In-hospital Care discussion slides November 28 th, 2012

Previously Identified In-patient Issue Categories

Context for understanding in-patient care

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, ,00057,71514% 34 Tiny<1,00013,0633% 86 Total424,183

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) % GP-Hospitalist20 (2) % GP-DOFP11 (3) % GP-Hope % GP-DOD3 (4) 15141% Total % 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

Patient categories Number of Hospitals # MSOC50 GPs # MSOC50 GPs delivering in-patient % GPs delivering in-patient care services in 2011/12 17 Large % 9 Medium % 26 Small % 34 Tiny % 86 Total % 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 Unassigned in-patient care models often much lower

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 For the 63% of GP Unassigned MRP cases

The different provider categories all affect one another

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

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

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

44% % provincial volume 2011/12 9 Medium Sized Hospitals (5, ,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

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

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

Summary of recommendations Draft Recommendations – Short Term (< 6 months) 1.Setting a direction for GP in-patient care provincially – see section Establishing a governance structure to align in-patient care – see section Checking in with each CSC on systems issues and hassle factors – see section Establishing a team to support evidence and measurement – see section Introducing a Hospital Networking Fee – see section Introducing Enhanced Clinical Service MRP and Support Fees – see section Exploring a GP Relationship Continuity Fee for In-patient Care – see section 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 Creating a provincial hospital typology methodology – see section Creating an In-patient Care Framework – see section Enhancing Education / Training & Recruitment / Retention – see section Other supports and enablers – see section 6.5. Draft Recommendations – Long Term (> 1 year) 14.Developing a Comprehensive GP Services Framework – see section Engaging with Patients, Families and Communities – see section 7.2. S M L