Wyoming Healthcare Commission
Rural Healthcare Delivery Subcommittee
Meeting Minutes
January 8, 2007
1:45-3:00PM
1:45PMI. Database
Questionnaire modifications
What’s next?
The committee discussed multiple changes to the questionnaire (see below). Beth will review with Dan Perdue, John Vandel, Grant Christensen and HPTC and then send it out for the committee’s review.
2:15PMII. Delivery systems study (RUPRI)
Review possible outcomes
The committee discussed the idea of an independent commission to oversee the integration of delivery models. RUPRI will identify models that make sense in Wyoming, and describe implementation steps for these. If there is an independent commission, it must be objective and should have a cabinet-level position (or similar authority), as well as accountability. We have quite a bit of flexibility since we have such a small market.
The next meeting will focus on the business plan for the database and the rough draft of the RUPRI report.
Meeting adjourned at 3:05pm.
01/04/2006
Conference call participants:Beth, Marlene, Greg, Rita
1. Applies to PA, APN -- I would recommend that the question on "Primary Specialty" on page one, be replaced with the specific question on page 3 about "Specialty" in which a variety of specialties are already listed. Then delete that question under both the primary practice location and the secondary practice location (since in most cases it will be the same. There are a few APNs that are dual certified in several areas and in theory might practice as a FNP in one setting and a CNM in another, but that seems unlikely).
Done.
2. Applies to PA and APN – The change above doesn't necessarily give us data on the types of setting they may be working in, e.g., a FNP working with a dermatologist. And as I look over the questionnaires, that seems to me to be one piece of information that is missing. It really isn't asked on the practice location setting (what type of setting this is) and I think that's something we ought to consider. Sometimes we'll know by the name of the clinic (the CheyenneHeartCenter), but often times it won't be clear.
Possible resolution: Ask Practice Location what type of facility they are: General, Geriatric, Pediatric, Cardiology, etc. This answer can then be compared to practitioner’s specialty. Beth will get more clarification from the committee on Monday.
Suggested language from committee:
How would you best describe the focus of this setting?
O Primary care
O Specialty practice, please specify type of specialty (e.g., cardiovascular)______
3. Applies to PA and APN – We ought to add "locum tenens" to the "overall work status' question on page 1 and to the "Practice Arrangement" questions on page 3.
Done.
4. In addition, we need to add a couple other types of specialties to the list of APN specialties (the one that we ought to move to page 1 from page 3). I would add the acute care nurse practitioner and psychiatric mental health nurse practitioner.
Acute Care and Psych/Mental Health are added as “Clinical Specialists”.
Beth will get more clarification from the committee on Monday.
Acute care nurse practitioner and psychiatric mental health nurse practitioner are separate categories from those that are clinical specialist – please add these two to the list.
5. Applies to MD, PA, APN -- I find the options listed under the question about practice arrangement not always clear. The following options are either vague or awfully broad and I wonder about their usefulness: administrative agency, agency staff, office, research, school/university, state institution. Is there a way to consolidate these and/or explain them better?
Removed Agency Staff and Office.
The committee suggested that in addition to this removal, we divide the choices into two headings: “Direct Patient Care” and “Administrative/Other. ” Example:
How would you best describe this practice setting? (please select one)
Direct Patient Care:
Alcohol/Detox/Halfway House
Clinic (Free-standing)
Clinic (Hospital)
CommunityHealthCenter
Hospital (Non-Federal)
Indian Health Services
Industrial/Occupational Health Clinic*
Long-term Care Facility
Military Facility
Occupational Health
OutpatientSurgeryCenter
Public Health
Rural Health Clinic (Federally-qualified)*
SpecialtyHospital
State Institution
Urgent Care
VA Facility
Administrative/Other:
Administrative Agency
Group Health Plan
Insurance Company
Research
School/University
*-note name change
The committee also felt that the questions asked in #4 and #5 on page 2 (patient activity and work time breakdown) were best placed on page 3, for each of the practice locations.
