1. www.gpscbc.ca A GP for Me and In-Patient Care Program Overviews April 2013 Revised: April 9, 2013

2. www.gpscbc.ca A GP for Me (or the Attachment Initiative)

3. www.gpscbc.ca A GP for Me: Background Number of unattached patients in BC uncertain Using Canadian Community Health Survey data, it is estimated: –13.8% of British Columbians (~615,000 people) have no regular family physician; and –3.96% (~176,000) are looking for a family physician, but cannot find one.

4. www.gpscbc.ca A GP for Me: Background Hollander's BC data indicates better outcomes at lower costs for patients attached to a FP Care through walk-in clinics or Emergency Departments –fragmented & expensive –poorer outcomes Lack of access = health inequities 2010 Government commitment to provide a family physician for any BC resident who wants one, by 2015

5. www.gpscbc.ca A GP for Me: Goals Confirm and strengthen the FP-patient continuous relationship Better support the needs of vulnerable patients Enable patients that want a family doctor to find one Increase the capacity of the primary health care system

6. www.gpscbc.ca A GP for Me: Consultation Nearly 400 FPs involved in creation of initiative: –as members of the GPSC shaping the high-level framework; –as members of both BCMA and SGP boards of directors, reviewing and approving the GPSCs work ; –as members of the provincial attachment working group from the prototype communities; –Approx. 300 physicians tested and implemented the prototype plans across three communities; –through workshops to define patient attachment and outline the responsibilities of both physicians and patients in this relationship; and –through addressing elements of attachment through CSCs: collecting and analyzing data to better understand unattached patient numbers and priority areas for improving the health of vulnerable populations. Co-designing community supports with Health Authority Partners

7. www.gpscbc.ca A GP for Me: Prototype Results Two-year prototype – White Rock/South Surrey, Prince George, Cowichan Valley –Approx. 9,400 unattached patients connected to FPs or primary care clinics –Many complex patients being served in primary care clinics and/or through Division of Family Practice / Health Authority collaborative initiatives –Currently, patients can find a FP immediately in White Rock/South Surrey.

8. www.gpscbc.ca A GP for Me: Expansion Components of Patient Attachment: 1.Practice Fee Supports 2.Divisional Supports 3.Alignment of existing Health Authority, Ministry and Physician Committee initiatives and programs

9. www.gpscbc.ca A GP for Me: Fee Supports Attachment Participation Code G14070: –Zero-Sum MSP code to indicate commitment –Once per physician per calendar year –Submission indicates the FP will: provide continuous full service family practice services confirm their primary care relationship with their patients register with and work with local Division of Family Practice and/or community to develop community-specific supports as they are able –Participation opens access to Attachment fees

10. www.gpscbc.ca A GP for Me: Fee Supports Attachment Participation Code G14070: Submit with Patient Identifiers –PHN#: 9753 035 697 –Patient Surname: Participation –Patient First Name: Attachment –Date of Birth: January 1, 2013 –ICD-9 code: 780

11. www.gpscbc.ca A GP for Me: Fee Supports Physician-Patient Compact: As your family doctor I, along with my practice team, agree to: – Provide you with the best care that I can – Coordinate any specialty care you may need – Offer you timely access to care, to the best of my ability – Maintain an ongoing record of your health – Keep you updated on any changes to services offered at my clinic – Communicate with you honestly and openly so we can best address your health care needs

12. www.gpscbc.ca A GP for Me: Fee Supports Physician-Patient Compact: As my patient I ask that you: – Seek your health care from me and my team whenever possible and, in my absence, through my colleague(s), xxxxxx – Name me as your family doctor if you have to visit an emergency facility or another provider – Communicate with me honestly and openly so we can best address your health care needs

13. www.gpscbc.ca A GP for Me: Fee Supports Physician-Patient Compact: NO need to call in each patient Can be done face-to-face, by letter or other communication, or by posting this standardized Compact in office and examination rooms Supportive materials (posters, brochures) are available from the GPSC website (www.gpscbc.ca)

14. www.gpscbc.ca A GP for Me: Fee Supports Attachment Fees 1.G14076 GP Attachment Telephone Management fee 2.G14075 GP Attachment Complex Care Management fee 3.G14077 GP Attachment Patient Conference fee 4.G14074 GP Unattached Complex/High Needs Patient Attachment fee 5.Non-Complex Unattached Patient Intake (future incentive)

15. www.gpscbc.ca A GP for Me: Fee Supports 1. G14076 GP Attachment Telephone Management Fee Requires submission of Attachment participation code by FP $15 per 'visit' All patients for whom that FP is community MRP 500 per physician per calendar year Intent is to use to avert need for a visit; in practice, WIC, ER Requires clinical discussion. NOT for: notification of appointments, referrals prescription renewals May be delegated to another College-certified healthcare professional Patients who are eligible for the GP Patient Telephone/e-mail Follow-up Management fee (G14079) are also eligible for the new Attachment telephone fee (not on same day)

