Project Option 1.9.2: Improve access to specialty care: EXPAND SPECIALTY CARE CAPACITY
Unique Project ID: 130601104.1.3
Performing Provider Name/TPI: Providence Memorial Hospital / TPI: 130601104
Project Description:
This project will entail the performance and implementation of a community needs assessment and formation of a specialty clinic based on the needs of the community.
Tenet is committed to increasing the access to primary and specialty care through its history of recruitment efforts. The establishment of a specialty clinic, based on the demand of these targeted services will increase access to much needed care. In addition, it will support population health, and the overall wellbeing of our community, by increasing the number of specialty providers and specialty services based on the identified community need. Following the launch of this clinic or clinics, Tenet will implement a transparent, standardized referral system for the clinic or clinics, and Tenet will also conduct quality improvement activities related to the clinic or clinics. Tenet foresees the identification and recruitment of specialty physicians as the major challenge with respect to the implementation of this project.
Goals and Relationship to Regional Goals:
Project Goals: The end goal of this project will be the launch of at least one specialty clinic, based on a community needs assessment that will also form the basis for a targeted specialty physician recruitment plan.
This project meets the following regional goals: Utilizing a community assessment to identify the community need for specialist services and target recruitment efforts, will align to the regional goals of increasing the number of specialist and scope of services offered in the community; and the patient experience through delivery of high-quality, effective healthcare services.
Challenges:
Tenet foresees the identification and recruitment of specialty physicians as the major challenge with respect to the implementation of this project.
5-Year Expected Outcome for Provider and Patients:
PMH through Tenet is committed to increasing the access to primary and specialty care through its history of recruitment efforts for adult and pediatric populations. The expected outcome of the establishment of a specialty clinic, based on the demand of these targeted services, is the increase of specialty care access to much meet the need of these services. In addition, PMH expects to support the population health, and the overall wellbeing of our community, by increasing the number of specialty providers and specialty services based on the identified community need. The expectation is that PMH will implement and maintain quality improvement activities related to clinic operations, patient experience and overall outcomes so as to ensure the delivery of quality healthcare to the region.
Starting Point/Baseline:
The deficit of physician specialists in the primary service area of Providence Memorial Hospital is in excess of 50 providers, as of December 2011. Based on the community needs assessment, Providence Memorial Hospital will establish specialty clinics within the community.
Rationale:
There is a severe shortage of specialty care providers in El Paso County and the surrounding region. A recent assessment revealed a shortage of 100 specialty providers for the population demand. This shortage, coupled with the shortage of primary care in the area, represents a severe lack of access to healthcare in the greater El Paso region. In turn, this lack of access to care has an untoward effect on the overall wellbeing of the population. Before there can be an expansion of specialty care and services, it is crucial to perform a needs assessment regarding health disparities in the region and the particular need for specialists in specific practice areas and geographic areas.
Project Components:
This project will accomplish the following project components:
a) Increase service availability with extended hours.
o Providence will extend hours by establishing a new clinic.
b) Increase number of specialty clinic locations.
o Providence will increase the number of clinic locations by establishing a new clinic.
c) Implement transparent, standardized referrals across the system.
o Providence will implement a referral process between the hospital and the new clinic.
d) Conduct quality improvement for project using methods such as rapid-cycle improvement. Activities may include, but are not limited to, identifying project impacts, identifying “lessons learned,” opportunities to scale all or part of the project to a broader patient population, and identifying key challenges associated with expansion of the project, including special considerations for safety-net populations.
o Providence will conduct quality improvement activities related to the clinic and/or hospital referrals to the clinic.
Unique community need identification numbers the project addresses:
· CN-2: Secondary and Specialty Care
How the project represents a new initiative or significantly enhances an existing delivery system reform initiative:
PMH has been committed to increasing the access to primary and specialty care through its history of recruitment efforts. Through a detailed and deliberate community needs assessment and a commitment to implement and maintain quality improvement activities related to clinic operations, patient experience and overall quality outcomes, this project will represent an ENHANCED initiative.
Related Category 3 Outcome Measures:
OD-6 Patient Satisfaction
IT-6.1: Percent improvement over baseline of patient satisfaction scores
130601104.3.3
Reasons/rationale for selecting the outcome measures:
As this project is implemented and specialty care clinics are established or expanded, Providence believes that patients will have better access to specialty care, which will result in an improvement in patient satisfaction scores for the target population of the project. Specifically, Providence expects that the successful implementation of this project will be accompanied by an improvement in patients’ rating of their access to specialty care in the target population.
Relationship to Other Projects: This project is part of Tenet’s larger plans to expand and develop primary care and specialty care services in the El Paso community, while improving access to care and containing the costs of care. Specifically, this project will complement Tenet’s Expand Primary Care Access project (130601104.1.1) in developing and expanding a robust community-wide network of primary care and specialty care services in El Paso.
Relationship to Other Performing Providers’ Projects and Plan for Learning Collaborative:
This project is congruent with an Expand Specialty Care Capacity project to be performed in RHP Region 15 by Sierra Providence East Medical Center (196829901.1.3).
