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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.)

10. 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.

11. 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

12. 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

13. 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

14. 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.

15. 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.

16. 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