16. www.gpscbc.ca A GP for Me: Fee Supports 2. G14075 GP Attachment Complex Care Management fee Access requires submission of Attachment Participation Code Includes diagnosis of 'Frailty' Use Diagnostic Code V15 Canadian Study of Health and Aging Scale; Level 6 & 7 Moderately Frail: Help is needed with both instrumental and non-instrumental activities of daily living Severely Frail: Completely dependent on others for the activities of daily living, or terminally ill FPs participating in the Attachment initiative still have access to the original Complex Care incentive (G14033) for qualifying patients. FPs choosing not to participate will only have access current FP complex care dual-diagnosis fee item G14033

17. www.gpscbc.ca A GP for Me: Fee Supports 3. G14077 GP Attachment Patient Conference fee Access requires submission of Attachment Participation Code Less restrictive; replaces G14015, G14016, G14017 Removes requirement for onsite attendance Removes need to conference with 2+ other healthcare professionals Initiation by facility not required; either side can trigger Any patient for whom FP is community MRP – no diagnostic restrictions Any time either side feels is clinically warranted $40 per 15 minutes or greater portion thereof Max 2/calendar day, up to max 18/calendar year per patient Non-participants still have access to current fees

18. www.gpscbc.ca A GP for Me: Fee Supports 4. G14074 Unattached Complex/High Needs Patient Attachment fee $200 in addition to visits providing care for new patients who do not have a FP Commit to provide ongoing, longitudinal FSFP care for at least one year Target Populations Complex/high needs populations »Frail in community and in residential care »High needs chronic conditions »Cancer patients »Severe disability »Mental health and substance use Mother/Baby dyad is counted as one »May be accepted into longitudinal practice at any time during pregnancy up to child aged 18 months Patient must be referred.

19. www.gpscbc.ca A GP for Me: Fee Supports 4. G14074 Unattached Complex/High Needs Patient Attachment fee (continued) Referral Sources Acute Care: ER and Admitted Mental Health/Substance Use Workers/Clinics Home and Community Care BC Cancer Agency or regional centres Public Health Colleagues Local Division Patients cannot self-identify

20. www.gpscbc.ca A GP for Me: Fee Supports 5. Non-Complex Unattached Patient Intake Future incentive Lower priority Placeholder for future consideration as funding is identified

21. www.gpscbc.ca A GP for Me: Divisional Supports 32 Divisions, including new provincial Rural and Remote Division Over 95% of FPs have a Division available $40M one-time funding to support the Attachment work of Divisions $24M Discretionary MoH support for non-physician expenditures; $16M GPSC allocation for physician-related costs In areas where there is no Division an alternate mechanism will be made available Allows: Engagement with and expansion of membership; Assessment of community makeup, local primary care system; Collaboration with local HA through the CSC to identify problems, develop local solutions and provide community-specific supports for Attachment; and Implementation of agreed-upon plan. Not to be used for: Long term (ongoing) Leases Long term (ongoing) Contracts with Allied Health Professionals or Physicians Solutions will vary – community-specific

22. www.gpscbc.ca Divisional Phases of A GP for Me Communication Introduce and explain Attachment Fee component: All Family Practitioners providing continuous care Dr. informs Division they have billed Attachment participation code Division Component Local approvals and provincial approval Access to portal fees Tools and resources to share Tools and resources to share Tools and resources to share Tools and resources to share Tools and resources to share Tools and resources to share ASSESS PLAN IMPLEMENT Approval and funding Agreement

23. www.gpscbc.ca Divisional Supports: Overview Summary Plan to be reviewed by Committee Pre Planning Phase: Work with PEL: Checklist Plan design Letter of Intent Pre Planning Phase: Work with PEL: Checklist Plan design Letter of Intent CONTRACT Planning Phase: ($xxx,xxx) Data Analysis Operation Plan Approach Metrics Planning Phase: ($xxx,xxx) Data Analysis Operation Plan Approach Metrics Plan to be reviewed by Committee CONTRACT Implementation Phase ACTIVATE Year 1 Year 2 Year 3 Implementation Phase ACTIVATE Year 1 Year 2 Year 3

24. www.gpscbc.ca A GP for Me: Alignment of Existing HA, Ministry and Physician Committee Initiatives Programs currently under way: Integrated Primary and Community Care Strategy NP4BC Practice Support Program/Physician Information Technology Office IT alignment Better at Home Program Home Health Monitoring After-hours Palliative Nursing Services Seniors Action Plan Partnerships with non-governmental organizations providing patient self-management supports

25. www.gpscbc.ca In-Patient Care Initiative

26. www.gpscbc.ca In-Patient Care: Background 48% of "MSOC-50" FPs providing In-patient Care Attrition of ~3%/Yr FPs leaving in-patient care service delivery 31% Percentage of community based GPs

27. www.gpscbc.ca In-Patient Care: Supports G14086 GP Assigned In-patient Care Network Initiative: Assigned In-patient: a patient whose family physician has: Accepted Most Responsible Physician status for their care while resident in the community, and Admitting privileges at the acute care facility in which the patient has been admitted. The Assigned In-patient Care Network Fee is designed to support the provision of in-hospital care to Assigned inpatients by their own family physicians. This includes the costs of group/network activities for their shared provision of care to their Assigned hospital in-patients. Funding Level: $8,400 per annum paid at $2,100 at the beginning of each quarter; and Payable in addition to visits.