Performing Providers, IGT entities, and the Anchor for Region 15 have held consistent monthly meetings throughout the development of the Waiver. As noted by HHSC and CMS, meeting and discussing Waiver successes and challenges facilitates open communication and collaboration among the Region 15 participants. Meetings, calls, and webinars represent a way to share ideas, experiences, and work together to solve regional healthcare delivery issues and continue to work to address Region 15’s community needs. UMC, as the Region 15 Anchor anticipates continuing to facilitate a monthly meeting, and potentially breaking into workgroup Learning Collaboratives that meet more frequently to address specific DSRIP project areas that are common to Region 15, as determined to be necessary by the Performing Providers and IGT entities. UMC will continue to maintain the Region 15 website, which has updated information from HHSC, regional projects listed by Performing Provider, contact information for each participant, and minutes, notes and slides from each meeting for those parties that were unable to attend in-person.
Region 15 participants look forward to the opportunity to gather annually with Performing Providers and IGT entities state-wide to share experiences and challenges in implementing DSRIP projects, but also recognize the importance of continuing ongoing regional interactions to effectuate change locally. Through the use of both state-wide and regional Learning Collaborative components, Region 15 is confident that it will be successful in improving the local healthcare delivery system for the low-income and indigent population.
Project Valuation
$6,717,071. In determining the value of this project, Tenet considered the extent to which increased access to specialty care will address the community’s needs, the population which this project will serve, the resources and cost necessary to implement the project, and the project’s ability to meet the goals of the Waiver (including supporting the development of a coordinated care delivery system, improving outcomes while containing costs, and improving the healthcare infrastructure). Specifically, Tenet considered the value to the community of a project such as this, which will be specifically targeted to identified specialty services needs of the community. In addition, Tenet considered the difficulty of recruiting and retaining specialty physicians in the El Paso area.
Tenet plans to implement a similar Category 1 project at its Sierra Providence East Medical Center location, serving a different geographic area of the city. The disparity in valuation between this Providence project and the similar Sierra East project is due to the fact that Providence is a much larger facility than Sierra East (with 508 beds, compared to 110 at Sierra East) and accounts for 270% more Medicaid and uninsured days than Sierra East.
130601104.1.3 / 1.9.2 / 1.9.2.X / Expand Specialty Care Capacity /Providence Memorial Hospital / 130601104 /
Related Category 3 Outcome Measure(s): / 130601104.3.3 / IT-6.1 / Percent improvement over baseline of patient satisfaction scores /
Year 2
(10/1/2012 – 9/30/2013) / Year 3
(10/1/2013 – 9/30/2014) / Year 4
(10/1/2014 – 9/30/2015) / Year 5
(10/1/2015 – 9/30/2016) /
Milestone 1: Establish baseline for metrics P-1.1, P-11.1, I-22.1, I-23.1, I-27.1, I-27.2, and I-27.3.
Metric 1: Establish baseline for future years.
Milestone 1 Estimated Incentive Payment: $1,642,757 / Milestone 2 [P-1]: Conduct specialty care gap assessment based on community need.
Metric 1 [P-1.1]: Documentation of gap assessment. Demonstrate improvement over prior reporting period.
Baseline/Goal: Completed needs assessment.
Data Source: Needs assessment.
Milestone 2 Estimated Incentive Payment: $1,792,160 / Milestone 3 [P-11]: Launch/expand a specialty care clinic.
Metric 1 [P-11.1]: Establish/expand specialty care clinics.
Baseline/Goal: Establish at least 1 new clinic.
Data Source: Documentation of new/expanded specialty care clinic.
Milestone 3 Estimated Incentive Payment: $1,797,370 / Milestone 4 [I-22]: Increase the number of specialist providers, clinic hours, and/or procedure hours available for the high-impact/most-impacted medical specialties.
Metric 1 [I-22.1]: Increase number of specialist providers, clinic hours, and/or procedure hours in targeted specialties.
Baseline/Goal: Establish 1 new clinic.
Data Source: HR documents or other documentation demonstrating employed/contracted specialists.
Milestone 4 Estimated Incentive Payment: $494,928
Milestone 5 [I-23]: Increase specialty care clinic volume of visits and evidence of improved access for patients seeking services.
Metric 1 [I-23.1]: Documentation of increased number of visits. Demonstrate improvement over baseline rates.
Baseline/Goal: 10% increase in patient visits.
Data Source: Registry, EHR claims, or other Performing Provider source.
Milestone 5 Estimated Incentive Payment: $494,928
Milestone 6 [I-27]: Patient satisfaction with specialty care services.
Metric 1 [I-27.1]: Patient satisfaction scores: Average reported patient satisfaction scores, specific ranges and items to be determined by assessment tool scores. Demonstrate improvement over prior reporting period.
Baseline/Goal: 5% improvement.
Data Source: CG-CAHPS or other developed evidence-based satisfaction assessment tool, available in formats and language to meet patient population.
Metric 2 [I-27.2]: Percentage of patients receiving survey. Specifically, the percentage of patients that are provided the opportunity to respond to the survey. Demonstrate improvement over prior reporting period.
Baseline/Goal: 5% improvement.
Data Source: Performing provider documentation of survey distribution, EHR.
Metric 3 [I-27.3]: Survey response rate. Demonstrate improvement over prior reporting period.
Baseline/Goal: 5% improvement.
Data Source: Performing provider documentation of survey distribution, EHR.
Milestone 6 Estimated Incentive Payment: $494,928
Year 2 Estimated Milestone Bundle Amount: $1,642,757 / Year 3 Estimated Milestone Bundle Amount: $1,792,160 / Year 4 Estimated Milestone Bundle Amount: $1,797,370 / Year 5 Estimated Milestone Bundle Amount: $1,484,784
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $6,717,071
93848.6