1. In-hospital Care discussion slides November 28 th, 2012 Darcy.eyres@gov.bc.ca

2. Previously Identified In-patient Issue Categories

3. Context for understanding in-patient care

4. Volume of in-patients by hospital categories Number of Hospitals Volume Categorization Total Cases in 2011/12 % of provincial total 17 Large≥ 10,000 annually290,02068% 9 Medium5,000 – 9,99963,38515% 26 Small1,000 - 5,00057,71514% 34 Tiny<1,00013,0633% 86 Total424,183

5. Provider categories 424,183 In-patient cases in 2011/12 Who had MRP? Model # Hospitals # in-patient cases 2011/12 % of volume in 2011/12 GP-Assigned80 (1) 6492037% GP-Hospitalist20 (2) 7718944% GP-DOFP11 (3) 1751410% GP-Hope54132348% GP-DOD3 (4) 15141% Total174370100% 1.There are specialty hospitals like BC Children’s. 2.Includes Cranbrook which is funded like a Hospitalist model. 3.PAH is a DOFP/Hospitalist mix. RIH DOFP is to support assigned patients. 4.Strictly speaking a few of the DOFPs have DOD agreements still in place which would increase this figure. 63% 109,450

6. Patient categories Number of Hospitals # MSOC50 GPs # MSOC50 GPs delivering in-patient % GPs delivering in-patient care services in 2011/12 17 Large178360934% 9 Medium53532561% 26 Small80449562% 34 Tiny29425787% 86 Total3416168649% Note: There can be some double counting across categories as some LHAs have multiple hospitals of varying size. Some LHAs do not have a hospital in them which lowers the overall provincial average to 45% of GPs continuing to deliver in-patient care services in 2011/12. Low of 5% in Kitimat to a high of 90% in Vancouver General. Low of 7.6% to a high of 18.8% based on CCHS. 1 2 3 1 2 3 Unassigned in-patient care models often much lower

7. Provincial In-patient volume breakdown For the 41% of GP MRP cases 424,183 In-patient Cases in 2011/12 Is made up of 3 reasons 1 2 3 For the 63% of GP Unassigned MRP cases

8. The different provider categories all affect one another

9. An overall matrix of the major categories for in-patient care

10. GP compensation by service categories - multiple inequities Compensation decisions need to be considered across the matrix !

11. 24% % provincial volume 2011/12 17 Large Hospitals (>10,000 in-patient cases in 2011/12) 76% GP Assigned Unassigned due to not having a GP 33% 67%68% % Medical Specialist MRP % GP MRP 17% 44% 39% Unassigned due to out of town Unassigned due to GP not delivering in-pat serv. GP Unassigned

12. 44% % provincial volume 2011/12 9 Medium Sized Hospitals (5,000 - 10,000 in-patient cases in 2011/12) 56% GP Assigned Unassigned due to not having a GP 53% 47%15% % Medical Specialist MRP % GP MRP 22% 39% Unassigned due to out of town Unassigned due to GP not delivering in-pat serv. GP Unassigned

13. 61% % provincial volume 2011/12 26 Small Sized Hospitals (1,000 – 4,999 cases) 39% GP Assigned Unassigned due to not having a GP 63% 37%14% % Medical Specialist MRP % GP MRP 33% 38% 29% Unassigned due to out of town Unassigned due to GP not delivering in-pat serv. GP Unassigned

14. 67% % provincial volume 2011/12 34 Tiny Sized Hospitals (<1,000 cases) 33% GP Assigned Unassigned due to not having a GP 97% 3% % Medical Specialist MRP % GP MRP 38% 34% 28% Unassigned due to out of town Unassigned due to GP not delivering in-pat serv. GP Unassigned

15. Summary of recommendations Draft Recommendations – Short Term (< 6 months) 1.Setting a direction for GP in-patient care provincially – see section 5.1 2.Establishing a governance structure to align in-patient care – see section 5.2 3.Checking in with each CSC on systems issues and hassle factors – see section 5.3. 4.Establishing a team to support evidence and measurement – see section 5.4. 5.Introducing a Hospital Networking Fee – see section 5.5.3. 6.Introducing Enhanced Clinical Service MRP and Support Fees – see section 5.5.4. 7.Exploring a GP Relationship Continuity Fee for In-patient Care – see section 5.5.5. 8.Recommendations related to service agreements – see section 5.6 Draft Recommendations – Medium Term (6 – 12 months) 9.Documenting and figuring out how to align in-patient care funding – see section 6.1 10.Creating a provincial hospital typology methodology – see section 6.2. 11.Creating an In-patient Care Framework – see section 6.3. 12.Enhancing Education / Training & Recruitment / Retention – see section 6.4. 13.Other supports and enablers – see section 6.5. Draft Recommendations – Long Term (> 1 year) 14.Developing a Comprehensive GP Services Framework – see section 7.1. 15.Engaging with Patients, Families and Communities – see section 7.2. S M L