6. Applies to MD, PA, APN –
Program Participation:
“Have you completed your training?”
“If yes, did you receive any support for your education from the following programs?"
Possibility:
1. Have you ever participated in any of the programs listed below? __ Yes __ No
Add:
How did you participate?__ Student__ Preceptor
If student, have you completed your training?__ Yes__ No
Suggestion:
1. Have you ever participated in any of the programs listed below as a student? __ Yes __ No
If yes, have you completed your training? __ Yes __ No
2. Have you ever participated in any of the programs listed below as a preceptor? __ Yes __ No
Beth will work with the committee
The committee liked the “Suggestion.”
We may also want to add a category for "Wyoming State Contract Medical Education Program (Creighton, Utah)" (or something like this) because those who got support from the previous contract program may not have known where to put that and put it under WWAMI.
Resolution: Add WyomingState Contract Medical Education Program (Creighton, Utah)
NOTE: Beth is verifying what professionals this addition applies to.
It only applies to MD. It was the program that preceded WWAMI.
Note: Beth has a call into the State Dentist, to ask which programs apply directly to dentists.
7. Applies to MD, PA, APN –
On page 2, we ask three questions about retirement and relocation with inconsistent language (retirement vs. leave active practice vs. re-locating outside Wyoming). Let’s ask:
What are your plans for retirement?
Do you plan to leave active practice in Wyoming by relocating outside the state?
Proposed resolution:
10. What are your plans for retirement? __ Yes __ No (no change)
(timeframes listed)
11. Do you plan to leave active practice in Wyoming? __ Yes __ No
a. If Yes, please select one. If No, please skip to question 13 (will be 12)
__ Less than one year, etc. (Timeframes)
b. If Yes, please check all the issues related to this decision.
__, Departmental Issues, __ Income, etc.
Questions 12 is now included as 11b.
The committee suggested the following:
10. What are your plans for retirement? __ Yes __ No (no change)
(timeframes listed)
11. Do you plan to change your practice in Wyoming? __ Yes __ No (If yes, please specify change and timeframe)
Relocate within Wyoming ______
Relocate outside of Wyoming ______
Stop patient care______
(timeframes listed)
12. If Yes to #11, please check all the issues related to this decision.
__, Departmental Issues, __ Income, etc.
8. Applies to hospitals – let’s talk about how to ask the licensed beds question, so that we don’t get the extreme inflation.
Proposed Recommendation: Separate question:
Total Number of Licensed In-patient Beds: ______
Number of Beds by Type:__ Medical/Surg__ Emergency Patient Crisis __ Rehab
__ Psychiatric__ Long Term Care __ Bassinets
__ Burn Trama__ Swing __ Ambulatory
Note: due to dual usage beds, “Total Number of Licensed Beds” may not equal “Number of Beds by Type”
Committee wants Beth to talk to Dan Perdue, director of the Hospital Association (unable to attend on Monday.
Pharmacist Changes
9.Pharmacy Survey – Section V: Questions (number 2)
- In an average week, approximately how many hours do you spend in each of the Pharmacy activities listed?
Add:__ Continuing Education
Committee agreed.
- Question to add (insert after #3)
In an average year, approximately how many house of your Continuing Education is obtained through: __ Publications __ Conventions __ Workshops __ Other
Committee agreed.
- Hospital privileges – may ask hospitals for counts (not names)
–need to determine what type of information hospital will/can provide – count of Wyoming actively practicing physicians
All physicians
Physicians with staff privileges
Physicians with admitting privileges
Physicians with guest privileges
Beth will discuss with committee to try to figure out what is meaningful.
Committee wants Beth to talk to Dan.
Additional changes:
- Applies to MD, PA, APN, DDS: On question 4 on page 2 (patient activity), the committee wants to add “Not seeing patients” as a choice, in case they do work for a university, insurance company, etc. As mentioned above, they want this question moved to page 3 for each of the practice locations.
- For Pharmacist survey: page 2 – “Which of the following best describes your present position?”
Add “Pharm D” as a choice.