28. www.gpscbc.ca In-Patient Care: Supports G14086 GP Assigned Inpatient Care Network Initiative For date of service use: April 1, 2013, July 1, 2013, October 1, 2013, January 1, 2014 Billing Schedule: First day of the month, per calendar quarter Once your registration in the network has been confirmed, submit fee item G14086 GP Assigned in-patient care network fee using the demographic patient information on the following slide. Your location will determine which PHN# to use. Use Diagnostic Code 780

29. www.gpscbc.ca In-Patient Care: Supports GP Assigned Inpatient Care Network Participant Location Specific patient demographics for billing Fraser Health Authority: PHN# 9752 590 548 Patient Surname: Assigned First Name: FHA Date of birth: January 1, 2013 Interior Health Authority: PHN# 9752 590 587 Patient Surname: Assigned First Name: IHA Date of birth: January 1, 2013 Northern Health Authority: PHN# 9752 590 509 Patient Surname: Assigned First Name: NHA Date of birth: January 1, 2013 Vancouver Coastal Health Authority: PHN# 9752 590 523 Patient Surname: Assigned First Name: CVHA (note first name starts with C) Date of birth: January 1, 2013 Vancouver Island Health Authority: PHN# 9752 590 516 Patient Surname: Assigned First Name: VIHA Date of birth: January 1, 2013

30. www.gpscbc.ca In-Patient Care: Supports Eligibility for the Assigned In-patient care Network Incentive: Be a family physician in active practice in B.C.; Have active hospital privileges; Be associated and registered with a minimum of three other network members (special consideration will be given in those hospital communities with fewer than four doctors providing inpatient care); Submit a completed Assigned In-patient Care Agreement Form; Submit a completed Assigned In-patient Care Network Registration Form; Co-operate with other members of the network so that one member is always available to care for patients of the Assigned In-patient Care Network; and Must provide MRP care to at least 24 admitted patients over the course of a year; networks may average out this number across the number of members. Exemptions can be made through the GPSC In-patient Care working group.

31. www.gpscbc.ca In-Patient Care: Supports Unassigned In-patient Care Network Incentive: Unassigned In-patient: a patient whose family physician does not have admitting privileges in the acute care facility in which the patient has been admitted Quarterly incentive based on the annual volume of unassigned in-patients admitted to the acute-care facility, and is available for most hospitals with a community GP run unassigned inpatient care model Incentive for Unassigned In-patient Care is not available for hospitals which have a Hospitalist model Payment will be made to participating Divisions of Family Practice, or where there is no Division or the local Division decides not to provide the oversight, to the Network group. Funding Level: Funding varies across hospital sizes from $8,213/qtr to $54,750/qtr.

32. www.gpscbc.ca In-Patient Care: Supports Unassigned In-patient Care Network Incentive: Funding varies across hospital dependent upon volume of unassigned Annual VolumeDaily paymentAnnual Rate >1,000$600$219,000 800-999$500$182.500 600-799$400$146,000 400-599$310$113,150 200-399$220$80,300 100-199$130$47,450 <100$90$32,850

33. www.gpscbc.ca In-Patient Care: Supports Eligibility for claiming the Unassigned In-patient Care Network Incentive: Be a family physician in active practice in B.C.; Have active hospital privileges; Submit a completed Unassigned In-patient Care Service Verification Form; Submit a completed Unassigned In-patient Care Network Registration Form; Also be a member of the Assigned In-patient Care Network unless an exemption is granted by the Division or the GPSC In-patient Care Working Group as indicated under the specifics of the Assigned In-patient Care Network Incentive; and Cooperate with other members of the network so that one member is always available to care for patients of the unassigned in-patient network. Exemptions can be made through the GPSC In-patient Care working group.

34. www.gpscbc.ca In-Patient Care: Supports G14088 GP Unassigned In-patient Care fee: $150 per patient for MRP care for duration of hospital stay Eligibility Must be member of a Unassigned In-patient Care Network and/or a Maternity Network; Payable once per unassigned in-patient per in-hospital admission; Payable only to the FP who is the Most Responsible Physician (MRP) for the patient during the in-hospital admission or is providing shared MRP responsibilities with a specialist due to a significant medical issue unrelated to the purpose of admission; Payable in addition to the hospital visits for care; Not payable to physicians who are employed by or who are under contract to a facility and whose duties would otherwise include provision of this care; and Not payable to physicians working under salary, service contract or sessional arrangements whose duties would otherwise include provision of this care. Exemptions can be made through the GPSC In-patient Care working group.

35. www.gpscbc.ca In-Patient Care: Supports Clinical Service Fee Bonus –25% lift to community FP MRP visit fees (13008, 00127) –Payable to all FPs performing this service Telephone Visits, Attachment Patient Conference –expanded conference with healthcare professionals, patients –all patients for whom FP has community MRP responsibility –initiated by either FP or patient/healthcare professional –any time during care as clinically indicated –expanded number per year

36. www.gpscbc.ca Questions?

37. www.gpscbc.ca Thank you