Primary Care Gap Analysis

Transcription

1 Primary Care Gap Analysis (Qualitative Report) Uvalde, Texas is a continually growing city and although the population continues to grow at a moderately stable rate, the access to primary care has remained consistently low. According to the US Department of Health and Human Services, Uvalde Memorial Hospital is located in a medically underserved area. In addition the number of physicians within the outlying areas has been decreasing due to retirement and other transitions. This is an issue that Uvalde Memorial Hospital is taking seriously as they strive to increase their primary care coverage. According to a Merritt, Hawkins and Associates study on physician recruitment, there is a need for approximately 16.5 additional primary care providers (family medicine, internal medicine, obstetrics, and pediatrics) for this area. This study was done in 2010, reported in 2012 and Uvalde Memorial Hospital has not improved their status to date. The clinic has incurred losses as well. In 2011 a Family Practice-OB left the clinic and recently the clinic lost two primary care physicians. In addition, the Family Medicine Committee needs two primary care physicians in order to prepare for the departure of two physicians approaching retirement. Uvalde Memorial Hospital s effort to recruit primary care physicians is not a new action, as they have done so for the last few years. The Family Medicine Committee requested that the hospital recruit two physicians to replace those that have left and two physicians to prepare for the retirement of current physicians. However, half of recruitments fail according to the Merritt, Hawkins and Associates physician recruitment study. This must be taken into consideration in setting a realistic goal. Uvalde Memorial Hospital is looking to recruit two physicians in order to improve this situation and extend care to the community.

2 Medicaid/uninsured need for primary care providers: Currently 32% of residents within each of the five counties we serve are uninsured. Our service area includes the following counties: Uvalde, Zavala, Edwards, Real and Kinney County. The populations we intend to impact by expanding primary care are: ED patients with non-emergent conditions, patients discharged with a high risk for readmission, patients without a primary care provider, and patients in need of enhanced follow-up post discharge. Our hospital operates with a Medicaid inpatient utilization rate higher than 50% and a low income utilization rate also higher than 50%.Our current primary care provider shortage combined with our high percentage of uninsured has caused our ED volume to steadily increase. This problem is exacerbated by 30 day readmissions and ED frequent flyers. Increasing primary care providers will impact/benefit the Medicaid/uninsured population by: The project seeks to recruit at least 4 new primary care providers to our service region. At the end of DY 4, the combined patient panels of primary care providers recruited in DY 2, 3 and 4 is expected to at least total 2,600 patients. This should result in between 5,200 and 7,800 combined patient visits. With the conclusion of DY 5, the combined patient panels of new primary care providers is expected to at least total 4,600 patients. This should result in between 9,200 and 13,800 combined patient visits. Also, the project aims to train 8 new community health workers (CHWs) by the end of DY 5. In DY 4 and DY 5, CHWs trained and selected for employment at UMH will ensure that 100 (DY 4) and 150 (DY 5) additional patients receive care under the Chronic Care Model for targeted chronic diseases or for MCC. The will achieve this by working alongside and communicating with RNs, case managers and physicians. These CHWs will enhance the continuum of care while assisting primary care providers and case managers to reduce preventable readmissions and ED visits for target conditions. Our program will reduce PPRs through case management that utilizes CHWs with an open line of communication with PCPs. Increasing the number of PCPs alongside this case management/chw program is vital as there is a severe

3 shortage of PCPs in the region currently. All 5 counties within the UMH service area are currently designated as primary health care professional shortage areas (HPSAs). This project will lower patient cost of care (important for a low-income population) through reducing re-admission rates and educate patients on the benefit of primary care over emergency department care. CHWs will help patients overcome common local barriers to primary care: transportation, insurance coverage, income, culture and education. We estimate that the % of Medicaid patients we will serve by expanding primary care will be at least 32% of the primary care visits to these new providers. We anticipate at least 24% of the primary care visits to these new providers will be from uninsured patients. These numbers are estimated projections based on historical data. The following benefits to the Medicaid/uninsured population are expected upon meeting our DY 3-5 milestones and primary care visit targets. Reduction in the number of patients who utilize the ED for primary care A decrease in patients cost of healthcare through a higher utilization of preventative care and disease management. The goal being to prevent and decrease these patients utilization of costly acute care. Improvement of population health measures

4 Physician Needs Assesment Year Population Physician Need Assessment 8/27/ * 2018* 48,006 50, % Growth INTELLIMED Forecasting Module Physicians With and Without Patients Page 1 of 2 txal County: 5 Selected Physician Need Rates ( Select one column) Specialty Group AMA Medical Economics User Defined INTELLIMED Age & Sex Adjusted Current Physician Supply System Gen Values Used User Mods Physician Demand + 5 Demand Variance + 5 Allergy/Immunology 1/ 0 1/ 125,000 1/ 0 1/ 56, Cardiology 1/ 22,222 1/ 25,000 1/ 0 1/ 19, Family Practice 1/ 4,347 1/ 2,000 1/ 0 1/ 2, Gastroenterology 1/ 45,454 1/ 50,000 1/ 0 1/ 40, General Surgery 1/ 10,309 1/ 10,000 1/ 0 1/ 10, Internal Medicine 1/ 3,922 1/ 5,000 1/ 0 1/ 3, Neurology 1/ 40,000 1/ 60,000 1/ 0 1/ 28, Neurosurgery 1/ 76,923 1/ 0 1/ 0 1/ 77, Obstetrics/Gyn 1/ 9,434 1/ 11,000 1/ 0 1/ 13, Oncology 1/ 0 1/ 0 1/ 0 1/ 48, Ophthalmology 1/ 18,519 1/ 20,000 1/ 0 1/ 15, Orthopedics 1/ 16,129 1/ 25,000 1/ 0 1/ 14, Other 1/ 0 1/ 0 1/ 0 1/ 3, Otolaryngology 1/ 38,462 1/ 25,000 1/ 0 1/ 31, Pediatrics 1/ 8,621 1/ 10,000 1/ 0 1/ 7, Plastic Surgery 1/ 0 1/ 0 1/ 0 1/ 50, Psychiatry 1/ 10,309 1/ 10,000 1/ 0 1/ 13, Pulmonary 1/ 62,500 1/ 100,000 1/ 0 1/ 59, Thoracic Surgery 1/ 0 1/ 0 1/ 0 1/ 83, Urology 1/ 33,333 1/ 30,000 1/ 0 1/ 30, Version , Copyright INTELLIMED International, Corp., 2013, All Rights Reserved.

5 Physician Needs Assesment Year Population Physician Need Assessment 8/27/ * 2018* 48,006 50, % Growth INTELLIMED Forecasting Module Physicians With and Without Patients Page 2 of 2 txal County: 5 Selected Physician Need Rates ( Select one column) Specialty Group AMA Medical Economics User Defined INTELLIMED Age & Sex Adjusted Current Physician Supply System Gen Values Used User Mods Physician Demand + 5 Demand Variance + 5 Urology 1/ 33,333 1/ 30,000 1/ 0 1/ 30, Report Total Version , Copyright INTELLIMED International, Corp., 2013, All Rights Reserved.