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

2. 2 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 PAFAC 2010 – Regional Referral Center Pilot Study Status Report

3. 3 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 PAFAC 2010 – Regional Referral Center Pilot Study Status Report

4. 4 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 3 rd -party collections PAFAC 2010 – Regional Referral Center Pilot Study Status Report

5. 5 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 PAFAC 2010 – Regional Referral Center Pilot Study Status Report

6. 6 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 PAFAC 2010 – Regional Referral Center Pilot Study Status Report

7. 7 Northwest Northeast Southwest PSA – Tribal (Typ.) PSA – Federal (Typ.) Demonstration Project PAFAC (Typ.) PAFAC 2010 – Regional Referral Center Pilot Study Status Report Recommended Regional Boundaries

8. 8 Recommended Participating Tribes by Region 1 Region to be selected by Tribe. NortheastNorthwestSouthwest 1.Coeur D’AleneChehalisSamishBurns Paiute 2.ColvilleHoh RiverSauk-SuiattleChemawa 3.KalispelJamestownShoalwaterCLUSTI 4.KootenaiLower ElwhaSkokomishCoquille 5.Nez PerceLummiSnoqualmieCow Creek 6.NW Band of Shoshone 1 MakahSquaxin IslandCowlitz 7.Shoshone-Bannock 1 MuckleshootStillaguamishGrand Ronde 8.SpokaneNisquallySuquamishKlamath 9.UmatillaNooksackSwinomishSiletz 10.Port GambleTulalipWarm Springs 11.PuyallupUpper Skagit 12.QuileuteYakama 13.Quinault PAFAC 2010 – Regional Referral Center Pilot Study Status Report

9. 9 PSA – Tribal (Typ.) PSA – Federal (Typ.) Demonstration Project Boundary PAFAC (Typ.) PAFAC 2010 – Regional Referral Center Pilot Study Status Report Recommended Demonstration Project

10. 10 Recommended Demonstration Project PAFAC 2010 – Regional Referral Center Pilot Study Status Report Recommended Participants*Possible Services 1.StillaguamishAudiology 2.TulalipMedical Specialties 3.SnoqualmieSurgical Specialties 4.MuckleshootAmbulatory Surgery 5.PuyallupAdvanced Imaging (Fluor, Mammo, CT, MRI) 6.NisquallyOccupational Therapy 7.Port Gamble S’KlallamSpeech 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. 11 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 PAFAC 2010 – Regional Referral Center Pilot Study Status Report

12. 12 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

13. 13 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 PAFAC 2010 – Regional Referral Center Pilot Study Status Report

14. 14 PAFAC 2010 – Regional Referral Center Pilot Study Status Report Summary – the demonstration project will: 1.be new funding for the Area with a recurring staffing package. 2.not diminish current funding or services for tribes. 3.provide only specialty care; primary care will continue to be provided at local sites. 4.is the first of a 3-phase master plan. 5.be available to ALL Tribes for referral to the facility. 6.reduce Tribes dependency on CHS, allowing CHS funding to be stretched further. 7.result in better continuity of care.

15. 15 Requesting a resolution adopted by ATNI: to support the planning and design of the Portland Area Regional Referral Center demonstration project. PAFAC 2010 – Regional Referral Center Pilot Study Status Report

16. 16 Questions…? To review full study you can access at NPAIHB’s website www.npaihb/XXXXX PAFAC 2010 – Regional Referral Center Pilot Study Status Report