Community Practice Model Florence, Oregon
Recruitment
Supply and Demand: Primary Care/Non-Primary Care Primary Care Projected shortfalls in primary care range between 14,900 and 35,600 physicians by 2025 Non-Primary Care Projected shortfalls in non-primary care specialties range between 37,400 and 60,300 by 2025 In percentage terms, the shortfall is greatest among surgeons (between 25,200 and 33,200). Larger surgical specialties are highlighted in this shortfall (e.g., ophthalmology and urology) https://www.aamc.org/download/458082/data/2016_complexities_of_supply_and_demand_projections.pdf
National Demand-Top Searches 1. Family Medicine (includes Family Practice/OB) 2. Psychiatry 3. Internal Medicine 4. Hospitalist 5. Nurse Practitioner 6. OB/GYN 7. Neurology 8. Orthopedic Surgery 9. Urgent Care 10. Pediatrics -Merritt Hawkins 2016 Recruitment Review
Supply and Demand: Nurse Practitioner, Physician Assistant Nurse Practitioners 2014 New Graduate Data from the American Association of Colleges of Nursing suggests an estimated 143,300 Nurse Practitioners (NPs) By 2025, the supply of NPs could exceed the number required to maintain current staffing levels by approximately 90,100 Physician Assistants The National Commission on Certification of Physician Assistants (PAs) reports that at the end of 2014, the U.S. had about 102,000 certified PAs Primary Care - 27% The supply of PAs is expected to grow to 127,800 by 2025 The projected rapid growth in PA supply plus the addition of new PA programs, by 2025, could grow to be approximately 53,500 more PAs than required to maintain current staffing levels.
Supply and Demand: NPs, PAs, cont. Overall Impact High-use scenario assumes that each additional NP or PA beyond the supply needed to maintain current staffing patterns will ease demand for primary care physicians by 50%. Moderate use scenario assumes the adjustment in physician demand is half of the above amount. https://www.aamc.org/download/458082/data/2016_complexities_of_supply_and_demand_projections.pdf Hooker RS, Muchow AN. Supply of Physician Assistants: 2013-2026. Journal of the American Academy of Physician Assistants. 2014; 27(3):39-45 Accreditation Review Commission on Education for the Physician Assistant, Inc. Projected growth in accredited programs. http://www.arc-pa.org/documents/current%20and%20project%20growth%204.17.15.pdf
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Digital Campaign
Primary Care Campaign Increased Applications o PeaceHealth website o Landing Page o HealthECareers o Indeed o PracticeLink We are noticing an increased number of location applicants within the state and close to PeaceHealth facilities.
Applicant flow increase by Quarter
2016 Placements Over the past 12 months 15 providers started o 11 Primary Care o 4 Specialists Providers scheduled to start in 2017/18 2017 2 Primary Care 1 Specialist 2018 1 Primary Care provider committed Upcoming Interviews 2 Primary Care interviews o 1 Family Medicine with OB o 1 Family Medicine 2 Non-Primary Care Interviews Offer out: 1 Physician
Changes and Retention Community Liaisons Identified community liaisons who meet candidates when they interview and connect again when they move to Florence. Contacts for school Resource for relocation Local experts Provider Meet and Greet Providers get a chance to meet each other in a social setting. New providers meet established providers Become familiar with colleagues
Practice Model
Florence Community Concerns Many patients - about 6,000 - were waiting for assignment to PCP o Today, about half of the need has been addressed with more than 3,000 patients assigned to PCP. o We are working to assign the remainder as our new clinicians are on-boarded. Concern about Advanced Practice Clinicians (Nurse Practitioners and Physician Assistant s) being assigned as PCPs. o We are recruiting both Physicians as well as NP and PAs who work closely together; also developing a Clinician Team Model that will better meet the needs and provide higher quality care.
Looking from past to the future Past Model of Care Patients trust in the physician who has known and cared for them and their families for years. Physician stayed in community, delivering children, caring for generations as well as for patient in hospital and clinic. Today s Reality National physician shortages Physician turnover and burnout is at all-time high Advance practitioners help meet need for primary care Population is aging Additional clinical staffing is providing better quality care.
How PeaceHealth is responding Successful efforts around recruitment with focus on benefits of living in smaller community Significant work around provider retention, burnout prevention and resilience Physician and Advance Practitioners work together; when NP or PA needs help, Physicians always available for second opinion PeaceHealth supporting four-year plan to redesign our Care Team by 2020.
Future Model 2020 Team-Based Practice of the Future Physician: sees fewer patients every day. Those who are more complex or high risk are seen by the physician - eight to 10 face-to-face visits/day o Physician is the team leader o Physicians see new patients, introduces them to the team o Reduces burnout Nurse Practitioners and Physician Assistants are essential to Team. Share a large panel of patients, so no longer physician s panel or Advance Practitioner s panel Lower complexity needs met by PA, NP and RN on team Provide same-day access to address acute care needs Whole Care Team knows the patient and their family About 100 patients touched each day: email, phone, outreach for chronic/ preventive care, group visits, visits with other team members instead of current model where may see 40-60 patients a day by team working independently. Margolius and Bodenheimer, Health Affairs, May 2010
Current Template Does not meet new demands Time Primary care physician Reason for Visit Nurse Nurse Practitioner Reason for Visit 8:00 Patient A Diabetes f/u Triage Patient H Sore Throat 8:20 Patient B Hosp f/u Injections Patient I Pneumonia f/u 8:40 Patient C Recheck BP Wounds Patient J Hosp f/u 9:00 9:20 Patient D Patient E MWV visit Complex visit A bit of time left for patient education Patient K Patient L CHF f/u MWV visit 9:40 Patient F Shortness of Patient M UTI Breath 10:00 Patient G Fall Patient N New patient
Template of the Future Time Primary care physician Medical assistant 1 RN 8:00-8:10 Huddle Nurse Practitioner Medical Assistant 2 8:10-8:30 8:30-9:00 9:00-9:30 9:30-10:00 10:00-10:30 10:30-11:00 E-visits and phone visits Complex patient Huddle with RN, NP Panel management Blood pressure coaching clinic Coordinate with hospitalists and specialists Complex patient RN Care management Huddle with MD Care management E-visits and phone visits Acute patients Panel management About 30 patients contacted/seen in three hours
Primary Care Transformation Roadmap Standard Office Flow Increase efficiency Begin monitoring clinic level data PASSED 2015 Introduce/expand roles around care management. Team-based care emphasis Caregivers engaged in process improvement Pre-visit preparation Focus on preventive care gaps PASSED 2016 Advanced access Leveraging technology (patient input of information/questionnaires) Improve the health of the population Additional roles on care team, Pharmacist, Nutritionist, Physical Therapists IN PROCESS Foundational: Payer Strategy, CareConnect Enterprise, Care Optimization, Provider Comp
Our Path to Expand the Care Team through 2020 and beyond Preventive care team (Panel Manager, Medical Assistant and Advance Practitioners) Women s maternity and infant care team (Physician, Nurse Midwife and RN) Chronic conditions team (Health Coach and Community Health Worker) Complex healthcare needs team (Physician, Nurse Care Manager and Pharmacist) Mental health/substance use care team (Physicians, Social Workers & Behavioral Health Providers in person or by Telehealth) End-of-life care team (Physician, Nurse Care Manager)
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