specialties identified as most in demand but the hardest to secure were Neurology and Orthopedics (40% of clinics)
Other surgical sub-specialties such as Urology and Neurosurgery were next
Oncology and Nephrology also identified
In the pediatric population Developmental Pediatrics is the specialty most in demand but hardest to secure.
Pediatric Neurology often with long wait times
Most safety net clinics do not have referral guidelines in place
One clinic uses the High Value Care Coordination (HVCC) Toolkit from the American College of Physicians and finds it valuable
Example of Referral Guidelines:
Also provides sample care coordination agreements between PCPs and Specialists

3. Key Findings Cont. Referral Network Findings
Overall general excitement about expanded referral services
All clinics have some form of support staff to facilitate care coordination as long as it is not too “cumbersome”
E-consults would be very beneficial for quick consults/questions about procedures or tests to order
Less than half of the clinics are connected to CORHIO, the rest are planning to in the future
Questions/Concerns include:
Financial/who will pay?
How quick would response time be? (any specialists able to be on call for immediate questions?)
If E-consult determined not to be sufficient, can an in person referral be arranged?

4. Other Issues identified
Follow up from specialists after successful referrals is sometimes lacking
Clinics noted that many specialists will see Medicaid patients but have a cap at one patient per month leading to long wait times (often three months or longer)
Some clinics have specific cultural/language needs that provide additional challenges to making successful referrals
Trying to arrange interpreters for rare languages/dialects
Transportation
One clinic did express concern about losing patients if referring to a larger medical system

5. Questions?
Thank you!